The problem with leaning more on companies to provide mental health support is that not everyone has access to such programmes.
Employee assistance programmes (EAP) are usually pretty dull affairs. For a few decades now, UK employers have paid EAP providers to run phone lines that their employees can call if they need support with personal problems. The idea is to provide some short-term support — a handful of counselling sessions, say — to help staff deal with mild problems before they get worse.
But this year EAPs have found themselves facing a swelling wave of complex mental health problems brought to them by people with nowhere else to turn.
“We were never designed to be a crisis line,” says Bertrand Stern-Gillet, who runs Health Assured, the biggest EAP provider in the UK with more than 80,000 clients. But he says “high-risk” calls have now become a daily occurrence, ranging from child or adult safeguarding concerns to someone who “might have taken a significant amount of pills or they might be standing on a bridge”. The company is hiring more staff and managers to try to deal with the rising complexity and emotional intensity of the work.
Andrew Kinder, head of mental health services at Optima Health, another EAP, ran an online seminar about bereavement for the employees of one client. He expected about 40 attendees, but 1,200 logged on. “People were actually sharing quite a lot of experiences about what they’ve gone through,” he says.
Antidepressant usage is also on the rise. In 2021/22, 8.3 million patients received at least one prescription item for antidepressant drugs in England, according to NHS data. That is 22 per cent more than in 2015/16.
What’s going on? On the positive side, people have become more comfortable discussing their mental health and asking for help. That’s an improvement on the past when “we had this undercurrent of need that wasn’t even being talked about,” says Vicki Nash, head of policy at mental health charity Mind.
But it’s clear that’s not the whole story. The loneliness, worry, grief and financial problems caused by Covid-19 and associated lockdowns appear to have damaged the mental health of people all over the world.
In the first year of the pandemic, the global prevalence of anxiety and depression increased by 25 per cent, according to the World Health Organisation. In the UK, young people are a particular concern: one in nine children aged six to 16 had a probable mental disorder in 2017; by 2021 that was one in six, according to NHS data.
At the same time, mental health services in many countries were disrupted by the pandemic and have struggled with the rise in demand. In the UK, waiting for treatment has become so common that Greater Manchester has created a service called “Waiting Well” to support people while they wait. But the longer people have to wait, the worse they tend to get. Nash says people can be turned away because they are not unwell enough to qualify for treatment, “so they have to wait until they become dangerously sick”.
One study into the experience of people on waiting lists interviewed a woman who said: “I didn’t shower, I didn’t get out of my bed because I thought in my head, I thought maybe if I stay in bed long enough someone will come and section me and then I’ll get help.”
Stern-Gillett of Health Assured says some GPs are telling patients to contact their EAP provider if they have access to one because they’re “more likely to get some kind of support quicker than NHS pathways”.
On top of that, the UK has now been hit by a severe bout of inflation and a likely recession. The people who are most vulnerable to a steep drop in living standards are those on low and insecure incomes. They are also more likely to have poor mental health — problems that often exacerbate each other.
A recent report by the Joseph Rowntree Foundation highlighted the striking link between antidepressant use and deprivation: in 2021/22, more than twice as many patients were prescribed antidepressant drugs from practices in the most deprived areas in England than in the least deprived areas.
The problem with leaning more on employers to provide mental health support during this time is that not everyone has access to such programmes. People on low pay, insecure contracts or no work at all are less likely to have such a safety net.
They will need as much help as the money-constrained state can spare. Some interventions don’t have to be very costly, such as integrating talking therapies with debt advice. Other policies that would help are already on the table but need to be implemented, such as government plans to make life in the rental sector less insecure.
Leaving people to cope on their own will store up more problems, both for them and the economy as a whole. Already, a rising share of people say they are too ill to work.
Although the over-50s are the biggest driver of this trend, there is also a worrying rise in inactive young people. For them, the biggest cause of long-term sickness is mental illness, phobias and nervous disorders, up 24 per cent since 2019.
Economic problems are hard for people at the best of times, and these are not the best of times. How well or badly we handle this moment will have ramifications long into the future.
Copyright The Financial Times Limited 2022
(Source – Irish Times – Economy – 23/11/2022)
When Do Covid Blues Become Clinical Depression?
Anxiety and depression increased by 25% in the first year of the Covid-19 pandemic.
The World Health Organisation (WHO) noted this year that anxiety and depression increased by 25 per cent across the globe in just the first year of the Covid-19 pandemic. And researchers have continued to find more evidence that coronavirus wreaked havoc on our mental health. In a 2021 study, more than half of US adults reported symptoms of major depressive disorder after a coronavirus infection. The risk of developing these symptoms – as well as other mental health disorders – remains high up to a year after you’ve recovered.
