News, Culture & Society

DR MAX PEMBERTON: Legacy of lockdown? An acute mental health crisis 

Two years ago this Wednesday, the first lockdown began. In some ways it seems a lifetime ago. But we are only just beginning to see the longer-term effects of the decision to plunge us all into isolation — specifically the impact it had on our minds.

Figures released last week show that NHS mental health services received a staggering 4.3 million referrals in 2021. The Royal College of Psychiatrists, which analysed NHS data, said England has suffered the ‘biggest hit to its mental health in generations’.

As many of us predicted at the start of the pandemic, our response to the virus, including locking down society, was not going to be without consequences. I’m now finding the NHS deluged with mental health problems — I can’t overemphasise how overwhelming it feels to be an NHS psychiatrist now.

As many of us predicted at the start of the pandemic, our response to the virus, including locking down society, was not going to be without consequences

The acuity — how unwell someone is — is on a level I’ve never seen before, because people have been sitting at home deteriorating and not getting the help they need in a timely fashion.

HOSPITAL ADMISSIONS ARE UP

Hospital admissions owing to Covid are up again. Thanks to the vaccine, the numbers are nowhere near as concerning as at the beginning of the pandemic.

From today, 200,000 over-75s become eligible for a booster. If you’re eligible, get yours as soon as possible. Those of us working in hospitals thank you. 

This is partly because many mental health services effectively shut down or were working remotely or with skeleton staff, and partly because people were isolated, without family and friends around to prompt them to get help sooner.

Nearly every single referral I now receive has some mention of the pandemic. Some of them are predictable: loneliness, isolation, and a lack of structure and routine has resulted in increased rates of depression and anxiety.

PTSD rates have also increased from people who spent time on an ICU or witnessed loved ones or — in the case of doctors and nurses — patients dying.

In fact, a therapist friend told me she currently has four doctors as patients who cite the pandemic as reason for their current difficulties.

Panic attacks have increased among those who experienced shortness of breath when unwell.

Some of those referred have a history of mental health problems and the effects of the pandemic have triggered a relapse, sometimes after many years of being well.

For others, they have no history but the stress, disruption and unfamiliarity of the situation they found themselves in has resulted in them becoming unwell for the first time.

Lockdown was stressful for some, but boring for others. As a result, drug and alcohol use has sky-rocketed.

In the summer of 2020, psychosis rates were 50 per cent higher than the previous summer, which I suspect is a result of people sitting at home using substances, particularly cannabis.

To give you an idea, in A&E we might typically see one case of drug-induced psychosis a week. Yet on just one night shift towards the end of lockdown, I saw four patients with it — this was not uncommon at the time, and rates have remained surprisingly high since.

I can’t help but think it could have been different. While our scientists and politicians scoffed at Sweden’s approach — they didn’t have a national lockdown — and warned it would lead to more deaths, in fact their approach is starting to be vindicated.

An in-depth study published last month found lockdowns only reduced Covid mortality by 0.2 per cent.

It concluded lockdowns caused ‘enormous economic and social costs’ and were ‘ill-founded and should be rejected as a pandemic policy instrument’.

This study received little media interest, I suspect because it would embarrass those calling for stricter lockdowns and criticising those who were more cautious.

What’s more, a recent study in the Lancet found Sweden fared better when it came to Covid deaths, too — where Britain had an excess death rate of 126.8 per 100,000, Sweden’s had 91.2 per 100,000.

In contrast to the UK and much of Europe, Sweden managed to keep facilities like day centres and schools open. This had a tremendous impact on the wellbeing of the nation.

Its National Board of Health and Welfare reported a continued decline in the number of people seeking treatment for anxiety and depression, particularly among the young. It’s thought a large part of this is likely down to the decision to keep primary and lower-secondary schools open throughout.

Even in upper-secondary schools, only children who tested positive or who had been formally contact-traced were asked to stay at home. Entire schools and classes were quarantined rarely and only in exceptional circumstances if advised by a local infectious disease doctor.

That’s a marked contrast to the UK, where as many as a million were sent home from school during the ‘pingdemic’.

An analysis of national grades published by the Swedish National Agency for Education found no evidence that the pandemic had negatively affected children’s educational attainment. Contrast this with the deluge of referrals to children’s mental health services here.

The Royal College of Psychiatrists found that nearly 200,000 young people had been referred to mental health services in just three months — almost double pre-pandemic levels.

While many of us now regard lockdown as a distant memory, for some it simply proved too much. We are on the brink of an unprecedented mental health crisis of a magnitude which we can only begin to imagine, and it is a direct result of the pandemic and lockdown.

She’s been robbed of motherhood

Given everything that’s happening in the world at the moment, the news that Nazanin Zaghari-Ratcliffe has finally been released after six long, horrific years in an Iranian jail is particularly welcome.

It’s good to have something so wonderful to finally celebrate. But we can only imagine her agony not just owing to the atrocious conditions but also being separated from her family, particularly her daughter, who was only two years old when she was imprisoned.

The news that Nazanin Zaghari-Ratcliffe has finally been released after six long, horrific years in an Iranian jail is particularly welcome.

The news that Nazanin Zaghari-Ratcliffe has finally been released after six long, horrific years in an Iranian jail is particularly welcome.

I’ve had a few patients who have been political prisoners and sought asylum here afterwards, and have seen how being wrenched from their family has profound, long-lasting effects. It’s difficult to rebuild relationships and forge a normal life after being away, particularly from children.

I remember one man saying how he was not just robbed of his liberty, but also the chance to be a father. Nazanin too has been robbed of being able to be a mother to her daughter.

It will be a long road to heal these wounds and I hope the family get the right psychological support to help the process.

Menopausal women have been reportedly forced to ‘barter for £50 bottles of HRT online’ owing to a pill shortage, which follows raised awareness and fading stigma about the menopause. While I’m horrified that women are having to resort to the black market, I trust this will be temporary and I’m pleased it seems that we’re starting to take the menopause seriously. The negative view that dogged HRT for two decades may be lifting. I’ve seen so many women diagnosed with depression when describing the menopause, yet for years GPs refused to give out HRT and wrongly prescribed antidepressants. 

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