Transcript: Episode 36
How can we protect our mental health during the pandemic?
people, mental health, pandemic, ucl, psychological trauma, psychiatrists, happening, act, impact, mental illness, trauma, potentially, psychiatry, hospital, grief, traumatic events, physical health, effect
Michael Bloomfield, Tony David, Vivienne Parry
Vivienne Parry 00:02
Hello, you're listening to Coronavirus: The Whole Story. My name is Vivienne Parry. I'm a writer broadcaster and UCL alumna, and your host of this award winning podcast, all about Coronavirus and its impacts as understood by the groundbreaking research that's happening here at UCL. This month, government announced sweeping reforms of the 40 year old Mental Health Act. Mental health was already on a political and public agenda before the pandemic. But it's come to occupy centre stage now, as we all grapple with the impact of lockdown, and the multiple assaults on our resilience caused by uncertainty, illness, recovery, financial insecurity, job losses, bereavement, home schooling, and so much more. It happens to have been Blue Monday this week, which apparently typically marks the low spots in our emotional year. Really, they may have to rethink that idea because for an awful lot of people every day of the last year has been a Blue Monday. But let's try to be upbeat and say that our focus on mental health right now could represent a real opportunity to build back better and create a mental health system that's right for our times.
With me to discuss the impact of Coronavirus on mental health and reforms to the Mental Health Act, are two researchers from the UCL Division of Psychiatry. My first guest is Professor Tony David, Professor of Mental Health and the director of the UCL Institute of Mental Health. Anthony is a founding member of the British Neuro Psychological Society, and British Neuro Psychiatry Association. He's authored several books on neuro psychiatry, including Into the Abyss, and Neuro Psychiatrist Notes on Troubled Minds. I'm also joined by Dr. Michael Bloomfield, the UCL excellence principal Clinical Research Fellow, a member of the COVID Trauma Response Working Group, Michael leads the translational psychiatry research group. And His research focuses on psychological trauma studies and the risk factors for mental illness that can occur during childhood.
So Tony, let me come to you first, how's COVID affecting our mental health, both in terms of the people who've recovered from the virus, and those who've been lucky enough not to get infected, we're just still having to experience this global pandemic.
Tony David 02:24
Well, thank you for inviting me to discuss this. It's obviously a huge question, and a huge challenge for all of us. And I think that all of us have mental health. And there's no clear dividing line between mental health and illness, even though we, as academics, and psychiatrists have to try and draw the line somewhere. So we've all had to deal with the change in the atmosphere around us, the atmosphere of uncertainty of Worry, worry about our health, worry about our loved ones, perhaps the experience of physical illness experience of bereavement. So all of that is going to have an obvious adverse effect on us. And so I think it's as if the temperature, the sort of emotional temperature has risen to a point where we're all feeling somewhat uncomfortable. The question is whether that does translate into people actually becoming ill. And to be clear, we're not really quite sure how it's all going to turn out. We know that people do express more in the way of symptoms of anxiety and depression. We don't know whether that is just a response to everything that's going on, or whether that's going to really make an enduring difference. Of course, there are specific vulnerabilities that people have that are already there that are going to be in many ways exacerbated. So people who are at the best of times prone to withdrawal from others, perhaps because of a more chronic mental illness, they're going to find themselves even harder to reach, and even more cut off from the rest of society and their friends. People who perhaps have already struggled with some drug addictions or alcohol may find themselves even more driven to, you know, taking up those substances to their detriment. So I think there's a lot of things that predictively are going to go wrong, but in the end, we shouldn't forget that our sense of pulling together, of resilience of coming through will also be in play. So we shouldn't necessarily be overly pessimistic about our mental health in this in this time of pandemic
Vivienne Parry 04:58
and alarmingly Some of those people that you would have expect to present with mental health problems who were ill before, have not come for help. in just the same way that you know, mysteriously there are fewer people with heart attacks coming into hospital.
Tony David 05:18
Well, of course, the accident emergency departments of, of hospitals always have their fair share of people presenting in a crisis, perhaps having taken an overdose of medication or have tablets or tried to harm themselves in other ways. And it seems that that that there's less of that going on, because perhaps people are just frightened to go anywhere near hospitals. And, of course, we don't know what the implications of that are these people really suffering, in silence and in solitude, which would be obviously very upsetting to think of, or are they finding ways of different ways of coping, we don't really know. But there's certainly been been less of that than would be expected. But on the other hand, people are still coming forward for help with their mental health. And through the miracle of technology, I think a lot of remote work is going on, that's going to be actually something we can carry on beyond the pandemic, to make accessibility to help to treatments to therapies, actually, easier for people to to make access to, at least that's that's one optimistic hope.
