BRIEFING - Covid-19 and the nation's mental health
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BRIEFING
Covid-19 and the nation’s mental health
Forecasting needs and risks in the UK: July 2020
Curtis Sinclair, Nick O’Shea, Louis Allwood and Dr Graham Durcan
Summary
Levels of psychological distress and mental ill health access to mental health support and increased
are rising internationally in the wake of Covid-19. It is isolation. This is likely to have a significant mental
not yet known how far and how soon they will fall back health impact for prisoners subject to long periods of
to levels that existed prior to the pandemic. being confined to cells.
Research has identified specific groups of people Youth unemployment has both short- and long-term
facing higher risks to their mental health at this time, impacts on mental health, as well as on lifetime
including the families of people treated in intensive earnings. There is a risk that young people will be
care, people with existing mental or physical health especially badly affected by the recession, whose
conditions, and pregnant women. There is also biggest impacts are likely to be in industries that
evidence that people with existing mental health employ large numbers of younger workers.
difficulties have been experiencing a worsening of their The economic impact of Covid-19 is likely to exacerbate
mental health during the pandemic. and entrench social inequalities. This is because its
The impact of the pandemic on children and young impact is felt disproportionately due to age, existing
people’s mental health is greater in areas and poverty and deprivation, mass unemployment and less
communities hardest hit by the virus and by lockdowns. work, and accelerated economic change.
Children from low income families, from Black, Asian The only solution for the economy will be to cure
and minority ethnic communities and young carers Covid-19. Reducing the duration of the pandemic will
are all more likely to experience poor mental health be crucial to reduce its economic impacts.
as a result of the pandemic. Children’s mental health
has been affected by disruptions to their education, A combination of further waves of Covid-19, a potential
compounded by reduced access to support for their winter flu epidemic, the likely absence of the furlough
mental health. scheme and a possible no-deal Brexit at the end of
2020 could have a significant impact on all parts of the
In prisons, actions taken to reduce the risk of Covid-19 UK economy and a consequent effect on the nation’s
to prisoners have also reduced levels of violence and mental health.
use of drugs, but at the same time they have limited
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
Introduction
The global Covid-19 pandemic has brought research, much of it from China. It looks at
about profound changes to societies worldwide, emerging evidence from surveys about the
including in the UK. It has also had a significant mental health of the general population and
impact on people’s mental health. This is Centre from studies focusing on the risks faced by
for Mental Health’s second forecast of the specific groups of people, including the families
implications of the virus for the mental health of of people treated in intensive care, people with
the UK population, in both the short- and long- existing mental or physical health conditions,
term. and pregnant women.
In our first forecast, we projected that the This briefing provides a further assessment of
pandemic would increase the number of the economic impacts of the pandemic and their
people experiencing a mental health difficulty implications for public mental health. It also
by approximately half a million in the UK. This reviews evidence relating to the criminal justice
paper updates our forecast, using research system and to young adults and the potential
and other evidence published since our first longer term psychological impacts of rising
briefing. It reviews evidence from sources youth unemployment.
including a growing body of international
The prevalence of mental health problems in the general population
There is growing evidence of worsening mental in England, which was 16.9% in 2017 (Public
health in both adult and youth populations Health England, 2019), these figures point to
attributable to the various social restrictions a possible rise in demand for psychological
in response to Covid-19. Presently, research services. Analysis of Understanding Society
on the mental health of a population has come Covid-19 survey data indicated that self-report
primarily from Asia and, more specifically, scores on General Health Questionnaire-12
China. However, findings from other parts of (GHQ-12) had deteriorated by 8.1% per cent
the world are emerging and suggest a similar since the beginning of the pandemic (Banks and
pattern in terms of mental health deterioration. Xu, 2020).
Large scale surveys of the general population What is less clear is the likely number of those
help to capture the likely prevalence of who are currently experiencing distress who
individuals experiencing symptoms related to will then go on to develop a common mental
common mental health conditions. In Spain, health condition as the pandemic continues. A
depressive, anxiety and post-traumatic stress longitudinal study from China would suggest
symptoms exceeded cut-off points in 18.7%, that, certainly in the early stages of the
21.6% and 15.8% of the sample respectively; pandemic, a reduction in these numbers is
meaning that these scores were indicative of unlikely, at least at 4-week follow-up (Wang
a possible disorder (González-Sanguino et et al., 2020). Understanding Society study
al., 2020). Similarly, in Italy, 18.6% reported data may provide further insights, as we move
moderate-to-severe likelihood of psychological through the various stages of the pandemic, as
distress (Moccia et al., 2020). Compared with to how quickly, after restrictions are eased, the
the estimated prevalence of common mental mental health of the nation might return to pre-
disorders (e.g., depression, phobia, PTSD, OCD) pandemic levels.
