How might COVID-19 affect people with severe mental illness?

Post traumatic stress

We heard there from Dr Stubley about what can make the current situation particularly challenging for people who have already had traumatic experiences. We heard about situations in which ongoing exposure to threat can become traumatic, and how already traumatised individuals can be affected.

Post traumatic stress is particularly topical during a challenging time such as COVID-19 and we’ll touch on it throughout the course. Those affected can include:

• People who have had coronavirus
• Frontline key workers
• People who have had Post Traumatic Stress Disorder (PTSD)
• Families, carers and colleagues of affected groups and individuals

PTSD that is ongoing or resulting from several traumas, including traumas in early life, can be classified as severe mental illness. People with such conditions may be affected by COVID-19 in different ways to the rest of the population.

Severe and enduring mental illness

It is important to consider the impact of the pandemic on people with severe and enduring mental illness such as personality disorders, schizophrenia, bipolar affective disorder, and severe forms of depression and anxiety conditions. We must be careful about drawing generalisations but many people with these conditions will be more affected as circumstances exacerbate their symptoms. People with severe mental illness can be marginalised at the best of times and so may experience even more disadvantage. We’ll discuss this more in later steps.

• Lockdown and the continual news feed of traumatic events are more likely to impact those who have experienced trauma before.

• We also need to consider how higher levels of fear can impact those who struggle with paranoia, a core symptom of schizophrenia.

• These individuals may be more digitally excluded or highly reliant on reduced services to provide social connectedness.

• At least 40% of people with severe mental illness smoke, almost three times the general population. This health risk is increased during COVID-19.

• Other health behaviours such as physical activity, diet and seeking healthcare are challenging for this group, even more so during COVID-19.

• More specific examples include ensuring that medications are adhered to and blood tests undertaken, support that may require extra thought and care.

For individuals who struggle socially, no longer joining overwhelming social interactions, attending job seeking courses, or being exposed to risk factors for drug, alcohol and other self-harming behaviours, may have brought some degree of respite in the short term.

However, the inevitable consequences of prolonged isolation, fear and uncertainty will be a particularly distressing mix for vulnerable individuals with pre-existing mental health conditions, and especially for those with existing adverse or traumatic experiences.

Why are people affected?

It is natural to ask why some people are affected and others are not. This requires an incredibly complex answer that is different for each person. However, there are some general considerations to bear in mind.

There is by no means a direct causal relationship between early life events and experiences in later life. However, some habits, templates and behaviours in adulthood can be influenced in our earlier lives. We know, for instance, that adverse childhood experiences can predispose physical and psychological difficulties later in life, including during the current COVID-19 pandemic. These could be loss, neglect, abuse and trauma, although people’s perception of these is also highly important.

We heard in Kevin’s story, for instance, that he has had to hide parts of his identity, that he had a traumatic experience in his teens and that his current mental health support has stopped.

These topics can be particularly emotive. Do check in with yourself and how you’re feeling. If it feels helpful you can add to the discussion below.