Mental health in the COVID pandemic: searching for historical comparisons

I was struck by this week’s variously-reported claim from Adrian James, the current president of RCPsych, that the pandemic is “the biggest hit to mental health since World War 2” (Mail Online) or “poses the greatest threat to mental health since second world war” (Guardian). My initial response was heartsink – yet more melodrama with yet another wartime analogy, especially something I could do without as plucky Britain goes it alone again as we leave the EU. But then I got thinking – where would you look for comparator epochs if you wanted to take this claim at face value? Two candidates come to mind; each covers 5 years.

The threat

First up, the post-war years 1947-1951. Winter 1946/47 was one of the worst winters on record, exacerbated by a fuel shortage for which the Labour Govt (personified in Manny Shinwell) was blamed, at least by the press. Industrial output is estimated to have fallen by 10% in the following year. The Labour Party held on at the 1950 general election but lost the snap election called the next year. In that year, 1951, there was a major influenza epidemic which is estimated to have increased all-cause mortality in those over 65 years by about 50% and causing the greatest number of excess winter deaths in any year in the second half of the twentieth century. Peak death rates in Liverpool were higher than during the Spanish flu epidemic of 1918.

My runner up is the years 1980-84. Thatcherism had a grip and there was social unrest with riots in 1981 in Brixton and Toxteth. On the economic front unemployment ran at 2.5-3 million (more than 10% of the working age population) and the hugely disruptive and divisive miners’ strike dominated 1984.

Set against these threats we have to ask about resilience in the population. The post-war years saw continued rationing and poor housing and poor physical health at levels we go nowhere near approaching. The NHS was founded but will have had little impact on mental health provision. It is difficult to know what to make of any sense of national unity and social solidarity at this time; much is made of growing disillusion with Attlee’s government but in 1951 they still gained more of the popular vote than did Churchill. They lost to our electoral system. Society in the 1980s was more affluent and physically healthier and the NHS had grown hugely, but it was undoubtedly troubled. Thatcher was a divisive leader of a divisive government, notwithstanding populist moves like selling off our social housing and privatising services in support of the idea of a laughably-named share-owning democracy.

The hit

So, there are elements of our current predicament in these previous epochs. How could we judge each in terms of their mental health impact? I find this pretty much impossible to say and we don’t get a clue from the press coverage. As with all NHS bed numbers, psychiatric bed numbers have fallen dramatically from about 155,000 (1953/54) to 67,000 (1987/88) and 18,000 (2019/20) so numbers of admissions won’t help. The Mental Health Acts of 1959 and 1983 will have dramatically changed practice and patterns of service delivery. The only robust measure of population mental health – the suicide rate – has fallen pretty steadily over the decades, with the most consistent evidence for deterioration coming at times of economic recession and mass unemployment.

It would be interesting to see a thoughtful analysis of these questions about the nature of major social upheavals and their consequences for mental health, but if it’s going on it’s not making it into the public domain. A note from March 2020 states that SPI-B received input from academic specialists in history; that committee’s terms of reference for October 2020 do not mention historians as one of the academics from whom advice is being sought.  What a pity.