The impact of COVID-19 on Londoners’ mental health and wellbeing
A report of the impact of the coronavirus pandemic on Londoners’ mental health and wellbeing was produced by Thrive LDN, and is available here. At risk groups identified via the report are outlined below, and are groups that IAPT services should consider targeting and supporting in particular during this pandemic.
Thrive has also produced guidance for supporting those adversely affected by the coronavirus outbreak.
Please see ‘Engaging with Ethnic minorities’ section within these online resources for more information.
Overall the pandemic is having a devastating impact on those from the ethnic minority communities in comparison to White men and women, with higher death rates among many ethnic minority groups (particularly Black, Asian and Bangladeshi ethnic groups).
Research suggests that men from ethnic minorities experienced a far greater deterioration in their mental health (14%) during the first COVID-19 lockdown than their White British counterparts (6.5%).
The COVID-19 Social Study has seen that people from ethnic minority backgrounds consistently show higher levels of anxiety and depression throughout the pandemic in comparison to their White counterparts. Recent findings from this research have also shown a rise in self-reported thoughts of death or self-harm (PHQ-9 measure) amongst individuals in minority ethnic groups and are at their highest since the start of the first lockdown.
Please see ‘Engaging with LGBTIQ+’ section within these online resources for more information.
Insights from community engagement with LGBTIQ+ organisations who support young people have reported worsening mental health in particular for this group, relating to the breakdown of community and support systems, hostile living arrangements or experiences of homophobia or transphobia.
Please see ‘Engaging with Older people’ section within these online resources for more information.
A recent report by Age UK highlights the impact of COVID-19 on older people’s mental and physical health, including:
- One in three (34%) older people agree that their anxiety is now worse or much worse than before the start of the pandemic.
- Many face a double-edged sword where they are afraid of leaving the house but at the same time cannot cope with the loneliness and isolation at home.
- The proportion of over 70s experiencing depression has doubled since the start of the pandemic.
IAPT service example: Newham
Trained shielding volunteers (who called up people who were shielding to see what support they may need) to speak to them about their mental health, let them know they can self-refer to IAPT and signpost them to the online resources and webinars developed by Newham IAPT service.
IAPT service example: Hillingdon
Working with the local COVID hub (including GP confederation, voluntary sector, Public Health and community services) to add two mental health screening questions to the telephone triage for all people in the borough who were shielding and directed them to IAPT services.
Please see ‘Working with secondary care’ section within these online resources for more information.
Those with a pre-existing mental health condition have been the most likely to experience stress and inability to cope during the pandemic, and this group has also reported suicidal thoughts and feelings at a rate almost triple to that of the general population [source].
Young people (18-24 years old) have been more likely to report stress arising from the pandemic than the population as a whole. They were also more likely to report hopelessness, loneliness, not coping well and suicidal thoughts/ feelings [source].
A recent survey conducted by the Prince’s Trust found that 50% of 16 to 25 year olds in the U.K. had experienced a decline in their mental health since the beginning of the pandemic, and one in four (26%) reported feeling “unable to cope with life”, rising to 40% in young people who were not in education, employment or training.
Evidence is growing of the unequal impact of the COVID-19 pandemic, lockdown and related crises based on gender. The Coronavirus: Mental Health in the Pandemic study, found that across the lifetime of the survey women have been more likely than men to report feeling anxious, lonely, and hopeless due to the pandemic, as well as being more worried about finances.
There has been a documented rise in domestic abuse and gender-based violence; calls to the National Domestic Abuse Helpline increased by 150% during the first lockdown.
Women, and particularly single mothers, have been more likely to work in sectors that have been shut down as a result of the pandemic. Parental stress and depression has been elevated during every period of lockdown – particularly when schools have been closed [Co-SPACE study].
ThriveLDN are working with Bounce Forward to offer online sessions for parents in London: https://bounceforward.com/
ThriveLDN resources for parents and families
For some people the symptoms of COVID-19 can continue weeks and even months after diagnosis, and this is now commonly referred to as long-COVID. The physical and psychological symptoms of long-COVID include extreme fatigue, muscle weakness, low grade fever, inability to concentrate, memory lapses, changes in mood and sleep difficulties. A report by the British Psychological Society also highlighted a number of risk factors that increase the likelihood of developing long-COVID, including pre-existing psychological distress or other mental health problems, recent bereavement/illness of family or friends, prior experience of critical illness and treatment in a critical care unit and socio-economic status/unemployment.
Studies here and here have also shown that Long-COVID appears to be more prevalent in women and younger people. In one study, 87% of those responding to a survey on long-COVID were aged 30-57. There is limited research at present on the impact of long-COVID on different ethnic groups.