2Factors affecting mental health from a sample in China that indicates an
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
increase in hazardous and harmful alcohol use
Across the range of international studies, (Ahmed et al., 2020). Furthermore, the issue
several characteristics were found to was found to be more prominent in younger
be associated with an increased risk of people (i.e. 18-40 years old). Concerns have
experiencing greater levels of psychological been raised about the possibility of a surge
distress (such as anxiety or depression). For in serious alcohol use cases because of the
instance, being female, younger (i.e., under stress caused by the pandemic (e.g. Clay &
35), having no psychological support, higher Parker, 2020). Moreover, warnings have also
education level, patients with Covid-19 highlighted the increase in alcohol sales during
and their families, individuals with existing the beginning of lockdown and how this might
physical or mental health problems, greater greatly affect both those who are already
exposure to social media and loneliness have alcohol dependent – who already struggle to
all been indicated as possible risk factors for a access support – and those on the brink (Finlay
deterioration in mental wellbeing. and Gilmore, 2020).
Longitudinal data showed that women’s
scores on a measure (the General Health Pre-existing health conditions
Questionnaire) of self-reported mental
Two studies highlight a possible issue around
health worsened by a greater degree (27.4%
the availability of medication and access to
pre-pandemic vs 44.5% in April 2020) in
health services for people with existing mental
comparison to men (18.8% vs 28.6%) (IFS,
and physical health problems. A study from
2020). Moreover, young women saw the
China found that some people with a mental
largest decline (18.2%) in their mental health
illness had reduced or completely stopped
alongside an increase in the proportion
their psychiatric medication because access
reporting at least one severe problem (17.6%
to prescriptions had been severely impacted
pre-pandemic vs 35.2% in April 2020), which
(Zhou, Liu, Xue, Yang & Tang, 2020). Moreover,
was higher than that seen for the entire adult
nearly a quarter of patients in this study
sample (10.6% vs 23.7%). Certain factors
reported that routine appointments had been
were reported to greatly impact upon women
suspended since the start of the pandemic.
more than men, such as having symptoms of
Similarly, Mind (2020) recently found that
Covid-19 at the time of the survey, very young
around a quarter of people surveyed who had
children, and working in shutdown sectors.
attempted to access mental health support in
Several other studies, from Asia and Europe,
the previous fortnight were unsuccessful in
support the finding that women’s mental health
getting support. Reasons included cancelled
is being more adversely affected than men (e.g.
appointments, difficulty getting through to
González-Sanguino et al., 2020).
GP or community mental health team, being
turned away by crisis services and issues
Alcohol and substance use accessing digital alternatives. The sample were
Government advice to remain indoors and predominantly those who had direct experience
avoid social contact will have affected each of mental health problems.
person differently. Indeed, findings suggest A study from Iran, focused on the experiences
that it is not the direct impact of being placed of people with Parkinson’s disease, reported
in lockdown that predicted mental health higher levels of anxiety around having access to
deterioration in China, but rather the impact on medication. Undoubtedly, health care provision
daily life (Zhu et al., 2020). and access to medication are substantially
Moreover, some groups will be at greater risk different in the UK, but this highlights the risks
of engaging in high-risk or unhealthy means of associated with a perception that medical
coping, such as increasing alcohol use or other care might be restricted (Salari et al., 2020).
substances. Whilst there is scant research on Furthermore, some people with a pre-existing
this issue, it is worth highlighting the finding mental illness may be at increased risk of
3relapse or new episodes of illness (Yao et al., (48.4%), sharing in decision making (47.8%),
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
2020). Certainly, initial evidence would indicate whose relative died after end-of-life decisions
that many people are experiencing a worsening (60%), and who shared in end-of-life decisions
of symptoms (e.g. Vindegaard and Benros, in (81.8%) (Azoulay et al., 2005). Family members’
press). post-traumatic stress symptoms were found to
vary in severity during the first year after the
Impact on families of people treated for relative’s admission to ICU (Alfheim et al., 2019).
Covid-19
Pregnant women
There is an inherent risk of developing
post-traumatic stress disorder (PTSD) after Pregnant women assessed during the pandemic
experiencing intensive care treatment for reported more distress and psychiatric
Covid-19, as we noted in our first forecast. symptoms than pregnant women assessed
Family members are not exempt from before the pandemic. One study found that
developing PTSD, especially given that many two thirds of women reported anxiety higher
would have been denied contact with their than normal (Saccone et al., 2020). It has
loved one whilst in ICU. been suggested that, because of the harmful
consequences of prenatal distress on mothers
In general, when family members of ICU and babies, extra measures should be put in
patients were surveyed, a third of respondents place to carefully monitor the physical and
reported post-traumatic stress symptoms mental health of mother and child during
consistent with a moderate to major risk of the pandemic, such as asking about specific
PTSD. People who experienced higher rates distress or symptoms during prenatal care
of post-traumatic stress included those who (Berthelot et al., 2020).
