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Mental health is central to our survival and recovery in coronavirus pandemic

Professor Siobhan O'Neill

Hard-pressed healthcare workers making impossible decisions about who and who doesn't get treatment are at particular risk of post-traumatic stress disorder, says Professor Siobhan O'Neill


The coronavirus crisis has put health workers under near unbearable levels of pressure

The coronavirus crisis has put health workers under near unbearable levels of pressure

The coronavirus crisis has put health workers under near unbearable levels of pressure

This was the last thing we needed. We were starting to recognise the profound effects of the trauma of the Troubles and trying to resolve outstanding issues. While, at times it was slow and fraught, progress was happening and, importantly, the parties were united in their resolve to address our mental health needs.

We are now faced with a different threat, and if this pandemic has taught us anything, it is that preparation is key. While safety and physical health is, rightly, the primary focus, mental health needs also to be prioritised, because it too is central to our survival and recovery.

At a very basic level, we need a calm and stable population to observe the measures that will halt the spread of disease, and we require a healthy workforce to protect the vulnerable and deal with the effects of the pandemic.

This pandemic is a different type of trauma, and some of us will adapt more easily than others. At least in the early stages, some will value a break from the rat race and will appreciate the opportunity to spend time with loved ones. For others, the trauma of the pandemic, on top of other traumas and losses, will be devastating.

In the initial stages, the virus robbed us of our sense of safety and, for some, also of the physical contact that is essential for emotional regulation to manage the anxiety caused by the threat.

In the long term, the illness itself may lead to suffering and distress on an unimaginable scale. The loss of livelihood and income is already profound. People who have worked for years and sacrificed so much to build up businesses are now faced with the threat of losing everything they have worked for.

One defining feature of this crisis is our use of technology to connect with each other and learn. This too presents opportunities in the form of creative mental health interventions that should now be explored and developed.

However, digital natives will adjust much more easily to this new way of connecting and working, while those who do not have access to the technology will struggle.

The evidence also suggests that instant access to news media and obsessively following Covid-19-related news items on social media can fuel the rumination that increases our risk of developing mental health problems.

The closing of schools and workplaces has implications for mental health that go beyond education and employment.

For many children, school is their safe haven, providing them with respite from abusive homes.

Workplaces also allow opportunities for connection and intervention and provide a structure for those who live with mental ill-health.

These structures can be difficult to recreate for people who are working at home.

The mental health consequences will not be equally distributed. The thousands of families who already lived in poverty may be tipped into destitution. Violence, alcohol addition and substance abuse will increase and this do untold damage to generations.

While some families will flourish as they spend more time together, strained family relationships are inevitable.

In many cases, the stress will exacerbate existing divisions, resulting in separation and further loss. The loneliness of those who long for family connections will be felt even more acutely.

We need to look after particular groups even more carefully. Healthcare workers are at particular risk of post-traumatic stress disorder.

They are putting themselves at personal risk and may witness levels of suffering and death that it are impossible to prepare for.

They may need to make impossible decisions about who receives treatment, and this will increase their risk of PTSD.

The danger is, of course, that this is a sort of honeymoon phase where our gratitude for frontline workers and the compassion shown to the vulnerable are to the fore. It is in the aftermath that we know, from experience, that the most serious problems will emerge.

We need to prepare now for the months and years to come, when some people will have returned to a type of normality; a normality that contrasts sharply with others whose lives have been changed immeasurably.

This is when the mental health fallout will be most acute, and this is the time we need to make plans.

The mental health strategy needs to be strengthened to mitigate against the effects of Covid-19 and to ensure that those with mental health needs, particularly trauma-related needs, receive evidence-based treatments, delivered by a competent, confident and well-resourced workforce.

Furthermore, we should now be setting ourselves up to lead the way in the delivery of online early intervention and treatment for people with mental health problems.

In Northern Ireland our needs were already greater, and we had acknowledged that we were starting from a lower baseline in relation to mental health services.

In response to this current crisis, every department should embed trauma-informed approaches in their policies and practices. This is an approach that recognises the effect of trauma and multiple traumas on the brain and body.

We need to ensure that we recognise and respond to the signs of trauma and resist re-traumatisation.

Several features of this approach are already emerging, and there is much evidence that we are more compassionate and considerate of the vulnerable.

We must not lose this in the haste to return to normal, because for many of us normal will no longer be possible.

Siobhan O'Neill is professor of mental health sciences at Ulster University

Belfast Telegraph