Mental health: so many have been crushed by lockdown

An evil, all-powerful god intent on maximising human distress would create a world characterised by loneliness, fear and uncertainty. A toxic mix of these three experiences provides a perfect milieu in which emotional pain and suffering can thrive. The government’s responses to the Covid-19 pandemic – in particular, the lockdowns, social distancing and mask mandates – have generated this potent combination of feelings among many of its citizens and, as a result, have delivered a punishing assault on the mental health of the nation.

Although some anxiety about catching a nasty virus is understandable, particularly for the more vulnerable elderly and those with existing health problems, the draconian coronavirus restrictions per se are largely responsible for creating unprecedented levels of alarm, isolation and insecurity about the future among the population as a whole. Consequently, the mental wellbeing of everyone has been threatened, many have succumbed to mental health problems for the first time, while those already struggling with particular psychiatric difficulties have endured extraordinary challenges. While few can claim to be unaffected by the recurrent lockdowns and other restrictions, young people and the elderly appear to have suffered the most.           

Young people

Despite children and young people being at vanishingly small risk of harm from the SARS-CoV-2 virus, the evidence strongly indicates that this section of our community has suffered considerably as a consequence of the restrictions. Unsurprisingly, prolonged school closures and separation from peers have taken an emotional toll. A survey in July 2020 found that 1-in-6 children were exhibiting significant mental health problems. A YouGov investigation for The Prince’s Trust calculated that, by winter 2020, one in four young people (aged 16 to 25) felt ‘unable to cope with life’, with over half the respondents reporting high levels of anxiety. The chief executive of the Prince’s Trust attributed these concerning findings to ‘a disrupted education, a shrinking jobs market and isolation from their friends and loved ones’.

Ofsted (the schools inspectorate in England) identified further specific signs of distress in young people. A report, based on school visits made in autumn 2020, highlighted a worrying increase in the incidence of self-harm and eating disorders. Also, senior paediatric doctors noticed an ‘explosion’ of children with disabling tic disorders and Tourette’s syndrome during lockdown.

More rigorous scientific investigation has confirmed the likely detrimental impact of Covid-19 restrictions on the mental health of children and adolescents. A systematic review of over 80 research studies concluded that social isolation and loneliness significantly increase depression and anxiety among this vulnerable group. Furthermore, they found that the longer the loneliness persisted, the more intense the symptoms – an ominous discovery in light of the recurrent and ongoing lockdowns. Other psychological experts have also highlighted the enduring negative effects of social isolation and loss of structured occupation on the mental health of our young people.  

Older people

While it is widely recognised that older people, particularly those residing in care homes, have died from Covid-19 in numbers much greater than the rest of the population, their disproportionately high emotional distress evoked by the restrictions is seldom acknowledged.

As the minutes of the meeting of the SPI-B (a subgroup of Sage) on 22 March 2020 clearly show, it was a strategic decision to inflate fear levels as a means of increasing compliance with Covid-19 restrictions. Evidence suggests that many older adults suffered mental anguish as a direct result of this scare campaign. An Age UK report in summer 2020 stated that ‘a substantial group of elderly people… have been left frightened, depressed and very much alone’. A similar observation was made by the Alzheimer’s Society, which found that 46 per cent of elderly people with dementia reported that lockdown had a negative impact on their mental health. The testimony of relatives in the Age UK report support these claims, feedback from loved ones suggesting a rapid deterioration in mood, sleep, memory and behaviour during the lockdowns.

The negative consequences of the Covid-19 restrictions on older adults may have stretched beyond the infliction of emotional distress: lockdown loneliness could have been directly responsible for the demise of many elderly people. In the period from January to July 2020, the largest increase in excess non-Covid deaths (over 5,000) occurred in patients with dementia. It is plausible that the social isolation suffered by this vulnerable group, as a result of either the restrictions or the heightened fear deployed to achieve compliance, will have evoked mental defeat and an intensity of loneliness sufficient to cause premature death.

Existing problems

Although the first lockdown witnessed population-wide increases in suicidal thoughts, symptoms of anxiety and depression and alcohol intake, many people suffering pre-pandemic mental-health problems will have faced additional challenges. The general rise in suicidal thoughts during the lockdown was greater for those already experiencing psychological problems.

The official number of completed suicides in 2020 is not yet known; the usual lengthy delays between death and coroner’s inquest having been further extended by the pandemic disruption. However, given the toxic mix of fear, isolation and uncertainty generated by the restrictions, together with the recorded increase in prevalence of anxiety, low mood, suicidal thoughts and alcohol intake, a significant rise in the number of people taking their own lives seems highly likely. Furthermore, the medium- to long-term outlook appears ominous when one considers the feelings of hopelessness generated by business failures, job losses, and career-stymying educational ruptures. Evidence from other countries lends support to this bleak expectation. For example, the USA recorded a 13 per cent rise in drug-overdose deaths in the first three months of 2020.    

The mask mandates and strategic fear inflation will have inflicted additional suffering for people already struggling with particular mental-health problems. The unrelenting emphasis on potential contamination concerns – starkly illustrated by the ‘act like you’ve got the virus’ mantra – will have ramped up the anxiety levels of many of those already suffering severe obsessive-compulsive problems. Similarly, those enduring generalised anxiety, characterised by excessive worrying about the future, will often have been activated by the government’s communication strategy involving slogans such as, ‘Coronavirus: anyone can get it; Anyone can spread it’ – accompanied by menacing images of emergency personnel wearing medical masks and visors for extra effect.  

