COVID-19: Real Problems but No Pandemic of Mental Illness

We are stronger than we think

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Amidst the public discussion about COVID-19, it is commonly said that we face a "pandemic" of mental illness. While nobody can deny increased rates of anxiety across the population, melodramatic pronouncements do little to reassure the vast majority of people who need practical social and psychological support, rather than diagnoses, in order to get through this. Labeling all of this distress as mental illness is not only unhelpful, but shifts much-needed attention away from the significant minority who genuinely require counselling and specialist mental health services.

Recent months have seen a great deal of research on this topic around the world. The results are remarkably consistent and provide robust guidance for the months ahead.

In the general population, around one person in every five has clinically significant symptoms of anxiety or depression. This is not a surprise. We are all anxious to some degree.

This does not mean that one-fifth of the population is mentally ill. Most people cope by reaching out to family and friends, exercising more, changing their lifestyles, and doing the things they have always done in times of difficulty. We are resourceful people, especially when we support each other.

This is not mental illness. This is a normal response to an abnormal situation. It can be highly distressing, but, with personal assistance and support, most people can get through it.

Over-medicalizing this kind of distress disempowers people who would otherwise cope quite well. It also de-emphasizes social and political solutions to much of their suffering: strengthening communities, protecting employment, supporting businesses, providing financial assistance to those who need it, and implementing public health measures that earn the public’s trust.

COVID-19 is not an equal-opportunity virus: It disproportionately affects the poor, minorities, and those who are marginalized. Addressing these inequities requires political will as much as public health measures. We need politicians as well as doctors.

Certain groups have greater mental health needs than others and require particular support. The rate of clinically significant distress among health care workers is approximately double that in the general population, at around 40 percent.

Again, we need to be wary of over-medicalizing this. Practical steps go a long way: careful rostering and shift allocation, facilitating annual leave, valuing staff feedback on services, and prioritizing informal, collegial support. For those who remain anxious or distressed, employers should provide accessible counseling, psychological services, additional leave, or alternative duties.

People who are hospitalized with COVID-19 are another high-risk group. Experience with Severe Acute Respiratory Syndrome (SARS) suggests that the rate of mental illness is likely to be high following recovery, with possibly up to 50 percent experiencing clinically significant anxiety, depression or post-traumatic symptoms over the coming years. Emerging data from COVID-19 suggest similar rates during the current pandemic, underlining the need for specialist mental health services for this group, even after recovery from the virus.

Other high-risk groups include people who experience bereavement and are precluded from rituals of grieving and people with pre-existing mental illness. Evidence suggests that people with schizophrenia and other serious mental illnesses have a higher risk of contracting COVID-19. This highlights the importance of expanding mental health services to both convey public health advice to this population and continue to provide mental health care.

For the majority of people, however, the impact of the current pandemic on mental health will be increased anxiety and frustration at the duration of our current, highly unusual situation. How can we cope with this?

There is much that we can do. It the first instance, we should remain informed about COVID-19 but limit our media intake to around 15 minutes twice per day. We cannot carry the weight of a global pandemic on our shoulders every minute of every day.

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To reduce our risk of infection as well as our anxiety, we should focus on what we can do in our own lives rather than what other people are doing or failing to do. We should read the public health guidance with care, and respect its permissions as much as its prohibitions. We should watch our diet, prioritize sleep, and go for a walk every day, when possible. We cannot always think our way out of a spiral of negative thoughts, but we can take physical actions that interrupt our ruminations. Walking, running, or gardening are all good choices, once we observe public health guidance.

It is worth remembering that most people have dealt with this pandemic far better than we would have predicted a year ago. In Ireland, for example, prescriptions of most anti-anxiety medications have remained stable. Some have fallen. For those who need specialist care, this should be provided.

The lives we live today are far more restricted, anxious, and uncertain than ever before, but our coping skills and communities have proven far more resilient than we could have projected.

Most people’s concerns have centered on protecting livelihoods for their families, supporting older adults, ensuring children attend school, and trying to connect with other people as best as possible. These are all altruistic impulses, focused on helping others and maintaining the social fabric as our best defense against the virus.

Pandemics pass. Our resilience has been tested by this one, but there are growing signs of effective public health measures, better treatments, and emerging vaccines.

And when this pandemic passes, one of the lasting lessons should be that we are stronger, wiser, and kinder people than we ever imagined.