After Coronavirus, We Need a New Mental Health System

10 million of us will need mental health support as a result of this crisis. Our current system won’t cut it.

by Sophie K Rosa

4 March 2021

Photo by Zackary Drucker as part of Broadly’s Gender Spectrum Collection. Credit: The Gender Spectrum Collection. Made available to media outlets via Creative Commons. No derivatives, no commercial use. See guidelines here: broadlygenderphotos.vice.com/guidelines

With life beyond lockdown seemingly within reach, the year ahead – and beyond – will likely reveal the extent to which we have all been psychologically impacted by the coronavirus pandemic. 

10 million people, including 1.5 million children, will likely require new or additional mental health support as a direct result of the crisis, according to the Royal College of Psychiatrists (RCP). Meanwhile, RCP president Adrian James described the pandemic as likely being “the biggest hit to mental health since the second world war.”

Despite the scale of the crisis, government support for those struggling with mental health during the pandemic has been all but nonexistent. Psychotherapist Dan Bristow says that the government’s consistent “disregard for issues around mental health has been remarkable and could have… deep psychical repercussions.” The full psychological impact of the past year, he argues, is yet to be seen.

The effects of living through this time of mass death and suffering, of people’s livelihoods and sociality being jackknifed… won’t be resolved simply by the reopening of the economy,” argues Bristow. It will instead have to be “work[ed] through” slowly, taking into account the specific needs of each person – with therapeutic provision playing a crucial role in the healing process.

Given the magnitude of the undertaking, mental health activists are doubling down on calls not only for drastic reforms to state mental health infrastructure, but for people to look beyond the state to build radical alternatives in their own communities. 

 


The coronavirus pandemic has had a devastating impact on most people’s mental health but some groups have been hit harder than others. Liv Wynter, a peer support coordinator at Hearts and Minds – the UK’s only peer-led charity for young people experiencing mental health issues –  says young people’s wellbeing has been seriously harmed by the pandemic. “It’s had a really obviously horrible negative effect,” they say. “The fact that they’re having to do their mock exams absolutely blows my mind.” A surge in child mental health cases is expected to emerge as schools reopen next week.

Indeed, a major new study by University Nottingham and King’s College London shows that people are experiencing significantly more stress, anxiety and depression since lockdown began, with young people and women most affected. 

Emily Reynolds, who works with a women’s mental health charity says many women “have been massively re-traumatised by lockdown.” A dramatic increase in care and domestic labour, along with the heightened risk of domestic violence under lockdown, has contributed to women’s declining mental health. Through her work, Reynolds says she has witnessed an increase in distress, isolation and loneliness. “Women…have had loads of progress they’ve made wiped out,” she explains. “Obviously, this is really linked to people’s economic situation.”

Indeed, financial precarity has played a decisive role in declining mental health during the pandemic. Millions of people in Britain have been plunged into financial hardship and poverty as a result of Covid-19 lay-offs; while many people – especially those who are digitally excluded – have had trouble accessing vital services to keep them afloat, for example, Universal Credit. This increased precarity has been “really anxiety-inducing,” says Reynolds. “More people are struggling with money than ever before.” And with a recession on the horizon, the mental health crisis is only set to get worse. After the 2008 financial crash, which was the most severe global recession since the Great Depression, there was a marked increase in suicides.

State mental health infrastructure has been ill-equipped to support people’s psychological wellbeing throughout the pandemic. The government has been “lacking in preparedness and policy in relation to mental health…from the off,” says Bristow. And rather than supporting mental health by funding NHS provision and community support projects, the government has instead marshalled a “neoliberal and individualist” notion of mental health ”to spur on risky and premature reopenings.”

‘We need a full culture change.’

Of course, the mental health crisis in the UK was well underway before the pandemic hit in 2019, the suicide rate for men hit a two-decade high. Mental health support services have long-faced “an absolute lack of funding and resources,” says Wynter. A decade of austerity has wrought havoc on people’s wellbeing at the same time as decimating NHS mental health services. Disappearing community services, staff shortages and growing waiting lists mean that it can be near-impossible to access vital support. 

For people unable to afford private therapy, waiting times for NHS provision can be months or even years-long – forcing many to resort to emergency or crisis services. Given the sector was “economically exsanguinated” by austerity, says Bristow, it’s hardly a surprise that it “would … [be] struggling to meet [the] demands created by the…global crisis.”   

But even if NHS mental health services were well-funded, argues Reynolds, they still wouldn’t have been able to meaningfully support people during the pandemic. “‘More funding!’ “has become a bit of a truism… a slogan,” she says. While more funding is obviously essential to improving healthcare, such a demand doesn’t get “anywhere close” to solving the problem of a broken system. We need “a full…culture change,” she says.  

