Tag Archives: mental health

“All the lonely people” – tackling the epidemic of loneliness

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Prior to the coronavirus pandemic, the UK was already experiencing what had been described as an ‘epidemic’ of loneliness.  The various lockdowns and social restrictions that were put in place to reduce the spread of the virus have exacerbated this already troubling situation.

Indeed, according to recent research by the Mental Health Foundation, 1 in 4 UK adults (25%) have felt lonely some, or all of the time, over the previous month; and 1 in 4 UK adults (25%) felt ashamed about being lonely.

With the huge impact this can have on mental health, it’s no surprise the theme of this year’s Mental Health Awareness Week was loneliness.

In its new report, “All the lonely people”, published as part of Mental Health Awareness Week, the Mental Health Foundation explores the clear links between loneliness and mental health, looking at what it’s like to be lonely, the causes, consequences and the groups of people who are more likely to experience severe and enduring loneliness.

All the lonely people

Through sharing the stories of nine individuals who often or always feel lonely, “All the lonely people” highlights the circumstances, situations and life events that can increase our risk of loneliness. It also investigates how well people understand loneliness and suggests ways that we can respond as individuals and across society.

While it is acknowledged that anyone can feel lonely, there are a number of risk factors that can increase the chances of severe and lasting loneliness that can impact mental health:

  • Being widowed
  • Being single
  • Being unemployed
  • Living alone
  • Having a long-term health condition or disability
  • Living in rented accommodation
  • Being between 16 and 24 years old
  • Being a carer
  • Being from an ethnic minority community
  • Being LGBTQ+

The health and financial impact of loneliness

Loneliness can have a huge impact on health, life expectancy and mental wellbeing. Research has shown that loneliness can be as harmful as smoking 15 cigarettes a day or having alcohol use disorder. Moreover, it has also been found to be more harmful than obesity. Not only does this have implications for individuals but also for wider society and the economy.

Recent government research estimated that the wellbeing, health and work productivity cost associated with severe loneliness (feeling lonely “often” or “always”) on individuals was around £9,900 per afflicted person per year. Other research has estimated that loneliness costs UK employers between £2.2 and £3.7 billion a year and that an estimated £1,700 per person (2015 values) could be saved over 10 years if action could be taken to reduce loneliness.

Given the significant health impacts and associated costs, the Mental Health Foundation report argues that preventing the development of loneliness should be a key priority and that a greater awareness of the risk factors and triggers needs to be created.

Public understanding but stigma remains

In terms of public understanding, the report asserts that the public has a good understanding of the link between loneliness and mental health. However, there is still significant stigma surrounding loneliness. Of the adults surveyed, 76% thought ‘people often feel ashamed or embarrassed about feeling lonely’. Only 29% of respondents agreed that ‘people who feel lonely are likely to talk about it, if they get the opportunity’. And people who experience loneliness themselves were more likely to recognise this sense of shame.

This stigma makes it difficult for people to talk about due to fears of discrimination or prejudice. Stereotypes about loneliness also still persist which can lead to some lonely people being overlooked. The findings show that despite the public’s understanding, there is a tendency to overlook certain at risk groups such as students, carers and LGBTQ+ people. People also tend to overestimate the link between loneliness and ageing or living in rural areas.

The survey found that people tended to believe that older people were more likely to feel lonely than younger age groups – 63% thought that being older (over 65) might contribute to someone feeling more lonely, whereas only 12% of respondents identified that being younger (aged 16-25) might contribute to someone feeling more lonely. This contradicts recent ONS data, which found that there were higher rates of reported loneliness among younger age groups.

Similarly, people tended to believe people living in rural areas would be more likely to experience loneliness (40% of people thought that living in a rural area could contribute to loneliness, compared to just 23% for living in a city). However, once again, the evidence suggests the opposite, with people living in urban areas reporting higher levels of loneliness than those in rural areas.

The report notes that stereotypes such as these can inhibit people from recognising and responding to their own loneliness, further exacerbate existing stigma and potentially limit the support offered to those who feel lonely.

Broader awareness

The report argues that a wider understanding of the factors that can lead to severe and enduring loneliness is needed to successfully combat the stigma and stereotypes associated with loneliness.

The stories of the individuals who experience loneliness demonstrate just how complex it is and how difficult it is to spot those who may be ‘lonely in a crowd’. It is therefore also important to understand the different barriers to connection for different people. These can be practical (lack of time, access to transport), structural (discrimination or prejudice) or emotional (lack of confidence, anxiety).

The report argues that a broader awareness of these factors could help people to stop blaming themselves for being lonely, encourage creative ways of supporting people and enable tailored support being developed for groups who are particularly at risk of long-term loneliness.

Previous research has also highlighted the importance of tailored approaches and developing approaches that avoid stigma.

Tackling loneliness

While highlighting what individuals can do to help combat loneliness, the Mental Health Foundation also highlights the need for action on the different barriers to connection if it is be tackled long-term. To this end, it has identified five UK-wide policy recommendations to address loneliness in society:

  • taking a strategic approach to loneliness;
  • developing the community resources needed to tackle loneliness;
  • building a greener lived environment that supports social contact;
  • supporting children and young people with interventions in education settings;
  • ensuring that everyone has access to digital communication technology, and the skills to use it, and respecting preferences for non-digital forms of communication.