reported receiving incomplete information
Children’s mental health
There is emerging evidence that lockdown itself much higher proportion of single parents has
is taking its toll on young people. A YoungMinds experienced anxiety, loneliness, hopelessness
survey of children and young people who have and ‘not coping well’ (Mental Health
experienced mental health problems, carried Foundation, 2020a). These experiences may in
out in the first week of lockdown at the end turn impact on children in those households.
of March, found that 83% reported that the There is also a trend in adult surveys that young
pandemic had made their mental health worse. adults are more likely to experience increasing
A survey of 11-25 year olds in Scotland carried anxiety and lower wellbeing (Kwong et al.,
out in April found that 39% of respondents 2020; Fancourt et al., 2020; Mental Health
were moderately or extremely concerned about Foundation, 2020a). This may relate to the
their own mental wellbeing and 61% were employment status and financial instability of
moderately or extremely concerned about the young adults rather than age itself.
impact of coronavirus on their future (YouthLink
There is limited international evidence of the
Scotland, 2020).
longer term impact of lockdown on children’s
Of the numerous surveys tracking changes in mental health. A study from the Chinese Hubei
mental health in the UK during the pandemic, province, carried out in early March (fewer than
few are gathering the views of children. Some two months since restrictions on movement
surveys suggest that depression, anxiety, were first implemented), measured signs of
loneliness and lower levels of life satisfaction depression and anxiety in primary school age
have been more common amongst adults children. It found that children in Wuhan, where
living with children (Fancourt et al. 2020), and the number of Covid-19 cases and mortality
that, compared to the general population, a rates were much higher, had a much greater
4prevalence of depressive symptoms than around two in five young carers were thought to
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
children in Huangshi, where cases of the virus experience a mental health problem (Alexander,
were much lower. The children least likely to 2014). While a much smaller number of
experience symptoms of depression or anxiety young people with caring roles are officially
were those who were least worried about recognised, the estimated total number of
Covid-19 and the most optimistic about the young carers in the UK is around 800,000. In a
future of the epidemic (Tuo et al., 2020). survey of over 250 young carers, 70% reported
that lockdown has made their mental health
This suggests that children in areas where
worse (Channel 4 News, 2020). A qualitative
the Covid-19 virus is more prominent locally
study identified key themes driving this change.
experience a more significant impact on their
These include an increasing complexity of the
mental health. This resonates with earlier
carer role; the added vulnerability of the looked-
research on post-traumatic stress amongst
after person; new responsibilities to look after
parents and children following health-related
siblings not in school; loss of support and
disasters. One study found that post-traumatic
regular contact from local services, especially
stress scores were four times higher in children
where these have been pared back by local
who had been quarantined compared to those
authorities; uncertainty over assessments;
who were not quarantined (Sprang and Silma,
difficulty home learning; and not having
2013). This is an important consideration for
space to process stress or break from caring
targeting mental health resources alongside any
responsibilities (Blake-Holmes, 2020).
‘local lockdowns’ implemented in future – and
for responding to the disproportionate presence The economic impact of Covid-19 creates both
of Covid-19 cases in some communities and immediate and long-term concerns for children
in areas with high levels of socio-economic living in or at risk of poverty. The Trussell Trust
deprivation. has reported an 89% increase in demand
for food in April 2020 compared to the same
Inequalities month last year, with the number of families
with children relying on parcels doubling (The
We know that experiences of the pandemic Trussell Trust, 2020). Food poverty exacerbates
have been far from equal across the population health inequalities and is associated with a
(Allwood and Bell, 2020). This is no less true for range or poor outcomes, including behavioural
children and young people. The digital support and emotional difficulties (Gitterman et al.,
service Kooth, for example, has (based on 2015). Poverty itself is a determinant of poor
requests for help from 51,321 young people) mental health – children from the poorest 20%
reported a steep increase during March, April of households are four times as likely to have
and May in the number of Black, Asian and serious mental health difficulties by age 11
minority ethnic young people under 18 seeking than those from the wealthiest 20% (Morrison
help for: Gutman et al., 2015).
• Anxiety or stress, rising by 11.4% compared
During the pandemic, families have lost
to 3% among white children of the same age
access to schemes like breakfast clubs and
• Suicidal thoughts, rising by 26.6% school resources which can alleviate some of
compared to 18.1% among white children the impact of poverty. At the same time, the
• Self-harm, rising by 29.5% compared to cost of living has increased, with less time
24.9% among white children to source affordable food and longer periods
spent at home incurring higher household bills
• Depression, which rose by 9.2% among
(Mental Health Foundation, 2020b). Children
BAME under-18s and fell by 16.2% among
in families already living in poverty, and those
white children (XenZone, 2020).
whose guardians are facing financial insecurity,
Children with caring responsibilities face have been exposed to a significant threat to
additional mental health challenges as a their mental health, the effects of which may
result of the pandemic. Before the pandemic, manifest over several years.
