Sunday 28 November

After social psychologist Professor Stephen Reicher tweeted that trust was crucial for people to accept and follow government restrictions a sceptic responded that trust is not specific to one area of government action: ‘sadly this government has repeatedly shown itself to be dishonest and corrupt, harming public health’. This principle is central to this blog, that we look to our leaders to provide psychological containment of the nation’s sense of security and when this doesn’t happen (repeatedly) it raises public anxiety considerably. This week there have been several intractable examples of short termism, dishonesty, narcissism and downright incompetence which would be risible if they wasn’t so serious. These include the latest manifestation of the migrant crisis, the social care bill debate, the instability inside no 10 and the very worrying emergence of the Omicron Covid variant, all of which need careful consideration, diplomacy and attention to detail followed by appropriate action. But what we mostly get is a series kneejerk responses which prioritise ego games and government narratives and which don’t address the urgency of the situations. One commentator tweeted: ‘I think we just all have to accept that there isn’t a single situation that Boris Johnson can’t make worse’.

Earlier this week the Prime Minister’s stumbling and unprofessional speech to the CBI provoked widespread concern and derision, a journalist even asking Boris Johnson afterwards if he was ok, to which a deluded PM responded that the speech had gone down well. Downing Street risked losing any shred of credibility by saying that the PM was ‘physically well (what about mentally?) and had a full grasp on the prime ministership…. he was not ‘pissed’ but I understand he did take a rather large overdose of cough and cold medicine this morning’.

He doesn’t seem to have any idea what danger he’s in and perhaps doesn’t yet realise that the narcissistic carapace is failing to serve him. During the 20 minute keynote speech to business leaders he compared himself to Moses, pretended to be an accelerating car, referred to himself in the third-person, lost his place and eulogised Peppa Pig World as an example of private sector entrepreneurialism. Numerous Conservatives were worried, publicly or privately, and a senior Downing St source said ‘there is a lot of concern inside the building about the PM….It’s just not working. Cabinet needs to wake up and demand serious changes otherwise it’ll keep getting worse. If they don’t insist, he just won’t do anything about it’.

Surely the sudden emergence of the dangerous Omicron Covid variant will finally stop ministers referring to the pandemic in the past tense eg last week ‘we’ve just come through a pandemic’. No – with around 1000 deaths a week we definitely haven’t, though you could be forgiven for not being fully aware because of the way it’s been minimised by BBC News. B.1.1.529, or Omicron, was designated as a variant of concern by the World Health Organization (WHO) on Friday night due to its ‘concerning” mutations and because preliminary evidence suggests an increased risk of reinfection with this variant’. It’s feared to have an R or reproduction value of 2 with the potential to evade vaccines. It’s now known we have two cases in the UK (which probably means many more). Having been contemptuous about mask wearing for some time, Boris Johnson is now saying we should wear these in shops and on public transport, but as ever with this administration, there’s no enforcement – those  required to quarantine are merely ‘asked’ to take tests etc and people have been tweeting from airports that no checks are being carried out. The official version is that ‘Travellers to the UK must take day 2 PCR test and self-isolate until they get negative result’.

In another example of Covid complacency, news has emerged that Boris Johnson has been accused of ignoring a plan to prepare Britain for vaccine-resistant Covid variants. Following the sudden emergence of Omicron, Clive Dix, former head of the vaccine task force, said there was no evidence that the blueprint he submitted in the spring had been acted on. ‘Under Dix’s strategy, a coordinating team would seek out new vaccines, give the company involved a “fast track” to a swift trial, access to the data and regulatory approval, in return for early access to new vaccines. He said this system worked at the start of the pandemic and should be repeated’. Being a partner in vaccine development means the UK is in a good position to secure doses, which doesn’t apply if we are out of the frame. Dix has seen no sign of his blueprint being activated.

You’d never guess this risky situation from the bland government statement, however. ‘This past year we’ve witnessed unprecedented scientific innovations and breakthroughs, made possible by collaboration between medical experts, governments and industry. Earlier this year, we joined the 100 Days Mission, which will ensure industry is part of a robust collaboration alongside governments, international organisations and academia over the coming months and years to take action towards a common goal: protecting people from future pandemics through developing and deploying safe, targeted and effective diagnostics, therapeutics and vaccines at scale’.

