Mental Health consequences of lockdown are absolutely no reason to limit COVID related restrictions.
I have been wanting to write something for a few weeks in response to what I keep seeing as spurious arguments against the escalation of COVID restrictions in Victoria, and around the world, which use “mental health” as a reason to suggest we should not be increasing social restrictions.
As I understand it, the argument goes that the mental health consequences of the damage to the economy, job losses, unemployment and social dislocation resulting from enforced economic and social lockdown will exceed the impact of COVID infections themselves. Suicide rates will rise and the resultant loss of life may exceed that associated with COVID related deaths, or at least mitigate the reductions in death we achieve through tighter restrictions.
I think this is just a somewhat more complex extension of the binary argument that has been presented now for several months: that we have a simple choice. We shut down the economy to fight the virus with harsh economic consequences (and effects on mental health) or we do the opposite to support the economy at a cost to physical health / higher rates of viral infection and COVID deaths.
This is a completely false choice.
Let me repeat that as many just don’t seem to get it: we do not have a choice. The economy, and peoples mental health, is going to be dramatically effected whatever we do.
As we are shutting down the economy, restricting economic and social activity this is having important and damaging mental health consequences. Every day I am seeing patients whose mental health has dramatically worsened during the pandemic and social isolation and unemployment are playing a significant role in driving these problems.
However, it will be no different if we don’t impose the lockdown measures required to get COVID under control. A society with more shops open and more businesses operating is not one that is going to result in better mental health outcomes.
First, this will not necessarily support better economic outcomes. The reduction in GDP in Sweden has been similar to that in other Nordic countries, at a much greater loss of life[1].
Second, more widespread COVID infections will directly worsen mental health outcomes. COVID infection leaves lasting mental health consequences[2]. These can arise directly from viral brain infection or the trauma of the illness experience itself, let alone the impact of chronic post viral physical illnesses that seems to characterise this disease. This is before we even consider the effects of grief as many would lose cherished love ones and the impact of the fear in the community that widespread viral spread will have.
Finally, what about the mental, as well as physical health, of healthcare workers. Hospitals around Melbourne (and in many places in the world) have growing numbers of infected workers, and many sidelined due to possible exposure. The job of caring for the community, people presenting with COVID as well as with strokes and heart attacks, is falling on the shoulders of a shrinking workforce, who also have families at home worried their family member will fall ill, or bring COVID home.
Increased rates of infection resulting from relaxing restrictions will have direct impacts on the mental health of individuals, their families and marked adverse consequences for health care workers. And the status quo is also unacceptable. The current rate of daily new cases in Melbourne (400- 700 per day), pales by comparison to some places in the world but is not sustainable for the health system or society in general.
For these reasons we have “simply no choice”. We have to act aggressively and with the cooperation of everyone in the community. The government has no choice but to impose strict sanctions on all of us, especially constraining the behaviour of those who cannot see the impact of their actions on others.
Regardless of what we do we are going to end up with a major hit to the economy and significant widespread mental health issues. However, one option leads us to also have an overwhelmed healthcare system, deaths and illnesses in healthcare workers and higher rates of physical and mental health illnesses directly related to COVID infection. I don’t want to be part of a society that chooses this option in the misguided belief that it is the pathway to sustain corporate profits and the share market. Or in the mistaken, but perhaps more well intentioned belief, that it is the way to support mental health.
To support mental health we need generous financial supports to mitigate income loss, extensions of health care programs to ensure all members of society have timely and affordable access to mental health support and a united society dedicated to finding all the innovative ways we can to support one another. We would be much better off channelling our energy in these directions than in these debates.
[1] https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html
[2] https://www.sciencedirect.com/science/article/pii/S0889159120316068
