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Psychology Open Letter to Policy Makers and the Public
Published 01 November 2020

We, as psychology professionals, would like to share our concerns regarding the psychological impacts of measures implemented in response to what has been named the COVID-19 pandemic, with the hope that these can helpfully inform individual/collective practices and policy decisions.

As human beings, we thrive psychologically through (physical and emotional) closeness and connection, engagement in play, work, leisure, family and community life.  We develop our sense of self, beliefs about others and the world around us, through our interactions with others, and the language and ‘stories’ of our history and present.    

 

For the last seven months, the language and stories in society have centred around extreme fear and threat from a ‘deadly virus’. This has been the basis for measures such as ‘social distancing’, ‘lockdowns’ and mask wearing, which were quickly labelled the ‘new normal’.

 

Although circumstances sometimes necessitate a heightened focus on survival rather than thriving, it is crucial for us all and, particularly, those shaping public policy to consider, and constantly re-consider, the balance between managing threats to life and core human needs for short and long-term wellbeing.  We hope professional concerns we outline here may be of use in redressing the balance.

Psychological concerns

 

During these months, the psychological health of the UK population has suffered greatly1with significant increases in reported stress, anxiety, depression2; escalating alcohol consumption3 and domestic abuse4,5; and increases in suicidal thoughts, especially among young adults6. People within specific groups, like those with developmental or learning difficulties and disabilities, such as deafness, have had an even more difficult time7, 8 .Within the younger population, 80% of surveyed young people have reported a deterioration in their mental health9. One in six children in England are now likely to meet criteria for a mental health problem10, with reported increases in self-harm11 and abuse12, reductions in learning and academic opportunities, delayed presentation to services13, and a concerning suggestion of increased child suicide14. Contributing factors to these issues are likely to be multi-faceted and multi-level.

  1. Heightened fear and sense of unpredictability

Fear is understandable in the context of repeated messages regarding a ‘deadly virus’, reinforced by reporting of daily counts of deaths and ‘cases’ (positive PCR test results, not necessarily people who are ill or have an infectious virus15). Fear provokes a useful alertness to danger, with the engagement of fight, flight or freeze responses essential for survival. However, when fear is sustained over time, it can become damaging, both psychologically, such as the nocebo effect (the role of negative expectations on illness and recovery16), and physically, for example, lowering the body’s immunity17

 

Contradictory guidance (e.g. masks advised not to be for general population use, but then becoming mandatory) and ever-extending restrictions (three weeks to ‘flatten the curve’ have turned into seven months thus far), result in feelings of uncertainty about our world and our future.  Over time, confusion and lack of control can lead to feeling hopeless, helpless, stressed, low and, in turn, to questioning if life is worth living18.

 

The sustained messaging of fear of contagion and the recommended changes in, for example, cleaning and disinfecting, are likely to increase phobias, obsessive and compulsive behaviours and general worry and anxiety.  Some children will develop beliefs such as ‘I am/others are/the world is dangerous, infectious and scary’, which have severely negative psychological outcomes19. Negative outcomes are likely to increase the longer this fear and unpredictability continues, especially in child-focused settings such as schools. 

Beck,  A.T. (1979) Cognitive Therapy and the Emotional Disorders. New York: Penguin.

2.  Physical distance and social isolation

Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2): 227-237.

Social connection and human touch are essential for psychological stability, wellbeing, child development and thriving. Limiting contact, both in relation to our loved ones and in public spaces, sets a context for fraying the social fabric and has devastating psychological consequences20.  

 

Isolation can lead to loneliness and multiple psychological and physical health problems21, is a predictor of suicidal thoughts and behaviour22; increases the risk of physical conditions (e.g. heart disease, stroke23); progression of frailty24, and even mortality25. Older adults living alone and in care homes have been particularly neglected26.  Specialists working with people with dementia have been attempting to raise awareness regarding the terminal nature of social isolation within their client group27.  

Valtorta, N.K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B., (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13): 1009-1016.

Gale, C., Westbury, L., Cooper, C., (2018). The English Longitudinal Study of Ageing. Age and Ageing, 47(3): 392–397.

Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2): 227-237.

