Ella Rhodes speaks to psychologists about their work during the pandemic and the lasting effects that remain.
02 January 2025
We can all remember the individual moments we realised that Covid was a real threat. Our environments changed almost overnight; masks, warnings littered across public transport and pavements, two-metre markers, crossing the road to avoid people. Missing weddings, funerals, seeing those we love trying to reach safety, unable to help.
Hundreds of thousands of deaths. Clapping for underpaid and overworked NHS and social care staff who were experiencing trauma and moral injury beyond most people's imagining. Relationships crumbling, others developing online. The realisation many key workers, previously dismissed as 'unskilled', were keeping us fed and supplied with essentials.
We have all come through that period 'changed' in some way. Many live with the debilitating physical, social and financial impact of long Covid. Perhaps you feel like your perception of time is muddled, almost like still living in a state of cognitive dissonance or denial. Did that really happen? For so long? Could it happen again?
So, how do we begin to heal from the scars and the ongoing psychological issues from Covid? I spoke to those working in adolescent mental health, education, and public health to hear about the changes they saw during the height of the pandemic, the problems which remain, and ways we might recover.
'At their root people want to be kind and loving and do the right thing'
Chartered Psychologist Professor Jim McManus worked as Hertfordshire County Council's Director of Public Health during the Covid-19 pandemic. Now National Director of Health and Wellbeing at Public Health Wales, McManus tells me he was aware in late 2019 of reports of the novel coronavirus affecting people in China. 'I remember thinking "This is going to run" because of the nature of travel and the nature of emergent diseases. Was it going to be SARS all over again? As Covid took hold I worked 100 days straight, seven days a week without a break, then seven days a week for the next year and a half. My team grew from about 100 to nearly 300. We saw the very best of people, but I think we also saw the very worst of people. We weren't ready, particularly in terms of the psychological variables.'
McManus has recently written a chapter for a book on leadership in a crisis and said he had learned numerous lessons during the pandemic, drawing on both his psychological and public health expertise – in particular, the importance of strengthening the healthcare system and working with local government. 'I think the essentials of leadership are communication, not micromanaging,' he says, 'Use the talents that are in other people because you won't get anything done otherwise. Trust people and be visible. And put your money where your mouth is and do what you say you'll do.'
Although as a public health leader, McManus had training in coping with emergencies such as Covid, he told me he was unprepared for how exhausting it would be for himself and colleagues. 'There's a kind of persistent, almost psychological and spiritual exhaustion. It's not burnout, it's very different from burnout. I don't think as a society, we really have learned enough from Covid.'
His hopes for the Covid Inquiry are that it celebrates and recognises the people who led but were unseen. 'There was so much unseen leadership, and they got us through; the local mosque, the local Caribbean and African Doctors' group who ran webinars for the Black communities of Hertfordshire when they were worried about the vaccine.'
Despite the many wonderful people McManus met during the last few years, he feels disheartened by the ways Covid has led to division, conspiracy theories, misinformation, and even violence directed at healthcare workers. 'How did we go from standing clapping for the NHS to me having to physically interpose myself between a nurse and a protester who wanted to punch her for vaccinating in a school? I think it will take us a long while to realise the psychological and social impact of Covid. You can't help but see that it is behind some of the politicised divisions that are being made.'
McManus also points out that many serious issues have existed in the UK for the past 10 years. 'Covid worsened a lot of things, but it isn't to blame for the deterioration in our children's mental health, there is no evidence of turbo cancer, and what you've now got is a maelstrom of misinformation. I fear for when we go into the next global infection incident.'
Rebuilding psychological safety and trust in the government, McManus says, would be key in preparing for the next pandemic. 'I think there's an issue about societal trust, there's an issue about the underlying health of the population and there's systemic issues. The NHS needs to be capable of coping, social care needs to be well-funded and capable and actually treated as important in its own right.
'At their root people want to be kind and loving and do the right thing. The greatest mistake of anyone in a pandemic is not respecting that and harnessing it. Probably the biggest lesson I found was that you will never get through a major public health crisis without the goodwill, trust and safety of the public. We need to work on protecting and enhancing that.'
'I think the Covid generation of kids will carry these scars for a long time'
On a bright, mild March day in 2020, Dr Gavin Morgan was in his office at University College London recording a lecture for his Educational Psychology Doctoral students. 'After three hours, I emerged into the corridor and in that time UCL had completely closed down. All of the offices had been cleared. A guy who worked in the admin team had waited for me to tell me I had to leave. I didn't go back to the office for 18 months after that – my world had changed in those three hours.'
