Transcript: Episode 5

How is it affecting our mental health?

Vivienne Parry  0:08  
Hello and welcome to Coronavirus: The Whole Story. I'm Vivienne Parry, writer, broadcaster UCL alumna and for the past month in the happy position of being able to bring you the latest insights and expertise and analysis on Coronavirus, direct from UCL's extraordinary range of researchers. And we really have been giving you the whole story, intensive care, tracking the virus education impact exit strategies, and those episodes are all still there for you to listen to. I'll give you the details later. But this week is mental health awareness week. So we're asking the question, How is Coronavirus affecting our mental health? I'm joined remotely Of course by experts from different quarters of UCL psychiatry, psychology and behavioural science to discuss how this virus has impacted the lives of frontline staff, vulnerable groups and you our listeners. 

So let's introduce our guests for this week. In this episode I'm going to be talking to Dr. Daisy Fancourt, Associate Professor of psycho biology and Epidemiology in the Institute of epidemiology. Someone who started off life as a psycho neuro immunologist, the science of how different social factors affect the body. Today she finds herself amongst other things, conducting a large scale study to measure the impact of the virus on population's mental health and loneliness. Also with me is Dr Jo Billings, Clinical Associate Professor Division of Psychiatry in the Faculty of brain sciences, who studies PTSD, trauma, resilience, and the mental health and well being of high risk occupational groups, which makes him a perfect guest to discuss the impact of those working on the frontline during this crisis. And last but very much, not least, Dr. Rochelle Burgess, who's a lecturer in global health and the Institute for Global Health in the Faculty of popular Health Sciences. Rochelle is a leading community health psychologist specialising in community based approaches to health. And we'll be talking about solutions both here in the UK and around the world. 

Daisy Fancourt  2:26  
So we were really interested in what's going to happen to people's mental health across this pandemic. There have been some studies of previous epidemics looking at quarantine, suggesting that people who go into currency and it can have quite bad effects on their mental health. But this is obviously a situation now with COVID-19 that is completely unprecedented globally. And we thought it was absolutely crucial that we know how people are being affected psychologically and socially so that we understand the impact of measures like lockdowns, but we also know what kinds of supports people need for their mental health and we're also able to give more targeted guidance on how people can stay well at home. So we started running the COVID-19 social study, a few days before lockdown came in, we were just in time to capture some baseline data from people. And to date, we've had over 90,000 participants, and people are taking part every week. So we've got a fantastic longitudinal data set building up. And what we're particularly trying to look at here is, what the risk factors are for poor mental health, what the trajectories are over time and what factors seem to be protective.

Vivienne Parry  3:30  
Now give us the big picture. First of all, what would you perhaps expect on what are your initial findings?

Daisy Fancourt  3:37  
But in terms of what we expect, the only data we've really had to go on are those previous epidemics that I mentioned. So I think initially, there were hypotheses that mental health might get worse during lockdown, but actually, we've also been considering other kinds of exposures. So there's a lot of literature on social isolation. That suggests that if people don't have regular contact with others, this can have detrimental effects on things like anxiety, depression, stress levels. But in fact, what we're experiencing now is a completely new social phenomenon. It's quite different from regular social isolation. And instead of people gradually withdrawing from social engagement activities over a long period of time, this has been completely enforced and very abrupt. It's not something people have generally wanted to do. And but also, instead of the world carrying on around people, everything has stopped, society is stopped. So we don't really necessarily have the same things like fear of missing out. So actually, in many ways, what we're experiencing is a bit more like incarceration or spaced expeditions where people end up being put into a situation and for a length of time, and sort of really quite abruptly cut off from what's been happening around them. So we've sort of been hypothesising based on some of these previous data, but our findings have actually gone against some of our hypotheses. So, for example, we found that in the lead up to lots and lots of people's mental health seems to have got worse perhaps because of the uncertainty of things. And in fact, in lockdown, it seems to me plateaued at a higher level than normal. But we've seen a plateau and also some decreases in certain stressors like worries about catching the virus or access to food. But that of course raises the question as to what's going to happen as lockdown is eased whether will start to get better mentally, as we can return a bit more to normal, or whether things will actually get worse again, as we have uncertainty.