Vivienne Parry 06:31
I'm wondering what kind of impact grief was making on our mental health. And of course, there's grief involved where people have have lost people dear to them. But also, there's a kind of collective national grief about the loss of the life that we would have led.
Tony David 06:50
Yes. And that really is unchartered territory. We know that in times of national crisis, there is a sort of feeling of we're all in this together, although, of course, politicians can exploit and distort that feeling. But for example, if you look at suicide rates, in times of war, they very consistently drop and this has been seen for centuries, ever since Durkheim studies in the 19th century. So there is that, but I think this completely novel, in a bad way, situation where people have lost relatives without being able to say goodbye, where the rituals of burial and grief have been compromised and interrupted by the pandemic, we really have no idea what sort of impact that's going to have. And presumably, all of these rituals and cultural mores have developed for a purpose, they've sort of evolved as a way of helping people societies deal with the inevitabilities of grief and loss. And, you know, I do worry that that's going to have an effect on as it were, the National psyche, but again, whether that's going to translate into crude mental illness, possibly not, but just a sort of shadow of unhappiness, perhaps is going to affect this generation.
Vivienne Parry 08:17
And do you think that because of the Coronavirus, I mean, we were already beginning to talk about mental health, I think differently before it hit. But it seems to have changed the conversation about mental health. It's brought it to a four, you know, in a way that I don't think that we've ever seen before. And I wonder whether you thought that that was a positive change.
Tony David 08:42
I think it's both positive and negative. I mean, I think the greater awareness of mental health that was happening already is generally a positive. There's so much stigma around mental health and secrecy, and avoidance. And it did seem that we were overcoming that that it was part of, as you say, the national conversation. One of the downsides of that is the tendency to make it seem like mental illness is ubiquitous, you know, it's so common, one in four people. And so is a statistic that's often quoted, which I think isn't really valid. And you get to think, well, if it's that common, is it really that important? Is it really that serious? So I think that's a bit of a downside. And that has spilled over into our approach to the pandemic where it's seen as it's almost inevitable, that if not one in four, perhaps even the majority of people are suffering from a mental illness or a mental health condition rather than just swimming in the same tide of uncertainty and worry. So you know, again, it is all to do with helping each other appreciating what's going on and not avoiding Not stigmatising, but also not necessarily medicalizing everything, because that can lead to problems as well.
Vivienne Parry 10:08
What role do you think psychiatrists have played in the pandemic, both in terms of guiding this conversation about our mental health, but also in making mental health services available more widely?
Tony David 10:22
Well, I think psychiatrists have risen to the challenge, especially in trying to make their services and and of their colleagues. Because of course, we work in multidisciplinary teams, making it more accessible, I think we have thought very hard about championing if that's the right word, our area, I mean, there is a tendency, I think, for people to think, oh, we need to put all our money and resources into you know, what's really important, which is the physical health and the infection and the vaccines, which of course, is a priority. But I think psychiatrists have stood up and said, Well, look, there are other things that we need to consider as well. And it's not a sort of a hierarchy, necessarily, that the mental and physical health always go in tandem. So I think I think we've played quite a good role there. I think also, particularly in my kind of area, which is about the interface between, as it were the brain and the mind between neurology and psychiatry, there's been a lot of very interesting activity there. And a lot of brilliant researchers have put forward ideas for future research about whether this virus actually gets into the brain, what kind of neurological illnesses can be a consequence, and and following from that, how that might affect people's thinking in the long term. So I think we've had really a strong part to play. And of course, I'm not, I've not mentioned the whole idea of trauma and people's coping with severe events. And I'm sure my colleague, Michael Bloomfield, will will say much more about that.
Vivienne Parry 12:06
Well, I must invite you more often, because that was a perfect segue.
There you go.
Vivienne Parry 12:13
Thank you. Michael, you're a trauma specialist. As Tony has said, It's clearly been traumatic for certain groups of people, frontline staff, and health care workers. And I also wonder whether you put into that category, people who are extremely clinically vulnerable,
Michael Bloomfield 12:30
and thank you for having me on as well. And yes, I would put people that are extremely clinically vulnerable into that category. I think when we're talking about psychological trauma, as I think there are echoes of what Tony was describing in terms of talking about mental health and mental illness, that of course, it's it's good that these conversations are happening. One of the things with with psychological trauma, though, is that we I think we need to be careful about how we're describing psychological trauma. And I think some really good working definitions come from the World Health Organisation, and also the American Psychiatric Association, which both of those publish the diagnostic guidelines for psychiatrists. And within those psychological trauma is defined as a, a severe event that side a potentially life threatening, or one that involves serious injury either to oneself, or to somebody else that's witnessed or to somebody else that we're close to that we've that we've heard about. And of course, because of the of the life threatening nature of the COVID pandemic, that by definition will involve a degree of exposure to to psychological trauma. Now, I think one of the important things to to put across is that not everyone who experiences a psychological trauma will develop problems. So just as being lots of people might be for those people who are involved in a car accident, for example, not all of those people will develop mental health problems because they've experienced something that's potentially traumatic, but the experience of psychological trauma does increase the risk of a range of different mental health problems. And that's why I think it's particularly important to think about and those people who have who are particularly vulnerable, well likely themselves have had previous experiences of trauma. So there can be an interaction between somebody's previous experiences of trauma and and what's going on right now, when they're when there are further experiences of potentially traumatic events.