3.  Severe disruption to life 

Across the age-span, ‘lockdowns’ have disrupted and, in some cases, devastated lifestyle patterns, including loss of work and earnings, education, social networks, access to leisure facilities, and social and healthcare provision. Important events like weddings, birthdays, funerals and cultural / faith celebrations (e.g. Eid, Easter), have also been restricted. These events often provide a sense of belonging and safety, as well as positive memories we cherish.

 

Research shows the clear negative impact of economic insecurity on psycho-social problems28 including suicide29, making the dramatic rise in unemployment and poverty deeply concerning30. The most disadvantaged and marginalised (e.g. minorities) are suffering most, increasing the poverty gap31, further impacting mental, physical and economic short and long-term prospects of these groups in particular, and of society as a whole32.

 

Due to the reprioritising and reduction of care provided by the NHS, there have been wide-reaching physical health impacts on both acute and chronic conditions (e.g. dramatic reduction in A&E attendance33, an estimated extra 35,000 deaths due to delayed treatment34).  The suffering caused by restricting the presence of loved ones during births and end of life is unimaginable, with psychological trauma to the individual, their family and staff.

Wilkinson, R. D., & Pickett, K. (2009). The spirit level: Why more equal societies almost always do better. New York: Bloomsbury Press.

4.  Mask use

Some authors state that up to 93% of all human communication is non-verbal35, which is key in relation to learning and interacting, and to people who are deaf or hard of hearing who depend on lip-reading. Impairing non-verbal communication by blocking facial expressions may have short and long-term implications for children’s developmental milestones, emotion regulation and the development of secure relationships36 – moderated by the amount of more typical interaction a child gets in absence of mask wearing/distancing. The distressing effects of only two minutes of interaction with an expressionless face (not dissimilar to a masked face) on an infant, can be seen in the video footage of the well-known still-face experiment37.

 

Covering of the face can lead to a sense of anonymity and social isolation, to changes in social dynamics, such as distrust and aggression38, and to reduced awareness of others’ needs, for example, not being able to see signs of distress. Enforced mask wearing has also created division (e.g. labelling of people as altruistic vs selfish) and discrimination (e.g. restricted access to those who are exempt) within society.

Mehrabian, A. (1971). Silent messages. Belmont: Wadsworth Pub. Co.

Chronaki, G., Hadwin, J.A., Garner, M., Maurage, P. & Sonuga-Barke, E. J. S. (2015) The development of emotion recognition from facial expressions and non-linguistic vocalizations during childhood. British Journal of Developmental Psychology 33(2): 218-36. 

Conclusions and recommendations

Illness and death are not new to humanity, nor the devastation they cause to individuals and families, and it remains crucially important to minimise both. Since psychological and physical health are intimately linked39, to achieve substantial, sustainable holistic health, at an individual and societal level, we must consider all aspects of wellbeing, including the context in which people live.

 

We appreciate that, initially, policy had to be implemented quickly, relying on limited data. Now we must find a way forward which balances all our needs across all sections of society, based on current and emerging data. For example, apart from week 17 (mid-April), all-cause mortality rates this year are comparable to recent years40  and 99% of cases are mild41, with the majority showing no symptoms42.  We urgently call for a review of current measures in relation to the concerns outlined in this letter. It is time to reconsider our approach. Our suggestions include: 

 

  • Giving a platform to the voices of citizens, particularly those most impacted. 

  • Involvement from professionals across multiple disciplines, crucially, psychologists and allied professions.

  • Open debate of different views and interpretations of the data.

  • Ensuring representation across all groups, from diverse backgrounds (e.g. class, ethnicity, age).

  • Supporting and enhancing resourcefulness within individuals and communities. 