Health Secretary Sajid Javid is surely taking quite a risk (of subsequent humiliating U-turn) by saying so bullishly that we’re ‘nowhere near imposing Covid social distancing rules’. But how does he expect the measures he has imposed from Tuesday (why the 3 days notice?) to be acted upon when so many people have disregarded them for so long, Do Not comply is trending on Twitter, there’s no means of enforcement and our own Prime Minister has set such a bad example via his contempt of mask wearing? Asked if he could guarantee that meeting families and friends over Christmas would go ahead, Javid responded that no guarantees could be given (at least they’ve learned that) but that these measures (including the likelihood of extending boosters to the under 40s) should be enough. ‘It will give us the precious weeks our scientists need to assess this variant. I think people should continue with their plans as normal for Christmas. It’s going to be a great Christmas’.

Meanwhile, the lockdown and (from February) compulsory vaccination in Austria has caused other countries to rethink their strategies. It might be that people’s personal liberty has to be infringed in order to prioritise public health and David Nabarro at the World Health Organisation has spoken of the necessity of mandatory vaccination. A clinician writing anonymously in the Guardian shows howmost of the resources we are devoting to Covid in hospital are being spent on people who have not had their jab’, exemplifying the feeble and unscientific ‘reasons’ the unvaccinated give for refusing the vaccine. Examples include ‘The man in his 20s who had always watched what he ate, worked out in the gym, was too healthy to ever catch Covid badly…. the 48-year-old who never got round to making the appointment. The person in their 50s whose friend had side-effects. The woman who wanted to wait for more evidence. The young pregnant lady worried about the effect on her baby. The 60-year-old, brought to hospital with oxygen saturations of 70% by the ambulance that he initially called for his partner, who had died by the time it arrived; both believed that the drug companies bribed the government to get the vaccine approved’.

Unfortunately, the BBC continues to collude with the government in repeatedly deflecting attention from the UK to Austria and Germany when the UK has 44% more cases than Austria and three times those of ‘national emergency’ Germany. This is not only unacceptable for the state broadcaster but also highly misleading, as many without other sources of information except the mostly right-wing press and perhaps with little interest in politics won’t know any better. In turn, this could reduce compliance with restrictions because of a false sense of security.

Recent attention grabbing news may have temporarily deflected attention from the controversial social care legislation currently going through Parliament, but another source of disillusionment for Tory MPs this week was the arguably disingenuous presentation of proposals which would seriously disadvantage the less well off. ‘Christian Wakeford, the Bury South MP, expressed anger that the plans appeared to have been changed since MPs voted in September to support the £12bn a year health and social care levy that will pay for the policy….The Department of Health and Social Care caused alarm on Thursday when it revealed it would calculate the £86,000 cap on lifetime care costs in a way that could leave tens of thousands of England’s poorest pensioners paying the same as wealthier people. Wakeford said: ‘If we’re changing the goalposts again, halfway through the match, it doesn’t sit comfortably with me or many colleagues…It shouldn’t be taken for granted that we’re just going to walk through the same lobby’.

After a key debate MPs voted 272 to 246 in support of a change to the social care reforms, meaning council support payments would be excluded from the new £86,000 cap on lifetime social care costs in England. In an utterly astonishing interview with Business Minister Paul Scully on the Today Programme, he wheeled out the lame excuse that this was better than what has gone before (the half-baked approach to policy again) and said ‘The social care bill is fair. Rich and poor people will pay the same’. When interviewer Mishal Husain pointed out ‘But, poor people will pay a far greater proportion of their assets’, in logic from the government’s parallel universe Scully responded: ‘But that’s levelling up’.

All is not lost, though. The House of Lords will get their hands on this bill soon. It will be interesting to see what modifications they manage to get through. Several MPs challenged the Sky News announcement of the debate’s result, generalising about support for the bill. Lib Dem Layla Moran tweeted: ‘Not all MPs. I voted against. I do want a Government to tackle social care and yes someone was always going to have to pay. But Lib Dem values mean we want the biggest burden to be carried by the broadest shoulders. This Tory plan hurts the poorest most. Atrocious. Yet expected’.

Although, as usual, Home Secretary was absent from the airwaves, the government instead sending others to do the media rounds, Priti Patel was firmly in the frame this week following the tragic death of 27 migrants as they crossed the Channel in small boats. Typically, as commentators have pointed out, the half-baked strategies being employed to deal with the migrant crisis are not working because they’re not addressing the fundamental ‘upstream’ issues. The Home Secretary did herself no favours in the way she spoke about the crisis, lampooned by the Guardian’s John Crace for its abdication of responsibility, not to mention its lack of humanity. ‘It was only last Monday that Priti Patel was forced to answer an urgent question on people crossing the Channel in small boats. Her response was typically belligerent and unapologetic. Nothing to do with her, everything to do with people-smuggling gangs, economic migrants trying to enter the country illegally. And, of course, the French. Never forget the French. Everything can usually be traced back to the French’. A sceptic tweeted: ‘People coming from France in small boats to the UK aren’t the real threat. The real threats are the people coming from Eton in their pin striped suits emboldened by their sense of entitlement to rule’.

