Increasing pressures on mental health and wellbeing
Part of the context for this briefing is that demand on mental health services is increasing at a level that services are not being resourced adequately enough to meet demand. This has been shown in recent reports from the Scottish Parliament’s Public Audit Committee and the Royal College of Psychiatrists in Scotland.
People in the community-led health sector we spoke to described how a range of groups across society were experiencing poorer mental health, including people of all ages, people in marginalised and disadvantaged communities and people living rurally. They listed a number of factors behind the increasing demand on mental health services.
Covid-19 placed additional pressure on people’s mental health and wellbeing. People who were already experiencing poor mental health, (e.g. stress, anxiety, loneliness and depression) due to range of factors, some of which we cover below, now had to contend with the pandemic and the resulting lockdown. This included young people, older people and many families, particularly those living on low incomes.
“It's [people’s mental health and wellbeing] just gonna get worse because what also happened with COVID was that parents that were struggling were struggling even more. And the children who probably were struggling at school then were told they didn't have to be at school and so why do they have to go back and that caused huge anxiety for so many families.” (Manager of a community-led mental health project)
Impact on disabled people
Disabled people were another group who were particularly impacted on by Covid-19. An interviewee highlighted the findings of Glasgow Disability Alliance’s (GDA) report on the impact of Covid-19 on disabled people. Supercharged: A Human Catastrophe shows how during the pandemic, disabled people, who were already more likely than average to experience poor mental health, had to contend with constant messages and media reporting around increased risk for people with underlying conditions. To make matters worse, discussions in the media and elsewhere around prioritising ‘healthier’ patients left many disabled people feeling that they were dispensable.
The increased pressures for disabled people continued beyond lockdown:
“When lockdown started to ease, because they had been shielding, a lot of the time everyone else was like, ‘well, we can go out. Let's go out for dinner.’ But they were still very, very frightened of going out in public places and and all that kind of stuff, so they almost, you know, held back, which increased the isolation and the loneliness and all those kind of things.” (Public health consultant in mental health)
Digital communication
People with pre-existing severe mental health conditions also faced particular challenges during Covid-19. Disruptions to essential mental health service provision are covered further on in this briefing. An example of how societal changes during Covid-19 have also impacted people with mental health conditions is the increased use of digital communication which, in many cases, has continued beyond Covid-19, replacing face-to-face contact. The manager of a community-led mental health project observed that members experienced hallucinations using video conferencing software.
Poverty and mental health
On top of Covid-19 and its legacy, people have been facing additional pressures on mental health and wellbeing due to the rising cost-of-living. In our discussions, we heard that financial hardship combined with difficulties understanding and accessing benefits were compounding stress and anxiety for people. As with Covid-19, there is a ‘feedback loop’ in effect between people’s material circumstances and poor mental health.
“People who are disabled and those that face other challenges [...] withdraw and they don't have the same access to opportunities, which exacerbates the poverty, which exacerbates the exclusion and the difficulty of paying bills, which then exacerbates the mental health.” (public health consultant in mental health)
As set out in our previous CHEX briefing on health inequalites, the cost-of-living, like Covid-19, is adding more pressure on people who are already struggling. The root cause of the health inequalities (including inequalities in mental health wellbeing) is the way our society is structured, with its built-in financial, social and power inequities. The people we spoke to in our engagement work for this briefing agreed with this. It was pointed out that a developing research area concerns the interlinks between poverty, mental health and a range of life-limiting conditions.
“I mean now what the research seems to be indicating is that a lot of lifetime health conditions, physical health conditions are being brought about by childhood trauma, mental illness [...] So what’s happening is childhood trauma from living in violent houses and alcohol and drugs and various other things that are that are problematic for raising children. What happens is that kids fight and flight mechanism is constantly activated and they now are seeing that, and I know there are different researchers that might disagree, but there seems to be a consensus that constantly having too much cortisol running about your body sets up the conditions for illnesses like physical illnesses later on.” (Manager of a community-led mental health project)
In addition to people experiencing poverty and financial hardship, some other communities were identified as experiencing significant challenges that affected their mental health and wellbeing. For instance, racialised communities, including refugees and asylum seekers, may experience poor mental health and wellbeing due to trauma from displacement, having to navigate the asylum-seeking system, lack of good quality housing and employment. The unrest and related media coverage around immigration and the rise of populist rightwing parties was also seen to be contributing to the poor mental health of many racialised communities.
Again, new emerging pressures can be seen to exacerbate pre-existing deeply entrenched inequalities, creating multiple pressures on mental health and wellbeing. Similarly, children and young people have long being recognised as a group facing particular challenges around mental health and wellbeing. The ubiquity of digital technology and social media, combined with the impact of covid-19 on many young people has, according to those we spoke to (and many others), been responsible for rising rates of poor mental health among young people.