Each of us can play a part too. By sharing stories of loneliness and shining a spotlight on the issue, we can all help to promote wider awareness and break the stigma of loneliness.

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Young carers: sacrifice and support

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While there has been a lot of conversation about the vulnerable over the last two years of the COVID-19 pandemic, and rightly so, there has not much attention given to the people who care for them, particularly the young people who do so. Young carers carry a lot on their shoulders, and this has only been increased with the impact of the pandemic affecting those they love. However, we also need to look out for these young people and give them the support they deserve.

Issues faced by young carers

Young carers are faced with many challenges due to their position and this can depend on the carers, their age, the level of care they give and who they care for. A report on siblings of disabled children from the UK charity Sibs found that the particular young carers they engaged with tended to not get as much attention and support from their parents because of their sibling needing more urgent care. Even something as simple as going out to play centres or restaurants must be adapted to fit the disabled sibling, with the carer sibling rarely getting their own choice.

Young carers have also been found to be at more risk of mental health problems than others, particularly if the person they are caring for is a parent with a mental illness or a history of substance misuse.  A study from Scotland found that young carers, much like adult unpaid carers, were more likely to have physical health issues such as tiredness, backache and bad diets in addition to reporting worry, stress, anxiety, depression and resentment. They were also found to have significantly lower self-esteem and feelings of happiness than non-carers.

Impact of pandemic

The COVID-19 pandemic impacted young carers greatly. Sibs reported that a lot of parents felt their carer children were extremely worried about contracting the virus and giving it to their sibling, or bringing it into the household if their family were shielding or vulnerable. Others also reported their child withdrawing from friends, either because of shielding or simply because they were uncomfortable socialising outside of their household. Sibs also noted cases where siblings would become the object of their disabled sibling’s anger or frustration.

In addition, a lot of activities and support groups normally put into place for these specific carers, in order to give them attention and opportunities to enjoy life outside of their role as a young carer, were cancelled due to COVID-19, and left many young carers at home, where they were often ignored if their sibling or parent needed additional support.

Other young carers have had to take on a range of duties, including shopping for their families or taking care of their home or other siblings. A lot of these young people have had to balance this with continuing their education from home and dealing with having their lives outside of the home cut off due to social distancing and isolation. This is on top of the general struggles of growing up as a child and adolescent. Izzy, a 12-year-old interviewed by a study from the Centre for Research on Children and Families, said she felt her entire life was “being a mini adult, but it’s not a pick and choose the time sort of thing.” 

Support

There have been a range of support services for young carers across the United Kingdom. Young carers groups have been found to be a great resource to help find other young carers and share some of the issues that affect them with people who understand. These groups  are also important as an outlet outside of their role in the family home, providing support  solely for  young carers. Even during the pandemic, some groups were able to schedule calls for young carers which provided them with interaction just for them, and something to look forward to each week at home.

However, many young carers remain “hidden” from services, either out of choice or because they have been ignored. Some simply don’t know about support groups or services, or have been found to not consider themselves ‘carers’. Instead, they  view their lives as “normal” or doing something that’s “expected” of them. Others may be afraid of the stigma their particular situation may bring them, and therefore want to be perceived as the same as their fellow students.

Final thoughts

The pandemic has pushed conversation and debate towards how we care for the most vulnerable in our society, and hopefully will lead to improvements in our attitudes towards care. However, this also has to extend towards unpaid carers, and particularly the young people who often shoulder invisible labour at the expense of their childhood.

Further reading: more from The Knowledge Exchange blog on carers

Playing catch up: education and the pandemic

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The coronavirus pandemic impact has been far reaching and it is predicted that the impacts will be felt for a number of years to come.

However, one of the potentially longest-term impacts is that on children at school who have missed out on learning which has been significantly disrupted for the duration of the pandemic.

Whether it is the mental and socio-emotional impact of children being isolated from peers, those children who missed out on key early years learning, or those children due to take important examinations, the impact has been significant and few children, if any have been unaffected.

Politicians and commentators have speculated about how easy it will be for children to “catch up” on learning they might have missed. Some have questioned if it will even be possible at all, with suggestions that we could be feeling the effects of the educational impact of the pandemic for many years.

Lost learning

Research from the Organisation for Economic Cooperation and Development shows that in the first 12 months of the pandemic (March 2020-March 2021), 1.5 billion students in 188 countries and economies weren’t able to go to school, for varying lengths of time. 

Further research published by the Education Policy Institute in October 2021 estimated that by the second half of March 2022, lost learning in primary school had amounted to 2.2 months in reading and 3.5 months in numeracy. The research also showed that the impact of lost learning is not equal across groups of children, with those from lower income backgrounds or areas of higher deprivation facing a greater gap in learning than those from more affluent backgrounds.

There have also been significant challenges faced by children with special educational needs and disabilities (SEND). Research has found that in many instances the pandemic has created a “double disadvantage” for children and young people with SEND and that it has exacerbated challenges they already faced with accessing support. Many children and their parents felt “left behind” by decisions that were made around school and care setting closures which they say will have a largely negative impact on children with SEND, not just from lack of learning, but also loss of routine, access to specialist therapies and equipment and interaction with peers.

