Mental health and the Covid pandemic
NHS psychiatrist Paul Blenkiron joined Chris Smith, Richard Hollingham and Katie Mack to reflect on how we're doing psychologically under the current Covid crisis...
Now, as we just heard from Dan about keeping physically fit during the pandemic, there's another aspect that's our mental fitness. Paul Blenkiron is a consultant psychiatrist, he's based in York. So Paul, I suppose that exercise is one thing that does make you feel actually more sane. Katie was saying just now that it makes her feel more sane when she does exercise. So is it just that we're not taking enough exercise? Is that why people are saying they're feeling miserable at the moment?
Paul - Well, I think it's become clear to all of us, hasn't it? That this COVID crisis is more of a marathon than a sprint if I could use that exercise analogy. So yes, certainly being active and keeping active is going to be a really important part of that. If you're working from home, I would certainly be doing a bit of structure to the day. Don't keep it all the same. And certainly don't take work home with you, metaphorically speaking, you know, leave those emails alone, do something active, whether that's mental or physical, it's going to be good for you.
Chris - There's been quite a big surge though in people reporting symptoms of mental illness during lockdown, hasn't it? I mean, the rates have increased a lot. There was a paper in the journal of the American medical association recently saying - I mean they were looking at people using internet search engines and looking at how often certain terms were cropping up. The number of searches for panic attacks and anxiety attacks has gone through the roof.
Paul - Yeah, certainly has. And I've just been reading about a study from the mental health foundation in England, they've been tracking people since the start of the pandemic and the latest figures from July show that about half the population had felt anxious in the previous two weeks. About one in five had felt lonely, and even 10% had had suicidal thoughts. And interestingly, those were more common sort of symptoms in certain groups. So people like women, the unemployed, students and those who already had a health condition such as anxiety or depression. So we’ve got to watch out for those.
Chris - Are these amongst people that have pre existing problems or these what we dub de novo cases, people who previously didn't regard themselves as having any kind of mental health issue and suddenly they have?
Paul - Well, it's difficult to know, isn't it? It's a mixture of the two I think. I'm looking at the Lancet study, which compared how people were doing before and after the start of the pandemic. And certainly by about late April, that was about a month after the lockdown in the UK, we had about 30% more cases that were clinically significant problems. So I think it's increased by about a third above what it would normally be, but we've also got all these other cases who already have the problem, which has been magnified by the pandemic.
Chris - And Katie, how has the scientific community coped? Cause there've been scientists and doctors like me that have been at the coalface and it's been so busy that we haven't noticed that we could possibly get stressed because it's been too demanding to worry about anything other than sorting out coronavirus. But for people that can't get into their lab, can't do their normal science, it's been, I would say, horrendous.
Katie - I'm a theorist so I don't need to go to a lab to do my work, but it's been a very big shift in how I work and in how my colleagues are working. And the biggest thing that I've found is suddenly a huge disparity in who is able to work and what the pressures they're facing are. So my colleagues who have young children at home for example, are completely stressed all the time, trying to take care of the young children and also balance their teaching and their research and everything. And then others who don't have young children at home or who have more support in other ways are able to continue working. And that big disparity has been very noticeable. And so that seems to have had a really strong effect on who's coping well and who's having a lot more trouble.
Chris - What about from your perspective, Richard, from the journalism side - are the people you're speaking to, are they so busy that actually they've found that the chance to retreat at home and be a bit theoretical like Katie has actually been welcomed and they've actually kind of enjoyed the break? Or are people saying they're actually getting quite itchy fingers to get back into work?
Richard - See people seem to divide it into two and I think this is across the board because I'm very careful about saying I've got too much work on, I have a lot of work on, cause I do have a lot of work on, but I've got similar colleagues, similar experience, similar backgrounds with nothing on. And that seems to have been this divide between people who are very busy and people who really don't have much or losing their jobs or, you know, all those horrors. And I had a question to Paul really about the change. So in the UK we had the big first lock down in April and it was a very stressful few weeks. And then we kind of settled into it and that was the new normal. Then we've had an easing, and this is true across the world, easing of these restrictions. And then that becomes the new normal with social distancing. But you can go out to the pub or anything. And then we just had a, not calling it another lockdown, but it's another retreat back and that's stressful. And I wonder about the change aspect of this Paul, whether that's a key factor - that you can settle into a new normal if you'd like, but it's that trauma of the change.
