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Science & research / Public health

Experts demand real-time monitoring to help safeguard mental health in crisis

By Andrew Sansom 16 Apr 2020 0

A 24-strong group of psychologists, psychiatrists, neuroscientists and public health experts have warned of the deep impact that the COVID-19 pandemic could inflict on the mental health of individuals and populations, and urged an international response from multidisciplinary mental health science research.

Authoring a position paper in the Lancet Psychiatry, the interdisciplinary group – from the UK, United States, Sweden and Australia – were convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health. 

They have outlined a research roadmap to help people stay mentally healthy through the pandemic and called for real-time monitoring of mental health to be rolled out urgently in the UK and globally. Frontline medical staff and vulnerable groups must be a priority for mental health support, they say, while digital apps and remotely delivered programmes must be designed to safeguard people’s mental health.

The paper warns that the COVID-19 pandemic could have a “profound” and “pervasive impact” on global mental health now and in the future, yet a separate recent analysis shows that so far, only a tiny proportion of new scientific publications on COVID-19 have focused on mental health impacts.

Two recent surveys – an Ipsos MORI poll of 1099 UK individuals, and a survey of 2198 people by MQ – have revealed the general public’s disquiet about mental health in relation to the pandemic. Both surveys were carried out in late March, the week lockdown measures were announced, and have been used to inform the paper. They showed the public had specific concerns related to COVID-19 including increased anxiety, fear of becoming mentally unwell, access to mental health services, and the impact on mental wellbeing.

Prioritising vulnerable groups
Paper author Professor Emily Holmes, from the Department of Psychology, Uppsala University in Sweden, urged governments to find evidence-based ways to boost the resilience of societies and find ways to treat those with mental ill health remotely during these uncertain times.

“Frontline medical staff and vulnerable groups, such as the elderly and those with serious mental health conditions, must be prioritised for rapid mental health support,” she said. 

The paper calls for ‘moment to moment’ monitoring of anxiety, depression, self-harm, suicide, as well as other mental health issues in the UK and global population. It also calls for the rapid rollout of evidence-based programmes and treatments, which can be accessed by computer, mobile phone or other remote ways, to treat mental health conditions and increase resilience among communities.

Co-author Professor Matthew Hotopf, vice-dean of research at King’s College London’s Institute of Psychiatry Psychology & Neuroscience, and director of NIHR Maudsley Biomedical Research Centre, said: “This paper gives us a research roadmap to help protect our mental health at this incredibly difficult time and in the future. 

“We are calling for real-time monitoring of mental health of the population to develop effective treatments. This needs to be on a bigger scale than we have ever seen previously, and must be co-ordinated, targeted and comprehensive to give us an evidence-based picture of what is really going on in societies around the world. 

“Knowing what is happening in real time will allow us to respond by designing more user-friendly and effective ways to promote good mental health while people are in their homes. Above all, however, we want to stress that all new interventions must be informed by top-notch research to make sure they work.” 

Understanding what builds resilience
The paper stresses there will be no ‘one size fits all’ approach to keeping people mentally healthy. It also calls for research to understand what makes people resilient in the face of this crisis, and actions to build resilience in society – whether supporting people to sleep well, be physically active, or do activities that improve their mental health. The surveys carried out in March suggested many people even then had started activities to boost their mental health, such as prioritising family time, staying connected, connecting to nature, and exercising.

Study author Kate King MBE, an advisor on lived experience to The Mental Health Act Review 2018, and who has personal experience of severe depression, said: “The digital age, for all its problems, has bestowed a real gift: social media, the internet, video and phone meetings mean that social communication and research can continue in a way that would have been impossible even 20 years ago. 

“We’re all in this together so, at this time, it’s essential that researchers continue to listen and work with people with lived and living experience to help those living with mental health challenges.”

Study author Professor Ed Bullmore, head of the Department of Psychiatry at the University of Cambridge, added: “To make a real difference we will need to harness the tools of our digital age – finding smart new ways to measure the mental health of individuals remotely, finding creative ways to boost resilience, and finding ways to treat people in their homes. This effort must be considered central to our global response to the pandemic.” 

Research into the effect on the nervous system 
The paper notes, too, that “almost nothing is yet known with certainty about the impact of COVID-19 on the human nervous system”. But, as other coronaviruses have been shown to pass into the central nervous system, the paper recommends research to monitor and understand whether COVID-19 also has effects on the brain and nervous system. It calls for a new database to be set up to monitor any psychological or brain effects of COVID-19 and for research to look at the way the virus could enter the nervous system.

Previous outbreaks of infectious disease have been known to have an impact on mental health of the population. The SARS epidemic, for example, was associated with a 30-per-cent increase in suicide in over-65s and 29 per cent of healthcare workers experienced probable emotional distress. Authors stressed that an increase in suicides as a result of the COVID-19 pandemic was not inevitable, but that monitoring and research is needed urgently.

Professor Rory O’Connor, Professor of Health Psychology at the University of Glasgow, and another of the paper authors, said doing nothing would risk an increase in mental health conditions such as anxiety and depression, and a rise in problem behaviours, such as alcohol and drug addiction, gambling, and cyberbullying, or social consequences, such as homelessness and relationship breakdown. 

“The scale of this problem is too serious to ignore, both in terms of every human life that may be affected and in terms of the wider impact on society,” he said. “Despite this situation making some of us feel trapped, it shouldn’t make us feel powerless – we can make a difference if we act now.”

The paper calls on UK research funding agencies to work with researchers and people with experience of the mental health impacts of the pandemic to create a ‘high-level co-ordination group’ to ensure these mental health science research priorities are tackled as a matter of urgency.