March 29, 2020

expert reaction to new advice to support mental health during the COVID-19 outbreak

The Department of Health and Social Care (DHSC) and Public Health England (PHE) have released new advice to support mental health during the COVID-19 outbreak.

Prof Andrea Danese is a Professor of Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“This is a welcome first step in considering the mental health impact of the COVID-19 pandemic. Beyond the enormous strain on the front-line healthcare practitioners and workers that make the country carry on in these times of crisis, the pandemic is affecting and will affect mental health across society.

“While we are all challenged by the circumstances, most of us will not develop psychiatric disorders as a result of the pandemic. However, there are some members of society who are more vulnerable and should be more adequately cared for. Of note, the mental health of children and adolescents is more likely to be affected and to remain unnoticed.

“Therefore, I hope to see substantial investment in provision for child and adolescent mental health services in the coming months.

“There are several reasons why the mental health of young people is likely to be more affected by the pandemic. Young people’s brains are still developing, and they may be less able to control emotional responses. They may look at their parents for reassurance and guidance, and may become distressed in seeing that their parents, too, are worried. They may struggle more to make sense of the alarm and the sometimes conflicting messages in the news. They have not been able to engage in many normative experiences, such as education and socialisation with peers. They may get bored and upset about restriction to their activities and distancing from their peers.

“There will be some young people who are more intensely affected. These will be young people with special needs, who may not receive the support they require; the young people who have pre-existing mental health problems, such as anxiety and depression, and who may struggle more than others to cope with these challenging times; the young people who suffer maltreatment at home and witness domestic violence; the young people who live in poor families, who will be disproportionally affected by financial downturns across society; and the young people living with front-line workers active during the emergency.

“We need to become better at working remotely with young people and families. This has been so far a positive experience. Young people have so far largely welcomed the opportunity to receive mental health support remotely.

“More than ever, it is also important to think about child and adolescent mental health more broadly – not only focusing on individual young people accessing our clinical services but also considering psychological needs across the population.

“The shift from face-to-face to remote working has several challenges.

“Overall, we need to build an evidence base regarding best practices for remote working in mental health, particularly with young people. First, it may be more difficult to build a trusting relationship without in-person interaction. Second, it is more challenging to assess and manage risk. For example, it is more difficult to assess and manage risk of self-harm when it not possible to closely observe young people’s behaviour or to ensure that they do not have means to hurt themselves. Equally, young people may not be able to inform practitioners about maltreatment they suffer at home if their communication is monitored or limited. Third, while there are some promising leads from research in adults, we know less about the effectiveness of remote treatment delivery for psychological interventions in young people. Fourth, it is more challenging to monitor pharmacological treatment remotely, for example when blood pressure monitoring or blood tests are needed.

“There are also several challenges to implement public health strategies. For example, different services will need to work together to promote mental health literacy for young people and their family and to address modifiable risk factors for poor mental health including violence victimisation and substance abuse. Furthermore, we need to get better at building individualised risk predictions to identify children in the community who are in the greatest need of interventions and allocate rationally the limited resources. Finally, we can hope that, at this time of universal crisis, people can come together through shared interests and collective action to resolve divisions.”

Professor Linda Bauld, Bruce and John Usher Chair in Public Health, University of Edinburgh, said:

“This new advice is welcome and will be helpful for many individuals and families. However, it doesn’t fully acknowledge the relationship between physical and mental health beyond the content on exercise and sleep. For example, adults who are currently not able to work, are working from home or required to stay in their home because a family member has symptoms may be at risk of using alcohol, drugs or tobacco more often. These are mentioned in the ‘look after your body’ section but only briefly and the links for further information are hidden in the section on telephone helplines – which contains a limited list, with nothing on smoking, for example. I think we need to recognise that these physical and mental health damaging behaviours are going to increase. We need to pay much more attention to this and offer practical advice and support in the weeks ahead.”

Prof Neil Greenberg, Professor of Defence Mental Health, Academic Centre for Defence Mental Health, King’s College London, said:

“At this very difficult time there has been a lot of good information about how to keep mentally healthy made available online and indeed this is often distributed widely by social media. However, it may be challenging for members of the public to know which pieces of advice to listen to and which to ignore. It is thus very helpful to have a respected organisation like Public Health England (PHE) providing practical advice and signposting information that the public can trust and rely on. However, it is important that advisory information and self-help materials/resources are backed up by accessible mental health services which are able to both reinforce the health promoting information the PHE provide and, where necessary, provide formal mental health assessment and interventions most probably remotely in most cases. Without access to formal mental health professionals, it is likely that some individuals, particularly those with more severe mental health difficulties, will find the current situation incredibly difficult to cope with and their mental health may deteriorate.”