Mainstream mental health provision tends to individualise people’s suffering – favouring personal responsibility and diagnoses over any kind of acknowledgement of the seismic impact that capitalism has on collective mental health. This is seen in the concerted effort across the mental health system to get people suffering with mental illness ‘back to work’. Reynolds argues that this work-focused understanding of ‘recovery’ turns “the individual person into a tool of production.” Far from being a useful metric of wellbeing, a focus on the ability to work is “fundamentally alienating,” and erases “how someone is coping, how they feel, the way they’re experiencing the world,” she says. 

Reynolds, who has lived experience of mental distress and suicidal crisis, says her “number one takeaway from having engaged with all kinds of different mental health services… is not being listened to.” Despite having had some good experiences with individual therapists or groups, she says that the dominant culture around mental health means that her experience has overwhelmingly been one of dismissal: “My knowledge of myself, my knowledge of my peers, my knowledge of my comrades, my knowledge of mental health generally, [has] just not [been] listened to [or] respected.” 

Wynter echoes her concerns, recalling how a young person they work with was recently sectioned and treated with a “complete lack of autonomy” in the process. “Sectioning people against their will, administering medication to people against their consent, not allowing people to have any consent: that’s not a very healing environment.”

‘Racism is built into the way people access care.’

This lack of agency is experienced more acutely by Black and trans people, as well as people with certain diagnoses or disabilities, says Reynolds, who argues that the pandemic has “shone a brighter light on” racism in the healthcare system – including the mental healthcare system. “Racism is built into the way people access care and also the care that they actually get.”

For Black people, this ‘care’ can look more like criminalisation. “The psychiatric system in particular,” says Reynolds, “is in many ways very, very carceral. It can be extremely violent; it can be extremely coercive.” Black people are four times more likely to be detained under the Mental Health Act, and are less likely to receive NHS therapy. 

To confront these systemic issues, Reynolds says our culture around mental health – including the approach of therapists – needs to better understand social factors such as poverty, racism, heterosexism and transphobia. “All of these factors can shape how people experience distress,” she explains, as well as “how they experience care, which [can be] exclusionary.” Queer women, for example, are much more likely to be diagnosed with borderline personality disorder.

Reynolds would like to see mental health professionals not only “explicitly identifying  the ways that capitalism makes us suffer,” but “actively organising against it.” Wynter agrees, arguing that the left as a whole needs to take a more critical approach to mental health, and building radical models for care rather than simply accepting a “medical model… designed by a group of rich, old white men.”

Cooperatively-built care.

Lockdown has forced us to reexamine what community and collectivity actually mean. Mutual aid efforts were vital in mobilising support for the most vulnerable in communities during the first lockdown, with around 1,500 groups forming in little more than a week. Activists argue that we should be looking to such efforts in order to reimagine the current mental health system and the broader culture around mental health.

“In order for mental health support to be as radical and helpful as it can be,” says Wynter, “we have to understand that it needs to be a community response, it needs to be a group of people who can help look after someone.” Under neoliberalism, supporting someone in crisis often falls to an individual who might feel unable to help on their own, and therefore decides to call the police or get the person they are supporting sectioned. But a cell, they say, is “not where people heal.”

During the pandemic, Wynter has been facilitating group ‘intentional peer support’ for young people and believes this mode – based around transformative relationships as a source of healing – is an example of the more collective, mutual approaches to mental health we need to be building.  “[It’s about] trying to find ways to mutually grow and learn together,” they say, as opposed to pathologising and disempowering people, as often happens in institutional mental health settings.

With peer support, Wynter explains, “it’s much more horizontal.” Rather than aiming to ‘solve people’s problems’ or to involve the state in mental health crises, their aim as a peer support coordinator is to be ”someone in [a person’s] life who helps them along their journey,” and who, crucially, “will learn from them [too].”

Reynolds believes we urgently need more spaces for such collective care – to improve our mental health, as well as to support our ability to resist the conditions that cause us to suffer. In terms of therapy, she advocates for “a kind of care that isn’t transactional, that isn’t labelling,” and that is “cooperatively-built – done ‘with’, and not ‘for’.” 

Where conventional therapy often aims to reconcile people to the injustice of the world, a more radical approach to mental health would validate people’s experiences and help them feel able to fight. Whether through friendships, peer support groups, consciousness-raising groups or more formal group therapy, we need more spaces where people are “allowed to be angry” about their experiences and not have their pain reduced to a symptom “that needs to be cured or repressed or quashed or dealt with,” says Reynolds. “[I want] to live in a world where we’re not afraid to be dependent on one another, and we’re not afraid to foster deep connections.”

“As more details of mishandling and negligence [are] revealed, and the work of mourning on a large scale is faced,” says Bristow, “there is… hope that the tatters [of our social consciousness] may regroup around something guided by…solidarity and a cohesive structure of care.”

Sophie K Rosa is a freelance journalist and writer.

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