The somatic sensations from wearing a face covering will be triggering for many victims of historical trauma, evoking distressing ‘flashbacks’ of assault or smothering. Many people already tormented by recurrent panic attacks, involving catastrophic thoughts of imminent death and feelings of breathlessness, will find masks very difficult to tolerate. Regrettably, exercising their legal right to go out without a face covering can attract harassment and victimisation.   

Service provision

While the pandemic and associated restrictions may have spawned creative ways of remotely delivering some talking therapies – for example, cognitive behaviour therapy for psychosis – they have, overall, had two deleterious effects on mental-health service provision. First, there has been a marked reduction in the volume of face-to-face support offered to people with emotional difficulties. Services for children and adolescents, in limited supply prior to the coronavirus crisis, have contracted further and, across all age ranges, in-vivo therapy has been restricted to only those most at risk. Given that many questions remain about the value of online psychological interventions, this decrease in human-to-human service delivery is of major concern.    

Second, insistence that clinical staff and patients wear personal protective equipment will, potentially, reduce the helpfulness of the services offered. Although the impact of Covid-safe environments on the effectiveness of professional help for people with mental health problems is unknown, masks might be especially problematic. Facial expressions and other forms of non-verbal communication are vital for the development of a therapeutic relationship, one based on trust, empathy and compassion; in the absence of such a relationship, psychological therapy is rendered ineffective.

Masks will also impede verbal communication, with the hard of hearing – who largely depend on lip reading – being effectively excluded from the conversation. Traumatic personal stories are often told in whispers, so a therapist may sometimes struggle to hear the words of a masked patient. Add the fact that many people who seek psychological therapy may harbour high levels of suspiciousness, and it is clear that face coverings in a therapy room can be hugely problematic.     

Steps to recovery

There will be some people among the general population whose mental wellbeing has not been detrimentally impacted by the coronavirus restrictions, who may even have drawn psychological strength from the sense of belonging that can derive from a group of people collectively fighting an external threat. In contrast, as shown in the above analysis, a substantial proportion of the general population will have endured an increase in emotional distress, with the young, old and those with existing mental health problems bearing the brunt. While a future expansion of psychological support to these groups will be required to alleviate the emotional damage already inflicted, as of now the most effective way to aid recovery would be to stem the main sources of this widespread distress by lifting the coronavirus restrictions and changing the narrative surrounding them.

Specifically, the nation’s mental health would best be served by the following actions:          

1. The immediate lifting of all remaining aspects of lockdown and an explicit government commitment to never lock down the nation again. There is a growing body of evidence that lockdowns (an unprecedented and untested approach to the management of a respiratory virus) do not reduce rates of Covid-19 mortality, yet cause widespread ‘collateral’ damage to, not only people’s mental health, but also to our physical and economic health. Enduring opportunities to return to leisure, sport and outdoor activities would ease the current social isolation and uncertainty. The pandemic planning policies in place in 2019 – which explicitly recommended against quarantining the healthy – should be reinstated as the framework for dealing with any further novel viruses.

2. The immediate lifting of the mask mandate. There is no compelling real-world evidence that the masking of healthy people in the community reduces viral transmission. But masks do perpetuate the current inflated fear levels, stymie emotional expression, heighten distress for many people with histories of trauma and impede effective communication in therapy settings.

3. The development and delivery of a Covid-19 communication strategy based on calm presentation of relevant facts. The messaging throughout the pandemic has strategically deployed covert psychological ‘nudges’ – often relying on fear, shaming and scapegoating – to promote compliance with the coronavirus restrictions. The deleterious impact of this approach on people’s emotional wellbeing has been considerable. From this point onwards, risk information should be disseminated in an open and factual way, allowing each of us to make our own informed decisions.

In conclusion, the central factors responsible for the pervasive increase in emotional distress of the British people throughout the pandemic have been the unprecedented restrictions imposed on our basic rights, in tandem with the inflated fear levels to encourage compliance. Mental-health specialists from all professions have, with few exceptions, failed to openly consider these connections. This lack of overt response has been disappointing, but perhaps understandable given the personal attacks and expressions of outrage often targeted at professionals who speak out against the mainstream coronavirus narrative. Personally, I have had several NHS clinical psychologists contact me privately to let me know that they agree with me but have felt too scared to say so publicly. My observations in the mental health sphere tally with the pervasive censorship I have witnessed (in the media and the scientific community) of any expert who questions whether repeated lockdowns and associated fear inflation have been the most helpful way to respond to the challenges presented by a novel respiratory virus.

Albeit belatedly, I hope that the People’s Lockdown Inquiry, and my small contribution to it, will help to encourage a much more open debate.

Dr Gary Sidley

Clinical psychologist, member of the Health Advisory & Recovery Team (HART).

Gary Sidley worked within NHS mental health services for 33 years in a variety of nursing, psychological and managerial roles. In the 1980s he was employed as a psychiatric nurse at a large asylum in Manchester, commencing his clinical psychology training in 1987. Subsequently, he worked as a clinical psychologist in community mental health services, inpatient units and GP practices, as well as operating as a professional lead and a member of a Trust’s senior management team.

Gary opted for early retirement in 2013 and currently is a freelance writer and trainer with an interest in promoting alternatives to bio-medical psychiatry as ways of responding to human suffering.

He is a member of the Health Advisory & Recovery Team (HART). To find out about their work, visit hartgroup.org.

Follow Gary on Twitter: @GarySidley