Transforming society and mental health in the post-pandemic era

Covid has disrupted our lives in numerous ways. It has also been a force for long-term change. Dr Antonis Kousoulis FRSA argues that certain social and cultural factors will be key in shaping a more central role for good population mental health after the pandemic.

With effective vaccines now widely available – at least in some parts of the world – and many governments removing all restrictions or protective measures, it is easy to imagine that Covid and its impact is over. This is wrong. History has shown that pandemics are forces of long-term change. The health, social, economic and cultural effects will cast a long shadow into the future. The sooner we begin to understand these, the better placed we will be to address them.

What will the human experience look like in the post-Covid era and what are the factors that will determine or mediate it? There are many impacts of lockdowns, such as not being able to see family and friends, travel or follow hobbies, that will ease quickly as protective measures are removed. But there are deeper impacts – on health and wellbeing, our physical and digital communities, and the economy – which will have profound effects around the world for many years to come.

The pandemic has shown the shortcomings in how we address the pre-existing mental health crisis. What was already going wrong, went worse. But we also saw a mental health conversation that we had never seen before, as the general population without any obvious vulnerabilities experienced uncertainty, loneliness and anxiety. Mental health, already at the forefront of the public agenda, became more and more a topic of conversation during the pandemic, though often without the nuance or the necessary structural initiatives to improve mental health for those affected.

But Covid didn’t only affect respiratory and mental health. Long Covid, a still poorly understood syndrome with far reaching physical health implications, reminds us of other post-viral syndromes or common chronic physical conditions, such as lower back pain. For those, the best available evidence suggests that support to patients must be offered across the continuum of the biopsychosocial model. Psychological support, especially in the community, is critical for recovery from and living well with any long-term condition. However, where most practitioners and researchers in the social, public health and psychological sciences had already largely been in agreement on this perspective, during the pandemic a narrow and traditional biomedical model has ruled, often at the expense of the most vulnerable.

Not all policy change has been deaf to complex needs, though. Economic and employment interventions by several governments have had a cushioning effect on poverty and education. The dire forecasts of the raw impact on poverty and inequality in European countries (based on early estimates) have proven smaller thanks to government retention schemes and compensating policies in some countries. But not without a cost. Public debt is soaring around the world and there will be long term effects of education losses due to the pandemic, especially for the most disadvantaged young people. Effective solutions that are more progressive – such as a wealth tax or a wellbeing economy – have been proposed but are not very likely to be taken up by current governments in the age of polarisation.

Some of this political and social polarisation has undoubtedly been fuelled by misinformation. Research shows any assumptions about the impact of misinformation requires much more careful analysis. There has been great interest in addressing misinformation, but this has not necessarily been proportionate to the scale of the problem. It is a topic that is more complex than what the mainstream media debates suggest. The true extent of the problem of misinformation has not been properly quantified, nor have we seen conceptual agreement between academics and the public. These heavily politicised relationships and our digital context have been extremely important in driving people’s behaviours and defining the human experience during the first two years of the Covid pandemic.

But what might 2022 and beyond bring for humankind? What will life look like post-pandemic (whenever that point comes)? Uncertainty is the new normal and most of us agree the future will look different from the past. In particular, the human experience will be significantly altered. Studies indicate alarming long-term physical effects of Covid and the psychological consequences of the pandemic, such as increased depression, anxiety, and rates of domestic violence. There will also be increases in food insecurity and in poverty, and shifts in education. Social, public health and psychological sciences are crucial to transforming the post-pandemic world into one that is healthier, more socially just and better-suited to elevating the human experience.

The public health experience of working in the field in the last couple of years has uncovered a conflicting message. The pandemic has exacerbated existing inequalities, created new ones, and painted a grim picture of disruption, illness and complex unmet societal needs. But it has also given us an incredible amount of learning and shown us the best of what empowered, holistic, grassroots community initiatives can deliver for citizens. Such challenges and such initiatives are emerging in different ways and in different time frames for people, communities, regions and nations. To ensure an increased uptake of interventions based on the biopsychosocial model of health, we don’t necessarily need better evidence, but better arguments and the ability to nurture social movements of patients and citizens.

We expect health and social activists to continue pushing for building back better and fairer. And we hope politicians, decision-makers and leaders who hold influence will be ready to harness these critical learnings. We need a switch in funding away from health service provision with little proven effectiveness in quality of life, towards mental health support with evidence of holistic benefits.

Dr Antonis A. Kousoulis is a Public Health Consultant and Director at Mental Health Foundation, London, UK. This blog is inspired by a session on Transforming Society and Mental Health at the international Post-COVID Summit in April 2022. The thought contributions of Prof Elke Van Hoof (VUB), Prof Frances MK Williams (King’s College London), Dr Juan C. Palomino (Oxford University), Dr Magda Osman(University of Cambridge) and Dr Sandra L. Shullman(Executive Development Group) are acknowledged.