Trying to predict the impact

Researchers have been attempting to use data from previous crises, such as the Christchurch earthquake and the Second World War to look at the potential long term impact of learning disruption on employment and earnings in later life.

Those examples highlight that long-run negative effects are considerable, but can be mitigated by significant government, school and parental responses. In other words, catch-up is not a natural process: it requires active and sustained efforts.

However, researchers have also noted that the response to catching up is also unprecedented, with little previous comparison for the immediate recognition of the disruption and the efforts in strategies like remote learning which have been employed to try and reduce disruption.

This effort to allow children to maintain some level of learning during the pandemic and allow those who have missed learning to catch up after it could be key in ensuring that children aren’t left behind.

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How to “catch up” on learning

 A report by the United Nations-led Accelerated Education Working Group has proposed multiple ways to deal with pandemic-induced learning losses. These range from extending teaching time to implementing formal catch-up programmes with remedial education for struggling pupils.

In 2020 £350million was invested by the UK Government in the National Tutoring Programme, with a further £200million allocated in February 2021. 

Research exploring the effect of extending the school day and summer schools on educational attainment from the Education Endowment Foundation has found that these measures have a low impact but moderate associated costs. This suggests that it is not an effective way to address gaps in children’s learning created by the pandemic. The evidence also indicates that these interventions aren’t effective in meeting the needs of the vulnerable children who need most support.

There are many, though, who suggest that the focus on “catching up” is not helpful, for learners or teachers. They say that the notion that learners need to “catch up” or are “left behind” reinforces the idea that children only have “one shot” at a “traditional educational route” and that those children who don’t meet those standards have somehow failed. It also puts them under pressure to perform academically at a time which has been challenging and unprecedented for everyone, which could do long term harm to their wellbeing. Instead, they contend that children should be encouraged to celebrate the learning and successes they have had in the past 18 months, whether that is in formal academic assessments, finishing a book they previously hadn’t read or learning to bake or sew.

Children will be returning to school to “catch up” on missed learning from different places – some will have made surprising progress, some will have seen developments in their socio-emotional learning, some will have endured a difficult series of months, some will be continuing to deal with challenges which have only been exacerbated by the pandemic.

The reality is that there is unlikely to be a “one size fits all” process that can restore children to expected curriculum targets as though the pandemic never happened.

Final thoughts

As announcements come of a potential return to formal examinations in 2022, both learners and teachers need to be supported to help make up gaps in knowledge and to ensure assessment is fair.

While learners need to be supported to catch up educationally, the pandemic has also had a significant impact on socio-emotional learning and mental health, and children and young people will need to be brought back into learning environments in ways which support this too. Teachers and those involved in schools and education are themselves under pressure from significant workloads and stressors on their own mental health and wellbeing which was also inevitably impacted by the pandemic.

There are, as yet, few studies which look at the longer term impact of large scale missed education, particularly the impact on older children who have missed, or will now be due to take, key examinations, or early learners who may have missed out on key developmental learning milestones. But the early research shows we face a significant challenge to help bring all children whose learning has been disrupted back to pre-pandemic learning levels.

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More than growing pains: young people and mental health

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The last few decades have seen increasing rates of mental health disorders among children and young people. But while children and young people’s mental health is currently high on the public agenda, many of these mental health conditions remain unrecognised and untreated.

The NHS conducted a Mental Health Survey for Children and Young People in 2017, interviewing 3,667 children and young people, which was followed up in 2021. The follow-up survey found that 39.2% of 6 to 16 year olds had experienced a decrease in their mental health since 2017, while approximately 52% of 17 to 23 year olds also reported a decrease. Within these last four years, a number of factors appear to have impacted these figures, including the continued rise and prominence of social media platforms, family life, and, of course, the Coronavirus (COVID-19) pandemic.

Impact of the pandemic

The beginning of the pandemic marked the closure of all schools, colleges and universities. Not only were young people faced with the anxiety and stress associated with living through a global pandemic, particularly for those who are immunocompromised or have family members who are, but these closures also cut off access to resources for mental health problems. A survey by YoungMinds in January 2021 found that among over 2000 participants who were under the age of 25 in the UK with a history of mental illness, 75% agreed that they were finding the current lockdown harder to cope with than the previous ones, and 67% believed that the pandemic will have a long-term negative effect on their mental health.

Peer support groups and face to face services such as counselling that could be accessed through school were closed, or made accessible through the internet or over the phone. While this does offer some kind of continued support, it is not a form of support that works for everyone and many young people were left feeling unsupported. The YoungMinds report emphasised that any future provision must recognise the value of face to face interaction alongside virtual and digital forms of support.

Alongside issues with access to support, school closures  also disrupted routines, which for many people of all ages with mental health problems can be particularly important as a coping mechanism. It has been suggested that being unable to attend school or university in person, or part-time jobs, can lead to a relapse in symptoms where young people relied on these routines. Refusing to undertake typical daily activities such as showering, getting out of bed and eating sufficient meals are some of the effects seen amongst these young people – all which can exacerbate feelings of depression or loneliness.