5Disrupted education
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
issues and put protective measures in place
have been missed. Teachers and other school
Most schools have stayed open during the staff play a key role in raising concerns and
pandemic, but with minimal staff and for a very referring to services. Early reports from local
small fraction of school-age children. Children authorities suggested sharp falls in referrals to
across the country have experienced a major social services over child protection concerns
disruption, losing the social interaction and (The Guardian, 2020).
stability that school brings to their lives. A large
national survey in which over 10,000 parents
Accessing mental health support
participated found that those with children
aged 4-10 years old reported significant Children and young people’s mental health
increases in emotional, behavioural and services have remained open during the
attention difficulties. Adolescents and children pandemic, but referrals have fallen sharply in
with special educational needs do not appear some areas. Estimates by NHS England and
to have been affected in the same way – some Improvement are that referrals for children and
have even reported improvements in emotional young people have dropped by 30-40% overall
difficulties (Pearcey et al., 2020). A rapid review (Health and Social Care Committee, 2020). It
also suggests that the risk of social isolation is too early to access published data on recent
is less likely to occur among older children, for and current referral rates, but a comparison
whom activities and contact with their peers is with data from April-June 2018, which shows a
more likely to continue (Brooks et al., 2020b). total of 144,224 referrals to children and young
people’s mental health services in England
Some children will emerge from lockdown
(NHS Digital, 2019), suggests that somewhere
having endured traumatic experiences at home
between 40,000 and 60,000 children and
without the respite or relief that school or
young people who might have been referred to
informal services can offer. Sources point to a
mental health services in the same period in
rise in experiences of abuse at home. Domestic
2020 have not been. This drop has likely been
abuse charity Refuge recently reported a tenfold
affected by the closure of schools, meaning
increase in visits to its website during lockdown
a loss of contact with school nurses – a key
(BBC News, 2020a). Calls to NSPCC’s Childline
referral route to services – and difficulties in
increased by 20% in the first four weeks of
making appointments with GPs.
lockdown (BBC News, 2020b).
Children with mental health problems and
Other children normally in receipt of enhanced
their families have faced difficulties getting
provision at school may have missed out. The
help long before any new challenges posed
latest data (11 June) from the Department for
by the pandemic. Research suggests that, in
Education suggests that the number of children
recent years, less than one third of children
attending school has risen over the course of
who have a diagnosable mental health problem
the pandemic, but that only 18% of children
received any access to NHS care and treatment
in years 1-6 who are classified as ‘children in
(NAO, 2018). Many who do get referred to
need’ or who have an Education, Health and
NHS mental health services are rejected, often
Care Plan in place attended school in the last
without being signposted to less formal support
week (Department for Education, 2020). This
(Crenna-Jennings and Hutchinson, 2020). It is
means that at least 419,000 children did not
not uncommon to experience a decade of delay
attend school, despite places being available
in receiving any mental health support from first
for them to meet their wider needs, safeguard
becoming unwell (Khan, 2016). These delays
their wellbeing or support their development.
have stark consequences for mental health
Some of these children could, however, be
during childhood and long into adulthood –
in the cohort within which improvements in
most parents report that their children’s mental
wellbeing have been reported.
health deteriorates while waiting for support,
Significant reductions in school attendance and the longer the wait, the worse the impact
means that opportunities to identify emerging (YoungMinds, 2018).
6With children’s mental health services already
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
by voluntary sector organisations, schools,
stretched in many areas, the consequence youth services, online providers, community
of the current drop in referrals could lead to groups and in other less formal settings. 26%
a backlog of cases, creating longer waiting of participants in YoungMinds’ survey (2020)
lists, higher thresholds and worse outcomes reported that they were no longer able to
for children. A financial outlook which access any kind of mental health support during
compromises the ability of the wider children’s lockdown. Longer term, the economic situation
sector to promote good mental wellbeing is presents a further threat to access to non-
concerning given the evidence that children are statutory services, with frontline organisations
experiencing rising anxiety and distress. across the third sector so far reporting steep
falls in income, cashflow and reserves (ACEVO,
Many children receive support for their mental
2020).
health outside of NHS services, delivered
Prisons and Covid-19
Prisons are notorious ‘hot houses’ for spreading 2020). The prison population across England
communicable diseases and can be a source and Wales reduced by 3.6% between April
for a contagion further spreading into the and June 2020 (women by 9.3% and men by
community, through prisoner release and staff 3.1%), probably due to normal releases and a
living in the community. The predictions for the reduction in new arrivals due to court closures
UK’s prisons during the pandemic were dire, (Ministry of Justice, 2020c).
with media reporting the worse-case scenario
The impact that these actions have had appears
estimates of 800 predicted Covid-19 related
to be dramatic. At the time of writing there are a
deaths. The prison authorities and NHS partners
small number of deaths attributed to Covid-19
in the UK responded rapidly to this threat.