Paul - Yeah, exactly. I think a lot of people, myself included, at the beginning, thought this is going to be three or four months, we'll be back to normal. But it's become more clear now that we know less about this virus than we thought we did originally. Certainly the thing about immunity is uncertain. Where I work, the staff that have volunteered for antibody tests, about 11% of them are seropositive. That means most haven't converted even though lots of people think they've had it. And I would go back to your question about attitudes and adjusting to this in the long term. It's probably best not to think of this as a second wave coming, as this tsunami that's heading our way. Maybe just as sort of inevitable, local outbreaks, temporary restarting of partial lockdown rules just to keep the virus under control until it eventually goes away or we do get a vaccine.
Chris - Katie, are you doing a lot of teaching?
Katie - Thankfully not doing teaching this semester, which is hugely helpful because I know that the teaching situation is extremely challenging right now.
Chris - Where I was going with that is that we've all ended up kind of square-eyed because of staring at screens, doing Zoom meetings, I mean, obviously other other sorts of platforms are available. Paul, do we know how people respond to long term exposure to these sorts of things where you're in contact with people, but you're kind of not at the same time. And that must have a bearing on especially young people.
Paul - Yeah I can only quote for my own personal experience. I've got some children here. They've gone back to school this week, much to the relief of many parents. And I can say that in terms of academic progress, it's fine to go on a laptop. But the thing that the children really miss is that social contact, no matter how much contact they've got via screens. I think the same is true of adults. It does vary between each of us doesn't it really. We've got, in the mental health service in the UK, we've revolutionised how we speak to patients and we are doing a lot more video contact, a lot more phone contact, but whether that's really the same thing as that personal touch, only time will tell I think.
Chris - Phil was wondering, will there be a pandemic-specific stress disorder from this? In other words, are we going to end up with kind of a big spike in people who have a range of mental health problems off the back of this and what sort of provisions are being made for that? Because presumably we are going to see people with consequences because of this in the long term.
Paul - Well, certainly previous pandemics, thinking of SARS and the swine flu, have led to an increase in things like stress disorders, post traumatic stress disorder and depression. So we're expecting people to have more cases like that. People are facing lots of different situations now, more domestic abuse and violence because they're stuck at home. Most people who've been ventilated because they've had COVID, they can get more post traumatic stress from being in intensive care units. So I think at the moment, certainly the national colleges, all kinds of GPs and psychiatrists are well aware that this is sort of a second wave, psychological wave, that is upon us now, really. We're certainly seeing an increase in referrals to the service and we have to be prepared for that really.
Chris - And Katie, what's the experience in the US like?
Katie - One of the things that I'm really concerned about is that the death toll in the US has been just staggering. And when there've been other major events with a huge number of people who have died there have been memorial services, there have been national grief exercises and so on. And that doesn't seem to be happening in the US despite the astonishing number of people who have died. And I'm wondering about the psychological impact of all this grief that has nowhere to go, where we're not having big memorial services, we're not having big national prayer things, or whatever, the ways that people usually deal with massive loss. And I'm curious about how that's going to impact people, just the weight of this sort of unexpressed grief of so many people lost.
Paul - That's a really good point, actually. And certainly the way people have been, in the early days, not allowed to attend funerals, which is sort of a tragedy really. It's almost a double whammy. You lose your loved one and then you can't even say goodbye. I think it's really important we do prioritise people being able to see people who are very ill, people who are dying, I think that's being recognised more. Another point I'd like to make about this, just this idea of managing uncertainty, because we're in this for the long haul. And we can go through our lives thinking; what if this happens, looking for the next tragedy, or the next lockdown. And yet we need to get on with our lives, and basically manage it in the here and now. If you've ever driven a car across a busy road, there's risk in our lives every day. And I think the best thing to do is to accept the risk, take the usual precautions, but just get on with things in a very practical way.
Chris - Any other tips you can offer for people who might be feeling vulnerable?
Paul - Yes. Well, you're not in this alone really. I think a lot of our therapies for anxiety problems would be well applicable to the COVID epidemic - cognitive behaviour therapy, for example, helping people to change the way they look at the situation. For example, you might say, well, you know, I've got a risk of getting COVID or I've got symptoms. My sort of tips there would be to say, if this is true or realistic, is it a helpful thought to have. If you're a rock climber or a tightrope walker who constantly thinks 'if I fall off I will die,' is that really going to help you to live your life? And those people who are stuck inside and they've put things on hold to the pandemic goes away, I would say, well, suppose we can guarantee that this pandemic's only going to last another six months, what are going to be your goals for that six months, what are you going to be doing during that? And if six months is not the right thing, what about two years? I'd like people to plan ahead, really just get on with what they can do within the current scenario, rather than waiting for some day when it's all going to be over.
Chris - One very nice piece of advice that someone who works in the psychiatry space said to me once was that they try and write down a few good things that have happened to them, or at least think of those things, every day before they go to bed. And then you at least go to bed on a positive note and you dwell on the positives, not the negatives.