Vivienne Parry  5:21  
And Is that why you're doing this really rather unusual thing which is releasing results weekly?

Daisy Fancourt  5:28  
Yes, we were aware that there are a couple of different sort of aims with a study like this, one of the things we wanted to do is almost provide a mental health dashboard about what is happening across the UK in real time, and particularly what's happening for certain groups that we might consider more high risk, like people who've already got a mental health diagnosis. So we're producing public reports every week that just give a day by day average, across all of our responses. And because we've got such a large and very well stratified sample, we're able to look at what's happening over time in a really nice way. So as well as going out to the public. These Also, these data also go to Cabinet Office to the government, Public Health England, the World Health Organisation, and also to hundreds of organisations nationally who are trying to support individuals. But as well as that we're doing much more rigorous and sophisticated statistical analyses of the data that are being submitted in the traditional way to journals for peer review, where we're really trying to look more at these predictors and risk factors and how things are varying over time for high risk groups.

Vivienne Parry  6:26  
Now, tell me a bit through those high risk groups. Let's start actually at the other end, who's doing well, in this at the moment,

Daisy Fancourt  6:34  
the people who are doing well, and obviously we're using well in inverted commas here and that's, this still might be worse than normal for many people, but the people who are doing the best seem to be adults over the age of 60, particularly people who have retired. And I guess we might hypothesise here that for these adults, there might be the the least change to their day to day activities, particularly they'll be fewer worries around things like employments, and there might be fewer financial worries, but it also might be that these people for a living, perhaps in a more financially settled way, in houses, perhaps with gardens, perhaps with partners or with family members, the people who seem to be doing the worst in terms of age are younger adults 18 to 29 year olds, so particularly those people we think, including students where their lives have been turned completely upside down, and their usual patterns have been completely flipped around.

Vivienne Parry  7:22  
And Daisy, is that also correlated with fears about catching a virus, because if you're over 60, you're really quite worried about catching the virus. Whereas perhaps if you're in your early 20s, you're not that worried because you know, the very few people have over your age have died from it.

Daisy Fancourt  7:39  
Yes, actually, I mean, I guess this was sort of the other way around from what you from the analysis. I just mentioned that, yes, older adults, things have changed the least. And in terms of mental health, they seem to be doing the best, but they are the ones who are most worried about catching the virus. And so we found that what fears about catching COVID have dramatically decreased since lockdown came in, I guess, because we all have felt safer at home, there was a slight blip increase last week, which is when discussions around the easing of lockdown started. And so it'll be interesting over the next few weeks to see how that develops is the chance of many people catching it actually does start to go up. But it's interesting that amongst young people who've got that lowest fear about catching COVID, we're still actually seeing they've got the worst mental health at the moment. So in other words, it's not just about worries about the virus.

Vivienne Parry  8:26  
It's fascinating. And it's ranting about fear of zoom calls. I swear, if I take another zoom, I may indeed go.

Daisy Fancourt  8:34  
We're not sure yet. But we have been capturing data and how people are using their time and locked down. So things like screen time, so it'll be very interesting. We're starting to do analyses now to see how this is LinkedIn over time without changing trajectories of mental health.

Vivienne Parry  8:48  
And indeed, things like increased drinking.

Daisy Fancourt  8:51  
Yes, we've also captured data and health behaviour. So including things like diet, amount of food consumption, smoking and alcohol, allegedly analyses on smoking are actually going against some of the early papers that came out suggesting that smoking was protective against catching COVID. And actually, we are seeing very much that it is a risk factor.

Vivienne Parry  9:11  
Finally, Daisy, I mean, this is a, an enormous study. And a lot of people have taken part. there's a there's a sense actually isn't there at the moment of every boat body being in it together. And as you mentioned, it happened to everyone, it all stopped for absolutely everyone. There wasn't that fear of missing out, do you think you are going to see as things break down, that being impacted on? I

Daisy Fancourt  9:42  
think the concept of all being in it together as a massive myth. I mean, I saw a lovely analogy, which said, we're all in the same storm, but we're all in different boats. And I think that's very much the case. We've had actually had some analyses that are shortly to be published, where we've looked at adversities during the COVID pandemic, so things like losing your job facing problems paying bills facing difficulties accessing food, etc. And there is such a clear social gradient across this. So people who are wealthier, and people who are higher educated, they're facing these problems a lot less than others. And this is so vital for us to understand because what we're finding is that even in the wake of measures that have come in like furlough schemes, and like some of the public reassurances, there is still this gradient, and there is no evidence that it's getting smaller. In fact, it seems to be widening. So I think when we're looking at the inequality aspect of this, I think COVID is actually exposing and exacerbating inequalities within our society at the moment.

