In its first 100 days, COVID-19 has brought half of humanity to a grinding halt.

In the European Union, 18 member states have imposed far-reaching measures, including so-called lockdowns, which restrict the freedom of movement and gathering to a maximum. The impact of this marshalled social distancing is not solely physical. By upsetting our habits and our biological clock, the lockdown also affects our mental health.

With their daily headcount, the deadly media headlines are disturbing for countries at peace. The pandemic is overwhelming, present on all our devices, everyone’s tongue and everybody’s mind. “While we have agreed to significant sacrifices to cease the dramatic outbreak of the Coronavirus, we should not neglect its huge impact on mental health. Mental health issues will not merely touch vulnerable people. They will affect all of us to a varying degree,” comments Marieke Dewitte, Assistant Professor Experimental Health Psychology at Maastricht University. Arguably, COVID-19 has taken hold of our imagination. That’s how the outbreak has upended our European way of life and hurt our collective European psyche.

Before the Coronavirus, already one in three European citizens were going to face a mental health issue at some point in their life. What does the response to the pandemic mean for public mental health? In this insight, we discuss how COVID-19 reveals the need for paying more attention to mental health issues at European level.

lockdown and public mental health

For legitimate as they may seem to stem a pandemic, lockdowns produce severe adjuvant effects. They affect everyone’s wellbeing, introduce different occupational hazards, and exacerbate existing domestic problems.

Most significantly, as of the date of publication of this insight, COVID-19 had already taken the lives of 212,000 people globally. Hundreds of thousands of families and friends have not only endured a loss but have also been denied the last goodbye. The deprival of this communal ritual – a first step towards coping with grief – is the most natural mental health consequence of the lockdown.

Meanwhile, healthcare workers also face death and the risk of contamination daily. Arguably, their position on the front lines exposes them to the risk of short- to long-term mental health problems, including post-traumatic stress disorder (PTSD). Stress factors include a combination of exhausting work shifts and the reality of seeing so many deaths over such a short period. On top of this, there is the stigmatisation and occasional harassment they experience as purported COVID-19 “carriers”.

Others must continue working to sustain the provision of “essential” goods (food) and services (healthcare, police, logistics). Many blue-collar workers are thus facing issues of insufficient protection in the workplace. It is an immediate risk for their physical health but also a source of mental pressure.

Poverty too is an aggravating factor in periods of lockdown. Households living in unsanitary homes, which concerns around a tenth of Europeans, can no longer escape. They can become trapped in cramped accommodations, which house 26.5% of poor Europeans. In a nutshell, social woes are felt exponentially by the most vulnerable members of our societies.

And lest we forget, those already facing mental health issues are likewise not left unscathed. Altogether, this experience is so widespread that it is no longer a particular but a public concern. The World Health Organization (WHO) has recognised this, publishing mental health recommendations for various target groups.

It is also worth pointing out the gender biases of the pandemic. If a majority of COVID-19 casualties are men, almost 80% of healthcare workers are female. Women and children suffering from domestic abuse are also worse off in such an environment. Already a fifth of European women in a relationship have experienced violence at the hand of their partner. Furthermore, about a tenth of all children in the EU – 18 million – are subject to maltreatment. With taking refuge outside the home no longer possible and access to confidantes barred, they are left to the hand of their abusers.

The nature of white-collar labour already predisposes these workers to workplace-related mental-health problems such as burnout and anxiety. Meanwhile, given how eligible they are to telework, white-collar employees or freelancers are the most shielded workers from physical harm. And yet, their lockdown at home can destabilise their work-life balance. At the same time, family duties are even more pressing than before (homeschooling).

Then, there is the economic breakdown, which is slowly receiving almost as much attention as the virus itself. The looming crisis is already affecting our wellbeing, with an increase in suicides all the more likely. The 208 million people making up the EU’s workforce now find themselves primarily confined to their homes. Their contacts with colleagues or social circles have come to a halt, as they brace for an impending economic crisis. This isolation and apprehension, combined with our tendency to consume media in silos, make them more vulnerable to fake news, conspiracy theories, extremist behaviour, and depression.

the case for a European mental health strategy

In recent years, mental health policy in the EU has ended up in limbo. Perceived as a low priority issue on which the EU has little to contribute, the few existing initiatives have slowly faded away. COVID-19 has given new and lasting relevance to an EU initiative on public mental health. According to Marieke Dewitte: “People do not cope well with feelings of powerlessness, prospects of insecurity, or the privation of the fundamental need to belong and physically connect. Because the virus is challenging many of the foundations of public mental health, we should act decisively together. The recovery should be an opportunity to destigmatise mental health problems and make it a priority on the European agenda.” If the pandemic affects the whole of the EU, its mental health consequences will do so too.

There is a strong economic rationale to so. In 2018, a joint OECD-Commission report estimated the financial costs of mental health problems at 600 bn EUR – 4% of the EU’s GDP. The estimate accounts for the costs of healthcare, social security and unrealised economic output. Action on mental health can thus become a pillar of a sound economic recovery measure. With the unfolding economic recession worsening, Member States must commit to delivering on mental health.

This genuinely European predicament calls for a different response. The Union’s very existence is a testimony to the potential of such cooperation growing out of collective trauma:

• First and foremost, greater coordination across the Member States on mental health will have the benefit of putting scarce resources to their best use.
• Second, Commission leadership is needed because mental health issues are pervasive. At the same time, expertise is scattered and national attention to such challenges fleeting.
• Third, greater cooperation on mental health could help to both reveal and disseminate best practices in all corners of the Union. While we might not be able to anticipate the exact mental health consequences, we do know what resembles an excellent mental health approach.

The opening shot, should, however, be a symbolic one. While it will take time for the Coronavirus to disappear, the worst of the pandemic will – hopefully – be over soon. The EU – be it the Council or the Commission – should take this occasion to commemorate this collective overcoming. It should also launch an open conversation on the European trauma sustained. After the Second World War, as reconstruction took all attention, the recovery from collective trauma was smothered. What followed were decades of silence for many. Now, though there is an economy to restart, there is no rubble to clear, and we can afford to take action on mental health.

conclusion

Thus far, EU policy on mental health has developed in fits and starts. Today, however, the Coronavirus pandemic is creating a new situation. Everyone’s mental health in Europe is under pressure. Many are suffering. Collectively, we can mitigate the current damage to public mental health and prevent further harm. With EU action, we will be able to weather this storm firmly together.