Addressing declining mental health at a population level: three key themes for IPPO to explore

IPPO recently brought together people working in mental health policy from all corners of the UK to consider this question: What are the most effective, scalable interventions to address widespread mental health issues that have surfaced during the COVID-19 pandemic?

Eleanor Williams

There is no doubt that our collective mental health has suffered during the COVID-19 pandemic. We have seen spikes in rates of stress, anxiety and depression at the population level, negative impacts on people with existing challenges such as eating disorders, increases in reported loneliness, and a general decline in reported wellbeing that will no doubt be familiar to many.

This has not gone unnoticed by academics or policymakers. Governments internationally are investing in strengthening their existing mental health supports, and urgently building the pipeline of mental health workers. But our existing systems are not made to expand and extend at short notice.

When facing these challenges, policymakers would generally draw on the evidence of what works. However in unprecedented times such as this once-in-a-lifetime pandemic, this means creatively bringing together evidence to determine a logical path forward.

This is precisely the aim of the International Public Policy Observatory (IPPO): to mobilise and assess evidence to inform policymakers from all over the United Kingdom about the best ways to mitigate social harms associated with COVID-19.

To meet this aim in relation to mental ill-health, IPPO is conducting a systematic review of international evidence considering the question: What are the most effective, scalable interventions to address widespread mental health issues that have surfaced during the COVID-19 pandemic?

IPPO recently brought together people working in mental health policy from all corners of the UK and a range of perspectives to consider this question – including academics, policymakers, think-tanks and intermediaries. The discussion aimed to guide and refine the review question and scope, and drew out three major themes for the review team based on emerging evidence.

1. We need to consider mental health outcomes by cohort

Mental health outcomes are worsening overall but the impacts should be considered by age, gender, ethnicity and even profession.

A range of quantitative studies have shown that the severity and duration of the mental health impacts vary between cohorts. At a more practical and tangible level, participants in the roundtable talked about the specific needs of a range of groups including, for example, the very young and the elderly, medical professionals, people with compromised immune systems. While the elderly living in care may be experiencing heightened loneliness, health workers may be dealing with burnout and fatigue and these differing experiences need to be considered separately.

2. We need to consider mental health outcomes by location and context

Location and context matter not only due to the differing impact of COVID-19 but also because of the available funded services. We heard from participants that, for example, England has invested heavily in Improving Access to Psychological Therapies (IAPT) but this is not available in Northern Ireland, Scotland or Wales.

There are also regionally observed differences in mental health outcomes. People in urban areas appear to have been more affected than people in rural areas in general which is not surprising given generally greater prevalence in densely populated cities and the consequentially more severe impacts of the pandemic.

3. We need to consider innovative and promising interventions

Roundtable participants were at pains to communicate that lack of evidence does not equate to lack of effectiveness when it comes to new and novel interventions to improve mental health. Any review of the evidence needs to recognise that some interventions, including activities to improve mental health through community engagement and activation, may not be rigorously tested through randomised control trials or robust evaluation techniques but nevertheless provide positive mental health outcomes for participants.

Stay informed

The IPPO review team will be using this input to guide the development of the systematic review which will commence early in the new year under the guidance of a multi-disciplinary advisory group. If you would like to stay informed as the review progresses, please contact the head of the IPPO review team, Kelly Dickson, at k.dickson@ucl.ac.uk

Eleanor Williams is Executive Director at the Victorian Department of Health