‘We face a post Covid-19 tsunami of mental illness’

We’ve been through a lot. Grief, Social isolation, disruption, and uncertainty have upturned all our lives. Only now, as we begin to feel safe, can we acknowledge the effects of the pandemic on our collective mental health.

Based on reports worldwide, one thing is sure: there will be a significant increase in emotional distress as a result of Covid-19. Traditionally, one in five of the population experience mental health challenges. In the coming year there will be many more.

Previous research on the psychological impact of natural and human disasters help us anticipate what may happen as we come out of lockdown. A follow-up study on the emotional impact of the Sars [severe acute respiratory syndrome] epidemic found that one-third of those who contracted the disease survived the crisis and did well. This finding – replicated many times in studies of major disasters – reminds us that there is a resilience within all of us that needs to be tapped.

Another third of the population didn’t do well. Much has been written and spoken about this group. People without work, without homes and without a voice. Families under chronic stress with few resources, single isolated parents, minorities, people living with enduring mental illness, disability, or addiction. But the ideal support they require is rarely achieved.

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Services in our social and healthcare systems should be prepared for the tsunami of need which will emerge from within this previously at-risk group.

The final third of the population is made up of people we can describe as the new at-risk. These include children, young people, adults and older people whose lives have been disrupted by economic and social upheaval. Their distress may be immediately apparent or delayed. About half of this group will show signs of acute distress as we exit lockdown, but make a steady recovery over the next 12-18 months. Interestingly, the other half will present as fine initially, but experience a delayed reaction and decline over the same time period.

Their mental health issues may be hidden but they could surface when they return to the security of routines

Many children and young people struggled with lockdown. They’ve missed the security that school, friends and normal activities gave them. Managing their lives online and meeting study demands has been impossible for some. Sleep hasn’t come easily as they’ve worried about their futures. They’ve had to negotiate transitions in or out of school and college that are stressful milestones at the best of times, but much more so now. Their mental health issues may be hidden but they could surface when they return to the security of routines and rituals. Teachers will witness student distress and they will need support as to how to respond appropriately and refer if necessary.

Families are reeling from the impact of job losses and reduced income. Some have yet to face the full implications of unemployment and limited employment opportunities. Job loss is hard for everyone but particularly those whose identity and self-esteem is closely linked to having gainful employment and supporting their family. Resulting anger and frustration may lead to substance abuse, relationship problems, divorce, domestic violence, self-harm or suicide.

People in the new at-risk group may be less resilient that the previously at-risk group. They have no playbook for dealing with the corrosive stress that loss of income, loss of identity, and shattered confidence brings. Being strangers to the emotional territory they now find themselves in, they may feel embarrassed about seeking help and end up suffering in silence.

We are kinder, more aware of how fragile we are, clearer about our values

Covid-19 has reminded us that mental health is not solely an individual matter. It is shaped by relationships and livelihoods that enable us to belong and contribute to community. Recovery will require that we restore the socioeconomic drivers of good mental health (food, shelter, adequate income, social connection), empower local communities to support vulnerable individuals and families, and encourage each of us to recognise our own distress and take responsibility for our mental health.

Bonanno identified three factors that help when we are impacted by potentially traumatic events:

1. People need to be listened to so that they can accept their emotional reactions to what has happened as valid. Knowing and trusting ourselves is key to resilience;
2. People need to face their worries, assess them realistically and focus on what they can do, rather than worry about what might happen;
3. People need to know who and where they can turn to for support, and have that step made as easy as possible.

Covid-19 has shaken us up but it has also opened our eyes. We are kinder, more aware of how fragile we are, clearer about our values and appreciative of people whose services we previously took for granted. As well as dealing with the stresses this pandemic has brought into our lives, can we also hold on to and nourish the insights we learned during lockdown about how we want to live?

• Tony Bates is adjunct professor of psychology, UCD.