(23, according to Gye, 2020), and certainly a
For example, in England and Wales, any new
much smaller number than predicted. Although
arrival had a period of 14 days’ isolation. HM
there is limited data we also believe that
Prison and Probation Service also attempted
infection rates have been lower than predicted,
to achieve single cell occupancy for as many
though there have been several hundred
prisoners as possible by creating several
confirmed infections among prisoners and
hundred temporary single occupancy cells
prison staff.
and recommissioned at least one mothballed
establishment (Ministry of Justice, 2020a). In addition, for at least part of the lockdown
there have been significantly reduced transfers
Prisons were shielded to some degree in
from prison to mental health facilities, and a
that, for several weeks, courts effectively
reduction in reported self-harm and in ACCTs
shut down and the flow of people coming to
(the system used in English and Welsh prisons
prison significantly slowed down. In addition,
to manage vulnerable prisoners at risk of self-
prison visits were curtailed (alternate virtual
harm). There was also a reduction in referrals
means of maintaining contacts with family
to prison mental health care teams. Perhaps
were introduced) and prisoners were locked in
unsurprisingly, given prisons have had no or
cells for most of the day with no or only limited
only limited chances for association, violence
periods of association with other prisoners
had reduced, as had incidences of bullying.
(Ministry of Justice, 2020b).
The actions by prison authorities appear to
Plans for early release for low risk offenders
have reduced the use of mental health services
were put in place, though it is not clear how
and perhaps mental health need initially. This
much this has been used. Up to 4,000 early
may have come about through a reduction in
releases had been proposed but as few as 175
bullying, violence and substance misuse (all of
prisoners were actually released early (Gye,
7Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
which affect mental wellbeing) amongst other was especially so in the justice sector and
things, as a consequence of a regime of virtual prisons. The cuts to front line prison staff and
solitary confinement. However, we do not know especially those with the most experience have
what the longer-term impact will be of such been associated with record levels of suicide,
a restrictive regime (now being relaxed) and reported self-harm and violence, including
we understand that referrals to prison mental violence on staff. It is anticipated that prisons
health care services have or are now returning will take several years to recover from the impact
to ‘normal’ levels, as may levels of self-harm of austerity cuts despite of a programme of staff
and admission to hospital. recruitment to prisons. It is vital that we learn
from our response to this previous crisis and
As is detailed elsewhere in this report, the UK
that the Government does not respond in similar
economy is and will continue to be, perhaps
fashion. Instead, where the evidence supports
for years to come, severely impacted by the
it, there should be greater utilisation of effective
pandemic and the necessary responses to it.
community sentencing (e.g. see Mews et al.,
With greater unemployment we might expect
2015) for non-violent offending. The decision to
a rise in offending (non-violent offending
build four new prisons and add 10,000 places
in particular – see Jawadi et al., 2019) and
to our current prison capacity suggest the
therefore greater pressure on the justice system
Government is looking to economies of scale
and prisons.
(if built on the HMP Berwyn model) for savings,
A key response to the most recent recession was rather than effective sentencing and robust
huge cuts in public sector spending, and there community offender management for non-
may be a strong temptation for the Government violent offenders. This is a missed opportunity
to revisit such measures in combatting the to achieve longer term and sustained savings
current crisis. These previous cuts were through effective rehabilitation.
arguably disastrous for all sectors, and this
Youth unemployment and mental health
The impact of the pandemic and lockdown on earning and job satisfaction may be lower than
the economy is going to be severe, of that there with employed peers (Bell & Blancheflower,
can be no doubt. But we will not all be affected 2011) which may also impact on mental
equally. Parts of our economy have been more wellbeing. The evidence suggests that,
dramatically affected and the travel, hospitality regardless of the economic climate, youth
and leisure industries have experienced the unemployment can have these long-term
biggest harm. Any ongoing social distancing negative impacts on mental health (Virtanen
requirements will likely continue to negatively et al. 2016), with depression being cited as a
impact these industries and there have already prominent problem. This means that during a
been some large-scale redundancies. These recession, the number of young people affected
sectors employ predominantly young people by this ‘scarring’ is greater. Huegaerts and
and therefore it makes sense to review the likely colleagues’ (2017) study of the impact of the
impact on younger workers. 2008 financial crisis on youth unemployment
in Belgium found marked differences in mental
The research evidence is quite consistent that
wellbeing between unemployed and employed
youth unemployment has long-term ‘scarring’
young people. They found 14% higher levels of
effects (e.g. Bell & Blancheflower, 2011), and
reported distress and 12% greater likelihood of
part of this is on future mental health. The
suffering from a diagnosable mental disorder
impact of unemployment in a person’s late
among the unemployed young people.
