Sunday 17 May

As the COVID19 death toll passes 34, 466, so it appears do divisions in society about key issues like the balance between freedom and safety. The debate surrounding lockdown easing is intensifying, many having decided to stick to the former regime and others feeling this is an attack on liberty, leading to a police state. This stance was reinforced by former Supreme Court judge Lord Sumption writing in the Sunday Times today. Perhaps not surprisingly, far more people admitted to breaching lockdown in an anonymous survey than if they were identified: with anonymity, 31% admitted to meeting up with friends and relatives from other households and 35% admitted breaching the 2 metre rule (Decision Technology/The Times).

Nineteen arrests were made at a demonstration against lockdown in Hyde Park, yet a number of councils in the north of England, where COVID19 rates are higher, are resisting opening schools on 1 June. During the last few days some extremely distressed callers to Radio 5 Live’s Stephen Nolan programme related their heartrending experience of illness and death in their families and said if libertarians had any idea what it was really like they would never take the risks they do, gathering in large numbers without distancing, as in yesterday’s demo. One caller repeatedly asked ‘where’s the justice in that?’ on the policy of only 15 being allowed at a funeral, yet thousands have been packing onto buses and trains to get to work in recent days, sanctioned by the government and thousands of air passengers have been entering the UK, with no checks and no distancing within airports.

Marking such a key loss as a close family member or friend is difficult enough anyway, but now stories abound of people unable to attend funerals because of this 15 person limit and this will impact on their mental health because that public ritual is an important part of mourning. One bereaved daughter thought her father’s funeral would have drawn 300-400 but only immediate family could attend.

Social inequalities could open up further as it becomes clearer that up to 10 million people could be excluded from the contact tracing app because of lack of digital access or skills, including numerous older people and those also more vulnerable to COVID19. Liz Williams is chief executive of FutureDotNow, which is running a campaign to get devices to the country’s most vulnerable. She says they risk being shut out of access to this smartphone-based contact-tracing app, unless the government urgently funds way to bridge the gap with digital training and support. ‘Missing out on the app has the potential to exacerbate those problems….My concern is it has the potential to add to social divides and employment outcomes… It would be easy to imagine a scenario where employers require it to access work.”

It will be interesting to see what happens, as 70-80% population penetration is needed to make the app viable and this is unlikely to happen if so many are excluded. There are also those who have smartphones but refuse to use the app because of privacy concerns. This could be one of the many issues with the capacity to change society, like those affecting transport and city planning. A very welcome decision is the one to close large areas of London to cars and vans in order to enable safer walking and cycling. Mayor Sadiq Khan announced what’s thought to be one of the biggest car-free initiatives of any city in the world.

The Royal College of Psychiatrists’ announcement about the marked rise in mental health presentations, including those experiencing difficulties for the first time due to lockdown, isolation, job insecurity, relationship and bereavement, comes as no surprise. There’s also the obvious fear of contracting COVID19 and people being cut off from their friends, families and normal social networks, leading clinicians to coin the terms ‘lockdown anxiety’ and “corona-psychosis”. Because of job loss or being furloughed, many will have more time to experience these distressing symptoms such as loss of sleep, anxiety. Although it’s not often referred to directly, one of these distressing phenomena is that of ‘skin hunger’, whereby people feel starved of physical contact with others, whether that’s hugging and kissing friends and family or the more intimate kind of contact. Without touch, which reduces stress hormones, humans are thought to deteriorate physically and emotionally. “We know from the literature that lack of touch produces very negative consequences for our wellbeing,” says Alberto Gallace, a neuroscientist at the University of Milano-Bicocca. This sheds further light on the isolated elderly people confined to their rooms in care homes and the suggestion that many are ‘fading away’.

An NHS spokesperson said: “Although there can of course be no reliable data as yet on any medium- or long-term impact of the coronavirus pandemic on mental health, the NHS has been adapting our services to ensure people can still get care like talking therapy or counselling with their clinician, even while still adhering to government guidance.” As a therapist, I find such statements concerning, because we know that despite these bland assurances, many do have difficulty in getting NHS help and in primary care there are often long waiting lists and a poor choice of talking therapies. And many can’t afford to wait: they need help immediately, but going privately may be unaffordable for them. At present, therapists can only work remotely, either by phone or online, and although some studies suggest that this can be as effective as face-to-face work, many clients will find it unsatisfactory and it curtails the practitioner’s opportunities to observe important aspects of the client’s demeanour and body language.

It’s timely that Mental Health Awareness Week starts tomorrow (18-24 May), run by the Mental Health Foundation, with the theme of kindness (research shows kindness is strongly related to good mental health).  While not a substitute for professional help, such campaigns help raise awareness, raise funds and perhaps most importantly, tackle stigma which has too long caused many to hide their distress.

All these issues have marked psychosocial dimensions and it’s becoming increasingly clear (Robert Chote of the Institute of Fiscal Studies is the latest to acknowledge this) that long-neglected areas like social care, mental health services, digital access, transport, leisure activities, city planning and job design/employment patterns will have to be radically changed or at least reengineered in the aftermath of this pandemic. A very welcome decision is the one to close large areas of London to cars and vans in order to enable safer walking and cycling. Mayor Sadiq Khan announced what’s thought to be one of the biggest car-free initiatives of any city in the world.

There can barely be anyone on the planet now who hasn’t heard of Joe Wicks, the chirpy and charming exercise and nutrition guru, who took on the role of ‘the nation’s PE teacher’ during lockdown, presenting his daily fitness videos on YouTube. But it’s not just ‘the nation’: he has followers all over the world, viewers tuning in from as far afield as Moscow, Nigeria, California and the United Arab Emirates. He’s so positive, humble and engaging he’d probably be able to motivate the most recalcitrant non-exerciser. But perhaps the key aspect of his approach (besides that of getting families exercising together) is his focus the mental health benefits of exercise, which are often overlooked in the general emphasis on physical fitness. He was interviewed recently on Radio 5 Live and here he is on the Radio 4 Food Programme, since he first came to fame for his cookbooks.

Finally, we have to take our hats off to organisations and individuals who come up with novel or ingenious ways to make lockdown restrictions more bearable. The Week tells us that in Berlin, residents of apartment blocks are being treated to film screenings, the film being projected against a blank wall they can all see. The WindowFlicks project is run by architecture and lighting company MetaGrey, and as if that wasn’t enough, another company is distributing free popcorn. Similar schemes have taken off in Paris and Rome so how long before some UK innovators follow suit here?

Published by therapistinlockdown

I'm a psychodynamic therapist in private practice, also doing some voluntary work, and I'm interested in the whole field of mental health, especially how it's faring in this unprecedented crisis we're all going through. I wanted to explore some of the psychological aspects to this crisis which, it seems to me, aren't being dealt with sufficiently by the media or policymakers, for example the mental health burden already in evidence and likely to become more severe as time goes on.

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