Vivienne Parry  10:38  
Just tell us now how quickly how we take part in the survey.

Daisy Fancourt  10:42  
It's very simple. You go to COVID, social study.org. And it's a it's a nice and simple 10 minute online survey that you get sent to your email address each week and we're looking for many more participants. So we hope people will be encouraged to take part.

Vivienne Parry  10:57  
So just as soon as you've had this off again, do it A great thing to do. Thanks very much, Daisy. So let me now turn to a key group that is particularly vulnerable. And that's frontline staff. Now, Joe, in a sense, a lot of the challenges frontline staff are facing the things that they've perhaps happened before, like the death of a patient or notifying loved ones, but not at this scale, nor in these circumstances, how might the particular context of Coronavirus have an impact on their mental health? And what sorts of adaptations to the kinds of self care that frontline staff may have already been practising could be made to help cope with the stress of working during the epidemic?

Jo Billings  11:42  
Absolutely, frontline health care workers are indeed very experienced in managing difficult situations that they're used to they're they're highly trained and looking after severely ill people that they're used to working with patients who might lose their life dealing with families, but as you say, this gave the current crisis is very different both in terms of the magnitude the amount of people affected, but also the duration over which this is going on. So there are several factors that are unique to to the current context that places additional stress on on healthcare workers. Perhaps one of the most important things that we keep hearing about is the direct risk to health care workers own health and well being and indirectly to their their family, as well. So not only are our frontline health care workers dealing with the health of their patients, but they're very, very worried about their own health as well and inadvertently affecting the health of their families. Healthcare workers are also struggling a lot with burnout and fatigue. A lot of hospitals and wards have been quite short staffed if other colleagues have fallen ill and had to take time off work, or people are shielding because of their own health responsibilities, or even if they've got childcare or caring responsibilities of the limited workforce. So the people still at work are having to work harder and more hours. That's impact on healthcare workers to

Vivienne Parry  13:02  
this very interesting data as well from the SARS. Sorry, yes, SARS, I'm from Toronto, where people who healthcare workers were particularly impacted as well, if they had to go into isolation or they became ill themselves, because they felt so guilty about other people left behind that they were having to work harder. So, you know, in all senses, you know, these things are piled on top of their shoulders.

Jo Billings  13:31  
Absolutely. And it's not just the kind of fear based responses that the healthcare workers might be experiencing a lot more sort of complicated emotions. Healthcare workers often feel guilty if they they can't work or if they get ill themselves or if they feel that somehow the care that they they usual care, the usual standards of care, they would apply the treatment of patients they can't maintain those to no fault of their own, perhaps to inadequate resources or difficult levels with And these put staff in very different, difficult ethical and moral dilemmas as well, that can be really difficult for them and indeed lead to them feeling quite guilty.

Vivienne Parry  14:09  
for lots of people they will want some sort of support. Tell us a bit more about that work with your colleagues

Jo Billings  14:26  
Yes, well, that work came about really because there's a small group of us who are clinicians and academics who work in trauma specifically so myself and my colleague in the Division of psychiatry, Dr. Michael Bloomfield, who's a consultant psychiatrist, and initially we were quite well placed to respond to the demands from some of our local acute hospital trusts to provide guidance to staff around self care. And, and from there really, that that work has been disseminated more widely across NHS England and across the country, and we're just really keen for that advice. And good evidence based and trauma informed guidance to be shared, shared more broadly,

Vivienne Parry  15:05  
Health care workers, as in NHS, frontline health care workers don't seem to be any more risk of death from COVID than the general population. That's not true of people in social care where there's a very much increased risk of death. But those figures I guess, are not that reassuring still to frontline staff.

