For several weeks there has been much media coverage on the effects of the Coronavirus on mental health, even references to a future ‘mental health pandemic’. Although it is important that concerns about mental health are being raised, the use of expressions like ‘mental health pandemic’ or clichéd and generalised references to ‘PTSD’ or ‘suicidal risk’ risk causing unnecessary alarm and confusion.
At Grespi we hold the view that a clinically-based, cool-headed approach is necessary to evaluate the current situation and plan adequate responses. This is important for HR managers during the current phase of lockdown and, even more so, over the next few months as restrictions are relaxed.
Pandemic and mental health conditions
Grespi clinicians have no doubt that fear of infection and psychological, economic and social concerns are having an impact on the mental health of the population. However, experiencing psychological difficulties does not automatically equate to suffering from mental health conditions in the diagnostic terms of the International Classification of Diseases and Related Health Problems – 10th edition (ICD-10). This is because it is an evidence-based epidemiological fact that most people are able to recover from demanding psychological situations without developing mental health conditions.
However, as we wrote in our news release on 20 March 2020, some people can develop mental health conditions that may be causally linked with the pandemic. These conditions typically fulfil the diagnostic criteria in ICD-10 terms for adjustment disorders.
Stressful situations (such as the multi-faceted aspects of a pandemic) can also expose pre-existing and underlying psychological vulnerabilities in ‘at risk’ people. This can, in turn trigger the development of fully-fledged mental health conditions – whether in the form of a first episode or a relapse of a past condition.
It is therefore reasonable to assume that the accumulation and persistence of stressors over a period of time will result into a noticeable increase in the rate of ICD-10 mental health conditions over the next few months.
Mental health conditions and mental health services
It is important to note that, should even a small increase in the rate of mental health conditions occur, it is highly unlikely that NHS specialist mental health services will cope, as they have been depleted of resources over a long time and struggled to cope from far before the pandemic. In addition, a recent initiative taken by NHS Trusts to divert entry-level psychological services (such as IAPT) to diagnosing and treating ICD-10 mental health conditions is unwise, as specialist mental health work goes far beyond their level of expertise.
In the private sector, counsellors/EAPs/basic-grade CBT therapists/charity ‘volunteers’ are referred to by the media as preparing for the expected spike of mental health conditions. This is a further source of concern, as these services are not professionally equipped to provide specialist assessments and treatments for ICD-10 mental health conditions.
Recommendation for HR managers
Grespi clinicians strongly recommend that, when it becomes apparent to HR managers during the next six-to-eight months that employees have become mentally unwell, they should consider requesting a specialist occupational mental health assessment without delay. This is because untreated mental health conditions, combined with aggravating and/or perpetuating stressors (such as the psychological, economic and social impact of the pandemic), are likely to become more severe and quickly entrenched – with return-to-work prospects becoming much more difficult to materialise.
We would like to reiterate that occupational mental health assessments should not be carried out by generic occupational health services, as it is extremely unlikely that occupational health clinicians are also mental health specialists. In other words, they are not professionally equipped to formulate diagnoses in the mental health field and provide clinical evidence-based advice to HR on fitness for work and to attend employment-related meetings; reasonable adjustments and return-to-work prospects.
As with most occupational mental health concerns, an important first step is the triage of potential referrals. This should be conducted jointly by HR and occupational mental health specialists, and in many cases, employment lawyers.
Dr Lorenzo Grespi and Dr William Badenhorst
1 June 2020