The mental health challenges of coming out of lockdown

In the 30 years I have worked in social care and housing, rarely has the position for people with mental health problems seemed more fragile. Service users and service providers were all worried about coronavirus and going into lockdown, but from a mental health perspective it seems to be only now that the scale of the real issues is emerging.

The coronavirus has had so many impacts on all our lives, starting with the tens of thousands of people who have died in the UK alone and continuing with the wider social and economic impact which will be felt for many years to come. There can’t be anyone reading this who has not had their life impacted economically, socially or in terms of their mental and physical health. And as we come out of lockdown, psychological distress is emerging in various ways.

Advance specialises in the supported housing sector, providing housing and support services to people with mental health conditions and learning and physical disabilities. We are seeing services and agencies stretched to the limit by the very real mental health challenges people are facing. The mental health emergency is real and it is impacting everywhere.  

Throughout the pandemic, like many other housing associations, we have introduced a large scale programme of proactive welfare phone calls to our customers. We have focused on those who may be isolated or more at risk, those shielding and those who don’t receive any other funded support. This approach has been appreciated by our tenants and shared owners. We have got to know a lot of our customers better and have built a rapport with them over the phone. Our shared owners, whom we have helped into home ownership, have particularly valued more regular contact.

We have worked hard to improve and update the information available for our customers, including on our website – notably with information about services and support to maintain good mental health and wellbeing. We have also worked hard to collate accessible information for those customers who need it. (Side note – we support Learning Disability England and their campaign in asking the government to make key public information as accessible as possible).  

Going forward we will keep doing what has worked well – a mix of digital, phone and face to face contact with our customers.

Our approach has led to some really positive outcomes.  But it is sad to report that the biggest challenge for all our customers has been the impact of isolation and reduced contact with other support services or agencies. It was inevitable that many of our customers already struggling with long-term mental health conditions have been hardest hit. The emotional and psychological distress of lockdown, and the uncertainty that comes with its release, is already translating into increased anxiety and depression and an increased reliance on alcohol in the general population, as reported by the Centre for Mental Health.

The psychological impacts are likely to be greater for those with pre-existing traumatic experiences who also face discrimination and exclusion and an adult social care system we all know is in desperate need of reform. We support the call by the Centre for Mental Health for the government to prepare for a rising tide of mental health issues this winter and invest in services accordingly. Seasonal flu, Brexit uncertainty, the end of furlough, recession and individual financial crises, as well as a potential second wave of COVID-19 are all converging and mean we must prioritise mental health support and specifically for those who are most vulnerable.

Sadly we are seeing an equal challenge for our customers with learning disabilities. Mencap recently reported that during the pandemic 69% of people with a learning disability had their social care cut when they needed it most. And many of these people are now enduring a longer lockdown as restrictions are eased for others. We join the chorus of support for reform of adult social care in this country and the seven principles set out to underpin that reform.

On a daily basis in our work at Advance we see a very real mental health emergency, sometimes expressed through behaviour which is directly harmful to self or others. As a supportive landlord, our focus is to assist the individual and work with other agencies to improve the situation. Our priority is to help everyone to sustain their home, as of course the cycle of poor mental health, harmful or anti-social behaviour and lack of continuity in housing can have a huge impact on a person’s wellbeing. Most often, this works.We manage. The individual will hopefully get support from the Community Mental Health team, there might be other services available in the area, there may be friends or family we can work with to help improve the situation. We are well used to these challenging cases and working with the police, other services and concerned neighbours to resolve them to the best of our ability.  

Sadly, during lockdown and particularly now that restrictions are partially eased, these approaches are being sorely tested. Statutory mental health services seem to be harder than ever to access, with face to face support and clinical input still very limited. When someone is seriously ill and at risk, the threshold for Mental Health Act assessments seems incredibly high. Communities struggling themselves with the challenges of the pandemic are inevitably less understanding when faced with an individual whose behaviour is challenging the social norm and may also appear to be flouting social distancing or other guidance.

So that’s the problem. What will we at Advance do about it? Lobbying and support for reform and investment, yes. But also the things that are at least partially under our own control and that we believe to be our moral duty:

• Find ways to provide assistance to our customers based on their needs – not the needs of the system. Our recent recruitment of a team of Housing Outreach Workers is a big part of this.
• Do whatever it takes to ensure people get to remain independent, in their home and in their community wherever possible.
• Be the human contact – either in person, by phone or on a video call – that people need when they’re struggling or unwell.
• Work with everyone we can to support people with mental health conditions or disabilities who are unwell so they get every chance and the right to live their best life.
• Be that link in the chain of multiple agencies who might offer support to an individual who can’t navigating the system themselves.
• Continue to work with other organisations to highlight the predicament of the people we support and seek system reform and change.
• Work with our customers to get their voices heard, so that service providers like Advance bring lived experience into their daily work and future planning.