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How can councils reverse mental health inequalities in the aftermath of COVID-19?

Andy Bell, Deputy Chief Executive, Centre for Mental Health think piece part of the health inequalities hub.

The COVID-19 pandemic has already put the public’s mental health under huge strain. For many, that is set to continue as the after-effects of trauma, loss and fear remain in many of our lives. An estimated 10 million people will need some support for their mental health as a direct consequence of the pandemic in England or 66,000 per average county or unitary council area.

Local councils are at the front line of protecting the public’s mental health. While county and unitary councils have responsibility for public health and social care, district and borough councils are responsible for vital services like housing, green spaces and the built environment. All have a huge impact on our mental as well as physical health: for better or worse.

And as we seek to recover from the pandemic and its aftermath, councils will have a pivotal role in supporting the communities they serve to recover psychologically and emotionally from the shock we’ve been through.

Prior to the pandemic, it was already clear that mental health among most age groups, and particularly young people, was steadily getting worse. For school-age children, the proportion living with a mental health problem rose from one in 10 in 2004 to one in six last year, with the highest rates seen among girls and young women.

It has also been evident for some time that our chances of having good or poor mental health were highly unequal. Children from low income families were four times more likely than those from the wealthiest households to have a serious mental health difficulty by the time they left primary school. Unemployment and poverty have always been associated with poorer mental health and a higher risk of death from suicide. And rates of severe mental illness were three times higher than average among black communities in the UK.

Studies of the mental health impacts of the pandemic have indicated that the inequalities that were already there have been exacerbated during the last two years. People with the least resources and lowest incomes; communities experiencing racial injustice (heightened by the events of last summer following the murder of George Floyd); women and children facing violence and abuse at home; and people living with long-term physical conditions have all been hit harder by the pandemic and its impacts on mental health. People living with mental health conditions have reported losing both informal networks and essential services during the lockdowns, and there is evidence that deaths from COVID-19 have been three times higher than average for people with psychosis.

Councils across the country are taking action to address both the mental health effects of the pandemic and the longstanding causes of poor mental health in the communities they serve.

Public health teams have been at the heart of this effort – working arm in arm with local people and community organisations to understand how COVID-19 has affected mental health and taking action to try to prevent the traumatic events of the last 18 months from leading to long-term difficulties. Many deployed grants to fund community groups to support people’s mental health in response to the crisis at a time when fundraised income came to a halt. Some are now producing mental health recovery strategies to take a coordinated and concerted approach to supporting wellbeing at this crucial time.

Well over 100 local councils in England now have elected member champions for mental health. They are providing leadership at an important time for their communities: both within the council to ensure the public’s mental health is taken as seriously as their physical health in their actions and policies, and more widely to open up conversations with citizens about wellbeing and mental health. This has never been more needed than it is today.

When the physical health crisis subsides, the mental health after-effects will be with us for some time. Schools, colleges and workplaces (including councils) will need to offer psychologically safe spaces for people who need time to grieve and process what has happened. For many council staff, burnout will be a major concern after what they have experienced, both at work and in their lives outside. Managing this process will need close attention to people’s mental health and easy access to support when it’s needed.

Local councils will be at the heart of our recovery from COVID-19, and at Centre for Mental Health we will continue to support them to make a difference using the best available evidence. Putting the public’s mental health at the heart of what councils do will bring about a healthier, fairer and stronger society for all.