Isolation, stress and drastic change of routine – the pandemic was bound to have a big mental health toll. When NHS recorded an overall increase in the prescriptions for antidepressants and antipsychotics nobody was surprised. However, the pandemic has been most astutely felt by those with pre-existing conditions as new anxieties became a reality and their bedrooms and living rooms became their therapists’ virtual office.

“It’s been a huge global event. It’s just a massive burden of stress,” said Dr. Jennifer Ahrens, consultant psychiatrist at Tower Hamlets Early Intervention Service, “And we know that these kinds of events do place people at increased risk of developing mental health problems, in the same way that any large potentially negative life events do.”

Tower Hamlets has seen the second biggest increase in the prescriptions of antipsychotics in the ELL area. In 2020, three out of the four boroughs recorded the highest number of antipsychotic prescriptions in five years. 

Ahrens is cautious about inferring a direct causation between the pandemic and psychosis, arguing that such “fluctuations are natural.” However cases of seemingly pandemic-induced psychosis in patients with no previous history of mental health issues, have been reported around the world, in countries such as Peru, USA, Italy and the UK.

“Self-isolation is one of the hallmarks of someone becoming unwell,” Dr. Steve Church, the leader of psychosis recovery team at the South London and Maudsley NHS Trust, has told the BBC. 

While in a recent study medical researchers and doctors from Northumberland have noted that the problem is particularly observable among older patients who had to shield by themselves. Their report included the case of a 71-year-old retired teacher who was hospitalised with psychosis symptoms after three weeks of shielding alone, and a 69-year-old woman who presented in hospital claiming that her late husband had come back from the dead to infect her with cancer so that she could join him in afterlife. 

They prefer a quiet city, they prefer not to have the stress of having to go out and about

Nonetheless, such cases are relatively rare and Ahrens, who works primarily with young psychosis patients aged 18-35 has noted that for some lockdown has had positive effects. “I think for some people psychosis has improved during lockdown,” Ahrens said, “they prefer a quiet city, they prefer not to have the stress of having to go out and about.” She added that many of her patients appreciated the flexibility of remote therapy sessions. “The flexibility has allowed people to engage a lot better in some ways,” she said, “They’ve been able to keep appointments that they previously might have found difficult due to having to ask for time off during working hours.”

Attendance at psychological appointments has been shown to improve during the pandemic, however not all patients have been satisfied with the changes made to mental health provisions. “It’s like the whole of the mental health service has been thrown into a tumble dryer,” said Eleanor Bradford from Lewisham, who says she has been receiving psychological treatment her whole life. Over the course of the pandemic she attended art and EDMR (Eye Movement Desensitization and Reprocessing) therapy over Zoom.

“I found [online therapy] to be really helpful when I’m sort of doing okay,” said Bradford who experiences PTSD symptoms, “but when I’ve had periods where I struggled, I found it much more difficult to engage and get the benefit that I need without that in-person support.” 

It’s like the whole of mental health service has been thrown into a tumble dryer.

“You cannot establish a meaningful human attachment through a screen,” said Angela Brassett-Harknett, a Croydon-based psychotherapist specialising in eating disorders, “The attachment hormones and the way that the mirror neuron system works, it doesn’t light up in the same way as when you’re face to face.” When the pandemic first hit, she immediately offered video sessions to all her patients, but believes the solutions to be far from ideal. Much of the work she did over the last year, she said, was centred more on “containing” her patients and helping them “cope with this situation,” rather than making progress in their treatment. 

Brassett-Harknett says that the start of the pandemic has been distressing to many of her patients as they were worried that their eating disorders might become more obvious to their families. Some were also anxious about the closure of gyms and stockpiling. “For some people, the shutting down of gyms was a concern for their ability to exercise or over-exercise,” Brassett-Harknett explained, “Others were initially concerned about access to food and being able to get their hands on their their “safe food” or even their binge food.” However she notes that with time most of these concerns faded. 

Instead Brassett-Harknett said the biggest issue is the inability of some to attend remote therapy sessions. “Some people don’t want to bring therapy into their homes,” she said, “They don’t have a confidential space in their own home, where they could have a video or telephone session, or they don’t have the internet access.” 

For some, she said, the lack of access to support has had tragic consequences. During first lockdown Brassett-Harknett was informed that a former patient, whom she finished working with three years ago, committed suicide. “She was, I assume, finding it difficult to get to a place of safety to have ongoing quality specialist therapeutic support,” Brassett-Harknet said.

Follow our These 4 Walls series this week to find out more about what happened behind closed doors during this pandemic. #These4Walls