Managing Mental Health and Psychological Wellbeing During the Covid-19 Outbreak

Annabel Head
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People across the world are facing unprecedented times. The novel coronavirus Covid-19 has been designated as a pandemic by the World Health Organisation. We all are affected, whether directly by the illness (ourselves or someone we know), or by policies and guidance being enacted by the government; or very possibly both.

Psychologists for Social Change’s previous briefing paper on austerity notes five key ways that mental health can be impacted by public policy.  We believe these also come into play at times of huge social uncertainty such as during the current pandemic:

1. Being trapped and powerless 
It is no understatement to say that the uncertainty around what will happen feels overwhelming at times. High levels of uncertainty can lead to more physiological stress than a known negative outcome. So the sense of powerlessness that many people are feeling in the face of the virus has led to increased levels of anxiety and distress. Some people who have been most detrimentally affected by austerity and cuts will struggle even more.

2. Fear and distrust 
It is understandable that there is a very high level of fear for those of us with health conditions or loved ones who are more vulnerable. The UK government has warned that we should expect loved ones tol die, and death rates are mounting around the world each day. There is also heightened fear around how the NHS and other services will cope. This has been exacerbated by many years of cuts to health services, and a social care system which remains woefully underfunded even without the context of the current Covid-19 crisis. With beds requisitioned from the private sector, there are still question marks over who will profit from the current crisis. At times like these, distrust of those in power is likely to mount, especially for people who already feel let down by the government. There needs to be scrutiny around the new coronavirus bill to ensure that it does not undermine human rights.
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3. Humiliation and shame 
As humans we are naturally concerned about our status relative to others. The growing inequality gap across the UK is thought to have increased our risk to  ‘social anxiety’ as a nation. This is said to be partly responsible for the breakdown in cohesion across communities and society. As the rich get richer the spread of wealth becomes polarised. This causes greater distancing between groups and a breakdown in ‘bridging relationships’ which support people to access resources beyond their immediate social position.  
When under threat like this, our defenses come up, cohesion breaks down and it is easy to blame or stigmatise others. Rising inequality over at least the last decade has eroded our social ties causing division which has contributed to a rise in populist nationalism. Against this backdrop we have already seen a rise in racially aggravated incidents as people come to terms with the virus. The out-of-our-control nature of the unfolding situation can fly in the face of some of our deeply-held values as people who want to help or support others. Sitting with these values whilst feeling powerless may make us feel torn about what to do. We could feel shameful because the right answer isn’t going to always be clear.

​4. Instability and insecurity 
COVID 19 is no doubt causing substantial instability and insecurity to hundreds of millions of people across the globe. In the UK there has been a huge increase in workers in the gig economy in the UK in recent years. This now accounts for millions of workers. Current guidance encourages people to stay off work when they show symptoms. But many people who do not receive sick pay face the hard decision of choosing whether to go without income or to be paid but risk their own and others’ health by continuing to work. As businesses do not receive the support they need people could lose their jobs and/or acquire unplanned debt as they try to manage their finances at this time. Children who rely on free school meals and breakfast clubs as well as families that rely on food share programmes will be impacted by the closure of schools and access to these programmes. 

5. Isolation and loneliness 
Many people will be affected by government guidance to self-isolate and socially distance. Research indicates that isolating can have a range of negative effects on psychological and general wellbeing. While it is known that older adults and people with pre-existing health conditions could be worse-affected by the virus, little attention has been given in the media or government statements to other vulnerable groups. This includes people who are in immigration centres, people who are homeless, those with intellectual disabilities and the many people who live in cramped and overcrowded accommodation. For the 6.5 million people who are carers there has been little thought or planning about how restricting community engagement could negatively impact both carers and those they care for. If specialist schools or residential colleges close, what support is there locally for families who may not have the resources to care long-term for children and young people with highly complex levels of need?

What We Can Do - Five Key Factors to Think about

These factors demonstrate how recent and historic social context and policies set the scene for a very turbulent and potentially distressing time when additional stressors such as the current pandemic impact on people's lives. Nevertheless, PSC’s Briefing Paper (2015) highlights that there is huge potential as a society to influence people’s lives positively. There are opportunities to make a difference and to hold onto hope for now and for the future. 

