This is an invited presentation for the Local Government Association Leadership Essentials course for senior officers and elected members on Mental Health and COVID impact

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Syndemic COVID-19 Impact
Mental Health, Wellbeing, Isolation.
LGA Leadership Essentials Event
16th October 2020
Jim McManus
Director of Public Health, Hertfordshire County Council
Visiting Professor, University of Hertfordshire
Vice-President, Association of Directors of Public Health (www.adph.org.uk)
Chair, Behavioural Sciences and Public Health Network (www.bsphn.org.uk)

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• BSPHN Behavioural Science Podcast
https://www.bsphn.org.uk/593/Podcast
• Public Mental Health COVID-19 Collaborative
https://khub.net/group/covid19-public-mental-health
• Centre for Mental Health
• https://www.centreformentalhealth.org.uk/
• British Psychological Society https://www.bps.org.uk/coronavirus-
resources
• PPMA Wellbeing Hub https://www.ppma.org.uk/coronavirus-
resource-hub-being-well-staying-well/
• CIPD Coronavirus MH and employees
https://www.cipd.co.uk/knowledge/culture/well-being/supporting-
mental-health-workplace-return
Some Resources

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The Psychological Contract
https://www.adph.org.uk/2020/10/protecting-our-communities/

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• Herts Behavioural Science Team
• Centre for Mental Health
• PHE
• BPS
• Trust and Resilience, Coping with very wide
Trauma all feature in the best psychological
evidence
Recent Science

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Key Public Health Perspectives for a
Syndemic of COVID and Mental Health Impact
Different
Populations,
Different Issues
Lifecourse
Perspective
Syndemic Lens
Self Care
Resilience
Early
Identification
and Response
Behavioural
Science
Normalise, DO NOT MEDICALISE
Meaning, Hope, Questions of Ultimate Concern, Spirituality, Faith

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Pandemic Milestone Assumptions Summary
This is provisional and subject to revision. Version 3
May June July Augus
t
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2020 2021
2
Some restrictions
eased
Switch measures on
and off as we regain
some control of curve
and demand .
Systems and planning
enables greater control
and infrastructure runs
better
May into June 2020
1a
Peak of cases.
Deaths
Lag cases by 2-3
week
Late April 2020
First
Peak
1b
Second
Peak
Second peak of cases
sees restrictions
switched back on and
peak of cases and
deaths
Oct 2020
Immunity
Significant increase in
population immunity
Q1 2021
3
Treatment
Candidate treatments
roll out for some cases
Q3-4 2020
4
Recovery Focus
Efforts change to
focus on recovery
Q2 2021
3
Shielding
Ends?
Immunity grows
Q1 2021
Vaccine
Vaccine starts population roll
out (earliest) with frontline
workers and clinically vulnerable
Q2 2021
Full
Recovery
Full return to new Normal
Aug – Nov 2021
Apr
Phase 1 – First Two Peaks
Phase 2 - Control
Phase 3 - Exit
This is all provisional. The key drivers of these phases will be
levels of infection, recovery and immunity
Phase 4 - Recovery
Gap between first
peak and second
allows time for control
and planning for
second peak
Sep
4
Rapid + pressure technology hits hospitals and
reduces deaths and ventilator need

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Not a Pandemic but a Syndemic
• Syndemic – two or more disease
states that adversely interact with each
other (Singer, 2009*)
• As we learned in HIV, Healthcare is
ONLY one aspect of response to a
Syndemic.
• Can we apply this learning post
COVID?
• The debate must not become focused
on healthcare and the NHS alone
• Look on Adverse Childhood
Experiences with a Syndemics Model
and we might get further.
*Singer,M (2009) Introduction to Syndemics: A Critical Systems Approach to Public and
Community Health.

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PHE Report Infographic….Syndemic Impact on BAME Communities

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Mental Health as a Public Health Issue
A substantial and partly preventable
burden of mental ill health
A substantial set of resilience
challenges (Syndemic Lens)
A substantial set of grieving and
loss issues (Syndemic Lens)

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Syndemic Impacts not Pandemic

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Mental Health and Young People
(Herts)
Predicted MH
Impact: CYP MH
Factors
Disrupted
social
development,
social
support,
routine,
education
Isolation,
Loneliness,
Exclusion
(inc. digital) &
< Structured
Activity
> Worry /
Anxiety,
Stress, Low
Mood
(?PTSD?)
Increased
vulnerabilities
& increased
exposure e.g.
ACEs, Socio-
EcReduced
access to MH
& pastoral
support. >
escalation of
MH diffs
Direct impact
of COVID-19
Unexpected
Bereavement
/ Complex
Grief
Vicarious
Anxiety.
[Parent/Carer
s;
School/Colleg
e; Media (inc.
Social Media)
Family
discord /
stress
Hopelessne
ss / Fear of
Future
Consequenc
es