In yet another macho intervention intended to humiliate France but which proved an own goal, the PM tweeted his letter to Emmanuel Macron when such a diplomatic device would normally remain confidential. This then led to the exclusion of Priti Patel of today’s meeting of European nations to discuss the crisis. Though he’s long protected her from scrutiny and the sack could Patel now be cursing her boss for his ill-advised action which caused her to be ‘disinvited’ from this important meeting? Her exclusion is shaming for this government. A commentator tweeted: ‘If you tried to write a letter designed to irritate France, this would be it: 1 self-congratulate and take moral high ground 2 make letter public, to enhance 1 3 tell France and EU to do more to patrol a border that the UK left EU in order to regain control over its borders’. We have to wonder again what advice the Prime Minister is getting in order for him to pursue such a short-sighted and embarrassingly sabotaging strategy. It was enlightening to see what was described as Lord Kerr of Kinlochard’s ‘brilliant evisceration of government claims about refugees yesterday in the House of Lords – the facts, stark and clear’.

He rebuts the government’s narrative and misinformation by stating that the numbers of refugees is far lower than 20 years ago, that the reason small boats continue to be used is the defences around train and road routes, that the reason migrants pursue this strategy is the lack of official asylum routes and that the majority are indeed asylum seekers, not the ‘economic migrants’ condescendingly alluded to by the Home Secretary. ‘Unless we provide a safe route, we are complicit with the people smugglers. Yes, we can condemn their case and we mourn yesterday’s dead, but that does not seem to stop us planning to break with the refugee convention. Our compassion is well controlled because it does not stop us planning, in the borders Bill, to criminalise those who survive the peril of the seas and those at Dover who try to help them. Of course, we can go down that road. But if we do, let us at least be honest enough to admit that what drives us down that road is sheer political prejudice, not the facts, because the facts do not support the case for cruelty’.

Part of the wider context of the migrant crisis has been the Home Office’s failure, three months after it was announced, to begin the programme to allow Afghans to resettle in the UK. ‘Some Conservative MPs are understood to have confronted the home secretary directly over the delay in launching the Afghan Citizens Resettlement Scheme (ACRS), which was announced with great fanfare in August as the Taliban seized control in Kabul. MPs say the Home Office’s failure to follow up its promise with action is pushing refugees to take deadly risks and leaving vulnerable people who have remained in Afghanistan at the mercy of the Taliban’.

The state of the NHS continues to cause concern – besides the increasingly common stories of long waits for ambulances, staff shortages and long waiting lists, news emerged that alcohol and drug related deaths rose by 27% between April 2020 and March 2021 (3,726 people died while in contact with drug and alcohol services – up from 2,929 the year before). We’re told that a key factor was changes to support and reduced access to healthcare during lockdowns but it’s also well known that due to funding cuts treatment availability was reduced. It’s galling that yet again last week former Health Secretary Jeremy Hunt was on the Today programme speaking about the situation in the NHS and social care. Not only is it always sidestepped that the deficits he alludes to were initiated under his watch but also his conflict of interest (in his current role as chair of the Commons Health Select Committee) is never addressed.

Meanwhile, the latest wheeze purporting to help cope with ambulance waiting times is for odd-job workers to be sent out to people’s homes under plans for a “one-stop shop” model for social care to ease pressure on the NHS. ‘Amanda Pritchard, chief executive of NHS England, said handymen and women could be dispatched by local councils as part of a team response so that ambulances were left free for more serious incidents’. This doesn’t sound very practicable or realistic – it will be interesting to see if this idea sees the light of day.

In important news regarding mental health, the National Institute for Health and Care Excellence (NICE), which dictates NHS policy, has finally launched a consultation on its update to the clinical guideline for Depression in Adults. This is after a long period of back and forth with various consultations on this key clinical guidance. The good news is that for those with ‘mild depression’ (though, in my view, defining ‘mild’ is problematic)  therapy is to be offered before antidepressant medication, which is often habit forming and which should only be prescribed for short periods but which many patients remain on for years. The less good news is that what NICE considers ‘therapy’ still privileges Cognitive Behaviour Therapy, when what many patients want and need is relational therapy which seeks to get to the root of their difficulties. It’s also group CBT as the first offer, which is likely to immediately limit patient take-up.

