In some ways it is quite gratifying and in others it certainly is not. That is how I would characterise the prominence of emergent COVID-19-related mental health discourses. What is gratifying is that as a society and as professionals we want to flag up mental health and wellbeing, talk about the impacts of the crisis on mental health and wellbeing and guard against potentially negative mental health consequences. The impacts are many, from subjective personal stress and distress (finances, job security, social uncertainties, family/domestic issues), to key worker anxieties on being exposed to the virus, as well as the costs of loneliness, social isolation and undiagnosed and untreated mental illness. Even when treatment is implemented, it is at social distance, behind masks or via virtual contact on personal devices. That we are appearing to consider these sequelae of COVID-19 and its associated public health and political management are markers that we are aware and that it is OK to talk about these challenging issues for our collective and individual mental health and wellbeing.
Another pandemic positive is that, despite so many emotional pressure points across society, we heard the need to take account of them from the very start. Politicians talking about exercise to support mental health, my own employer offering rest days as a thank you and a chance to physically and psychologically restore after pressured activity, even the voluble public concern (when second wave infection numbers accrued) about the mental health damage of lockdown and restriction—especially in light of shorter days and poorer weather than during the first lockdown.
One less helpful aspect is that more people are struggling with mental health challenges. Perhaps a little more subtle is a tendency towards using the term ‘mental health’ as a catch-all, something of a synonym for mental wellbeing, mental health, mental distress and mental illness and I propose that this is not helpful. Each of these things are different and convey different messages. Statements I heard on television in a week leading up to new restrictions included ‘rates of mental health rocketing’ and ‘mental health will go through the roof’. I tweeted these and it generated a lively discussion about the contemporary meaning of mental health. I have always associated mental healthiness as something to aspire to, to protect and to retain when we have it (if we can), whereas statements like these that use mental health as a euphemism for mental distress thereby run a risk of inadvertently demonising the term by a conflation with illness.
The roots of this may lie in an ever more mental-health-aware public seeking to separate subjective challenges to our mental health and wellbeing (what one may term ‘mental health problems’) from the traditional notion around diagnosed mental illness. This is grown-up citizenship for me as it acknowledges that mental health (as a notion) is a continuum that we journey back and forth along, from absolute wellbeing to illness and everything in between—our sense of mental health neither being fixed, nor black and white.
Those in health care have witnessed some challenges and moves away from traditional medical conceptualisations of the term mental illness over recent decades, with opposition from some to the very idea and a search for other ways of describing it. A prominent mental health nursing professor/writer responded to my tweet saying he used the term ‘mental ill-health’ sometimes in order to distinguish between wellbeing and a journey into mental health difficulties, terminology I have also used for similar purposes in my teaching. This distancing from the idea of mental illness has also allowed the clumsy (if not nonsensical) term of ‘mental health illness’ to enter the field's discourse and unofficial lexicon.
Whatever the debates or merits of this terminology, I simply make a couple of pleas in our current situation. First, that we continue to raise a prominent voice in acknowledging mental health as an issue for societal concern in the pandemic and (of course) beyond. Awareness and understanding can breed compassion for those in need. This will be needed as the impact of the virus will continue to cause anguish and distress well into our time of recovery from the situation. The second is that we seek to retain mental health, as both a term and a concept, as something that is positive and good and not to use it as a soft-soap synonym for experiences of mental distress or illness.