Role of families

Families have been found to play a vital part in helping young people who are suffering from mental health issues. This has only become more apparent with the impact of COVID-19 lockdowns, where young people would most likely be living with their family – whether that be parents, siblings or other relatives or caregivers. Lockdown guidelines that mandated staying at home would leave these young people spending more time with their families, and the closure of other services outwith the home, meant these young people’s households often became their main support system. The NHS follow-up survey found that both family connectedness and family functioning were associated with mental disorder, highlighting the importance of supporting families to enable them to support young people’s mental health.

The Local Government Association has recently published a guide on a “whole household approach” to young people’s mental health, stressing the importance of educating families on how to support their young people. This is highlighted as particularly important when they transition from child services to adult services as many teenagers and young people struggle with the lack of support offered when they are legally considered adults.

Social media

Another big issue affecting young people’s mental health is the use of social media. While there are many reported benefits of social media, particularly in relation to connecting with others, there are also growing concerns about its effects on wellbeing and the pandemic has undoubtedly exacerbated this. The NHS survey found that, in 2021, half (50.7%) of 11-16 year olds agreed that they spent more time on social media than they meant to and 16.7% using social media agreed that the number of likes, comments and shares they received had an impact on their mood. Those with a probable mental disorder were particularly likely to spend more time on social media than they intended, and girls seem to be more affected that boys.

The survey found that 21.1% of girls reported that likes, comments and shares from social media affected their mood, compared to 12.1% of boys. It also found that double the number of girls than boys spent more time on social media than they meant to. Other research has also highlighted the disproportionate impact on young girls. One study found that constant social media use predicted lower wellbeing in girls only and that these mental health harms may be due to a combination of cyberbullying, and a lack of sleep or exercise. This was not found in the teenage boys interviewed.

Solutions

When addressing mental health problems, it is clear that a ‘one size fits all’ approach does not work. As highlighted in the research, mental health problems can present themselves in a range of ways, and depend on a number of variables.  People from different socio-economic and cultural backgrounds, or those with additional needs, often face more stigma and can find it more difficult to express their problems or access the correct support for their specific needs.

There have been suggestions for more targeted support for young people and the issues they may be facing, including more investment in schools and social services. Particularly for adolescents who are transitioning to adulthood, it is important to provide continuous support. As highlighted in the NHS Mental Health Survey, more adolescents and young adults (17 to 23 year olds) mentioned a decrease in their mental health than younger people (6 to 16 year olds). Children and Young People’s Mental Health Services (CYPMHS) notes that the transition from child to adult mental health services tends to begin around three to six months before the individual turns 18, although there can be flexibility.  Perhaps even greater flexibility is required, particularly as we assess the damage left by the pandemic. It is argued that engaging adolescents in the provision of mental health services and a shift towards early intervention and prevention will also be important as we look to build new solutions.

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Keeping our finger on the pulse: recent additions to our collection across health

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The health and care landscape has been changed in unprecedented ways over the past year. The coronavirus pandemic has not only highlighted strains within the system and required a response to a public health emergency unlike anything else that has been seen for decades, it has also provided an opportunity to push innovation in areas like digital infrastructure and partnership working, and encouraged decision makers to look at public health as an essential part of policy making in all areas.

The Knowledge Exchange database is full of reports, articles and documents which offer insight into these themes, published by organisations from across the heath and social care landscape. In this blog post, we’re highlighting some recent additions to our collection and some of the big themes being discussed within the sector.

Covid-19, “building back better” and a “health in all policies” approach

In March 2021 think tank IPPR published their report State of health and care: the NHS Long Term Plan after Covid-19. The recommendations form a £12 billion blueprint to ‘build back better’ in health and care and the report calls for an adaptation of the NHS Long Term Plan published in 2019 focusing on cancer, mental health, cardiovascular disease and multimorbidity. The authors believe the Long Term Plan needs to change to ‘build back better’ health and care post-pandemic, in relation to: ensuring a sustainable workforce; resourcing the NHS to deliver transformation; empowering integration; upgrading the digital NHS; funding and reforming social care; and levelling up the nation’s health.

Another report, from the Local Government Association (LGA), published in September 2020, provides specific guidance to local authority councillors on ways to improve the approach to population health and use of public health resources in dealing with the pandemic, highlighting the Health in All Policies (HiAP) approach to addressing health inequalities and improving wellbeing. There are a number of other resources which look at public health approaches to tackling other areas of policy such as youth violence and urban regeneration.

Build back fairer: the Covid-19 Marmot Review: the pandemic, socioeconomic and health inequalities in England, published by the Health Foundation and the Institute of Health Equity examines inequalities in coronavirus mortality, looks at the effects that the pandemic, and the societal response, have had on social and economic inequalities, the effects on mental and physical health, and the likely effects on health inequalities in the future. The report assesses the inequalities in the risk of COVID-19 and mortality and explores the impact of containment on inequalities in the social determinants of health, in terms of: early life; education; children and young people; employment and working conditions; a healthy standard of living; healthy and sustainable places and communities; and healthy behaviours.