Jo Billings  15:37  
Now, I mean, there seems to be mixed mixed information really about the degree to which health care workers might be at a greater a greater risk. I mean, they certainly have potentially very high exposure and exacerbated by the fact that there's not always adequate personal protective equipment for them. So there definitely is a higher risk for them and we know our colleagues in health care, so It says in care homes have been very deeply affected by this

Rochelle Burgess  16:03  
Joe Tommy,

Vivienne Parry  16:04  
in particular, but one aspect of all of this, which I think is particularly distressing, you know, because of the nature of Coronavirus, farmers are having to say goodbye to loved ones remotely. And some people aren't even getting that chance and changes are also having to be made to funerals and memorial services. And lots of families are not able to grieve in the way that they normally would have done. How about some advice for them? How do they cope with loss under these dreadful circumstances?

Jo Billings  16:39  
Yes, this is extremely difficult for for families who were put in this position and also for the healthcare workers who are sometimes having to step in and take the role or that a family member would normally have taken, perhaps being beside someone in their last moments of life. And so it's extraordinarily difficult for everyone involved. We know that social support is incredibly important in terms of managing grieff. And that is difficult at the moment when people can't engage in their normal social support systems, they can't see people physically, they can't physically give someone a hug or sit down for a cup of tea with them. But nevertheless, things that people can do to stay in touch with family or friends remotely, is really important to engage with the community and perhaps a community of people with shared experiences. We also know it, you know, don't underestimate the importance of small gestures when people are grieving, you know, it's really important to still, you know, do what we can during this time. And, and it's not that we can't provide some kind of memorial service for people in terms of say, traditional funeral at the moment, but these things are likely to be delayed. So I think it's important that you know, even if we can't have a sort of traditional funeral or memorial service at the moment that we think about how we can put these things Paste down the line.

Vivienne Parry  18:01  
wise advice there now you're listening to Coronavirus, the whole story a podcast brought to you by UCL Minds. If there's a question about coronas you'd like our researchers to answer please email us at minds@ucl.ac.uk or tweet at to UCL.

So we start talk there about families and communities and Russia. I'd like to come to you now to talk about how people have been responding to Coronavirus and to lockdown. How to the challenges and solutions associated with mental health during COVID-19 differ around the world?

Rochelle Burgess  18:44  
Well, I mean, that's a really interesting question because I think in reality, what's been suggested has not been that different around the world. A lot of it has been oriented around what we know and around how We frame mental health to begin with, largely, not really thinking about not thinking as much about the sort of social structural pathways that might drive people to experience distress. And so, because of that our solutions are focused on largely on the psychological, trying to increase people's access to relational resources, social capital, those types of coping, through contact, obviously, distant contact now, but you know, trying to connect people either through online apps or tele centres for talking therapies and that kind of support. And that is really helpful in a lot of ways and a lot of instances. But I think personally, when I, when I think about sort of the experiences of the communities that I've worked with around the world in terms of how their mental health challenges were developed, Long before COVID, these big sort of socio structural inequalities that COVID has reminded us of have always been there. So poverty in the inability to feed your children is something that is a reality for millions, if not billions of people around the world, and it always has been. And with COVID now, more and more people have that as their reality. And so one of the things that always strikes me is how do we get our mental health responses to match the full gamut of pathways to experience mental distress. So we have lots on how to do this in terms of psychological distress, but not so much about the environments where that distress sort of happening

Vivienne Parry  20:47  
in other communities we tend to see families come together as, as large groups, intergenerational groups, that's much less common in the UK. Is that a route to better coping, or, or not?

Rochelle Burgess  21:05  
Well, I think it ties back a little bit to something that Daisy said sort of trying to highlight that it sort of depends on where you started before COVID happened. So you could be in an intergenerational family. But if that family doesn't have resources to cope with the increased social stressors, then the family doesn't necessarily equate to increased well being if that family has increased needs that are sort of worsened by by sort of the social and economic impacts of the COVID crisis. So I think, ultimately, if we're thinking about solutions, to sort of mental health challenges and our concerns about potential increases in suicide and whatnot around the world, then it also calls for us to rethink what treatment might look like. And sort of what complex interventions might be needed that pay as much attention to sort of psychological anxieties and stress, but also the the wider environmental realities that might also be driving that stress. I've been working with colleagues at the Department of Public Health in hartfordshire. And one of the things we've been talking about is how do we embed sort of pathways for people to access socio structural resources during these times of crisis within the support that is offered for mental health. And so this might look like ensuring that if you have a mental health hotline or an app, an online programme that's providing chat services for people who are experiencing distress that all of those staff are given access to telephone numbers and locations of food banks or organisations that can help women who are are isolated in homes where there's domestic abuse, or sort of realising that people will also want to respond to these environments, these structural things in their environments that might be adding to their risk.