 
Co-Signatories

Dr Harrie Bunker-Smith 

(BSc, MSc, DClinPsy)

 

Clinical Psychologist

Dr Maria Castro Romero 

(BSc Hons, DClinPsy)

 

Narrative and Community

Psychologist, Senior Lecturer in Clinical Psychology

Emma Kenny 

(BSc, Ad Dip Couns, MA)

 

Registered Psychological Therapist

Prof. Ellen Townsend

(BA Hons, PhD)

 

Psychology Professor

Dr Faye Bellanca 

(BSc, DClinPsy)

 

Clinical Psychologist

Dr Camellia Kojouri 

(BSc Hons, PGCE, DEdPsy)

 

Educational Psychologist

Dr Sheetal Gopal 

(MSc)

 

(Chartered) Principal Counselling Psychologist

Elizabeth Smith 

(PGDip, MA Hons)

 

Counsellor and Psychotherapist

Patrick Harper

(MSc)

 

Consultant Psychological Therapist and Advanced Certified Schema Therapist

Dr Sara Kutereba

(BSc Hons, MSc, DClinPsy, PhD)

 

(Chartered) Highly Specialist Clinical Psychologist

Dr Lesley Pilkington

(BA, PGCE, PGDip, PGCLTHE,

DCounsPsy)

 

Chartered Counselling Psychologist

Dr Liesse Pinteau

(BA, MSc, Psychd Counselling Psychology)

 

CAMHs Psychologist

Dr Damian Wilde

(BSc Hons, PGCE, PGCert, DClinPsy)

 

(Chartered) Highly Specialist Clinical Psychologist

Alex Dalziel 

(BA Hons)

 

Psychoanalytic Psychotherapist

Dr Sarah Harper

(BSc, PGCert, DClinPsych)

 

Clinical Psychologist

Dr Annie Waring

(MA, DClinPsy)

 

Clinical Psychologist, Accredited IPT

Practitioner and Supervisor

Dr Naomi Simcock

 (BSc, DClinPsy)

 

Senior Clinical Psychologist

Steve Rooney

 (BSc, PGCE, MA)

 

Educational and Child Psychologist

Livia Pontes

(BSc, MSc ClinPsy)

 

Chartered Clinical Psychologist

Andrea Halewood

 (BA Hons, MSc, Ad MSc)

 

Chartered Psychologist and Psychotherapist

Dr Alison Bromley

(BA, MSc, DForenPsy)

 

(Chartered) Principal Forensic Psychologist

Dr Gary L. Sidley

(BSc Hons, BA Hons, MSc ClinPsy, PhD)

 

(Former) Consultant Clinical Psychologist

Charlotte Feeny

(BSc Hons)

 

Counsellor

Dr Sasha Lillie Lyons

(BA Hons, PGDip, DClinPsy)

 

Clinical Psychologist

Dr Clare Young

(BSc, MSc, DClinPsy)

 

(Chartered) Consultant Clinical Psychologist

Felix Economakis

(BA Hons, DiplPsych, MSc, PGDiplPsychol)

 

Chartered Counselling Psychologist

Dr Anna Whalen

(BSc, DclinPsy, PGCE, PGDip)

 

Clinical Psychologist

Dr Funke Baffour-Awuah

(BSc Hons, DClinPsy)

 

Consultant Clinical Psychologist

Dr Christine Langhoff

(BA Hons, MSc, DipPsych, DClinPsy)

 

Chartered Clinical Psychologist

Dr Keri Nixon

 (BSc, MSc, Phd)

 

Chartered Consultant Forensic Psychologist

Dr Rachel Newton

(BSc, MSc, DClinPsy)

 

Clinical Psychologist

Dr Alison Bates

(BSc Hons, DClinPsy)

 

Chartered Clinical Psychologist

Dr Richard House

(MA, PhD, CertCouns)

 

Educational Consultant, Chartered

Psychologist, (former) Senior Lecturer in

Psychotherapy and Counselling

Natasha Harris

(BSc, PGDip)

 

Accredited Psychotherapist

Dr Charlotte Ingham

(BSc Hons, PGCert, DClinPsy)

 

Clinical Psychologist

Jo Cullen

(BA, MA, MSc ClinPsy, PGCE)

 

Psychologist and Educationalist

Dr Gill l’Anson

(BA Hons, DClinPsy)

 

Consultant Clinical Psychologist

Andrea Watson

(BSc, MSc)

 

Chartered Forensic Psychologist

Dr Ayesha Roche

(BSc, MResClinPsy, DClinPsy)

 

Clinical Psychologist

Dr Vanessa Moulton

 (BSc Hons, PsychD)

 

Chartered Psychologist

 
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