Mental health

Mental health services have been under significant pressure in the UK for a number of years now, with children’s services (CAMHS) particularly stretched as the number of specialist practitioners is limited. The coronavirus pandemic has, according to many specialists, exacerbated existing pressures and placed even more demand on services. In April 2021 the All-Party Parliamentary Group on a Fit and Healthy Childhood published a report: The COVID generation: a mental health pandemic in the making – the impact on the mental health of children and young people during and after the COVID-19 pandemic  which explores a range of themes in relation to the impact of the pandemic on the mental health of children and young people. The report presents evidence from a range of sources on the potential implications of the pandemic on young people’s mental health and discusses the impact of school closures on children’s future health and well-being.

The Children’s Commissioner for England recently published a report  which looks at the progress made in improving children’s mental health services in England, and  the impact of the pandemic on the mental health of children. The report also examines the provision and accessibility of children’s mental health services in 2019/20, finding that access is still not adequate and not improving as quickly as expected.          

The other pandemic: the impact of Covid-19 on Britain’s mental health  explores how the mental health of people in the UK has been affected by the pandemic, drawing on a survey of over 4000 people. It describes the different experiences of groups across society and the highlights the disproportionate mental health impact on people who are exposed to higher levels of social deprivation, as well as on women, younger people and those who live alone.

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Structural reform

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, such as taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

One of the main focuses of the health and social care white paper published in February 2021 is around developing an integrated health and social care system and taking a ‘population health’ preventative approach to healthcare, while a report from the NHS confederation recommends a reformation of the framework for elective care and increased healthcare funding.

Digital transformation

Even before the pandemic, The King’s Fund was publishing widely on digital transformation. But their recent report Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic  looks specifically at the impact of the pandemic on accelerating the transformation of the delivery of some services by GPs to focus more on digital delivery and whether this change can (or should) be sustained once the pandemic is over. It explores the challenges around trust, staff and patient digital literacy and the evaluation of digital tools in practice. Parliamentary Office of Science and Technology (POST) published their own review of AI and healthcare , providing an overview of AI in the healthcare system and its potential impacts on the cost and quality of healthcare, and on the workforce.

Final thoughts

The landscape of health and care is changing. The Covid-19 pandemic has placed unprecedented demands on a system which was already facing significant challenges. While in some instances this has led to innovation and accelerated the pace of change, it has also exposed some of the significant weaknesses of the system.

This blog highlights some of the big topics the sector is currently grappling with, but there is more available for TKE members on our database. Members can also sign up to receive our health Topic Update, which will provide fortnightly email updates of items recently added to the collection in health, easily allowing you to stay up to date.

If your organisation is not a member of the Knowledge Exchange and you would like more information, please contact us.

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A nudge in the right direction? Using behavioural insights in health

Virtual reality: a game changer for mental health treatment?

Devolving health and social care in England: an opportunity to transform how we approach health and care?

Cross-border handshakes: what’s next for digital contact tracing?

Living and working in an ‘age of ambiguity’

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The pandemic is having a wide ranging impact on all aspects of people’s lives. From the massive shift to home working for many to the furlough scheme for others, employees have experienced a fundamental shift in the way they work and live.

According to a recent survey of workers, employee happiness has declined and there has been an increase in presenteeism during the pandemic, as the boundaries between home and work, which were once certain, have become blurred.

Blurred lines and a culture of presenteeism

The survey by Aviva, polled 2,000 employees in February 2020 and again in August 2020, finding that most people were happier before the pandemic and that a culture of presenteeism had emerged. Key findings included:

  • More than half (52%) agree the boundaries between their work and home life are becoming increasingly blurred – up from 40% in February.
  • The number of employees who are completely happy almost halved: 20% in February vs. 13% in August.
  • 43% of employees ranked their mental health between ‘very bad’ and ‘fair’, compared with 38% in February.
  • 84% say that they would carry on working even if they felt unwell.

A significant trend of presenteeism and the ‘always on’ culture was highlighted by the survey. The increased uncertainty and heightened anxiety has led to many employees working longer hours and taking fewer sick days. In February 2020, 67% of employees took zero sick days over a three month period; this increased to 84% in August.

Employees may feel the need to prove their productivity while working from home, particularly if they feel their jobs are at risk. But such e-presenteeism is likely to have a negative impact on productivity and inevitably mental wellbeing. According to the report “the ambiguity experienced is compounding behaviour that is detrimental to long-term employee wellbeing.”

Young people (18-25) were found to be particularly affected, with 53% reporting feeling anxious compared to the national average of 34% and 17% ranking their mental health as bad compared to an average of 11% across all age groups.

There have been changes in employee self-determination across the board and the main priorities for employees have shifted as they are increasingly looking for a greater work-life balance over salary – a trend which has increased since the pandemic struck.

Employer considerations

Most employers have implemented new ways of supporting employees, which has been welcomed, but the survey highlights that more needs to be done. Despite a majority of employees believing employers have made some effort to adapt, there is still a loss of motivation among employees. Just 15% of employees agree that their employer is trying really hard to understand what motivates them and only a quarter (26%) agree their employer is genuinely concerned about their wellbeing.

