All in it together?

It is being said that this pandemic is a great leveller. Oh that it was so. The world waits with trepidation, anticipating the devastating effect that is likely once the virus takes hold and sweeps through countries like Syria already ruined by war, the poorest countries in Africa and Asia, and over-crowded refugee camps. 

Here in the UK, we worry about the speed of infection spreading in our overcrowded prisons, hostels, and immigration removal centres, as well, of course, as our care homes. Not only are the people in these institutions more likely to suffer serious morbidity and death because of malnourishment and  chronic health problems , they are also more likely to catch the virus because of over-crowding. Lock-ins are being increased, certainly in prisons, but the effect on mental stability is expected to be significant. Moreover, with many prisoners sharing overcrowded cells and prison staff coming in daily from the community, the risk of contagion is still high.

Those of us lucky enough not to be shut away in institutions at this time, still face differing odds. Socio-economic status has a huge effect on morbidity and mortality. This has always been the case, but has got much worse in the last ten years with austerity driving public policy. Obesity, hypertension, asthma, chronic obstructive pulmonary disease, and diabetes, for example, are all more prevalent in low income families, all conditions that put you at higher risk of dying from the virus. So much easier to shield oneself in a comfortable house with garden and separate bathrooms. Spare a thought for poorly housed families crowded into a small space where the 2m rule must seem a joke. Add in a drunken, abusive father or stepfather, and you have all the conditions for fear, not just of violence, but of rapid infection. 

As a retired psychiatrist, I am particularly aware of mental health patients. My niece phoned me last night. She is a gentle, compassionate mental health nurse working on an elderly ward where most of the patients suffer from severe dementia. Like healthcare staff all over the country, she is having to step-up, with many clinical managers off sick and staffing levels lower than ever. She didn’t know Aimee O’Rourke, a young nurse who has just died from the virus, but some of her colleagues counted her as a friend and the atmosphere in the team has darkened.  But what made my niece cry, was the clear imperative to wear masks at all times when in contact with patients. Of course, she knows that minimising the risk of infection trumps everything else at the moment but she can’t bear to see the fear that the masks engender in the eyes of the frail confused elderly people  in her care. 

Even within mental health services, there are hierarchies, with some patient groups being seen as more important than others. Trusts are instructing their staff to identify and focus their care on the most high risk patients, particularly those with a forensic history and those reliant on depot medication. But most patients in mental health services are high risk if the social and psychological support for them is abruptly withdrawn. After all, people are referred to mental health services when family and community support is no longer enough and the gateway into services in recent years  has been set at a very high bar. Psychotherapy colleagues  I speak with are being asked to put their therapy patients on hold, and focus on crisis work. Thankfully, many of them realise the harm that this would do and are maintaining some ‘under the radar’ virtual connection with their regular patients, squeezing this in between the crisis work they are being asked to do by the Trust.

It feels difficult to talk about the needs of mental health patients,  prisoners or asylum seekers when we are being faced with the reality of previously healthy young nurses succumbing to the virus.  At least, they are now reporting deaths of nurses, not just the doctors, but one wonders if any NHS cleaners are dying?  By the way, is anyone else wondering why so many of the reported doctors dying were from ‘ethnic minority’ groups – surely statistically significant. I don’t know what to make of it, except I hope people are noticing how much our NHS depends on people of all races, cultures and creeds.

The next two weeks are going to be particularly difficult for everyone as the numbers of deaths continue to rise. But this is not a good time to be poor. It is not a good time to have special needs. And it is not a good time to be on the margins of society.

Penny

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