Vivienne Parry  23:12  
That's very interesting, because I, I think what we're seeing in so many different areas, is that the change that might have occurred within two or three, or maybe even five years is happening in a matter of weeks. And do you it's very interesting, you're talking about structural change to mental health services. And actually, Joe, I wonder if that's something that you do, you'd thought of as well, that actually will emerge from this with a different view of mental health and how it ought to be treated and more diverse ways, perhaps, in which it could be treated. Joe, what are your thoughts on that?

Jo Billings  23:54  
I mean, one of the things we might hope as a legacy of this pandemic would be that greater recognition of mental health issues, particularly in the vulnerable groups that Daisy and Rochelle have talked about. And perhaps the best service we can do for our NHS colleagues and people in other high risk, occupational roles is provide the kind of mental health support and the sort of systems and responses that we've been recognising they need now because although the scale and magnitude of this pandemic is unprecedented, these people do face difficult decisions and traumatic experiences day to day. So one of the things that might be good as if that can come out of this is perhaps that we we can offer more of that those services and that support to these people,

Vivienne Parry  24:42  
indeed, and may and do you think their services are going to look different?

Jo Billings  24:46  
I think we we have to be very thoughtful about what are the right interventions for whom and at what point in time, I think initially in response to the pandemic, it was a sort of sort of urgent and admirable response to want to help people and provide psychological interventions. But actually what most of the evidence shows is that in the early phases, people value sort of or want support around more basic human needs. People want to be able to get food from the supermarket, as we've seen, people want to be able to rest, get adequate sleep and feel safe, and for themselves and their families. But as these things progress people, they have a longer sort of impact on their lives. And as the crisis starts to recede, that's when people will start to process the experiences they've had and either make sense of them and integrate that in their, into their life narratives or not, and actually, that's probably when we're going to see more mental health issues arising or people presenting to services is perhaps in the later phases of this.

Vivienne Parry  25:45  
Rochelle, let me come back to you about the particular topic of inequality and how much it matters to mental health responses. What are your key recommendations for how particularly vulnerable communities can overcome their own mental health challenges.

Rochelle Burgess  26:04  
For me, I think that particularly vulnerable communities have been doing a lot of sort of self mobilising for for many, many years, because they've been on their own for for many, many years. And so I think it's important for sort of communities and groups and families to recognise the ways in which that they have been promoting their survival so far, and sort of try and harness those sort of those really great examples and history of survival in some intervention work that I've done in South Africa. with women who have experienced complex trauma, the big the heart of that intervention is trying to help women recognise that throughout their lives, despite having this narrative of, of trauma that weaves throughout it is that there's also a narrative of survival and so retelling that On stories through recognising survival was a huge factor in sort of reducing their levels of depression at the end of the intervention. And I think that huge transition from despair, to hope and possibility was a huge mediating factor for for women in that group. So I think communities should, you know, be celebrated and recognise the strength in the ways in which they've survived thus far. But also, there's something to be said about communities coming together to try and mobilise for additional support from political structures. inequality that we are seeing, being reminded of now during COVID is, has very much always been there, you know, in the UK before COVID hit there were already 50% of UK families who did not have any savings in preparation for things like this and and and the social determinants of health report the 10 year update that Professor Marmot put out sort of a couple weeks before things sort of went totally bonkers for lack of a better word. I know that irony of that during this particular podcast is not escaping me. But essentially, reminding us that one third of families in the UK were one paycheck away from homelessness. And those realities were always there. And that is what made the impact of COVID. So starkly unequal, is because the world it came into was already unequal. And for us to really think about how we, as Joe said, sort of think along this sort of, sort of the trajectory of experiences of distress the most important one work that we can do to sort of bolster mental health comes quite early on in the creation of environments that enable people to have good mental health. And in a lot of my work, I call that mental health enabling environments and mental health enabling communities where people have access to a range of resources that make good mental health possible. And part of that is relational resources. And Daisy didn't talk about this work, but a lot of her work on social prescribing and sort of getting people engaged with the arts and community is a huge part of sort of enabling good mental health to begin with. And those families that were talking about before Vivian sort of working within and living within, sort of intergenerational families or the families that we create for people who might be separated from their families are a huge part of that. But material resources are also a really big part, you know, and so we think about the sort of stuff that I said earlier, I'm one in three working families being a paycheck away from homelessness, we need to come up with better economic policies to enable people to protect themselves and and build that kind of protection that a lot of middle class families have. So that those worries don't aren't a part of that part part of the equation.