With research confirming a conclusive link between wellbeing and productivity – employees are 13% more productive when happy – no organisation can afford to ignore the issue of employee wellbeing.

Indeed, employee wellbeing was already rising up the corporate agenda pre-Covid-19 but the pandemic has propelled it further into focus for many organisations.

It is argued that a new partnership is required between employees and employers. Personal control surpasses employer control when it comes to what employees want and there is clear evidence that more tailored support, rather than a one size fits all approach, is required.

Aviva’s report argues that “now more than ever there is a case for employers to embrace the ‘Age of Ambiguity’ to support their workforce with their mental health, physical and financial wellbeing.” To this end, Aviva recommends five ‘employer considerations’:

  • Understand how they can deliver on emerging flexibility needs.
  • Personalise mental health and wellbeing support.
  • Create sense of purpose, clarity and autonomy in the workplace.
  • Prepare workers for fuller working lives and the transition from work to retirement.
  • Create more targeted interventions by understanding personality types.

Towards a happier future

As all personality types were found to desire flexibility, it is suggested that prioritising employee wellbeing as a ‘need to have’ rather than a ‘nice to have’ and incorporating flexibility into working life could be a way forward for businesses when it comes to recruiting and retaining the best workers.

The ‘age of ambiguity’ could be the perfect opportunity for businesses to make the necessary changes to support their employees, helping them to improve their physical, mental and financial wellbeing – for mutual benefit.

The pandemic has thrust the world of work into a period of intense change and uncertainty, but many of the trends were already underway, particularly the shift in employee outlook. Employees’ desire for flexibility continues to grow as they seek a better work-life balance and there is no sign of this abating. The Aviva survey has shone a spotlight on this trend and suggests that “employers who embrace their employees’ desire for long term flexibility will see the benefit of a healthier and happier workforce” – leading to a happier future for all.

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From rainbows to Banksy – have lockdowns created a new appreciation for the value of the arts?

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Cultural and creative sectors are among the worst affected by the coronavirus pandemic. Recent analysis suggests that jobs at risk in the sector range from 0.8 to 5.5% of employment across OECD regions. In the UK, the arts, entertainment and recreation sector saw the second largest economic decline of all sectors of the economy during the pandemic.

While the negative impact of crises is justifiably focused on, there are often positive opportunities to arise from such shocks such as widespread collaboration and innovative behaviours to find solutions. Indeed, the current pandemic is no different. Amidst the myriad of reports of the dire economic impact emerges a much more colourful picture of a resurgence in arts and creativity across not only the country but the world.

Rising creativity

From the abundance of rainbows displayed in windows across the UK to singers and musicians entertaining their neighbours from their balconies in Italy and elsewhere, the global pandemic has led to many turning to the arts and creative activities in a bid to help each other’s wellbeing and to thank those on the frontline for their heroic efforts to protect us all.

Many young people found new ways to express themselves through creativity during lockdown, whether drawing or making things, creating music or videos to share on social media. Examples of what young people in England have been creating are presented in Arts Council England’s project The Way I See It .

All sorts of artists from across the globe have been sharing their coronavirus-inspired artwork via social media.

The infamous street artist Banksy has also been joining in, creating a variety of new work from rats encouraging people to wear face masks on the London Underground to a piece paying tribute to NHS workers in Southampton General Hospital.

And the industry itself has had to get creative finding new ways to reach people. Many cultural and creative organisations have moved to delivering digital content to keep audiences engaged, which has opened the door for many future innovations. Organisations and individuals have also been doing a variety of work to reach those most in need such as projects creating new programmes or adapting existing work to reach people who are shielding or vulnerable in their homes, overwhelmingly addressing loneliness and isolation. One participant described their experience:

“I found the process of drawing and painting both cathartic and healing at the most difficult time of my life.”

Economic and social value

While there has generally been a need to make the case for the value of arts and creative activity, whether in education or business, perhaps the impact of lockdowns has afforded the opportunity for everyone to recognise their value both at times of crisis and as part of recovery.

The sector is already an economic driver and source of innovation. In 2019, the economic output of arts and culture was equivalent to 0.5% of the whole UK economy. And despite the immediate economic impact of the pandemic, there is hope that the sector will recover quickly, albeit with significant government support. Recent research from the Centre for Economic and Business Research (CEBR) predicts that the sector’s Gross Value Added (GVA) will return to its pre-lockdown level of £13.5bn by 2022 with the help of the Culture Recovery Fund, a full year earlier than was anticipated without government intervention. The research also shows the sector is set to be worth £15.2 billion to the economy by 2025.   

As well as contributing to the economic recovery, the sector can also play a crucial role in the social recovery as indicated by the many examples highlighted above.

As non-educators, many home-schooling parents have moved towards cultural and creative enrichment for their children. It has been well-documented that arts and creative activities can help improve mental health and wellbeing and at a time when there are grave concerns about young people’s mental health, surely this can only be a good thing.

As previous pandemics and disasters have consistently shown, a major focus of recovery needs to be on mental health; something that the arts and creative industries can clearly help with.