US analysis has found that COVID-19 survivors have significantly higher rates of psychiatric diagnoses, with 18% developing a mental health issue within 3 months of a COVID-19 diagnosis. Those who contracted COVID-19 were twice as likely as the general population to develop a mood or anxiety disorder for the first time, and older adults with COVID-19 were found to have a 2 to 3 times greater risk of developing dementia. It is worth noting that psychiatric history is a potential risk factor for being diagnosed with COVID-19, independent of known physical risk factors.
IAPT services will be critical in providing support to long-COVID patients. Modelling by the Centre for Mental Health, assuming that 7,000 Londoners are currently experiencing persistent COVID-19 symptoms for weeks and months, estimate that:
- Over 2,500 Londoners will experience anxiety, with 25% requiring access to services (718 people)
- Over 2,000 Londoners will experience depression, with 25% requiring access to services (516 people)
- Over 1,600 will experience post-traumatic stress, with 25% requiring access to services (403 people)
In response to COVID-19 the National IAPT Programme (NHS England and Improvement) offered from April – June 2020 a webinar series (NHS Futures link – not publicly accessible), on delivering different therapies during COVID-19. Owing to the popularity of the initial series they offered a second series (NHS Futures link – not publicly accessible), in August looking at post-COVID syndrome (now commonly referred to as long-COVID). Recordings and slide packs are available on the IAPT Future NHS platform – access can be requested using your NHS email address. This platform has also been utilised during the period of the pandemic to serve as a forum for discussion with national IAPT colleagues and to share good practice.
IAPT service example: Haringey
Set up COVID-specific interventions, such as group sessions on managing anxiety and step 3 1:1 sessions on coping strategies. Have had low uptake of both – particularly the group sessions. Have prioritised screening for people who have had COVID-19 (using an additional question within the referral form) and front-line workers.
IAPT service example: Hillingdon
To support those with long-COVID, the Hillingdon IAPT service are building on existing LTC pathways working across both physical and mental health care. They will be working with West London Trust to develop replicable pathways that can be evaluated across the 8 IAPT services in NWL, measuring who is coming into the service and look at which treatments are effective. They will share interventions for different neuro-cognitive presentations and run specialist groups. Potentially developing one clinic for North West London for all neuro rehabilitation patients to feed into.
The team also have a fatigue service in Hillingdon which could be used as a hub for excellence and encourage sharing of expertise.
IAPT service example: iCOPE
Camden and Islington iCOPE set up a COVID-19 Step 3 Brief Coping Intervention
Research has shown that for each COVID-19 death up to 5 people will be bereaved (or feel the close impact of loss) and will potentially require access to bereavement services.
A review of complicated grief confirms the pandemic has increased prevalence of risk factors associated with complicated grief, for example, sudden/unexpected death and low levels of appropriate social support.
Several IAPT services have provided bereavement webinars and support for their local population. For example, Bexley have developed a service for complex bereavement with Greenwich Cruse, Bexley Hospice and Bexley Mind, who meet every other month. Not many referrals have been received for this service yet but this is expected to increase in the coming months.
Modelling by the Centre for Mental Health, assuming that 83,930 (approx. 16,786 deaths x 5) Londoners are bereaved by COVID-19 or experiencing persistent symptoms for weeks and months, estimates that:
- 8,225 Londoners will experience prolonged grief disorder, with 25% requiring access services (2,056 people)
- 11,750 Londoners will experience post-traumatic stress disorder, with 25% requiring access services (2,938 people)
- 15,443 will experience depressive symptoms, with 25% requiring access services (3,861 people)
Support after sudden bereavement during the COVID-19 Pandemic https://thriveldn.co.uk/wp-content/uploads/2020/11/Support-after-sudden-bereavement-during-the-COVID-19-pandemic-Nov-2020.pdf
Please see ‘Digital’ section within these online resources for more information.
The COVID-19 pandemic has placed greater importance on digital connections due to the rapid transition to online services – including IAPT therapy.
IAPT service example: Barking & Dagenham
Since COVID-19, SilverCloud, webinars and groups have been advertised on social media – Facebook, Instagram, Twitter and LinkedIn. Many clients self-referred to groups through this campaign.
Please see ‘Working with: ‘life issues’ section within these online resources for more information.
When stratifying employment loss and furlough by income level, the future economic consequences of COVID-19 are likely to be worse for those on lower incomes, creating an additional burden in the long run on the mental health and wellbeing for Londoners in this group.
Groups that have been particularly hard hit financially by the pandemic include: the self-employed, adults with a household income less than £15,000 per year, those aged 18-54, and ethnic minority adults.
Income and employment are intrinsically linked to health and wellbeing. There is a strong socioeconomic gradient in mental health, with people of lower socioeconomic positions having a higher likelihood of developing and experiencing mental health problems – (source).
Citizens Advice can provide debt advice.
London Mayor’s office page re: providing financial support during Coronavirus.
Healthy London Partnership’s Coping Well During Covid Webinar series, on Managing Financial Anxiety