‘Either community spirit gets us through, or we fall apart’

After undertaking a UK-wide survey they found that people with no history of mental illness were developing serious psychological problems for the first time as a result of the lockdown, amid growing stresses over isolation, job insecurity, relationship breakdown and bereavement.

The RCP’s research of the experiences of psychiatrists across the UK revealed that families were experiencing significant tension as a result of staying at home together all the time, with four in ten psychiatrists reporting an increase in people needing urgent and emergency mental healthcare – including new patients – in the wake of the lockdown.

Adults and children are having psychotic episodes, mania and depression, with some taken to hospital because of the heavy toll on their mental wellbeing.

The Royal College’s findings are contained in a survey of 1,369 psychiatrists carried out between May 1-6. It showed that 45 per cent of psychiatrists said that they had seen a fall in the number of patients attending routine appointments during the pandemic, which could see services facing a “tsunami” of people needing treatment once restrictions are eased.

The findings follow the UN’s warning this week that the pandemic could lead to an “upsurge” in the number of people needing mental health care.

This does not bode well for Northern Ireland, where significant research indicates a higher rate of suicide, anxiety, depression and post traumatic stress disorder compared to other regions of the UK.

Much of this is to do with economic deprivation and the legacy of the Troubles which has left us with what Siobhan O’Neill, professor of mental health sciences at the University of Ulster, calls ‘intergenerational trauma’ - the idea being that parents who experienced traumatic events during the Troubles are more likely to raise children who will also suffer a degree of trauma or some form of mental pathology in later life.

Add the dearth of mental health service provision to the already high rates of psychological distress and we find ourselves facing a whole new set of problems with the challenges of social isolation having become the new normal.

It is in this difficult context that we mark Mental Health Awareness Week, which runs until May 24, filled with uncertainty about the long-term consequences of what clinicians are calling ‘lockdown anxiety’.

Professor O’Neill said: “The pandemic constitutes another stressor on a population that already shows higher levels of mental illness then the rest of the UK and it could well lead to a mental health crisis here although we don’t yet have a broad spectrum of research to support such a view.

“I am not a clinician but in my opinion most of us will be resilient enough to cope with this lockdown. Really the problem is for people who are already battling or having a propensity towards mental ill health.

“Yes, the data suggests that anxiety has increased because of lockdown, but that is normal and proportionate to the situation.

“Some people may develop mental illness as a result of the pandemic, but conversely I would say many people are finding themselves buoyed by increasing contact with family that they normally would not have.

“Initially we have what I would call a ‘honeymoon effect’ where we feel connected because we are all in this together. For some there is a a renewed sense of solidarity with their communities and a hope that this might lead us to a more equal society.”

While this could be the case, we must acknowledge the high levels of pathology experienced here.

“Research I undertook in 2008 showed that Northern Ireland has a 25 per cent higher incidence of depression, anxiety and other mental illnesses compared to other parts of the UK,” says O’Neill.

“In the study we showed that this excess of mental illness is attributable to the trauma of the Troubles. But the biggest adverse factor is poverty. When we look at the suicide rates in Northern Ireland we can see that they are highest in deprived areas.

“And so really I feel that the pandemic’s biggest threat to our psychology will be the consequences of economic instability. With many people having lost their jobs or being plunged into poverty and being forced to claim benefits - that can be a huge trigger point.

“If there are austerity measures, if for example welfare benefits are cut, then that is going to increase mental illness and we can say that with some certainty because we have already studied this in other scenarios.

“A large part of the province’s mental health coming out of this emergency will depend on how the government responds in terms of resolving a damaged economy.

“What concerns me is that our mental health services were already stretched going into this pandemic and we know that there is much to be done here in terms of improving the care that is available to those in mental anguish.

“Also because of the pandemic many are hesitant to see their GP or avail of services since there is fear of covid infection. That is really bad for someone who desperately needs psychiatric attention, where early intervention is crucial.”

Consultant psychiatrist and clinical director of the regional trauma network, Dr Ciaran Mulholland agrees that lockdown, as the Royal College of Psychiatrists has predicted, could well lead to a mental health crisis, but he shares O’Neill’s faith in community spirit doing much to mitigate the likelihood of mass psychological damage.

“Anxiety, depression and economic deprivation operate in a symbiotic relationship.

“Most people’s anxiety will dissipate as they adjust to the new normal. People are resourceful and can rely on support networks and hobbies that they find enjoyment or relaxation in.

“But, yes, we are expecting an increase in mental health referrals over the coming weeks and months. I do think there will be an increase in depression and anxiety in particular.

“Patients and staff in the health service are obviously also at increased risk of post traumtic stress disorder.

“My advice is that you should eat well, take exercise, link in with friends and family, try music, yoga or reading and don’t over-indulge in negative media coverage or turn to drug or alcohol abuse.”

The Public Health Agency (PHA) has services people can avail of such as apps and online stress courses. Virtual counselling is accessible including telephone services such as Lifeline.

Mulholland continues: “There could be an increase in the suicide rate as a result of the pandemic but at the same time we do know from research undertaken, during war time for example, that sometimes adversity can enhance a sense of community and suicide rates can then actually drop because there is a sense that we are all in this together.

“If people are assessed and treated quickly we can avoid a high frequency of negatve psychiatric outcomes.

“We also would worry that those who lose loved ones due to covid are not allowed to be present at the time of death and normal funerals are not possible - and that puts people at risk of complex or unresolved grief that would need to be addressed clinically by things like cognitive behavioural therapy or medicaton.

“I think and hope that the sense of co-operating for the greater good will help people get though this but there does remain the risk of a surge in mental illness.””

So despite the research conducted by the Royal College of Psychiatrists and UN warnings of a risk in the rise of mental illness post-lockdown, we can retain hope that solidarity might just see us through.

If you are feeling overwhelmed and distressed you should see your GP. Or you can call Lifeline on 0808 808 8000.