Morgan, along with much of the UK, had felt the slowly growing unease of what might come next. As a tutor on the UCL Educational Psychology Doctorate Morgan had been discussing moving teaching online and with the BPS Division of Educational and Child Psychology (DECP) committee talk of using Teams and Zoom was in the air. 'I was thinking there was no way I'd ever get my head around it, that just wasn't going to happen as far as I was concerned. Then pretty much overnight we made our in-person teaching at UCL completely online.'
Also a practising Educational Psychologist in Northamptonshire, Morgan feels the pandemic was a turning point for his career. During a time before schools were closed and lockdowns enacted, he became concerned about the importance of attachment and the ways potential school closures could impact children. He was contacted by SAGE (Scientific Advisory Group for Emergencies) to share his expertise and join its behavioural science sub-group SPI-B (Scientific Pandemic Insights Group on Behaviour).
'The first question I asked at the SPI-B meeting was "When are schools going to re-open?"', Morgan tells me. 'There was no plan to reopen schools and I was concerned that this massive decision had been taken without a strategy to get them open again. I said from the outset that for many of our kids, school is a safe place while home may not be. The attachments some children have with their teacher can be really profound and important, and overnight we denied that to them.'
Although Morgan understood the government wanted to prevent mixing, he was deeply concerned about children's health and wellbeing, and he was approached by many journalists to share his point of view. 'Sometimes I was lumped in with these wacky anti-mask, anti-lockdown libertarians, but I felt it was important to have a counterargument to the prevailing narrative that lockdowns were universally a good thing. No one seemed to be thinking about the impact on kids.'
Given his work as an Educational Psychologist, Morgan has also seen first-hand the impact of the pandemic and lockdowns on children's development and wellbeing – an impact he said we will be dealing with for many years. 'It's been profound and significant,' he says, 'Away from Covid, there's been an imperfect storm of societal pressures on children, cuts to services, financial pressures on families and all of the legacy of austerity on health and social care.'
Indeed a recent report from Ofsted inspectors, 'Strong foundations in the first years of school', based on visits to 20 primary schools in 2023, found that schools were facing significant challenges dealing with the impact of Covid on children in reception and key stage 1. Inspectors noted that children were starting reception with delayed communication and language, poor self-help skills and emotional difficulties.
Morgan confirms that children have emerged from Covid needing extra help and support and that support has been chronically underfunded. 'The caseload of Educational Psychologists has shifted since Covid to include many more behavioural issues. We're also dealing with school attendance problems because we made attendance seem optional during closures. There are many reasons that school is pretty much always the best place for young people to be and if kids aren't going to school the impact is quite profound. I think the Covid generation of kids will carry these scars for a long time.'
Morgan does, however, want us to consider the positive lessons we learned during that time. 'As a psychologist, whether it's something as profound as Covid or something on a smaller level, I try to get people to recognise the strengths they utilise to overcome adversity and difficulty. It's not about getting back to how we were, because we can't. We're all different because of the experiences we went through but we all also demonstrated different strengths and we can learn from those.'
'Where we were at when Covid happened, is always going to be an absolutely key part of our story'
As a Clinical Psychologist and researcher at the University of Bath specialising in adolescent mental health, one of the first concerns Dr Maria Loades had was the impact of lockdowns on young people during the most formative period of their lives. 'Early on I was wondering what would happen for all these young people at home, given everything that we know about what helps healthy development in the teenage years and how important socialising is for forming your identity, to developing your independence from your family of origin, to exploring different ways of being.
'I started pulling together a rapid review of the evidence in terms of what we already knew about the mental health impacts of loneliness for children, young people and young adults, and that really framed the first lockdown for me; desperately looking at what we could recommend going forwards in terms of what might be helpful for preventing a mental health fallout for young people.'
Loades began to gather a group of fellow academics – including early-career researchers and experts in loneliness, mental health and clinical psychology. 'We all worked together to push through something that would usually be done over the course of several months very quickly over the course of several weeks. It felt like this really mattered, to get it out there as soon as we could. It was hard to balance the need to do rigorous science with the need to get answers out as fast as possible.'