It’s not surprising that the pandemic has had such a huge impact. “It’s a seismic event,” said Dr Ziyad Al-Aly, a clinical epidemiologist at Washington University in St Louis. Health concerns, grief from losing loved ones, social isolation and the disruption of everyday activities were a recipe for distress, especially early on in the pandemic. But compared with those who managed to avoid infection (but also dealt with the difficult impacts of living through a pandemic), people who got sick with Covid-19 seem to be much more vulnerable to a variety of mental health problems. “There’s something about the coronavirus that really affects the brain,” Dr Al-Aly said. “Some people get depression, while other people can have strokes, anxiety, memory disorders and sensory disorders.” Still others have no neurological or psychiatric conditions at all, he said.
Why do some people get depressed when they have Covid?
Scientists are still learning exactly how the coronavirus alters the brain, but research is beginning to highlight some possible explanations. A few studies, for example, have shown that the immune system goes into overdrive when some people get sick. They can end up with inflammation throughout the body and even in the brain. There is also some evidence that the endothelial cells lining blood vessels in the brain become disrupted during a bout of Covid-19, which may inadvertently allow harmful substances through, affecting mental function. And cells called microglia, which normally act as the brain’s housekeepers, may go rogue in some patients, attacking neurons and damaging synapses, Dr Al-Aly said.
It’s possible that Covid-19 may even compromise the diversity of bacteria and microbes in the gut. Since microbes in the gut have been shown to produce neurotransmitters like serotonin and dopamine, which regulate mood, this change could be at the root of some neuropsychiatric issues.
Who is most at risk?
One of the biggest risk factors for developing depression after Covid-19 – or after any major illness – is having a diagnosed mental health disorder before you get sick. People who had severe Covid-19 symptoms and had to stay at a hospital during their illness also have increased chances of depression, said Megan Hosey, a rehabilitation psychologist who works with ICU patients at the Johns Hopkins Hospital.
According to WHO estimates, young people are disproportionately at risk of suicidal and self-harming behaviours after Covid. Women are more likely than men to report mental health effects after the disease. And people with pre-existing physical health conditions, such as asthma, cancer and heart disease, are more likely to develop symptoms of mental disorders after Covid.
Additionally, people who experience extensive sleep disruption, social isolation or a significant change in other behaviors, like the amount of alcohol they consume or the type of prescription medications they take, may be more likely to face depression after the physical symptoms of Covid-19 fade away. “We know that having additional stressors on your plate can predict depressive symptoms later on,” Hosey said. Some studies suggest that people who experience these stressors may be more vulnerable to developing long Covid in general.
When do Covid blues become clinical depression?
While you are in the thick of things, fighting off viral infection, it is normal to feel tired and headachy. “When you feel physiologically terrible, it can interfere with your mood,” Hosey said. “I would never diagnose somebody with a clinical depression in the acute phases of a Covid infection.”
But if your exhaustion and feeling of being overwhelmed persist for two to six weeks after your Covid infection and start to interfere with day-to-day activities or negatively affect your relationships with others, it could be a sign of depression, Hosey said.
Some people with depression may also experience persistent sadness, tearfulness, irritability, changes in appetite or weight, trouble thinking or concentrating, or feelings of immense guilt, worthlessness or hopelessness. Those with severe depression may think frequently of death and develop suicidal ideation, Hosey said.
What can you do to treat depression after Covid?
If you are concerned that you or a loved one may be experiencing symptoms of depression after a Covid infection, it’s important to talk to a medical or mental health professional. “Not everyone will need to see a psychiatrist to be evaluated for depression,” Dr Al-Aly said. People can share what they are going through with their primary care doctor to get help as well, he said. “The most important thing is to seek help. And seek help sooner rather than later.”
Depression is not something you can typically shake off on your own, Hosey said. It can be tempting to use online resources and self-diagnostic screening tools and to order supplements that promise to calm Covid-related inflammation or repair your gut health. But many of these interventions are not reliable or backed by evidence.
It is a good idea to take stock of your diet, sleep and drug and alcohol use. Consuming more nutritious foods and setting up a good sleep routine, for example, may have a small positive impact on your mental health. Research suggests that exercise and meditation may also help heal the mind in some cases. But if behavioural changes don’t work, a professional can recommend therapy or medication, depending on your needs.
This article originally appeared in the New York Times
(Source – Irish Times – Health & Wellbeing – Knvul Sheikh – 20/11/2022)