Adrian James (Covid poses ‘greatest threat to mental health since second world war’, 27 December) sees clearly that a pervasive problem like the pandemic, over which most people have only limited control and many potential points of vulnerability, is likely to leave a legacy of poor mental health – on a scale not seen since the battle of the Somme. With a year to prepare, the Johnson government has failed to promote personal resilience – a key lesson from preventing post-traumatic stress disorder (PTSD) in military populations – and so this winter millions of Britons look ahead helplessly to a grim time indeed.
However, there is still a policy area that could reduce population illness: tackling the shocking level of health inequalities. A steep gradient of social inequality damages both physical and mental health. That damage is especially long-lasting for children “at the bottom of the heap”. James suggests 10 million more people will need mental health services (including 1.5 million children), but there is not much chance that existing services can be beefed up that much during 2021. Boris Johnson talks about levelling up children and families as if we were all just another brick in the wall. Starting at a community level, we need to ask families what would make a difference for them, facing the future.
As I learned from commissioning Sure Starts, hope and resilience in a population are much stronger and long-lasting if they are homegrown.
Woody Caan
Special interest group for mental health, Faculty of Public Health; former chair of the School Health Research Group
• Having recently retired after a long career as a consultant psychiatrist, I welcome the increased awareness of the possible impact of Covid-19 on the mental health of the population. The statement by the president of the Royal College of Psychiatrists highlights the ongoing Cinderella status of mental health services compared with physical health, and reiterates the need for parity of esteem and funding.
However, the apocalyptic predictions of national mental health collapse are based on a raft of assumptions, and risk medicalising the normal and appropriate human response to an unprecedented public health emergency. The Centre for Mental Health’s assertion that up to 20% of the population – ie 10 million people, including 1.5 million children – will need mental health support is based primarily on a study of self-reported anxiety/depression (the symptoms or feelings, not illnesses) in March and April this year, when many of us were understandably very worried and very unhappy. Their estimates for increased rates of anxiety, depression and PTSD in children are based on studies following human or natural disasters such as earthquakes, volcanic eruptions, hurricanes etc, and are not directly comparable with Covid. By overstating the entirely reasonable case for improved mental health services, there is a danger that many people who would not otherwise seek health services put those with more serious illnesses (relapses, new-onset psychosis, drug/alcohol dependence) at a competitive disadvantage and pathologise normal human reactions to adversity. As Nils Bohr said, “prediction is very difficult, especially if it’s about the future”.
Dr Cliff Sharp
Melrose, Scottish Borders
• I was moved by Alexandra Topping’s article (What mental health impact of second world war tells us about post-Covid life, 27 December) but wished it had mentioned the impact on members of the armed forces and their families during and after the second world war. I and a close friend suffered the behaviour of fathers who fought in the war. Clearly, we were not isolated cases. Both our fathers emerged from the war as violent and self-destructive alcoholics who, because of cultural stoicism, rarely if ever discussed their experiences – the trauma of combat and witnessing the war’s impact in Europe and north Africa.
My dad was 18 when he joined the army. He’d never left Glasgow, then was catapulted on to the world stage. Can you imagine spending the six most formative years of your life like that, seeing the worst of the human race? Having to kill other young people? Fight at Monte Cassino? Pick up the pieces after the devastating bombing of Dresden and Hamburg?
I am fed up with the sentimental, jingoistic tosh around the war. It’s held us back as a nation because it’s never allowed us to really examine the impact of that war on the generation that fought it, supported it or the subsequent generation of boomers. As for the use of cheap war tropes by wannabe-Churchill politicians to manipulate and coerce the population during the pandemic – well, enough said. We need to grow up and move on.
Jane Easton
Bristol