It’s also tricky that NICE recommends that ‘a menu of treatment options’ be offered to patients by health professionals before medication is considered: in theory this is good but NHS therapy services often have such long waiting lists, with only CBT mainly on offer, that GPs could find themselves hobbled in such discussions with patients and fall back once more on medication. ‘This (group CBT) could be followed by offers of seven other treatments including individual CBT, self help, group exercise or group mindfulness or meditation, before medication is discussed as an option)’.Nevertheless, the consultation is timely as  ‘Figures from the NHS Business Services Authority show more than 20 million antidepressants were prescribed between October and December 2020 – a 6% increase compared with the same three months in 2019’.

In more cheerful news, since museums and the arts have considerable potential for enhancing our wellbeing, it’s good that 925 cultural organisations across England have received grants totalling £107m in the latest round of the Culture Recovery Fund. This includes more than £100m awarded in continuity support grants to 870 previous recipients of the Arts Council England-administered fund. A further 57 organisations in need of urgent support have received a share of £6.5m through the National Lottery Heritage Fund and Historic England arm of the fund, and 62 cinemas have been awarded £6m through the British Film Institute. The Museums Association quotes Darren Henley, Chief Executive of the Arts Council: ‘This continued investment from the government on an unprecedented scale means our theatres, galleries, music venues, museums and arts centres can carry on playing their part in bringing visitors back to our high streets, helping to drive economic growth, boosting community pride and promoting good health. It’s a massive vote of confidence in the role our cultural organisations play in helping us all to lead happier lives’.

During the last few months we’ve heard a lot about food and drink shortages due to the supply chain crisis. Now the emphasis is on Christmas as retailers gear up for what they hope will be healthy sales. But it’s interesting that several of the feared shortages applied to less than healthy items, if you remember the kerfuffle over the potential lack of fried chicken, milk shakes and crisps. It also smacks of ‘first world problems’. The latest candidate is a potential alcohol shortage, as a group of 48 wine and spirits companies including the Wine Society have written to Transport Minister Grant Shapps with their concerns. They said that rising costs and supply chain “chaos” had held up wine and spirit deliveries, raising the risk that supermarkets will run dry and festive deliveries arrive late. ‘The alcohol industry is the latest in a long line of sectors to warn of possible Christmas shortages amid supply chain difficulties, with concerns also raised about deliveries of turkeys, trees and toys….The supply chain is facing a number of pressures, such as drivers leaving the industry and difficulties recruiting new ones, border issues and delays with the movement of shipping containers’. Somehow, I think we’ll manage……

As the beautiful curlew is one of my favourite birds, it was pleasing to read of an initiative in Wales to prevent their extinction there. We’re told that the curlew holds a cherished place in Welsh folklore and culture because ‘its bubbling, haunting call is traditionally regarded by many as a harbinger of spring’. But the decline (possibly as few as 400 breeding pairs left in Wales and numbers are continuing to fall) has prompted conservation groups to get together with a plan to arrest this decline. ‘The 10-year programme includes a plan to identify the areas where curlews survive, and introduce targeted conservation measures, such as managing grass and heathland more effectively. It will be launched on Monday by an umbrella organisation called Gylfinir Cymru/Curlew Wales….. Gylfinir Cymru will work for packages of support to be provided to farmers and land managers, enabling them to create the sort of landscapes in which curlews can thrive. Also planned is the recruitment of a Wales curlew programme manager and volunteers to help’. Let’s hope the plan succeeds.

Finally, another acronym gaining momentum is HOGO, featured for example in Wednesday’s Woman’s Hour. A relative of FOMO (Fear of Missing Out), HOGO stands for the Hassle of Going Out, particularly noticeable after 18 months of getting used to having to stay in, coupled with the now freezing weather and uncertain service in restaurants etc. ‘We have become too comfortable sitting on our sofas watching TV. The effort of putting good clothes on and leaving the house is too much. This hassle of going out (HOGO) has been blamed by the hospitality industry for an increase in the number of no-shows at restaurants and paid-for live events’. All this is understandable but one of the programme’s interviewees made the important point that especially for those living alone it’s important to get out and meet people, get a change of scene and so forth so it was worth challenging one’s HOGO. We might need to waste no time in doing this in case another set of Covid-related restrictions descends in the not too distant future!

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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