By Dr Sarah Carr, Senior Fellow in Mental Health Policy
Department of Social Work and Social Care and the Institute for Mental Health, University of Birmingham.
“Many mental health social care service users experience profound inequalities. Evidence is showing us that the most socio-economically marginalised have been disproportionately affected by COVID-19.”
In their recent blog and British Medical Journal article, Professor Jon Glasby and Professor Catherine Needham highlighted the terrible neglect of adult social care during COVID-19. They argued that by its very nature social care is not about medical intervention and that we must pursue ‘a lasting settlement for social care.’ If we examine the situation with adult mental health care this argument certainly rings true. We have to consider the social as well as the medical in mental health research, policy and practice for such a lasting settlement.
The need for research into the social causes of mental health problems
Health research funders have issued numerous rapid response calls to support research into the mental health effects of COVID-19. For example, in June the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) put out calls for research to help ‘reduce the emergence of new, and exacerbation of existing, mental health problems, and to improve outcomes for people whose mental health has already been adversely affected by the COVID-19 pandemic.’ Many of the resultant COVID-19 studies are, or will be, situated in the medical research paradigm, and whilst this research is crucial, social research is also needed if we are to advance mental health knowledge.
In August, a group of academics and independent mental health researchers (myself included) published an Open Letter presenting the case for the recognition and investigation of the ‘underlying social causes’ of mental distress during the pandemic. We argued that ‘it is critical that the expertise of social scientists, and of those with lived experience of mental ill health, play a key role in policy development and implementation’ in both the short and long term and that clinical evidence will be incomplete if social causes of mental distress and illness like inequality, discrimination and poverty remain unaddressed. Distress, we said, is a natural response to the ‘threats and disruption’ caused by the COVID-19 pandemic and does not necessarily indicate the onset or relapse of mental illness that requires access to specialist mental health interventions, but can certainly require practical support. Social care forms part of this practical support for those living with mental health problems and for those experiencing reactive distress or an onset of mental illness as a result of the pandemic.
Mental health inequalities
Many mental health social care service users experience profound inequalities. Evidence is showing us that the most socio-economically marginalised have been disproportionately affected by COVID-19. In response, community, mutual support and service user organisations have mobilised to meet the practical, social and psychological needs of these marginalised groups, continuing an established trend in social care and support provision. Recent research into the early impacts of the pandemic on mental health care and people living with mental health problems found that although there were problems with ‘access to services and resources’, instances of ‘resilience, effective self-management and peer support’ were also evident.
In our Open Letter, we argued that for post-pandemic individual, community and societal recovery there has to be ‘rapid investment in local community facilities and services – local authority, community and voluntary sector organisations – across a range of health and social sectors.’ Similarly, the authors of a paper published in the Lancet Psychiatry emphasized the exacerbation of mental health inequalities as a result of the pandemic and that ‘governmental and non-governmental financial support for mental health and social care services’ is urgently needed. The authors argued that ‘now more than ever, we need to put in place service provision that targets health needs and reduces disparities, both globally and within individual countries.’
A recent editorial in the Lancet Psychiatry urged stakeholders to ‘change the conversation’ about mental health in the wake of COVID-19, calling for ‘further pressure from clinicians, researchers, service user advocacy organisations, and journalists is needed if societal discourse [about those living with severe and enduring mental health problems] is to be shifted.’ Ultimately, this is necessary if we are to achieve a ‘lasting settlement’ for social care. The voices of mental health service users and carers are crucial for changing the conversation.