They reviewed 83 articles – including studies on the impact of social isolation and loneliness on mental health in children and adolescents, observational, longitudinal and cross-sectional studies, including one retrospective study following a pandemic. They saw a clear pattern that loneliness and mental health were related in both directions.
'If we're lonely we're more likely to get mental health problems later. But also, if we've got mental health problems, we might be more likely to be lonely later. And what we were really interested in, of course, in the pandemic context, was that being lonely now – which we saw coming with all the lockdowns – could lead to later mental health problems with one study showing increased symptoms of anxiety and depression up to nine years later.'
The review was published on 1 June 2020 thanks to the Journal of the American Academy of Child & Adolescent Psychiatry fast-track pipeline for Covid-related outputs. 'We were really the first people to publish something more than just an opinion piece on Covid youth mental health. I remember feeling that we had to try to influence policymakers around the world to prioritise young people being able to socialise as soon as we could. I linked up with a number of other people including Professors Helen Dodd and Sam Cartwright Hatton to start a campaign called #PlayFirst, which was arguing for the need to allow children dispensation from social isolation even if it was outdoors, to interact with each other as soon as possible.'
Loades reflects on the frustration she felt when pubs in England re-opened before schools and, while countries including Scotland had exempted under 12s from some lockdown and social distancing restrictions before they did for adults. 'We were trying to communicate this message to prioritise children and young people interacting and maintaining interactions online – even though we knew that wasn't a replacement for face-to-face interactions.'
As time passed with further lockdowns and as schools began to reopen, Loades emphasised that children and young people should be allowed time and space for emotional and social catch-up rather than just academic catch-up. 'That felt critically important. Obviously, schools are places where young people socialise, where they emotionally develop, and yet, I guess schools in their main remit that see are about academic learning and academic progress, and there was always that risk that would be what would dominate at the cost of actually allowing that space for those other key aspects that schools ultimately provide.'
On the fourth anniversary of the first UK lockdown Loades looked at the evidence that had emerged and found it confirmed what her early review article predicted. 'The evidence showed that those young people who reported being lonely were particularly likely to also have mental health problems. For many young people, things improved once lockdowns lifted, but others continued to struggle, and mental health problems increased again.
We are now, says Loades seeing whole generations of adolescents who missed out on key milestones – moving from primary to secondary school, missing proms and exams. 'We still see the legacy of those losses. We see university cohorts who haven't had the chance to build the life skills and independence that they would have done.
'It was a huge disruption globally, for some people positive, for some people negative, for many of us, aspects of both, but particularly because adolescence is such a vulnerable period where so many of the crucial things were disrupted, the crucial transitions, developing independence and life skills, I think we really particularly have to continue to attend to the unique needs and stories of those young people as they progress now into early adulthood and beyond.'
As Loades says, 'The stories we tell ourselves, matter, as they help us to (re-)shape our experiences in ways that can help us to move forwards or can hold us back. I noticed this as a mother with my little one… it was about the narrative behind things. He was around two or three during the pandemic and it helped him to know that the key people that we were no longer able to see, like his grandparents, were still there, and to connect them with him through screens, but also through posting physical objects to each other so that he could see something had come from his grandma's house to his house, and then he sent something and that was on her screen at the end… a transitional object that could move between these places was absolutely key.'
Loades tells me she is 'personally not great at tolerating uncertainty, and it was a huge lesson in learning to live in the moment and making the most of the things that matter the most. So for me, I think that a key takeaway is, how do I just celebrate this moment? I'm only allowed to go for a walk once a day. How do I make the most of that walk and make the most of the beautiful sunshine and being out and about in nature without getting preoccupied with other thoughts like concerns about buying toilet paper.'
The power of stories
Before I set out to write this article I had an inkling that the simple act of sharing our stories of Covid was important in its own right. Thanks to the wisdom and insight of the people I spoke to I now realise it is a key part of healing from the scars left by the pandemic – scars which will take a long time to heal.
We should acknowledge one another's sorrow, bereavement, trauma, that feeling of time lost, the joy of parts of it, the absurd, surrealness of it. Only by witnessing this in one another can we start to recover and rebuild a life beyond Covid – one that is resilient and prepared for the next pandemic, one in which the wellbeing and health of the next generation are paramount in our minds.
SOURCE:
https://www.bps.org.uk/psychologist/covid-stories-scars-and-healing(accessed 3.1.25)
