Mental Health Inequalities: The Start Point and the End Point of COVID-19?

By Will King, ToHealth Ltd

Published 1 August 2021

Illness, inclusive of mental health, is moulded by society in so many ways and societal setups, exposing inequalities.3 As a species, those who live in ‘blue zones’; five global locations where life expectancy is at its highest (see figure 1)say that a basic human need is a sense of belonging. As the COVID-19 pandemic worsened, humans were reduced to operating in more isolated means, consequently fracturing community value and purpose. Mental health has long encompassed many health inequalities. Those who experience it are more likely to suffer from job loss and financial difficulties (Reducing health inequalities in mental illness). This can often be interlinked with an increase in health risk behaviours, which not only cost money, damage health but also worsen mental health in the long run, despite the instant gratification and improvement that may be felt. These behaviours include the adverse use of prescription medications, smoking, physical inactivity and alcohol consumption. An increase in prevalence by 50.7%, 46.8% and 40.3% respectively has been noted in those who are mentally ill (https://doi.org/10.1177/0004867415569798). COVID-19 will have only compounded the inequalities we see.

The COVID-19 pandemic has undoubtedly caused individuals some form of well-being decline over the past year. How we begin to quantify and contextualise this in the workplace environment is hugely important but difficult. Tangible indicators such as 2020 absence rates paint a very troubling picture but these are just the tip of the iceberg as it is not representative of the physical and psychological build-up involved overall. The fallout of the pandemic on the nations holistic health will be huge. To gain further insights into health and the UK workforce, we must look at health inequalities and inequities within daily life. Sir Michael Marmot bought the idea of social determinants of health to the forefront of public health over a decade ago in his ground-breaking Marmot Review. Social determinants of health are the conditions in which we are born, grow, live and age which somewhat pre-determine our health outcomes in life. The COVID-19 pandemic has simply widened the crevices of structural and social determinants that were already failing the nation’s physical and psychological health. Many of these can be seen filtering into the workplace and leaders should be aware of the structural barriers’ individuals face, and work to remove them to achieve health liberation.

The intangible nature of mental health makes it a labyrinth for economists to try and assign value. As we continue to work longer hours, compete for more resources in society and ignore our basic human drivers, we allow the modern-from-home world to grab hold of our mental health and plunge us into burnout. The process of burnout is more than a concept and currently costs organisations 300 billion pounds a year (Burnout — More Than an Occupational Phenomenon – Spring Health). COVID-19 is a catalyst for burnout, inducing feelings of disconnect and alienation on individuals and undermining the conditions that humans require to thrive in a mental capacity (Monthly Review | Capitalism and Mental Health). We want to positively draw ourselves away from medical models of mental health, towards an understanding of social models, including health inequalities, encompassing effects of the environments we live and work on our mental health.

Figure 1
Blue zones 9 core habits that lead to longevity of life and thriving wellbeing, both mentally and physically
 (Blue Zones—Live Longer, Better – Blue Zones)

The pandemic has tangibly caused mortality but intangible casualties such as loss of community, disruptions to social cohesion and collapse of routines receive less attention. The social costs of isolation have been uncovered and it is too early to even begin to imagine the fallout we will see in regards to mental health decline post-pandemic. Research demonstrated that communicable disease leads to increased mental health risk and vice versa, demonstrating why relationships between COVID-19 and mental health must be acknowledged (Reimagining Global Health: https://socialwork.journals.ac.za/pub/article/view/105). Early intervention in the workplace and acknowledgement of reduced mental health, health inequalities and poor health behaviours, is crucial.

Many UK adults are taking medication for depression and anxiety, however, getting to the source of the problem requires further depth than just looking inwards. Structural and social determinants of health exist everywhere. The work environment, work demands and how we manage stress in the workplace can affect individual health, agency and rationality of health choices. Improving workplace health through addressing the six key management standards of stress outlined by the Health and Safety Executive (HSE); demands, control, support, role, relationships and change can have positive effects on reducing health-risk behaviours associated with poor mental health. These include reducing smoking, sedentary lifestyles, substance abuse, poor nutrition, just to name a few and therefore help to tackle the causal loop of work-related mental health and modifiable behaviours.

One HSE standard of stress to focus on, in this current climate is change. Inequalities in health must be brought into the consciousness of decision-makers as whilst we acknowledge everyone has been put through lockdown restrictions and isolation measures, for some, this will have more profound impacts. Consider those with young children, single parents, informal carers and lower socio-economic class who live in typically tighter spaces. Thinking beyond general boundaries to understand how the health of employees will have been affected as a collective, but also as diverse sets of individuals, is crucial in identifying the social determinants of health that may be further negatively impacted by a changing work environment and increased stressors. Relationships, the cornerstone of human wellbeing, has been highlighted during the lockdown. Being able to connect with colleagues, friends and family members at the drop of the hat was taken for granted but now we realise how crucial these interactions were for our mental health. Considering virtual fatigue, making time for non-work conversation, encouraging people to check in on each other, signposting and giving support can ameliorate the negative effects to some extent. If colleagues feel supported and empowered they get a sense of belonging which creates a work community and a work community leads to self-efficacy, efficiency and a cohesive work culture/atmosphere.

Health inequalities in the workplace have always been there, we are just becoming more aware of them. No one individual should have their health or status determined in life by the circumstances they were born into but it happens all too often and whilst these often begin outside of the workplace, these effects can be mitigated with good work environments. With the current pandemic, demographics may well be an intangible contributor to the cause of death, which can and has been exacerbated by workplace conditions and workplace demands (ONS). This is not an issue that will resolve itself. Action is needed or we risk causing further fallout in inequalities, productivity and loss of social cohesion within our work communities.

Addressing workplace factors is essential in reducing health inequalities, however, the workplace is also an ideal arena for raising employees’ awareness of self-management to improve general and mental health and wellbeing. This may help to reduce poor lifestyle choices, as noted previously when managing in the current and future world.

One program is Martin Seligman’s PERMA model, a ‘theory of happiness’. The PERMA model is a fair and impartial pursuit of happiness. Everyone has, within our grasp, the capability to forge strong relationships, find what makes us tick, celebrate our achievements and identify where our energy is best spent.

Figure 2
The PERMA model explained

A positive mindset is something in which we can craft, much like you would practise a sport or playing an instrument. It is a trait; a semi-permanent characteristic that can overhaul the way we approach the future if we commit to the themes of this model. Engagement is all about finding what gets you into an occasion in which everything is harmonious, called the flow state. If we can find our flow, we are one step closer to achieving a positive state of mind. Relationships are the epitome of a human thriving state. We are social creatures and depend on this connection with other beings which lockdown has highlighted. Investing time, respect, energy, and authenticity into meaningful conversations with everyone we interact with daily,  builds us a resilience and support network. Developing meaning in life is a subjective experience, created by discovering what brings you joy and committing to it. Achievement is celebrating your personal and professional victories and learning to allow the positive moments in the day to outweigh the negative moments.

Will King, Health and Wellness Expert  at ToHealth Ltd.
BSc in Sport and Exercise Science
Studying MSc in Global Public Health currently.
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