Vivienne Parry 14:18
And is the chronicity of this in other words, that it just goes on and on and on. And really, there seems to be no let up. Is that also adding to the problem?
Michael Bloomfield 14:28
I think it is adding to the problem in a few different ways. So one of the things that we know with, so Post Traumatic Stress Disorder, which is the archetype or psychiatric diagnosis for people who've survived psychological trauma, we know that that there's a difference between going through one traumatic event surviving that and surviving repeated traumatic events over time, the complexity of some of the problems that can come about, well, they can be more complex, they can potentially be more severe. And there are important differences. as well for treatment for those people who do develop, who do develop problems. So I think because this is going on for a long time, particularly in certain high risk groups, where their people are being repeatedly exposed to potentially psychologically traumatic events, as the potential for for retraumatization On one hand, on the other hand, as well, because it's ongoing, it does mean that potential solutions and help can be implemented along the way to try and make things better. Just to put some balance there. I think one of the other important things about the the current situation is the concept of a shared traumatic experience. So there's a literature around people who are in war zones, for example. And so if you have social workers and doctors and nurses, for example, working in in war zones, they're trying to help their patients, but they themselves are experienced are experiencing the war. Now, we have to be careful, I think, with the analogies and comparisons between the pandemic and being in a war because I think, I think sometimes they're overused and it can be unhelpful, but I think the important thing to realise is even for those people who perhaps aren't being traumatised, that actually that there's still this, this effect of being in lockdown and, and hearing of the impact and seeing the new story. So even for those people who aren't experiencing trauma, as defined by the World Health Organisation, that there's still this, this adversity going on in the background. And so that kind of creates an environment of a shared traumatic narrative, which is really important to think about, too.
Vivienne Parry 16:25
Now, you've been working with a COVID, trauma response, working group, developing guidance and advice for hospital staff working through the pandemic, can you tell me the kind of recommendations you've been making.
Michael Bloomfield 16:36
So the kinds of recommendations that we've been making have been really, really focused on trying to address what we know about being the main risk factors, or not just post traumatic stress disorder, PTSD, but also for some of the other common mental health problems that can come about when people are under a huge amount of stress. So some of the most important things are ensuring that basic safety measures are followed. So for example, at the at the start of the pandemic, there were huge concerns around the lack of access to personal protective equipment and the impact that that could have on staff members. So one of the key recommendations was around making sure there's appropriate access to pee pee, and then some of the other some of the other things that were around actually making sure as much as possible basic needs can be met. So making sure people can take regular breaks, and also making sure that the appropriate structures are in place within organisations to foster as much of a supportive environment as possible, given the pressures that our colleagues are under. And also to make sure that for those people who actually do need to seek professional advice, support and treatment, that they're able to access that and that very rapidly. Importantly, in our guidelines we bought so emphasised that there is some types of approach some types of intervention that might be unhelpful. So for example, when the pandemic started, there was a rush of very, very well meaning colleagues from across lots of different mental health professions who wanted to go out and help. Now we know from the literature on disasters and disaster management, that there are some types of intervention that can be very helpful when there's when there's a very stressful event happening as some types of intervention that can actually make some types of mental health problems worse, and those ones are ones which interfere with our own natural coping mechanisms. So for example, it would be completely normal for lots of us if we were facing a very difficult event, cyclic, psychological traumatically event, to in the days and initial couple of weeks afterwards, for example, to experience nightmares, to experience intrusive memories of that event, that's normal. And that tends to get better quite quickly in most people, if the wrong type of interventions done at that point. And what that can do is that can actually make those memories worse, make them carry on for longer, and actually increase the risk of post traumatic stress disorder. So it's, it's about getting the balance, right between different types of help and making sure that the right type of helps available at the right time, and that the first rule of medicine is always followed, which is do no harm.
Vivienne Parry 19:08
I want to talk about a different group. Now. I know you've got a lot of expertise in young people and young people, of course, you know, the adolescent years are often when psychiatric conditions appear for the first time. And we've had on previous episode, how things like lockdown and school closures have been acutely stressful for young people, and particularly the lack of involvement with their peers. How do you think they're going to be coping in the future?
