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Adrian James (Covid represents ‘the greatest threat to mental health since the second world war’, December 27) clearly sees that a widespread problem such as the pandemic, over which most people have limited control and many potential points of vulnerability, it will likely leave a legacy of poor mental health, on a scale not seen since the Battle of the Somme. With a year to prepare, the Johnson administration has failed to promote personal resilience, a key lesson in preventing post-traumatic stress disorder (PTSD) in military populations, so this winter millions of Britons are looking forward helplessly to a really bleak time.
However, there is still one policy area that could reduce disease in the population: addressing the staggering level of health inequalities. A strong gradient of social inequality damages both physical and mental health. That damage is especially long-lasting for children “at the bottom of the heap.” James suggests that 10 million more people will need mental health services (including 1.5 million children), but there is not much chance that existing services will be so strengthened during 2021. Boris Johnson talks about leveling off children and families Like we’re all just another brick in the wall Starting at the community level, we need to ask families what would make a difference for them going forward.
As I learned when commissioning Sure Starts, hope and resistance in a population are much stronger and more durable if they are homegrown.
Woody caan
Special Interest Group for Mental Health, School of Public Health; former president of the School Health Research Group
• Having recently retired after a long career as a consulting psychiatrist, I am grateful for the increased awareness of the possible impact of Covid-19 on the mental health of the population. The statement from the president of the Royal College of Psychiatrists highlights Cinderella’s current state of mental health services compared to physical health, and reiterates the need for parity of esteem and funding.
However, apocalyptic predictions of the collapse of national mental health are based on a number of assumptions and risk medicalizing the normal and adequate human response to an unprecedented public health emergency. The Center for Mental Health’s claim that up to 20% of the population, i.e. 10 million people, including 1.5 million children, will need mental health support is based primarily on a self-reported anxiety / depression study ( symptoms or feelings, not illnesses) in March and April of this year, when many of us were understandably very worried and very unhappy. Their estimates of higher rates of anxiety, depression, and post-traumatic stress disorder in children are based on studies after human or natural disasters such as earthquakes, volcanic eruptions, hurricanes, etc., and are not directly comparable to Covid. By exaggerating the completely reasonable case for improving mental health services, there is a danger that many people who would not otherwise seek health services will put people with more serious illnesses (relapses, new-onset psychosis, drug dependence / alcohol) into a competitive disadvantage and pathologize normal human reactions to adversity. As Nils Bohr said, “Prediction is very difficult, especially when it comes to the future.”
Dr. Cliff Sharp
Melrose, Scottish Borders
• I was moved by Alexandra Topping’s article (What Impact on Mental Health of World War II Tells Us About Life After Covid, Dec 27) but I wish she had mentioned the impact on members of the military and their families during and after World War II. . A close friend and I suffered from the behavior of parents who fought in the war. Clearly, we were not isolated cases. Both of our parents emerged from the war as violent, self-destructive alcoholics who, due to cultural stoicism, rarely or never spoke of their experiences – the trauma of combat and witnessing the impact of war in Europe and North Africa.
My dad was 18 when he joined the military. He had never left Glasgow, then was catapulted onto the world stage. Can you imagine spending the six most formative years of your life like this, seeing the worst of the human race? Have to kill other young people? Fight at Monte Cassino? Pick up the pieces after the devastating bombing of Dresden and Hamburg?
I’m sick of the sentimental and patriotic nonsense of war. It has held us back as a nation because it has never allowed us to really examine the impact of that war on the generation that fought it, supported it, or the next generation of boomers. As for the use of cheap war tropes by would-be Churchill politicians to manipulate and coerce the population during the pandemic, well, we’ve already said. We need to grow and move on.
Jane easton
Bristol board
