Mental health and COVID-19: understanding change through shifting lenses

One pandemic, many crises

The current pandemic has touched on nearly everyone’s life and mental wellbeing. It has changed how people can work, socialize, travel, and care for each other. Despite a sense of collective tragedy and new forms of solidarity (e.g. mutual aid and furlough schemes), the mental health impacts of Covid-19 were felt differently and unequally. While some suffer from loneliness and isolation under lockdown, others face the triple burden of working, parenting, and educating children from home. Yet others endure looming and real job losses, while key workers have no choice but to labour under an increased risk of infection, stress and exhaustion. While some suffer Zoom fatigue in endless conference calls, others lack laptops or Wi-Fi to participate meaningfully in online work or schooling. Minority communities, who have long experienced discrimination and heightened measures of surveillance, now face greater rates of mortality and loss from the virus. In many ways, the differential burden of illness and distress under Covid-19 follows long entrenched patterns of disadvantage and social inequality drawn along gendered, racialized, socio-economic, and environmental lines. And just as we are entering into a second wave, the longer-term effects of Covid related mental distress are beginning to emerge.

^{Photo by Thomas de LUZE on Unsplash}

Shared experience: uncertainty

Despite the stark differences, one experience most share in this present moment is that of constant change; of having to live with an ever-receding horizon of certainty. On this shifting terrain, predictions and rules are both desired and contested. Phrases like the “new normal” reassure us we are in fact transitioning between orders, past and future; a path leading through questions about intimate and everyday living: When to see and hug each other, how to visit our elders, go to the pub or on a date, or send the kids to school? The infectious nature of the virus makes it so that none of these questions can be answered in isolation or by an individual alone; the answers found will always affect others. In other words, the pandemic brings us into view as profoundly social and interconnected beings. Questions about the everyday then quickly become those of larger orders: What kind of community, society, or environment do we want to live in and require to be well? Rupture and change bring disorientation and unease, but also new perspectives. Many have been spurred into re-thinking and protesting the current social order, for example, its grounding in environmental destruction, extractive capitalism, and structural racism. Normality, so yearned for in its absence, may not be worth returning to unchanged.

What may this year’s WMHD theme “Mental Health for All: Greater Investment, Greater Access” mean against this backdrop, and how is the meaning of its longstanding premises itself changing through the pandemic?

Care under Covid-19: disrupted, digital, lay-ified

The mental health of many is predicted to be strained – from the loss of life, loved ones, and livelihoods, the hardships of isolation or conflict under lockdown, and the fear and trauma experienced by key workers and marginalized members of society at higher risk of infection. At the same time, mental health services as we know them - and where they exist – are, according to the WHO, severely disrupted due to “the risk of infection in […] care homes and psychiatric institutions; barriers to meeting people face-to-face; mental health staff being infected with the virus; and the closing of mental health facilities to convert them into care facilities for people with COVID-19.” WHO’s call to expand the responsibilities for mental wellbeing and care is then not only directed at health care officials, but at a much broader cast – friends, family members, employers, governments, health professionals, and journalists – who, each in their own domain, are asked to “do something life-affirming” on World Mental Health Day. The notions of “greater investment, greater access” here begin to broaden beyond an epidemiological and economic calculations of coverage and a “return on investment” for every dollar put into formal care. With economies impacted by the pandemic themselves, losses and gains of productivity have become uncertain, too, and new rationales to care and advocate for mental health are coming to the fore.

^{Photo by Joel Muniz on Unsplash}

Mental health and care in society

In both high and low- and middle-income settings, care strategies have been adapted in response to the pandemic, often by accelerating trends already underway. Among them, for example, are the use of lay and peer mental health workers (“task sharing”) and digital technologies to deliver diagnosis and treatment across social, geographic, socioeconomic, or institutional distances. Designed originally to care for those considered “hard to reach,” - in prisons, humanitarian settings, disaster zones, and remote rural and indigenous communities - they now offer services to many. Such care, however, remains characterized by inequality, be it due to a persistent digital divide that further worsens economic inequalities, or the delegation of care to a poorly paid and supported lay and peer workforce.

At the Centre, social scientists and researchers of mental health in society are called upon to reflect, accompany and shape the responses to mental health under the social conditions of the pandemic - through interdisciplinary research, dialogue with service users and policy makers, and through attention to both the acute ways in which people are affected in the current moment and the bigger picture of how social inequality “gets under the skin” over longer arcs of time – the course of a person’s life, a generation, or a broader slice of history and its changing conditions and policies.