Mike Armiger: Mental Health Post-Pandemic

I work strategically both on the ground with regards to mental health services, with a special focus on trauma in psych, and also within education environments. I float between all those things doing strategic advising and implementing trauma informed practice and care. I also work with in crisis teams and suicide prevention as well.

So, how has the last year been? I'm not going to lie, it's been tough. I think tough on staff, especially those working in ICU and acute settings and those working social care. Obviously, education and teachers have had it really rough as well, in terms of the amount of support the schools have had to offer. In psych, it has been incredibly intense and challenging.

I think one of the things that is strange, is that many staff members are existing in two spaces, two different worlds. I can be on shift in a day and see lots of different things happening and then I think about what happens after the pandemic. As it comes towards an end or in its closing stages and we are looking at an endemic, I think we have got so much to do in terms of backlog workloads. But then also step out into public with everybody else and go “I can't wait for the restrictions to end”. It is trying to do both that is quite strange sometimes. There is a lot of exhaustion and because of the nature of the amount of work that we must do and the bandwidth of tasks that people have to do every day, on top of the workload that we already had, that increasing volume is challenging and I’m starting to see the effects it is having.

For people that I have met, and I’ve spent time with both in and out of services, amongst a number of other things, grief has been a significant theme every single day. The other thing which has become quite prominent, as well as the amount of people who are feeling very anxious about the different stages of both isolation and then reintegrating, is that a lot of people who were struggling pre-pandemic and who were finding ordinary life quite distressing anyway, have commented on how they sort of feel that other people are now in the same boat as them. They feel that people have stepped into their world for a period of time, because they find the world quite overwhelming a lot of the time, there are now more people in their boat. So that has been interesting.

I think the picture that I paint at the moment is that there are a lot of people in need and who are struggling, but I think we're still trying to identify what those needs are. My biggest concern is not just the people that are contacting services and saying they are struggling but the people that aren't. That, for me, is one of the big effects we have seen. We see that there are a lot of people who know how overwhelmed the NHS is and so are not getting in touch with the services. That worries me. I think about what state people might be in when we do eventually get to them, so there are lots of different things that are starting to unfold.

Now, I wouldn't say that it is absolutely like a war zone, every day. In the initial stages, it was very much like that because we weren't sure what was going on and things were quite chaotic. Now things have calmed down quite a lot, we've got a little bit of a flow and routine and we know what's going on. I’ve spent some of my time supporting ICU colleagues, sitting with them and talking about the things that they've seen or witnessed and how that's affected them. We have got a lot of people who've been profoundly affected, but these people are still having to juggle a huge workload. So it's been really tough.

At the start of COVID we were told we would see the need rise straightaway and that there would be a huge amount of people in distress almost immediately and, of course, there were people that were distressed immediately. But one thing I said at the start, and I got criticized quite a lot for it, was that we wouldn't see the effects immediately. Evidence from around the world, from different environments and countries where there have been environmental disasters, where people have lost homes and lots of adverse events have happened. The evidence and studies from those areas very clearly says, that people actually struggle when they get to the point of pandemic fatigue. It tends to kick in probably around a year later as to what is happening, because everybody is so busy just surviving, regulating and just trying to cope. Then what happens is that people start to contemplate what has happened to them and how they have been affected and it's at that point that things start to get difficult.

So, are we seeing a bit of a wave now? I would say that there is evidence in my day-to-day work and from conversations with services, that there is starting to be a greater emergence of need. But we should also be clear that needs will not all arise at the same time, it will probably arise over a period of time. People will probably get to the end of the pandemic and then drop everything and go “Oh my gosh, I can't believe all of that happened”, because they have just started to process it. Take COVID aside, it is the same as when something happens to you as an individual. Say something might have happened to you at the age of 13 but you just cope as you need to survive, it might not be until the age of 36 that the penny drops. It is when people stop and reflect that sometimes the distress can set in. Conversely, there are some people who are fatigued and really struggle because they've been dealing with it with a huge level of distress for a long period of time. So, I would say that we have got to think about this as a long-term picture.

What will happen is after this is finished? Lots of different things will start to kick back in, community events, political events, social life, economics… it will be over the next couple of years, that we will have to think about how we recover from this collectively. From all the evidence that we have looked at, it suggests that the needs are going to emerge within the next 24 months, rather than the next couple.