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1.Flu like symptoms,
no fever
1.5% need hospital
breathing support
2.Flu-like + Fever
As Group 1plus loss
of appetite and fever
3. + Gastrointestinal
Diarrhoea, anorexia,
headache chesy pain.
Usually no couch
4.+ Fatigue
8.6% require
breathing support
5. + Confusion (plus
fatigue etc)
10% require breathing
support
6. + Abdominal and
Respiratory
20% need breathing
support
6 “Clusters” of COVID Symptoms
Source: Covid Symptom Study
All have Psychological Sequalae from Resilience to “Survivor Guilt” and More

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Long Term
Consequences
• “Long Covid”
• Individuals who continue to have
Covid-19 symptoms which disrupt
their health
• Outside of the two-week period in
which they are believed to be
infected. (i.e. after time virus
should have cleared)
• Estimates (rough) 1.5% of those
infected persist with symptoms at
3 months
• Extreme fatigue
• Muscle weakness
• Hearing Loss
• Low grade fever
• Inability to concentrate Memory lapses
Changes in mood
• Sleep difficulties
• Headaches Needle pains in arms and
legs
• Diarrhea and bouts of vomiting
• Loss of taste and smell
• Sore throat and difficulties to swallow
• New onset of diabetes and
hypertension
• Skin rash
• Shortness of breath
• Chest pains Palpitations
• Heart Muscle Weakening
Source: Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19:
research needs. Lancet Infect Dis 2020; published online September 1.
https://doi.org/10.1016/S1473-3099(20)30701-5.
Source: https://institute.global/policy/long-covid-reviewing-science-and-assessing-risk

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Public Mental Health Skills in Practice
Self-Care (Blogs , CMH, LGA Workforce)
Team Care Skills
Balance
Building Resilience
Normalising the problems and reactions – “It’s OK not to be OK”

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Key skills for Recovery
Horizon scanning
Sense making of multiple strands of information
Influencing
Articulating clearly tasks and issues for the system
Being able to iterate measures
Agility
Facing in different directions
Monitor Public Fears and Concerns – Formal Survey (Herts) and Elected Members

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Key Things for Public Morale – The Psychological
Contract with Residents
Give People Hope and Confidence
Can DO
Motivation
Pro Social Behaviour, Enforcement ONLY in that context
Normalising the problems and reactions – “It’s OK not to be OK”

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Herts Work (alone or in Collaboration)
TOOLS ON
RESILIENCE
HTTPS://WWW.HERTS
MINDNETWORK.ORG/
YOUNG-PEOPLES-
HELPLINE
WWW.JUSTTALKHERT
S.ORG
BEHAVIOURAL SCIENCE
ADVICE
RESIDENTS’ LEAFLET,
COMMS
CENTRE FOR MH LEAFLET
STAFF WELLBEING
WORK
PUBLIC MENTAL
HEALTH CELL
BEHAVIOURAL
SCIENCE PODCASTS
TRAUMA
RESPONDERS
PTSD TRAINING FOR
CARE HOME
CHAMPIONS

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Long Term
Consequences
• “Long Covid”
• Individuals who continue to have
Covid-19 symptoms which disrupt
their health
• Outside of the two-week period in
which they are believed to be
infected. (i.e. after time virus
should have cleared)
• Estimates (rough) 1.5% of those
infected persist with symptoms at
3 months
• Extreme fatigue
• Muscle weakness
• Hearing Loss
• Low grade fever
• Inability to concentrate Memory lapses
Changes in mood
• Sleep difficulties
• Headaches Needle pains in arms and
legs
• Diarrhea and bouts of vomiting
• Loss of taste and smell
• Sore throat and difficulties to swallow
• New onset of diabetes and
hypertension
• Skin rash
• Shortness of breath
• Chest pains Palpitations
• Heart Muscle Weakening
Source: Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19:
research needs. Lancet Infect Dis 2020; published online September 1.
https://doi.org/10.1016/S1473-3099(20)30701-5.
Source: https://institute.global/policy/long-covid-reviewing-science-and-assessing-risk

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• https://www.centreformentalhealth.org.uk/publications/supporting-mental-health-
during-covid-19-brief-guide
• https://www.hertfordshire.gov.uk/media-library/documents/public-
health/coronavirus/professionals-pages/autism-and-mh-offer-leaflet-for-children-
final.pdf
• https://www.watford.gov.uk/info/20286/coronavirus/1061/coronavirus_support_pages
/12
• https://www.healthyyoungmindsinherts.org.uk/parents-and-carers/covid-19-advice-
parents-and-carers
• https://www.healthyyoungmindsinherts.org.uk/schools/how-look-after-your-mental-
health-and-emotional-wellbeing-during-covid-19-outbreak
• https://www.justtalkherts.org/just-talk-herts.aspx
• https://www.hertsmindnetwork.org/coronavirus-update
Mental Health Resources
www.hertfordshire.gov.uk/coronavirus

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Any questions?