Final thoughts

At time when we might all feel like social distancing from ourselves, the arts and creative activities can provide an escape for everyone. The value of arts and culture, both economically and socially, cannot be underestimated. Perhaps the most positive outcome of the current pandemic for these sectors, will be the newfound appreciation of them from all walks of life which will hopefully translate into decision-makers thinking twice before laying the brunt of budget cuts at their door.

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The year of living differently: reviewing The Knowledge Exchange blog in 2020

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2020 has been a year like no other. A microscopic virus – 10,000 times smaller than the width of a human hair – has dominated, disrupted and redefined the way we live and work.

Although the pandemic is primarily a public health emergency, its effects have been felt in all areas of public and social policy, from economic development and employment to transport and the environment. Throughout this year, our blog has reflected on the impacts of the coronavirus and the restrictions introduced to prevent its spread.

The COVID-19 knock-on

While the coronavirus pandemic has dominated the news headlines, it has also obscured the knock-on effects on the NHS. In October, we reported on the impacts of delays to preventative healthcare measures, such as screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

As the blog post noted, the impacts have been wide-ranging, including not only delays in care for case of physical ill health, but also for those seeking treatment for mental health conditions:

“Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this.”

The ‘hidden epidemic’

Long before the coronavirus pandemic, domestic violence had become known as a ‘hidden epidemic’ in the UK. In September, our blog highlighted the unintended consequences of quarantine for domestic abuse victims.

After the UK entered lockdown in March, calls and online enquiries to the UK’s National Domestic Abuse line increased by 25%. Three-quarters of victims told a BBC investigation that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received.

Despite additional government funding, the local authorities and charities which support victims of domestic violence have been struggling with the financial fallout from the pandemic. Even so,  important partnerships have been formed between local government, educational institutions and third sector bodies to provide safe spaces for women and their children fleeing violence. Among these was an initiative at the University of Cambridge:

“St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.“

‘Same storm, different boats’

As the recent Marmot review has stressed, the coronavirus pandemic has exposed and deepened many of the deep-rooted inequalities in our society, including gender, ethnicity and income.  It has also shone a light on more recent inequalities, such as the growth of precarious employment among sections of the population.

In July, we looked at the uneven economic impact of the pandemic, focusing on the heavy price being paid by young people, women, disabled people and Black and Minority Ethnic (BAME) communities.

Women often work in the frontline of care services and have had to juggle childcare during lockdown. BAME communities are over-represented in key-worker jobs, and so were particularly vulnerable to coronavirus.

And although there has been much talk about ‘building back better’, our blog post drew attention to the observations of Dr Sally Witcher, CEO of Inclusion Scotland during a Poverty Alliance webinar:

“She asks whether indeed we should want to build back, when the old normal didn’t work for a large proportion of people, particularly those with disabilities. Dr Witcher also questions ‘who’ is doing the building, and whether the people designing this new future will have the knowledge and lived experience of what really needs to change.”

The impacts of a pandemic

Many other aspects of the impact of COVID-19 have been covered in our blog:

  • How housing providers have embraced the fluidity of an emergency situation, including tackling homelessness, engaging effectively with tenants and addressing mental ill health.
  • Digital healthcare solutions for those with coronavirus and for the continuity of care and day-to-day running of the NHS.
  • Creating and managing a COVID-secure workplace.
  • How COVID-19 is changing public transport, including an acceleration towards contactless payment and mobile ticketing.
  • The additional challenges of the pandemic facing autistic children and young people.
  • The impact of the coronavirus restrictions on the arts.
  • The role of green new deals in tackling climate change and economic inequality as part of the post-Covid recovery.

Beyond the virus

Although the pandemic has been at the forefront of all our minds this year, The Knowledge Exchange blog has also taken the time to focus on other important issues in public and social policy:

We’ve also taken advantage of the ‘new normal’ experience of remote working to join a number of webinars, and to report back on the observations and ideas emerging from them. Most recently, our blogs have focused on a series of webinars organised by Partners in Planning, which included contributions on how the planning system can help address climate change.

Final thoughts

The health, economic and social impacts of the pandemic are likely to be long-lasting – restrictions on travel, work and socialising will continue into the spring, and insolvencies and unemployment numbers are likely to rise. And the continuing uncertainty over the UK’s new trading relationship with the European Union will generate additional challenges.   

But, as a frequently difficult, often challenging and sometimes distressing year draws to a close, there is cause for optimism about 2021. Vaccines to prevent the spread of the virus have been developed with lightning speed. Across the UK people are already being vaccinated, with greater numbers set to receive the jab in the coming months.

Here at The Knowledge Exchange, we’ll continue to highlight the key issues facing public and social policy and practice as we move towards the post-Covid era.

Season’s greetings

It’s with even greater meaning than ever before that we wish all our readers a happy Christmas, and a healthy, prosperous and happy new year.

Best wishes from everyone at The Knowledge Exchange: Morwen, Christine, Heather, Donna, Rebecca, Scott, Hannah and James.

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Virtual reality: a game changer for mental health treatment?