1. Agency 
At a time when there is so much we cannot control, there are small things we can have agency over. This includes following hygiene advice, self-isolating when showing symptoms, and avoiding buying more than we need. Switching off the news if it is getting too much can help, as can getting outside if possible, and trying to notice and appreciate the now. Charities have warned how buying more than we need could impact on the most vulnerable in society. This means those without a car to transport large volumes of goods, or the financial means to buy in bulk, or those who use food banks. We all have a role in making sure those in need are not left without. Think twice before sharing those photos or stories about empty shelves as this could inadvertently cause others issues. This could be a time for re-evaluating the overtly consumerist ideas in our capitalist society. Does owning more really lead to contentment? Will it lead to a re-evaluation of "what makes a good life" and lead to a new path of "longing for less”?.
But while we have agency over some things, remember also the limits to our agency. Focus on the things you can control. Try not to get too lost in thoughts or worries about what will happen in the future, or what is happening globally.

2. Security 
A great many people off work could struggle to keep up with their bills. We need to see the government develop transparent, clear plans for how small businesses and their workers will be protected, as well as how the Department of Work and Pensions will support not hinder those who use benefits. It is encouraging to hear that radical new ideas are being considered, such as Universal Basic Income, which would be a stark contrast to how the 2008 recession was handled. There are still opportunities to support local cafes and shops - many have moved business online or to deliveries, and are using social media to advertise to their communities.

3. Connection 
While we may be restricted in physically meeting up, this is a time to remember the importance of connecting with others. Ideas have been shared online, such as posting cards through the doors of neighbours to let them know you could give practical help or a friendly phone call when they are lonely. It can also be helpful to remember that social cohesion, solidarity and mutuality will ultimately be needed to get through these difficult times. An increase in altruism has been a hallmark in previous responses to pandemics. Mutual aid groups, which are community groups set up to exchange resources and skills, are being set up around the country. This should be a wake up call to the government to reverse cuts to community provisions such as libraries and family support centres. This will foster the community integration which is so needed in times like these.

4. Trust
Societies which have higher levels of trust report higher levels of wellbeing. It is a delicate balance at the moment - both weighing up the information and using this to make logical decisions, and reacting in ways which may contribute to anxiety or even panic. We all have a responsibility for how we communicate about the virus to keep ourselves and others informed, without falling into sensationalism. As the WHO briefing paper to the media notes, “words matter”. It would be prudent to check the sources, and to be cautious about sharing disinformation. False stories about the virus may cause more harm than good by giving wrong advice that may make people stop following that which is backed by scientific evidence.

5. Meaning 
Being in quarantine or having to self isolate can be frustrating. It is therefore important to keep ourselves and others engaged in meaningful activities which give us enjoyment and a sense of purpose. It will be important to keep parks and green spaces open to be used safely, to allow for people to walk and cycle, which are so important for mental health. There are inspiring initiatives popping up which make use of virtual networks, such as online choirs. However, those without the resources to connect online will be left out, and these are no substitute for real life meaningful activities, which must be backed by the government with real investment once restrictions are lifted.
While the impact of the virus should not be overstated, there is opportunity for re-evaluating ourselves as a society, what our collective ethics and goals are, and for growth as a society following this. Already there is also the sense that maybe we took our previous ways of life for granted. In the future we may be more mindful and less wasteful.  It was so easy to meet up with friends, go out whenever and wherever we wanted, have easy access to food and resources with no fuss. Perhaps when all this is over we will look at these small everyday pleasures with a renewed sense of gratitude, for things we never thought to be grateful for before. 
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These are incredibly challenging times. No one knows what is ahead, when normal life will resume or indeed what this new ‘normal’ will look like. However, the ability of societies to get through critically dark times is a repeating theme in human history, and we will get through this - together. 

Author 
Annabel Head is a Clinical Psychologist and a member of London PSC ​