Dr Rochelle Burgess, Deputy Director, UCL Centre for Global Non-Communicable Diseases and Lecturer in Global Health, said:

“I am excited to see a clear focus on mental health during these turbulent times, and many people will take solace and support from what is on offer. My concern is that much of this advice is largely geared at, for lack of a better descriptor – the middle class. As it stands, it doesn’t do enough to think about the sections of society that will be pushed further into hardship and difficult circumstances, and how their mental health and wellbeing are impacted by these times. 

“I am thinking about the millions of people who relied on food banks, who are now unable to access that support. I am thinking about the women and children and people who are now confined in households where they may not be safe, and are exposed to violence. I am thinking about the people who remain at the front lines doing the work to keep a lockdown functioning – staff at supermarkets, postal workers, delivery staff, who do this work also in the knowledge that they may be one pay check away from homelessness.  People whose anxieties are increased by these real situations, may not find relief with these suggestions. 

Mental health supports in these times must also be prepared to connect with and support people’s access to structural resources – as these trying times will mean that thousands of people who are already on the fringes of society, will be further marginalised. mental health care during this crisis must think about the environments as much as the relationships that keep us going.”

Prof Sonia Johnson, Professor of Social and Community Psychiatry, University College London  (UCL), and Director of NIHR Mental Health Policy Research Unit, said:

“This is good advice for the public. It’s also very important at this time to consider the needs of people who have already been experiencing significant mental health problems, including long term users of mental health service users. As well as the anxieties experienced by the general population, many are experiencing closure or severe restriction of the services they normally use, and isolation from the people whom they rely on for support. Given the high rates of physical health comorbidities among people with psychosis, bipolar and other forms of severe mental health problem, many are in high risk groups for severe COVID-19, but they may be living in circumstances where self-isolation is challenging. Social exclusion may make it difficult for them to rely on the networks of local mutual support and volunteer action that are springing up around the country, and people with mental health problems are also on average less digitally well-connected than others and already more susceptible to loneliness. There is an urgent need to investigate impact in this group, as well as on people with intellectual disabilities and autism.”

Dr Michael Bloomfield, Excellence Fellow, Head of Translational Psychiatry Research Group and Consultant Psychiatrist, University College London (UCL), said:

“It is very good to hear that Public Health England is incorporating mental wellbeing as part of their advice about the COVID pandemic.  It is also very warming to have the support of Their Royal Highnesses the Duke and Duchess of Cambridge.  

“Whilst wellbeing advice and additional funding for mental health charities is welcome to support the mental health of the general population, an enormous amount of additional support is immediately needed during this time of national crisis.  We are deeply concerned about the mental health of a number of groups and the long-term effects that this may have.

“We are extremely concerned for the safety and wellbeing of our colleagues in frontline NHS services who are understandably concerned about their own physical safety when caring for patients with COVID. We are equally extremely concerned about the mental wellbeing of patients with COVID who are severely physically ill.  The whole country must demand that the Government immediately supply full WHO compliant PPE equipment to all clinicians and participate in whichever schemes immediately rapidly increase the number of ITU beds available, including EU schemes. The lack of PPE and ITU are important factors that are contributing to our concerns about the level of exposure to psychological trauma faced by both clinicians and patients. It is in this context that we have convened an expert group of trauma specialists to coordinate advice to our colleagues up and down the country on the psychosocial response to the crisis (www.traumagroup.org). 

“We are also concerned about other vulnerable groups including children, young people and adults who are currently experiencing abuse. These groups are at heightened risk of harm and psychological trauma as they may be physically “trapped” with an abuser and unable to access normally available support structures.

“Finally, mental health services, which have been under huge strain after year upon year of cuts, are now facing further challenges in caring for people with mental health problems.  Many services have had to move to providing remote support only.  We must not neglect those with severe mental illnesses during this crisis who require ongoing care and treatment, which needs to be given face to face.  People with certain types of mental health problem require much more support, care and intervention than lifestyle advice and a helpline.

“Urgent action, policy and funding is immediately needed in all of these areas. 

* PHE are launching new advice to support Mental Health during the coronavirus outbreak

Declared interests

None received.