When Lily Gardiner’s sister took her own life at the end of July, Gardiner was left feeling as though her sister’s mental health struggles and death had gone unnoticed during the pandemic.
The loss is even harder for Gardiner (not her real name) to bear, given that in February her sister’s life seemed back on track. After she experienced paranoid delusions and was sectioned in 2019, she had been discharged, was on medication and had regular support from mental health services. That disappeared when lockdown set in.
“I feel she was left with nobody,” says Gardiner. “Mental health should be equal to cancer. They’re both life-threatening and frightening to manage. My sister must have been desperate. She had so much potential to look forward to but she didn’t have anybody there to see her through.”
Nuwan Dissanayaka, a psychiatrist on an assertive outreach team at Leeds and York NHS partnership trust, agrees that the pandemic has led to mental health taking a back seat to physical health. “There was a lack of parity between those with physical and mental health issues immediately,” he says. “Those with physical health issues were identified and afforded additional support. A lot of the people I see didn’t have that.” In an effort to plug the gaps, his team continued to see the people they work with – who have severe mental health issues and often no access to the internet – face to face.
“It’s been particularly difficult,” he says. “Some people’s moods have been affected by substance misuse and alcohol consumption, which have increased. We’ve had some people who have been stable for years unpredictably end up in hospital and we’ve seen some suicidal ideation.”
Coronavirus and lockdown have taken an immeasurable toll on people’s mental health. A survey conducted by the Royal College of Psychiatrists in May reported that 43% of UK psychiatrists saw an increase in urgent and emergency cases following lockdown. According to data from the Office for National Statistics, almost one in five adults (19.2%) in Great Britain were likely to be experiencing some form of depression in June – nearly double the rate before the pandemic.
With services now resuming face to face appointments, demand is high. “Mental health services are under intense pressure,” says Nick Lake, head of psychological services at Sussex partnership NHS trust. “Our services will have more demand over the next six months to two years due to the physical and psychological effects of Covid, as well as the social and economic impacts of the virus.”
Research evidence from the Sars pandemic points to the risk of both patients and healthcare workers experiencing diagnosable symptoms of traumatic stress in the months and years ahead. Moreover, it has been suggested that 500,000 more people will experience mental health conditions in the UK related to the economic downturn. Dr Adrian James, president of the Royal College of Psychiatrists, says recessions are terrible news for the nation’s mental health. “Debt, unemployment and poverty are linked to higher rates of anxiety disorders, alcohol use, depression, and even suicide.”
Meanwhile, some people who were already vulnerable have found it harder to cope. A report into UK maternal deaths between March and May revealed four preventable suicides and concluded that women were not able to access appropriate care. Had they received the specialist care they needed, their deaths might have been prevented.
Many mental health services were pared back and in some cases moved online, with routines and daily contacts being lost. Online services work well for some people but not for others, says Lake. “Online doesn’t do a good job when someone is in crisis. There’s something about face to face contact, the experience of someone in the room with you hearing and understanding, that makes a real difference.”
Other people with existing mental health conditions, who were just about managing without help from services before lockdown, really struggled. Caitlin Carrick Varty almost lost her father when a chip pan fire engulfed his flat while he was asleep, leaving him with severe smoke inhalation and burns. He is only alive because his neighbour woke him after smelling smoke.
Caitlin’s father lives alone with severe and enduring mental health problems and she saw him deteriorate after lockdown hit. “[There’s no doubt] Covid and lockdown exacerbated his mental health problems … it left him very isolated and alone and in a tricky situation.”
She adds: “This is the first time there’s been an accident that has been so damaging.” Caitlin, 22, was also left struggling with her own mental health after such a traumatic episode. Throughout lockdown she visited her father almost every day and cared for him. “I was exhausted, and felt physically and emotionally drained,” she says. “My anxiety levels were sky high.”
• In the UK and Ireland, Samaritans can be contacted on 116 123 or email firstname.lastname@example.org or email@example.com. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.