One of the other things I’ve been made aware of is how difficult the dynamics are within families, around COVID restrictions. I know myself, and many of my colleagues, have had to have exceedingly difficult conversations with family and friends because we are ultimately working with people, patients, vulnerable people, who sometimes do not have the level of support, safety, and reassurance that we do. So obviously our thought is not just for us, it is about them too.

With the introduction of hugging, it is interesting because a lot of people I’ve spoken to have said there's no way they’d feel comfortable in doing that. There are also a lot of people who didn't like hugging anyway so are actually quite content with the way things are. As we start to go back to normal, there are going to be people who will see that re-emergence of anxiousness around certain things, like hugging, but also there will be people, like myself, who would absolutely love to give you a hug. Sadly, I still have to think about the different people in my care on a day-to-day basis so will probably have to opt out. But this is something that is not easy for some people to navigate, especially when it’s family and friends saying “What are you talking about? Don’t be silly were alive. Do it.” People’s anxiety levels about opening back up are increasing, ultimately just because somebody said it is okay to do so, does not mean you feel it's okay. So, I think we need to be mindful of how we reintroduce people back into those spaces and we need to think about it gradually and over a period of time.

I think one thing that has very much been overlooked is people who were shielding and who have not been able, yet to have their full restrictions lifted. There are a lot of young people who have autoimmune difficulties or other complexities and health conditions that mean that they cannot interact with people yet or they have got to care for somebody else so can’t. So, we have also got to be mindful of those people and how they must be feeling. They haven't been sat down watching TV for the whole of the lockdown, they've been really concerned about their health or the health of the person they care for. That in itself, having to sit with that level of stress every day, is draining.

I spent the last couple of days with a lot of new parents. As a new parent the first thing you think about is, how you can spread spirits and share that joy with other people. Also, who can you get to help so you can sleep. For many people that has been entirely impossible for them. They have not been able to share their children with others, literally in terms of looking after them, but also in terms of the feeling of joy.

Young people's education, at university level, is also something I've been really concerned about and mainly freshers who are first years coming into living in halls. They have not had the opportunity to meet people from their course, they weren't able to go around all the different societies, meet people, sign up to everything and then eventually meet their tribe and find out where they fit. They have not had that process and on top of that, they have had to sort housing out for next year! I remember thinking in September, October how strange that must be in the middle of a pandemic to think about who you are going to live with next year, when you haven't even got through your first year in the time of COVID, I mean that's just odd.

However, children, I think, have borne the brunt of it for multiple different reasons, one of them being education. I do not agree with the catch-up narrative that is being floated around academia at the moment. I think it is really damaging to children, to tell them that there are the COVID generation, and they are going to be lost forever in the abyss of the world. It is just not helpful for anybody. Children have also missed out developmentally. There are lots of different experiences that they have not had in those formative early years, there are gaps and I think that is a problem. Some of these problems were there before the pandemic too, so they have just broadened. What we now need to think about is, if there is a larger gap, what we want to create in terms of the way we support them going forward and what systems we have in place to allow them to thrive even more.

One of the things I talk about quite a lot is therapeutic communities. We need to think about how you raise a child in the community, in our country at the moment. We used to have lots of childcare settings and lots of places where parents could go and interact and get support. You didn't used to have to rely on family all the time, there were things that were there to support you.

For students, one of the things a lot of people have missed out on is not just that ability to meet people but also explore who you are as well. That is what a lot of people go to university to find like-minded but also different people and find out where they fit in the world. All these things have been really impaired this year, but we should be very hopeful because people adapt very quickly.

I remember the day I was sitting with all these existential problems and I went into one of the school sites I go to regularly, a pupil referral unit where there are lots of different children who are outside of mainstream school. I was thinking “Oh my gosh, how are we going to support these kids and get them back into education”. I saw one of them, for the first time in about six months, he was nine years old and he just wanted to tell me about his imaginary big purple dog! That was the thing he was most concerned about. COVID is going on but all he cares about is his purple dog. I am not saying that there won't be people who are finding it hard, of course, there are. We know that poverty, stress, families and other things have really compounded. But I also think that people will probably surprise us, both children and young people. I have a lot of faith in young people, I think they are extraordinary, and they will continue to do extraordinary things. But we need to give them the support and the right environment in which they can thrive.