teens and early 20s can be seen in their 30s
and 40s (Strandh et al., 2014). Prolonged Such concerns beg for employment programmes
unemployment and repeated episodes when that focus on young people and help them to
young also makes it more likely there may find sustained employment.
be further periods of unemployment. Future
8Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
Economic forecast
Prescient economic forecasts are rare. During possible to reverse much of the damage
the recession of 2008, the Queen asked a caused and the only negative will be a large
team of top economists, ‘Why didn’t you see National Debt. A ‘boom’ will ensue, where
it coming?’. Everyone looked at the floor. This pent-up demand is released instantaneously,
year’s World Economic Forum, Davos 2020, did restaurants and pubs are overflowing and more
not include ‘pandemic’ in its Top Five Global people take holidays. This is the ‘V’ shaped
Risks by either ‘impact’ or ‘likelihood’ rankings recovery referred to in the previous Centre
(World Economic Forum, 2020). forecast (sharp recession, sharp recovery).
Consequently, economists often rely on the If that does not happen and we are subjected
traditional cycle of boom and bust to inform to further waves of Covid-19, it is difficult to
forecasts. Typically, every ten to twelve years, see how the following months will be positive.
a crisis emerges and the economy shrinks. The OECD (2020) already forecasts that the UK
Two or more quarters of decline is a recession. will see the biggest economic deterioration of
Most recessions are caused by an economic any ‘developed’ nation, -11.5%. And that is in
shock: sub-prime loans (2008), Exchange a ‘single hit’ Covid-19 scenario. Recovery from
Rate Mechanisms (1990), share-price collapse multiple waves is harder – with hope of a ‘W’
(1929). shaped recovery (repeated downturns), but
potentially an ‘L’ (a recession followed by little
But this one is different: Covid-19 is a
or no growth).
health problem, not an economic one. So,
while the financial symptoms are the same Four inauspicious factors are particularly
– unemployment, receding economies, relevant for the next six months, suggesting a
ballooning debt – the cause does not stem from difficult winter:
faulty economic levers. Nor does its solution.
1. Furlough will come to an end. 9.4 million
The only cure for the economy is an actual cure
people have been furloughed since April.
for Covid-19.
That means that business owners judged
This shifts the status of economic forecasting the production value of 9.4 million workers
from ‘unpredictable’ to ‘unknown’. The future to be less than 80% of their salary. This
of the economy is dependent on scientific scheme is expensive (£60bn, according to
endeavour and ingenuity. Financial Times, 2020) and ends in October,
when companies will have to decide
For forecasting purposes, there is one crucial
whether to effectively re-employ people
vector to consider: time. How long does the
or make them redundant. Even if 80% of
pandemic last?
people are retained, that is still nearly two
million people made newly unemployed.
Duration of the pandemic
2. National Debt is greater than the value of
The longer the duration of the pandemic, the the UK Economy for the first time since
greater the economic damage and the greater 1963, at 100.9% of GDP (Office of National
its lasting impact. A trivial but illustrative Statistics, 2020). While this will not cause
example is spilling red wine on a white carpet. a further economic shock immediately, it is
There is a short window of opportunity where the breaching of a key psychological barrier.
the damage can be reversed. But leave it too Second waves of the fiscal generosity
long and the stain becomes indelible. We to metabolise the major impacts of the
are within that window now. We have slid pandemic will be less attractive to debt
all our fiscal ‘chips’ onto a date in October markets – particularly if there is no end in
when furloughing and related compensatory sight. It also makes us highly vulnerable
measures end. If there is a vaccine, medication to increases in interest rates, where small
or other medical breakthrough, it will be
9rises would result in much larger debt 4. Each winter, influenza kills between
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
servicing costs. The ability of the Bank of 11,000 and 28,000 people in England
England to purchase much of this debt (PHE, 2019b). Unhelpfully, it has similar
(as it has been) will also recede over time, symptoms to Covid-19 which make it
increasing exposure to international debt difficult for the sufferer to know which they
markets. have contracted. The NHS would be strained
by either, but both are likely to hit at the
3. Brexit is set for 31 December, but with
same time creating dual epidemics. This
no-deal. The economic impact will be akin
increases the potential need for further
to throwing another (slightly smaller)
lockdowns and the accompanying economic
glass of red wine onto that white carpet.
damage.
An important factor is that while Covid-19
has hit the hospitality, leisure and travel Overall, the economic impact of Covid-19
sectors, Brexit’s biggest impact will be is increasingly negative. The pertinent
in manufacturing, science and financial consideration is how this will create, reinforce
services. The combination of the two and entrench economic inequality.
laminates most of our economy:
Pandemic impacted No-deal Brexit
industries impacted industries
Travel Science
Leisure and Financial Services
entertainment
Hospitality Manufacturing
Figure 1: Forecast for Winter 2020
UK winter Covid-19 Brexit
No furlough Influenza
10Inequality new families are forming and homes are being
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
bought – the ages of 25-35 – millennials face a
Covid-19 is likely to increase economic second crunch point, probably worse than the
inequality because its impact is felt first.
disproportionately due to age, existing poverty
and deprivation, mass unemployment and less Poverty and deprivation
work, and accelerated economic change.
