Are we seeing the light at the end of the tunnel? Maybe. It comes as no surprise that almost half the respondents to a survey conducted by the European Parliament between March and April 2021 indicated “uncertainty” as their current emotional state.

In addition to uncertainty, respondents mentioned feeling frustrated (34 %), helpless (30%), angry (22 %), fearful (22 %), and lonely (16%). All feelings that have increased since the pandemic hit and that show a growing burden on people’s mental health.

Mental health impact and reactions

People that cope well with the many stresses of life can realise their potential, can function productively and fruitfully, and are able to contribute to their communities are considered having good mental health – as defined by the World Health Organization (WHO).

Still, according to the WHO, the health crisis’ mental health impact can be categorised in:

• Direct effects of the outbreak, mainly resulting in fear and anxiety around getting sick, infecting others, or seeing someone close get sick.
• Indirect effects of the measures, for example the feeling of isolation due to the lockdown measures, or the mental burden of coping with a merged working routine and family life.
• Indirect effects of the socioeconomic fallout, such as stress and exclusion related to unemployment, debt, eviction, or impoverishment.

Many cities created or adapted initiatives to support their residents and help them maintain good mental wellbeing during the pandemic. Free online or phone-based services operated by professionals were offered in Milan, Poznan, and Bordeaux among others. Bordeaux also developed specific services for people grieving a loss of a loved one, as did Madrid. Other cities, like Vilnius, made sure their seniors didn’t feel isolated and lonely.

The stressors generated by the pandemic have generally reduced the capacity of people to cope. People who had few experiences of anxiety and distress before the crisis may be more exposed since. Some have developed a mental health condition during the pandemic, and those who had mental health problems may have seen a deterioration of their condition.

While the coronavirus pandemic’s mental health consequences affect all ages, some groups have been hit harder than others, increasing inequalities both within the population and between social groups.

Who helped who?

We have asked too much from our health and care workers during the last year and a half. A terrible example of how much of a burden was placed on them is the result of a July 2021 study of the Laura Hyde Foundation that shows that more than 300 UK healthcare workers attempted suicide last year.

Some cities have directly addressed health and care workers’ burden. In Cardiff, for example, young carers could rely on support WhatsApp group chats to help them cope with their daily care job, and in Bordeaux a phone line was created for healthcare professionals to receive support and advice.

People with pre-existing mental health problems have also been particularly vulnerable. Many facility-based services and community-based support that were usually at their disposal were disrupted by the pandemic, making them less accessible to those who needed them.

Women have taken on the informal care role more than men, exposing them more to mild mental health issues. Young mothers and people from the LGBTQ+ community have especially suffered from being cut off from their support networks and communities.

Young people and students have faced major disruptions to their education and living situations, and are concerned with their future and their place in it. Some may even suffer lifelong economic impacts. A study by the Belgian University VUB surveying 7,100 students found that 55% of them had mild complaints related to their mental wellbeing, 18% had more severe issues, and 2% felt so overwhelmed they had suicidal thoughts.

Aware of the vulnerability of young people and children, Zaragoza and Cardiff organised two initiatives directed at them. While the Spanish youth could reach professionals by phone or email for free counselling, the British exchanged their thoughts and feelings in the form of diary entries on the ‘Diff Diaries’ online platform.

Mental health is for everyone

Helsinki registers around 150 visits a week to their free mental health service, Mieppi. Of these, most are between 20 and 24 years old. The low-threshold service started in November 2019, offering appointments with professionals digitally, via a chat, by phone, or in-person.

People don’t need a diagnosis to use Mieppi’s service – everyone who feels like they need the service can resort to it. Walk-ins are also possible, and since August 2020, the service has opened a second centre, increasing their reach. A third one is planned for the autumn of 2021.

“We each have our difficult moments or life situations,” says Outi Forsström, Senior Planning Officer at the Social Services and Health Care Division in Helsinki. “In that case, a conversation with a reliable professional can help decisively.” Helsinki focuses on making their mental services easy and quick to access, and encourages its residents to use them. A prevention strategy that will help to avoid more serious mental disorders. In some cases however, Mieppi psychologists can offer additional services, like psychotherapy vouchers.

The road ahead

But Helsinki is not claiming victory yet. The city is planning on improving their mental health services especially for children and youth. It will strengthen basic services and access to psychiatric assessment and care, improve professionals’ skills, and increase the role of schools and educational institutions in preventing mental health problems. Many different actors are involved in mental health prevention and care, and cooperation between them is paramount.

In practice, the City of Helsinki will allocate additional resources to primary child and youth mental health services. It will also focus on improving skills in identifying and providing early intervention for mental health issues. The city wants to define practices for clinical consultations in order to reduce referrals to specialist services, when primary services suffice. Helsinki will pilot new evidence-based mental health interventions and training.

The European Parliament has recognised mental health as a fundamental human right in a resolution in July 2020 calling for a 2021-2027 EU action plan on mental health. A step forward considering the long-term effects of the pandemic on mental health are still unclear, though some experts predict an increase in obsessive-compulsive disorders, general anxiety, chronic loneliness, and stress induced by unemployment or precarious living situation. Cities have valuable experience and case studies on the subject and should be included in the plans going forward.

Photo credits: Virpi Velin