Michael Bloomfield 19:39
I think we're going to have to we're going to have to wait and see to to find out unfortunately, I think it is concerning that there are particularly high risk groups that I think we have to be very careful about so that for example, we know that experiencing childhood abuse can be particularly damaging for somebody long term mental health and of course with that The lockdown measures that are in place at the moment that can make it much harder for young children, young people to seek help, and also to escape the abuse when that's happening. So I think for those kind of groups, I think they're a particularly vulnerable group that we need to be that we do need to be careful of. I think, on the other hand, it's absolutely you know, adult adolescence in protect childhood especially but adolescence, in particular time when our identities are forming, where our our social interactions are so important. I think one of the the saving graces of the of the timing of this pandemic, is that because of technology, we do live in a much more connected world than even had this happened 20 years ago, for example, you know, when I when I was a teenager in the 90s, when the level of connectedness wouldn't be possible. So notwithstanding some of the concerns about the effects of social media on on mental well being, I think that the fact that it's happening now, and that there are other ways where young people can connect with each other, it's possible that may provide a buffering effect, because that's just a hypothesis. And so we are going to have to wait and see. And to do that research.
Vivienne Parry 21:02
I want to ask you both now about the Mental Health Act reform proposals. Tony, the, as I said, in my introduction, the Mental Health Act is 40 years old. Now, why does it need well? What are the particular aspects of mental health that that need updating?
Tony David 21:19
Well, the Mental Health Act has been there, there have been codes of practice that have tried to keep the act up to date, but it is does seem timely that a more radical revision should have been carried out. And one of the things is the observation that people detained, for example, in hospital under the Mental Health Act were disproportionately drawn from black and ethnic minority groups. You know, and that's, it's a complicated issue. And there may be many reasons for that. But at least one should consider whether such people are not being treated optimally by the Mental Health Act, and, and the whole conundrum of, you know, care, and so forth, the way care is organised, there's certainly a suspicion that something's going wrong, and part of our community isn't being best looked after. So the new Act will try and address that. And that's to be, you know, strongly welcomed. I think just the whole idea about the focus of detention in hospital being the sort of cornerstone of psychiatric treatment, which it probably was 50 or more years ago, is also going to be reflected with shorter detentions time for treatment in hospital more opportunity for proper appeal. And another thing that will be very different is how a person's nearest relative or close confidant can be brought into the process. And previously, the law itself decided which relative should be consulted on your behalf. And, you know, that obviously, wasn't ideal. And so that's going to be thoroughly addressed and changed. So it puts the individual much more at the centre of the process. And, of course, in the end, it may be that a decision is made on a person's behalf that at the time, they may not completely agree with, but that element of practice is going to be kept to the absolute minimum, for the moment, amount of time and even within the process to involve the individual and their wants and needs much more. It's going to be a really important innovation in the new Act, which we hope will be enacted in due course.
Vivienne Parry 23:45
Michael, is there any changes that you think that are really important?
Michael Bloomfield 23:50
I'd agree with what Tony had just said, with those changes, I think around, there's a shift in emphasis towards as much as possible having some kind of shared decision making also having the ability to have some advanced directives incorporated incorporated into management as well. So I think that it's a subtle shift in emphasis, but I think it's something that could potentially be very powerful. And and I think it's an opportunity to, to actually, in and of itself be used therapeutically, potentially. And hopefully,
Vivienne Parry 24:22
one final question for you both, I want to end by giving our listeners a bit of practical advice. Usually on this podcast, I give my guests a magic wand and tell them they can use it to improve something this week. And I want to ask you, if you were to get our listeners to change one thing to help protect or improve their mental health over the coming months, what would you do?
Michael Bloomfield 24:42
I think one of the things that I think would be really helpful would be to take regular breaks away from what's happening. So making sure there's time away from the news, having regular breaks to take your mind somewhere else that somewhere is just somewhere nicer, whether that's watching the travel programme or watching an programme, just something that take your mind off what's happening at the moment just to give you a little rest and try and have that as regularly as possible.
Tony David 25:10
I think it's very important to look after your physical health, because mental and physical health are so inextricably linked, and one follows the other. So do take advantage of the exercise, you were allowed, get the vaccine, keep safe, and, you know, 90% of your mental health will be protected in that way.
Vivienne Parry 25:35
Thank you very much to both of you. I mean, this is something that we could talk about for many hours. It's so hugely important, and I suspect a lot of what the effects will be will only become apparent not just immediately after the pandemic is over, but actually in many years to come.
You've been listening to Coronavirus the whole story. This episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the very lovely Cerys Bradley. I was joined today by Professor Tony David and Dr. Michael Bloomfield. If you'd like to hear more of the podcasts from UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.