Covid-19 has been damaging for lower-income
Age communities. In England, the age-standardised
mortality rate of deaths involving Covid-19 in
Undoubtedly, older people have been hit the most deprived areas was 128.3 deaths per
hardest by Covid-19 in terms of health and 100,000 population. This was more than double
mortality. Economically however, over-65s the mortality rate in the least deprived areas
hold 46% of all housing equity and 22% are (58.8 deaths per 100,000) (ONS, 2020b).
millionaires (ONS, 2019). Currently, they
also benefit from a ‘triple-lock’ escalation for Gateshead, South Tyneside, Sunderland and
pensions which maintains and increases its real Middlesbrough currently have the highest
value. rate of Covid-19 cases per head of population.
Regional unemployment is high and at least
Instead, it is millenials (people born between 20% of jobs are below the living wage. The
1981 and 1996) who will concede much of North East economy was one of the worst hit
the economic pain. They have already faced regions during the 2008 decade of austerity. It
a unique range of economic challenges. Their is economically vulnerable and fragile. Parts of
initial careers were damaged by the 2008 Great London and the South West of England are in a
Recession which coincided with their entry into similar circumstance.
the labour force. Over the next ten years they:
There are some mitigating factors. The IFS
• Worked in an economy where average real
predicts that poorer local authorities may
wages in 2018 were lower than those of
manage to sustain more of their income than
2008
affluent ones and notes that £3.2bn has already
• Were the first to pay tuition fees and been distributed to councils to cope with
accumulate large-scale debt Covid-19 (Ogden and Phillips, 2020). However,
• Rarely experienced a defined benefit the ‘levelling-up’ agenda will require significant
pension scheme resource to be meaningful.
• Entered a workforce where zero-hours
Mass unemployment and less work
contracts, Sunday-working and limited/no
overtime payments are the norm The previous forecast focused on the economy,
• Were more likely to live at home with their borrowing and fiscal stimuli. Jobs, employment
parents than any other post-war generation, and hours worked are now becoming the
locked out of the housing market measurements to watch because the impact
could be on millions of people. Whilst the
• Only experienced government policy as
current unemployment rate (to end of April)
adults in terms of austerity.
remains at 3.9% (ONS, 2020c), other measures
In 2020, following four years of Brexit are less positive. The number of people
consuming all political minds, Covid-19 has claiming out-of-work benefits increased to 2.8
resulted in the Chancellor predicting ‘the million during May, a jump of 23%. The number
worst recession we have ever known’. Sectors of job vacancies fell by 342,000 to 476,000
that employ large numbers of young people – between March and May. Most concerning is
tourism, hospitality, leisure and fitness – have that the number of people on company payrolls
been obliterated in just three months and may fell by 612,000 over the same period (ONS,
never return in the way we have known them. 2020d), despite 9.4 million people being on
At the point where most careers are taking off, furlough.
11A significant change in the UK since 2010 has now be sealed in weeks. The abilities to ‘pivot’,
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
been the emergence of the ‘gig’ economy, to adapt, and to transform a business quickly,
characterised by zero-hours contracts, diluted are crucial attributes. Those with business
labour rights and flexible working. This models with debt, high rents and slow customer
pliability now means that many organisations decline, who were waiting for sunnier economic
have simply cut hours, rather than sacking times, will hit the buffers.
people. Similarly, those who are sole-traders
The key thing about accelerated change is
have seen their activity fall. For the quarter
that, much like an accelerating bus, it becomes
ending April 2020 (only half of which was in
increasingly difficult to steer. That increases
lockdown), hours worked collapsed by a record
the chances of change being felt differently and
fall of 94.2 million hours, or 9% (ONS, 2020c).
disproportionately. If you can adapt, you will
This statistic is bad. Someone may have a job
prosper. If you find yourself in possession of
but if they are working zero hours, it’s unclear
newly valued talents, you will thrive. But if your
how that is different to being unemployed.
options are limited and you only know one tune,
the economy is likely to deal a tough hand.
