The mental health of the nation has never been so under threat

Posted by Fiona Duncan, Postdoctoral Research Associate, Durham University

Lockdowns and self-isolation, increasing care demands, concern for others, and ongoing uncertainty are exacerbated by a reinforcing 24-hour news and opinion cycle, playing havoc with our stress and anxiety levels and battering our overall sense of wellbeing. The coronavirus crisis.

However, for many people across the country, a feeling of their wellbeing being under attack is not new. Experiences of overwhelming debt, long-term unemployment, insecure housing, poverty, food insecurity, social isolation lasting months or years and/or discrimination are common and can collectively chronically diminish the mental health of the public as a whole.

These normal and extraordinary circumstances raise the question of how the mental health of an entire population can be supported, or in other words, how can we improve public mental health (PMH)? Over the past year, I have had the privilege of investigating this complex question in detail within Fuse.

My work has primarily involved mapping interventions currently being delivered to improve PMH, exploring models of good practice and searching for emerging innovative ideas. This focused on two areas – Blackburn with Darwen, and Redcar and Cleveland – which were selected on the basis of mental health statistics and varying characteristics (e.g. rurality, deprivation etc.).

I found this mapping exercise a great opportunity to get out and about and talk to people who organise and deliver projects to improve PMH on the ground in their local area. I spoke to a lot of very helpful people who were very passionate about the work they did and it was inspiring to hear about the variety of innovative projects that were being provided for people in these local authority areas to promote good mental health and prevent mental illness.

One of our main findings was that interventions to prevent social isolation and loneliness by providing various social activities were most common. This may reflect how recent campaigns surrounding reducing social isolation in older adults have influenced policy. Although a multitude of individual, family, community and structural factors influence PMH, not all of these were addressed. Does this suggest a wider variety of interventions are required in the future or would it be better to develop interventions which have the ability to target multiple factors at the same time? For instance, interventions which increase social networks within society, self-confidence or self-efficacy may enable people to deal with many different threats to their mental health without having to use a specific service.

An interesting finding of this mapping exercise was that a lot of these interventions either hadn’t been evaluated at all or only a very basic evaluation had been carried out so there was very little objective evidence regarding their effectiveness. This is something we hope to address in the next phase of the project by carrying out in-depth evaluations of promising interventions, including their potential to be delivered on a larger scale.

One final finding from this mapping that seems more relevant now than a month ago is that very few of the public mental health interventions could be delivered exclusively online. The implications of this are that the vast majority of the projects that we identified will most likely be suspended and many people who depended on this support will be left to cope alone. Moreover, people who are currently struggling with the isolation of lockdown have reduced options for help. Although Public Health England has published online guidance for the public on the mental health and wellbeing aspects of coronavirus there is an urgent need for supporting remote delivery or new online interventions within the next few weeks (of course, recognising that not everyone has access to these).

We also need to consider what we are all going to do when the COVID-19 situation is over. Will the country’s mental health bounce back to normal levels without any help, perhaps benefitting from the shared sense of community and new ways of living and working developed during the crisis? Or, will we need to work hard to develop and deliver services at the individual, family, community and structural levels to repair the damage that has been done to the mental health of the nation?


This work was part of WP4 of phase one of the NIHR SPHR Public Mental Health programme.  Information about the wider programme is on the SPHR website and was a collaboration of researchers based at Fuse, UCL, Imperial College London and Cambridge University.