Looking forward

Everybody’s looking forward: to the data enabling the dates; to the vaccine offering protection; to families and friends meeting, playing and sporting; to businesses opening doors and tills. Optimism, despite the need for caution, appears almost realistic. But the damage that we will also face is, frankly, frightening.

With countless livelihoods lost, poverty and inequality skyrocketing, many businesses ruined, sport and the arts in a parlous state, and the economy catastrophically damaged, we await a spring budget – and more in the autumn and well beyond – that must grapple with these crippling blows.

Education, and the millions of children and young people whose development and wellbeing depends on it, have taken a serious blow. The results of what will be more than a year of disruption, isolation and social deprivation, loss of routine and purpose, and at best patchy learning, will need understanding and action.  The disproportionate effects on various social, ethnic and geographical groups of school children and students will require honest recognition, with determined targeting of those most in need with well-resourced, sensitive and supportive intervention. 

Health and social care services will face enormous challenges.  An exhausted and widely traumatised workforce will have to continue to deal with (hopefully decreasing) Covid.  Probably more challenging will be ‘catching up’ – with the illnesses where diagnosis and treatment have been delayed, with the domestic and child abuse that has gone unnoticed, and with the under-the-radar deterioration of minds and bodies, and lives, of vulnerable and disabled people of all ages.

People leading and working in all sectors will have to grapple with the challenge of rebuilding in the light of this damage.  It is not enough to think of restoring the status quo. Strategies for the long-term treatment of the damage done, to re-shape and re-focus services and initiatives, will be required. And, given the gap we have become accustomed to between words and action, intelligent, concerted, and properly resourced delivery of carefully targeted interventions will be desperately needed.

There are many anxious voices warning of greatly increased mental health problems in our society after the pandemic. They point to the likely effects of living with the fear, and awful consequences, of Covid, and of the disruptions to social life of the measures taken to respond to it.  The anxiety, anger and mistrust that have grown in response to how these things have been managed will also contribute to this escalation of mental ill-being. There are signs of dangerous social fragmentation and conflict. Then there is the consequences of the increase in unemployment and poverty.

Children, single parents, lonely older people, members of black and minority ethnic groups, people with long-Covid, indeed traumatised healthcare workers, are all groups identified as likely to be most in need.

I think this increase in mental distress is highly likely – indeed it’s already here.  What alarms me is that the discourse seems mainly to forget that most of these issues have been escalating for a very long time.  We have been in a period of chronic crisis for years. The social determinants of mental vulnerability and disorder have been increasing, particularly since the 2008 crash. Poverty, inequality, inhumane benefits systems, racial injustice, and reduction in public services are all contributing factors. Mental health services, especially, but by no means only, for children and adolescents, and for older people, have been badly under-resourced for years.

How will we respond as a society?  Will we just tell inadequate services what the need is and to get on with meeting it, however impossible that is?  Will we make ‘moonshot’ gestures, setting up call-centres staffed by people on the minimum wage to meet the need?  Will we outsource services to organisations with no expertise, driven by profit? Will we create labyrinthine eligibility and access systems to slow down demand?  Will we continue to side-line mental health as a society? You’ll get my drift…….

We face an acute phase of a long incubating condition – frighteningly rising mental ill-being. We also face the option of denying or minimising it.  Or we could work together to acknowledge it and do something that will help. We need to develop a realistic national strategy, now. Though such a project would be complex and expensive the costs of not doing it will be far worse.  Critically, attention to all the factors I have summarised above has to be seen as part of such a strategy: they are the social determinants of mental health – and ill-health.  Building the social capital that nourishes mental well-being has to be part of the plan – just as important as (but not an alternative to) resourcing and supporting adequate mental health services, in the voluntary sector, in social services and in the NHS.

I wait, with some anxiety, to see whether the right people and sectors are brought together – urgently, now – to develop such a strategy. Our hopes for the future will very significantly depend on it.

John