Accelerated economic change
The pandemic has induced rapid economic The impact on mental health
change. Markets have been swept away
overnight, while brands that were unheard of in The longer the pandemic lasts, the worse the
2019 (Zoom) are now common parlance. ‘Only economic damage and the greater the impact
when the tide goes out do you discover who is on our mental health.
swimming naked’ (Buffett, 2004). The tide has The nature of the recession means we are not
indeed gone out. ‘all in it together’ and so some will be worse off
Just as Covid-19 targets those with poor health than others. Inequality will increase and that is
and underlying vulnerabilities, for the economy bad for mental health.
it has proved an instantaneous exposition of Unemployment will rise and will likely be the
financial weakness. The sudden visibility of biggest financial impact of the pandemic. As
those weaknesses increases the velocity of described in the previous forecast, long-term
change. Firms without the ability to adapt are unemployment in particular impacts on mental
floundering. In retail, the collapse of the high health.
street that was taking place in slow-motion will
12Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
Recommendations
The economy is markedly deteriorating and by the virus – among them children from some
although a Covid-19 cure could be found, the Black, Asian and minority ethnic backgrounds
most likely scenario is that the UK faces a tough and children who experience socio-economic
winter. This is the moment to prepare ourselves deprivation (Allwood and Bell, 2020). Children
to cope with the simultaneous impact of whose access to schools and colleges, social
pandemic, epidemic, recession and Brexit. services, mental health services and informal
support has been interrupted must be able to
An effective test-trace-and-isolate system is
find their way back to support that meets their
fundamental to limiting Covid-19 transmission
needs. This will require targeted funding for
and the number of infections in the absence of
services that are known to work effectively with
cure or vaccine to reduce the economic impact
the groups experiencing the biggest risk factors
of future lockdowns.
at this time.
1. Target mental health resources where
3. A psychologically informed return to
they are most needed
school
The NHS needs to prepare for winter by
Schools need to be prepared to respond
identifying those who are most vulnerable to a
to the psychological impact of Covid-19 on
pandemic in November which will be far harder
pupils attending school now and returning in
than one in a sunny April. We know well who
September. A safe return to education is about
is going to be disproportionately impacted
more than just ‘catching up’ on schoolwork
by the economics of Covid-19: the poor, the
and preparing for the next set of exams.
young and the most deprived geographical
There should be a national commitment to
areas. Ethnically diverse communities feature
encourage and enable all schools to adopt an
predominantly within all three categories.
effective ‘whole school approach’ to mental
Targeted interventions for mental health are
health (Public Health England/Children and
needed now.
Young People’s Mental Health Coalition, 2015).
We also need to adapt and change the offer, Specifically, this involves:
providing mental health programmes that help
• Adjusting behaviour policies for children
people to adjust to sudden and significant life
displaying conduct problems, recognising
changes. The chances of things returning to
they are a sign of distress
‘2019 normal’ recede daily and the population
is differentially prepared. The effect on mental • Preparing to respond to trauma, for example
health will be correspondingly disparate. And where abuse has been experienced at
as many of the groups whose mental health home (Wilton, 2020) and from bereavement
is at greater risk from the crisis have poorer and loss (for example in families that have
access to effective mental health support, the experienced deaths during the pandemic or
need is more pressing than ever to work with losses of livelihood)
communities to co-produce services that meet
• Taking steps to reduce anxiety, where some
their needs on their own terms.
children might fear school due to concerns
about the virus, or about returning to a
2. Proactively protect the mental health of
place where they have experienced bullying
children and young people or discrimination.
There is clear evidence that some groups of Supporting the mental health of school staff will
children will experience the mental health also be an important factor in providing the best
impacts of Covid-19 more than others. There response to children. In professional surveys,
are children from communities identified in teachers have reported increasing levels of
recent reports as disproportionately affected stress (Education Support, 2020).
13The £1bn package to support children to ‘catch- 5. Improve safety in the criminal justice
Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
up’ academically is not enough. Children will system
need access to support for learning; but they
will also need support to reflect on adverse The Government should take action to reduce
experiences, manage anxieties and cope the number of people going to prison, investing
psychologically with the fallout of the global instead in community sentencing options.
crisis. While the prison system has so far experienced
relatively few losses of life due to Covid-19,
4. Provide additional mental health the measures taken to improve safety from
the virus may have longer term effects on
support for groups facing further risks
prisoners’ mental health. Instead of increasing
In the first forecast we recommended the NHS prison places, the Government should focus
provides tailored and proactive mental health on modernising the estate and reducing the
support to people who have received treatment number of people who are detained.
in ICU for Covid-19 and those bereaved during
the lockdown. In addition, we would suggest 6. Support young people seeking
that support will also be required for the employment
families of people treated in ICU. Extra support
should also be offered to pregnant women The Government should prioritise employment
and those who have given birth during the programmes that will support young people
pandemic – for example at the six-week GP who are seeking work to reduce the long-
health check and in other routine appointments. term psychological ‘scarring’ of protracted
Additional mental health support is also unemployment. This should draw on the
needed for people with long-term physical and principles of Individual Placement and Support,
neurological conditions whose mental health which has been demonstrated to achieve higher
has worsened during the pandemic. success rates than traditional employment
programmes among many groups of people,
especially those living with mental health
difficulties.
14Centre for Mental Health BRIEFING Covid-19 and the nation's mental health: July 2020
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