Why averting a mental health catastrophe is key to coming out of an induced economic coma

14 May 2020

By Paul Burstow

We humans are a resilient and hopeful species. We have survived pestilence, floods and other natural and manmade calamities. Is it because we are optimists at heart?

Our hope can be a powerful balm in times of trouble.  But our ability to cope and capacity to recover from adversity – our resilience – are under attack by Covid19 and the societal trauma it has triggered.  We face a cascade of compounding economic and psychosocial risks which will be felt for years to come and will further compromise our resilience.

A study by the LSE has attempted to put a number on the human cost of Covid19 and the lockdown.  They concluded that it amounts to a total cost to individuals of £2.25 billion, or £43 per adult per day.  The figure excludes business impacts, impacts on children, government and healthcare expenditure and mortality due to COVID-19, the full cost to society will be far higher.

Amongst the deepest and most damaging impacts of Covid19 are those that undermine human capital – our individual and collective knowledge, skills, competencies, health and habits.  Strengths that are essential to our resilience, recovery and renewal as we suppress, contain and tame the virus.

Washing handsThe way in which the first wave of Covid19 has been fought has suppressed the spread of the virus, saved lives, and prevented our NHS from being overwhelmed, just.  But at the price of placing our economy and to some extent society in an induced coma.

As the Prime Minister told the nation on Sunday, we will be taking the first highly conditional steps to “modifying the lockdown” in the coming weeks.  In truth we are just at the end of the beginning.  As the form of lockdown begins to change, we need to understand, mitigate and respond to the collateral damage that the pandemic continues to inflict. 

The social contract between Government and people of voluntary self-denial, which has saved millions of lives, points to the possibility of a renewal of social solidarity.  It is said that we are all in it together, and that sense of solidarity should be nurtured.  But it must not blind us to the fact that not everyone is experiencing this pandemic equally.

We may all be doing our best to ride out the same storm, but we are not all in the same boat. Some people have no boat at all, not even a seaworthy raft!

As the Institute for Fiscal Studies has reported the health effects caused by an economic downturn or depression will be complex, will differ across generations, geographies, ethnic and social-economic groups and last a long time maybe even longer than the Great Depression.  These inequalities must be addressed in the Prime Minister’s detailed plans for unlocking the lockdown.

Unemployment in the UK doubled to 3 million in a matter of days after the lockdown, on top of this are the 6.3 million people who have been furloughed who face an uncertain future.   Some forecasters say unemployment could reach 5-6 million.

Designing the right strategies to protect and renew our human capital and social infrastructure are as vital as the right economic policies if we are to avoid a mental health catastrophe.

Previous disasters and economic shocks give us clues to the likely short, medium and long-term effects on the mental health of both the front-line responders and the public due to Covid19 and the global recession it has triggered.  There are lessons history can teach us about how we might best respond.  The early signs suggest the mental health of our whole population will have suffered, with the disadvantaged, vulnerable and the least resilient most affected.

The response to this societal trauma must not just be seen as just a matter for the NHS or for individual responsibility, it’s a collective one.  We must see the promotion of mental wellbeing and resilience put centre stage in the workplace, in education and in all aspects of our communal life.  

The lockdown has led us all to seek shelter at home.  For some the lockdown is causing harm. For example, the Police in London are reporting a 24% increase in charges and cautions for domestic violence and this is just the tip of the iceberg.  Empty street

At the same time the Children’s Commissioner has expressed concern that "at risk" children are facing increased danger in the lockdown, with only a tiny fraction of vulnerable children in England taking up the emergency school places kept open for them.  The harm to children’s future prospects as schools remain closed will be especially felt by the poorest and youngest. 

Designing the right support for rebooting complex eco-systems, like schools, or enabling businesses to bring their workforces safely out of furlough are all part of the challenge. All set against a background of increased anxiety, lost confidence and falling wellbeing while pubic health measures to suppress the spread of the virus continue.

The challenges posed by the pandemic require a whole-of-society non-pathologising approach that combines top-down and bottom-up leadership and action. 

Any strategy that aims to protect and invest in human capital and social infrastructure must be non-stigmatising, inclusive, equitable, adaptive and collaborative in the design and testing of promising national and place-based solutions.  It must build trust and legitimacy by co-designing the solutions with those affected.

It is vital that action is taken now to mobilise this whole-society response.  The social solidarity so evident in recent days must be harnessed to support a collective response, a new social contract that restores our personal and community resilience, rebuilds our human capital and renews our social scaffolding.  Without such a strategy bringing the economy out of coma will be much harder. 

Rt Hon Paul Burstow, is a former Minister of Mental Health and now Chairs the NHS Tavistock and Portman Clinics in north London and is Professor of Mental Health Public Policy at the Institute of Mental Health at the University of Birmingham.


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