To lock down or not to lock down? Part 2

Michael Wee sheds light on the complexity of mental health concerns in the pandemic. (Read Part 1 here)

The dilemma of lockdown certainly cannot be reduced to one of ‘lives vs livelihoods’ – that would be far too simplistic. There are many factors to consider when examining the impact of lockdown – job losses and the impact on mental health being just two among many others.

But it is worth reflecting on mental health in particular – and why it can be difficult to give it its due weight in determining whether lockdown is a proportionate course of action or not. 

To begin with, there are few things as stark as a catastrophic death toll, or the sight of hospitals bursting at the seams, for a government to deal with. Surely it is right to seek to avoid such a scenario. 

By contrast, the severity of lockdown’s adverse effects on mental health seems far less obvious, or far less concrete a problem to address. It is an even more invisible problem than unemployment or business closures due to coronavirus restrictions.

Added to that, we know that mental health has not always been treated as an immediate priority in policymaking and in communities. 

Mental health problems are still regularly mistaken for character defects like laziness, weakness or attention seeking.

And ‘mental health’ is such a broad term – encompassing not just diagnosable mental illnesses but also well-being and social functioning – that it can be difficult to pinpoint mental health concerns precisely. 

Hence, it is difficult to determine whether mental health concerns, combined with other factors, might be sufficient to outweigh the case for lockdown. We first need to be able to think about it in more concrete terms.

Looking back at the first lockdown, then, what lessons have we learnt about mental health that can help make it less ‘invisible’ as a concern?

In May 2020, the UK’s Royal College of Psychiatrists reported that ‘43% of psychiatrists have seen an increase in their urgent and emergency caseload while 45% have seen a reduction in their most routine appointments’. 

Neither statistic is particularly encouraging – the former may reflect the stresses of the pandemic, including lockdown, while the latter may be a sign that regular patients are not accessing mental health services until it is too late, possibly due to a fear of infection.

To add to that picture, according to the UK’s Office for National Statistics, at the beginning of lockdown 49.6% of people reported high anxiety, and in particular 39% of those married or in a civil partnership reported high levels of anxiety, compared with 19% in the last quarter before the pandemic. 

No doubt, increased time spent at home, the loss of social contact and of usual coping strategies – which for many might be embedded in the workplace and local communities such as churches and sports groups – will have contributed to these statistics. 

To complicate things further, the psychological impact of lockdown also has to be considered in relation to its economic impact, given that poverty is a major risk factor for poorer mental health at any age and employment is a determinant of mental health, with mental health problems more common amongst people who are unemployed and those in precarious work.

From all this, it should be clear that simply staying at home to curb viral transmission is by no means a ‘neutral’ option that might save lives with just minimal impact on the population. 

To be fair, many of these mental health effects may still have occurred even without a full lockdown – general anxiety during pandemic and other less drastic public health measures will also reduce social interactions and affect the economy. So the question is really whether the additional burden on mental health which a lockdown imposes is proportionate to the purported increase in effectiveness in dealing with the pandemic that a lockdown brings, compared with less restrictive measures. 

It is also important to emphasise that the onset of mental illness from the pandemic and from public health measures should not be seen as inevitable if appropriate protective measures are taken and early mental health care responses are provided to those who do develop symptoms of anxiety and anger.

One notable strategy in this pandemic has been the increase in telemedicine, with psychiatry being no exception, and this can go a long way in assisting vulnerable patients.

One final thought … could there, in fact, be positive mental health effects from a lockdown? 

Anecdotally, we hear that many people have welcomed more family time, or more time to read and cultivate themselves. Many do not miss their daily commute, or the stressful work environments they once had to deal with. During the first UK lockdown, when schools were closed, one study found there was actually a drop in anxiety levels among teenagers!

No doubt, it is useful to reflect on how we can make the best of lockdown situations. But we should not shy away from how the pandemic has, in more ways than one, shed light on many hitherto unseen or ignored inequalities in society. 

COVID-19 itself has highlighted our failings in protecting those who are vulnerable in terms of physical health – these could be the elderly in care homes, or migrant workers in cramped dormitories. 

But lockdown has also highlighted a different kind of inequality – those for whom staying at home does not simply mean a retreat into peaceful family life, but something else altogether, be it abuse, extreme isolation and neglect, or unsanitary conditions. These are those whose mental and even physical health might be most harmed by lockdown.

In short, there is no simple answer to the question of whether mental health concerns outweigh the case for lockdown, and that is in part because lockdowns are crude instruments which do not reflect the nuances of society. 

Their adverse effects may be disproportionately spread out in the population, and this in turn may also make it harder for mental health to be given due weight against the backdrop of hospitals under pressure and rising death tolls.

But lockdown or not, the key thing is that mental health should not be seen as something to be dealt with only later, in the aftermath of coronavirus (whenever that will be). If we are to take mental health seriously, then we need to consider how mental health needs and vulnerabilities in the population ought to shape public policy in tandem with decisions about potential restrictions to curb the spread of coronavirus.

If not, we risk suppressing one pandemic while seeding another. 

*This article is adapted from the paper Public Mental Health and the Ethics of COVID-19 Lockdowns, originally published by the Anscombe Bioethics Centre as part of its COVID-19 Briefing Papers series.

If you have been experiencing any challenges with your mental health, please do not hesitate to reach out for help. ‘Mental health in an age of pandemic: three strategies for staying well in a crisis’ by Clinical psychologist Michael Killoran Ross analyses the challenges of staying well and offers some strategies for good mental health. Additionally, support services can be found on Mind, the mental health charity, which offers a helpline for you to seek support for when you are living with a mental health problem or supporting someone who is.

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