There is a deepening recession in mental health

Employee assistance programs are usually pretty boring stuff. For several decades, employers have paid EAP providers to maintain hotlines that their employees can call if they need support with personal problems. The idea is to provide some short-term support – a handful of counseling sessions, say – to help staff deal with mild problems before they get worse.

But this year, EAPs have found themselves facing a rising tide of complex mental health issues brought to them by people who have nowhere else to turn.

“We were never designed to be a crisis line,” says Bertrand Stern-Gillet, who runs Health Assured, the UK’s largest EAP provider with more than 80,000 clients. But he says “high-risk” calls have now become routine, ranging from concerns about protecting a child or an adult to someone who “may have taken a significant amount of pills or may be standing on a bridge”. The company is hiring more employees and managers to try to cope with the increasing complexity and emotional intensity of the work.

Andrew Kinder, head of mental health services at Optima Health, another EAP, conducted an online bereavement workshop for one client’s employees. He expected about 40 attendees, but 1,200 entered. “People were actually sharing quite a lot of experiences about what they were going through,” he says.

Antidepressant use is also on the rise. In 2021/22, 8.3 million patients received at least one prescription item for antidepressants in England, according to NHS figures – 22 per cent more than in 2015/16.

What’s happening? On the positive side, people have become more comfortable discussing their mental health and seeking help. It’s an improvement on the past, when “we had this hidden need that wasn’t even talked about,” says Vicky Nash, head of policy at mental health charity Mind.

But it is clear that this is not the whole story. Loneliness, anxiety, grief and financial problems caused by Covid-19 and related lockdowns appear to have damaged the mental health of people around the world.

In the first year of the pandemic, the global prevalence of anxiety and depression increased by 25 percent, according to the World Health Organization. In the UK, young people are particularly at risk: one in nine children aged 6 to 16 had a probable mental disorder in 2017; by 2021 it was one in six, according to NHS figures.

At the same time, mental health services in many countries have been disrupted by the pandemic and are struggling to cope with rising demand. In the UK, waiting for treatment has become so common that Greater Manchester has set up a service called ‘Waiting Well’ to support people while they wait. But the longer people have to wait, the worse off they get. Nash says people can be turned away because they’re not sick enough to qualify for treatment, “so they have to wait until they’re dangerously ill.”

One study on the experience of people on waiting lists interviewed a woman who said: “I didn’t shower, I didn’t get out of bed because I was thinking in my head, I thought maybe if I stayed in bed long enough, someone would come and get me separate and then I will get help.’

Health Assured’s Stern-Gillett says some GPs tell patients to contact their EAP provider if they have access to one because they are “more likely to get some sort of support quicker than NHS pathways”. .

In addition, the UK is now suffering from a severe bout of inflation and a likely recession. The people most vulnerable to a sharp decline in living standards are those on low and insecure incomes. They are also more likely to have poor mental health – problems that often exacerbate each other.

A recent report by the Joseph Rowntree Foundation highlighted the striking link between antidepressant use and deprivation: in 2021/22, more than twice as many patients were prescribed antidepressants by practices in the most deprived areas of England than in the most deprived areas.

Bar chart of number of patients prescribed antidepressants by IMD decile*, showing that antidepressants are prescribed more often in poorer areas

The problem with relying more on employers to provide mental health support during this time is that not everyone has access to such programs. People on low wages, insecure contracts or out of work at all are less likely to have such a safety net.

They will need as much help as the cash-strapped country can provide. Some interventions don’t have to be very expensive, such as integrating talk therapies with debt counseling. Other policies that would help are already on the table but need to be implemented, such as government plans to make life in the rental sector less precarious.

Leaving people to fend for themselves will pile up more problems both for them and for the economy as a whole. Already, a growing proportion of people say they are too sick to work. Although the over-50s are the biggest driver of this trend, there is also an alarming increase in inactive young people. For them, the biggest cause of long-term illness is mental illness, phobias and nervous disorders, up 24 percent from 2019.

Economic problems are difficult for people at the best of times, and now are not the best of times. How well or poorly we handle this moment will have ramifications long into the future.

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