Julie Bass, chief executive of health and social care organisation Turning Point, writes that the unique mental health challenges posed by the pandemic require innovative solutions, and especially to avoid an elongated financial and social toll due to long-Covid.
Months locked down in isolation or separated from loved ones, job anxiety, and uncertainty about life ever returning to normal have played havoc with our minds. The Centre for Mental Health predicts one in five people in England will need new or extra support.
Then there are the less well understood psychological consequences triggered by long-Covid. According to the Office for National Statistics, long-Covid syndrome is estimated to affect around 10 per cent of Covid-19 patients – that’s 150,000 people. In some cases, problems last for months or disappear only to return with a vengeance.
Many are reporting symptoms such as brain fog and mood disorders, and more than half reporting persistent exhaustion, which itself can lead to depression or low morale. A recent US study has identified an increased incidence of psychiatric conditions among Covid patients with no previous history of mental illness. While it’s unclear exactly how the virus affects the brain, the authors say there are implications for clinical services.
There has been incredible progress in ending the stigma around mental health. However, many who have experienced issues know only too well that negative perceptions around depression or psychiatric illness are still all too prevalent.
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Greater awareness of the psychological and physiological symptoms of long-Covid is essential to prevent discrimination
The chronic nature of long-Covid raises concerns that sufferers could face discrimination from employers, especially if they have to take extended periods of time off work as a result of fatigue or low mood. One study has found that one in five long-Covid sufferers are still unable to do their job after six months because of problems including insomnia and memory issues. Undoubtedly, the psychological effects of this syndrome will be an additional setback for those with pre-existing mental health issues.
The evidence is robust that being unemployed can undermine confidence and self-esteem and have a serious knock-on effect on mental health. But people may be deterred from seeking help from services for fear of being unfairly labelled a 'liability' – that long-Covid is wrongly seen as just an ‘excuse’ to miss work.
None of this can be allowed to happen, especially individuals missing out on support. But it will only be through awareness-raising about the psychological effects of long-Covid that we can stop this from becoming a reality.
What could a treatment package look like for those who have been psychologically affected by the condition?
Turning Point works with people with long-term conditions through its Improving Access to Psychological Therapies (IAPT) services. We know from people with chronic fatigue syndrome and disorders like fibromyalgia that unhelpful thoughts such as ‘it’s going to last forever’ and ‘I should be better by now’ can trigger low mood.
Not being able to plan ahead because you don’t know how much energy you’ll have on a particular day can affect quality of life dramatically.
Overlap exists here with long-Covid such as feelings of uncertainty, low mood resulting from chronic pain, and the psychological ups and downs triggered by fluctuating energy levels. People often attempt to ignore long-lasting physical discomfort, which makes it worse and over-exert themselves on a 'good' day.
Mindfulness is proven to help individuals cope with pain, CBT can help to identify and challenge unhelpful thoughts, and both can be delivered as digital interventions instead of via face-to-face attendance at IAPT services.
Simple strategies around planning, pacing and prioritising activities are also likely to be useful and feature in a recovery plan devised by the NHS for those experiencing long-Covid.
There is still much to learn about the syndrome, especially the links between its physical symptoms and the mental impact. Inevitably, it will be a case of using evidence-based approaches for long-Covid that we know work in other long-term conditions until peer-reviewed research becomes available.
It’s welcome to see work underway to further understanding. A £20m research programme by the National Institute for Health Research (NIHR) and UK Research and Innovation will cover the lasting mental effects of Covid-19. In addition, a Long-Covid Taskforce will oversee NHS support such as psychological assessments to identify people suffering from depression, anxiety, PTSD, or another mental health condition.
NHS England has stated patients could be referred from designated Covid recovery clinics and signposted into IAPT and other mental health services. As yet, though, it is a grey area how GPs will identify who is suitable for referral to IAPT or other services.
As we slowly move out of the height of the pandemic, we cannot forget those still suffering from long-term symptoms
What is clear is this country’s response to long-Covid must be part of a comprehensive and long-term strategy from government. A plan that makes mental recovery a priority and is supported by adequate funding across the entire sector so that people don’t fall between the cracks or are abandoned.
The overstretched and under-resourced mental health services can’t be expected just to pick up the extra demand created by this debilitating condition.
This is on top of the additional need for support created as a direct consequence of the pandemic. From specialist mental health services to those provided by social workers, all parts of the system are already buckling under the strain of dealing with a drastic rise in cases. The capacity of the health and social care system to respond is also a concern.
An NIHR review has warned of significant psychological and social impacts of long-Covid that will affect individuals and society in future, unless they are well managed. Their analysis also highlights the urgent need to consider how to provide support, suggesting the voluntary and community sector can play a role alongside care from hospital clinics.
We need more innovative solutions like these to avoid a heavy financial and social toll from long-Covid.
Covid has demonstrated the overwhelming importance of a collective response to dealing with a crisis on the scale of Covid. Where everyone in society comes together to protect the sick and ensure they’re not abandoned.
Let’s not forget this means those suffering mentally as well as physically as a result of the pandemic.