Sun 5 December 2021

The Coronavirus pandemic has exposed an urgent need to reform long-neglected areas of healthcare, argues Byline Times’ chief medical officer John Ashton

One year into the COVID-19 pandemic and one of nature’s humblest creatures, an RNA virus, has ruthlessly altered the way human society operates.

With a death toll of millions worldwide, many economies, not least that of the UK, are under severe strain, and healthcare systems in even the wealthiest countries are struggling to respond effectively. Amid this backdrop, decades-long assumptions about the nature of human interactions are surely destined for a re-examination.

One aspect that has yet to receive the attention it deserves is the impact of the Coronavirus crisis on mental health – not just for individuals but for whole populations. It is seems likely, and indeed beneficial, that the pandemic will spur more attention and investment in public mental health provision.

Treatment Usurps Prevention

Like physical health, mental health services in recent history have focused too heavily on treatment rather than prevention. This distortion has a long history, bound up in the dominance of the practice of medicine as a private responsibility rather than a public good, even despite the role of the NHS.

It is more than 50 years since celebrated London School of Economics academic, Bryan Abel Smith, pointed out that services established to address long-term illness had been hijacked by the rich, in order to cater to their acute needs. In this scenario, health was less focused on prevention, since the wealthy did not suffer from the same pervasive health inequalities as the poor.

Meanwhile, there has been a pernicious stigmatisation of mental health services in the UK – epitomised by the outrageous abuses of private ‘madhouses’ in Victorian England.

Consequently, resources have rarely kept up with need, even despite a growing campaign in recent years for parity between mental and physical health services.

With ever-increasing levels of mental distress among young people, increases in suicides among middle-aged men, and an epidemic of dementia in an ageing population, the country’s mental health services were struggling even before the COVID-19 pandemic struck. Now, factoring in the turmoil of repeated national lockdowns and deep economic uncertainty, Britain is set to reap a bitter harvest of this longstanding neglect.

In the early days of the Coronavirus pandemic, there was justified concern about potential increases in suicide rates among those affected either directly or indirectly. While the classical studies by sociologist Emile Durkheim would suggest that increased social solidarity – such as the neighbourhood campaigns launched in the first national lockdown – might protect people against these outcomes, more recently there has been a breakdown of this solidarity. A loss of trust in the Government and the sheer length of the public restrictions have also sadly worked to exacerbate mental health problems.

From a practical public health point of view, the mental health impacts of the pandemic are likely to prove wide-ranging. People who suffer the worst effects of COVID-19 are starved of oxygen, which can lead to direct effects on the brain. There is also evidence of Long COVID, whereby people are bed-ridden, suffer from shortness of breath or lose their sense of taste and/or smell for months at a time.

This doesn’t take into account the brutal effects of the pandemic on frontline workers, particularly those in the health service, who have been forced to witness death on an almost daily basis.

This is a generational challenge – and one that requires concerted planning and investment to build a public mental health service fit for the modern world. A world in which health and economic shocks are, unfortunately, a regular feature of our common existence.

Dr John Ashton is a former director of public health and the author of ‘Blinded By Corona


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