Thanks to COVID-19 we may well be on the cusp of a public mental health crisis. The ONS (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/
healthandwellbeing/bulletins/coronavirusandthesocialimpactsongreatbritain/
latest#understanding-the-impact-on-society) reports that 48% of adults feel their well-being has been affected by COVID-19, with evidence of a continuing upward trend, while 31% of those whose well-being has been affected said it was making their mental health worse. Grief, loneliness, uncertainty, an inability to access health and social care, and rising levels of domestic abuse are only some of the factors that are affecting people’s mental health right now. Many I am sure will have seen the following chart indicating the potential size of this harm relative to other aspects of the COVID-19 crisis.

4 waves of impact

Yet, this picture is in many ways misleading, there is no data behind it, but merely a hypothesis about how the present situation will unfold, put forward by Dr Victor Tseng, a Pulmonary & Critical Care Physician.

In reality, the impact of COVID-19 on people’s mental health will depend greatly on how we respond to it. That is why a group of psychologists and I have put together a briefing note through the Association of Liberal Democrat Engineers and Scientists arguing how we could combine health, education and social policy interventions to form a a compassion based approach to recovery and resilience (http://www.aldes.org.uk/public-mental-health-and-covid-19-a-compassion-based-approach-to-recovery-and-resilience/).

Our work starts with the important fact that not all experiences of COVID-19 have been negative. For many, this crisis as offered opportunities to connect with the local community, reconnect with loved ones, reflect upon their lives and make changes that they have been putting off for years. Often these positive experiences arise in-spite, or even because, the challenges people have faced. Acknowledging and validating these positive experiences does not mean ignoring or invalidating the many negative aspects of COVID-19, quite the opposite, it helps us to understand better why so many are suffering right now, and what we can do about it.

This understanding is the very essence of compassion, which it is important to understand as a psychological motive, not a feeling. Those who have taken on caring responsibilities during COVID-19 have not been compassionate because they are ‘nice’ or ‘heroic’. Rather, many doing this work are forced into it as the only way to make ends meet. Yet they exhibit compassion when they exhibit the courage to seek to understand the suffering of others and the wisdom to find suitable ways of addressing it.

However, the psychological study of compassion reveals that it is not only something that is good for other people, but rather essential for achieving and maintaining good mental health. Roughly speaking, people have three systems (developed during different periods of evolution) to regulate their emotions: a drive system to seek out food and mates; a threat system to detect and respond to danger; and a caring system to create social groups of mutual aid and support. When people engage just one or two of these systems this often leads to unbalanced and unpleasant emotional experiences. Western culture has done much to stimulate the drive and threat systems, and downplay the importance of care, and much about COVID-19 has reinforced this message. However, when we respond by coming together and helping one another this helps to bring our regulation systems into balance and can turn threats of post-traumatic stress into opportunities for post traumatic growth.

Another impact of cultivating compassion is to help people to develop a compassionate self, a positive identity that mediates between individuals and things they feel threatened by (including not only COVID-19 itself, but threats of unemployment or isolation). This helps people to focus their attention away from the stress inducing natural ‘fight and flight’ reflex towards more productive responses of reinforcing personal relationships (tend and befriend), preparing for future challenges (rest and digest).

So, what can we do at the national level to encourage greater compassion? Firstly, we need to actively avoid knee jerk reactions to the threat of a widespread mental health emergency. For instance, many people who come across this idea too often without putting it into context or suggesting ways forward may simply feel even more threatened by COVID-19 than before, or even worse may feel that anything but suffering and anxiety is somehow an incorrect response. Disaster scholars have for decades shown how disasters can have good effects as well as bad ones. However, psychologists and psychiatrists too often only care about negative effects and are willing to overdiagnoses them, and overprescribe whatever remedy is in fashion at the time. So the worst thing we could do would be to role out some one sized fits all mental health strategy that makes people feel that if they aren’t currently sertraline and CBT, there must be something wrong with them.

Rather we propose offering a far wider range of interventions, including through non-medical channels like occupational health and social care. This will also be the easiest way to increase the supply of interventions in what is already an underfunded and understaffed area of health. For obvious reasons, we believe it would be especially helpful for the government to increase access to to compassion focused approaches to mental health promotion, including Compassion Focused Therapy, both as clinical interventions and tools for public mental health.

However, this is more than a healthcare issue. Children and young people are especially vulnerable to negative mental health impacts from COVID-19 due to many factors: living with stressed, frustrated, angry, anxious, or withdrawn parents; missing peer group relationships; and disruption to their educational. Families, schools, and mental health services all have a responsibility to address these challenges. Enhanced stress from the pressure to perform academically also needs to be considered, especially for those coming up to examinations.

Finally, pro-social attitudes, economic equality and empowerment are crucial to ensuring societies bounce back after disasters; while a sense of attachment to what has been lost or threat from how much has changed make communities less resilient. Policies and rhetoric, that inspire compassion as the social change process that many wish to see, can offer a framework for guiding major social and political change. Now is a great time for ambitious and creative thinking: such as developing proposals for a Universal Basic Income; providing more support for businesses that are willing to take on a social purpose (https://www.compassioninpolitics.com/
hotels_and_charities_urge_government_to_support_domestic_abuse_survivors); and rethinking our approach to many aspects of social policy in a post COVID-19 world. Evidence suggests that these can have an extreamly significant impact, not only on our economy and people’s standard of living, but on our culture, communities and people’s quality of life. For instance, initial results from the Finnish pilot study of a Universal Basic Income found that improvements in people’s wellbeing and mental health were amongst its main benefits (https://stm.fi/en/article/-/asset_publisher/perustulokokeilun-tulokset-tyollisyysvaikutukset-vahaisia-toimeentulo-ja-psyykkinen-terveys-koettiin-paremmaksi), along with poverty reduction and higher levels of employment.

Our paper on compassion and mental health was produced entirely independently of Layla Moran’s very similar recent messaging (https://leftfootforward.org/2020/05/layla-moran-after-the-crisis-heres-how-we-build-a-fairer-country/), yet it is clear that there is a lot of overlap. It is very easy for people to dismiss this kind of talk as lacking substance. However, we can confirm that there is a considerable body of work across psychology, sociology, disaster studies, and even economics, to back up the importance of treating the mental health impacts of COVID-19 with compassion, not only within mental health settings but across society as a whole.

* Simon Beard is Academic Programmes Manager at the Centre for the Study of Existential Risk and a two time PPC for Dartford. He lives in Cambridgeshire.