Vivienne Parry  30:24  
This is such a fascinating area. And there's lots that we could talk about. But unfortunately, we've got limited time today. So I want to finish up by asking you each for a piece of advice because it's mental health awareness week that you could give to our listeners to help with their mental health during these extraordinary, extraordinary times. Daisy, I'm gonna start with you.

Daisy Fancourt  30:50  
Purpose. I think purpose is such a fundamental part of people's mental health and I've done research with colleagues, including Andrew Steptoe professor at UCL where we We found that having a sense of purpose and meaning in life is associated not just with good mental health, but with better immune function, physical function, longevity behaviours. So I think at this time, a lot of people's normal sense of purpose has been majorly disrupted. They might be on furlough from work, they might not be able to do lots of their usual activities. But I think finding a sense of purpose, whether that's taking up a hobby or setting yourself a project at home, or whether it's volunteering or getting involved in research, like our study, just as a shameless plug, all I think all of these things are really good for people to maintain as good mental health as they can at this time.

Vivienne Parry  31:37  
Well, my little bit of purpose is I've been doing a bouquet on Twitter every day from my garden.

Daisy Fancourt  31:44  
I've seen the photographs they've cut.

Vivienne Parry  31:49  
Jo, how about you bit of advice from you?

Jo Billings  31:52  
Oh, I think it's important to remember that these are extraordinary times. So whatever people are experiencing, whether They're feeling anxious and worried or low or actually they're feeling fine. And they're just getting on with things. This is all normal. And it you know, these are all normal responses to a very unusual life experience. And so you know, it's important to understand that and give ourselves the time and space to support ourselves and support each other. But if people are really struggling, if these difficulties are persisting, but the Help is out there, we have really good primary care psychology services, we have the expertise out there to help people so don't struggle in vain.

Vivienne Parry  32:35  
And finally, Rochelle

Rochelle Burgess  32:38  
try to go last because those were both really good and also on my list, but I guess the final thing that I would say is, I think it's really important to try and find a way to celebrate the microcosms of success. So if you can sort of look at your at each day each moment closely and just Give yourself a break and congratulate yourself on just sort of making it through finding that, that one thing and actually when you start to do that exercise, a lot of times you find more than just one thing. But it's really important to in the midst of all this doom and gloom and there is a lot of it going around at the moment that there are things that you can celebrate and to find them and to do that in the ways that you can with the people you care about.

Vivienne Parry  33:31  
..but not possibly with yet another cocktail. This has been a really fascinating podcast. Thank you so much, all of you, sadly time to finish.

You've been listening to Coronavirus, the whole story and this episode was presented by myself Vivienne Perry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the splendid Cerys Bradley. Our guests today were Dr. Daisy Fancourt, Dr. Jo Billings and Dr. Rochelle Burgess and don't forget you can take part in the COVID-19 social study by going to covidsocialstudy.org, and if you or someone you know is struggling with their mental health there's support available details can be found in the description of this podcast episode and on the UCL website. And you can also follow at mental health on Twitter for more helpful content. If you'd like to hear more of these podcasts, UCL Minds of course you would subscribe wherever you download your podcasts or you can 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 that are open to everyone. Hope to be with you again very soon. Bye for now.

Transcribed by https://otter.ai