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Demand for mental health treatment in the UK far outstrips supply. And the outbreak of COVID-19 has forced many primary care services to think creatively not only about demand and supply, which has increased further during the pandemic, but also about delivery. GPs and community mental health teams in particular are thinking about more innovative ways to deliver remote support to people with mental health conditions, including the use of Telehealth and virtual reality (VR) platforms.

People are probably most familiar with VR in a digital gaming context, with devices like Oculus headsets offering immersive gaming experiences where players can place themselves “in the game”, but it has been suggested that integrating VR, alongside other telehealth options like apps and videoconferencing into mental health consultation and treatment could make counselling and alternative treatment options more accessible to those living and working remotely. Early research suggests that while discussions about investigating the benefits of this type of delivery of care have been accelerated by the coronavirus pandemic, researchers and practitioners were already beginning to explore how VR and Telehealth could be a tool that could be utilised more regularly in the treatment and engagement of people with mental health conditions, not just during periods where face to face contact is a challenge.

Blended treatments to help improve outcomes

Telehealth encompasses a number of different approaches and techniques, including using platforms like skype for mobile conferencing, or mobile apps to help people manage conditions and to help deliver some treatment options. It has previously been used in other areas of medicine, for example to help those with chronic conditions self-manage, with various levels of success and uptake.

One foundation embracing remote mental health support, even before the arrival of coronavirus, is Greater Manchester mental health foundation trust who use a mobile app called ClinTouch, to support people recovering from psychosis, schizophrenia and bipolar disorder. Although patients will typically see a care co-ordinator monthly, symptoms of a relapse can appear within days; with the app, users are asked how they feel a few times a day, and an alert is generated if a relapse looks likely.  Some NHS organisations have also adopted telepsychiatry – videoconferencing therapy sessions. 

Using VR for remote therapy almost takes telehealth a step further, and involves using a complete virtual environment, with the potential for this to be integrated into treatment plans, so clinicians can, for example, create a setting which looks like the inside of their office, or use virtual environments to model external scenarios that may cause anxiety to help patients practice coping techniques like breathing exercises.

One of the potential extended uses for VR and telehealth in a clinical mental health treatment setting which has emerged is its application for rural populations, or for people who are isolating because of exposure to coronavirus. However, this has raised some additional questions about the potential barriers to uptake exacerbated by digital illiteracy and poor access to digital devices, as well as the problem of poor or slow internet connections, something which will need to be considered by health boards if they decide to offer these treatment options.

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More research is needed, and is being done

While recent research has shown face-to-face therapy remains the optimal treatment method in mental health care, VR-based therapy has been found to be more effective than Skype-based or phone only counselling. The research also suggests VR-based Telehealth sessions could improve engagement, compared to phone only sessions and greatly reduce dropout rates for clients which in turn can support positive clinical outcomes. It appears the general consensus is that self-service, VR and automated technology, in the form of apps and notifications could support and augment healthcare professionals and help support the delivery of more traditional approaches.

The virtual reality lab at the NIHR-Wellcome Trust-King’s Clinical Research facility aims to improve the understanding of the mechanisms that play a role in the onset and maintenance of mental health problems. They use virtual reality environments to assess and develop treatments to improve the well-being of people with mental health problems.

Research is also being done on the specific reaction to young people of engaging with digitally driven treatment options. There are some suggestions that the delivery of digital interventions to support young people with mental health problems may help them to engage more, in part because they are more familiar with digital platforms and may feel more comfortable using them day-to-day, however there is also a suggestion that young people also prefer the feeling of “distance” and “impersonality” that a digital platform provides which can lead to some feeling more able to express how they are really feeling, compared to a face to face meeting with a clinician which can sometimes be a stressful and intimidating experience.

Where next?

So far in clinical psychology and psychiatry, the primary focus of VR has been its role in treating anxiety and stress-related disorders, specific phobias, panic disorder, and post-traumatic stress disorder. However the disruption to face to face mental health treatments caused by the coronavirus pandemic has led to clinicians thinking even more creatively about the applications of VR and telehealth options to help support the treatment of people with a wider range of mental health conditions.

While it is clear that virtual treatments should not replace the face to face consultation in mental health treatment entirely, research suggests there is a growing role for VR and Telehealth options in augmenting face to face treatment options and that they could be offered as an option for those who are unable to attend face to face sessions. Telehealth and remote treatments are something which will continue to be explored beyond the coronavirus pandemic and could soon be integrated into practice as part of the standard delivery of mental health care and treatment.

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Counting down the hours: could a shorter working week raise productivity and improve our mental health?

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In 1930, the influential British economist John Maynard Keynes predicted that within 100 years the working week would have shrunk to 15 hours. He believed that as living standards rose people would choose to have more leisure time as their material needs were satisfied.

For a time, it looked as if Keynes might be right. In the post-war period, average working hours continued falling, and analysis by the New Economics Foundation has suggested that if this trend had continued we would currently have an average working week of around 34 hours.

But in the 1980s, labour market deregulation, reduced collective bargaining, and slower growth in pay for low income workers put the brakes on working time reductions.

In the UK, 74% of the workforce work an average of 42.5 hours a week. That’s longer than in any EU country, apart from Greece and Austria.

The benefits of a shorter working week

In recent years, the twin challenges of climate change and automation of jobs, along with growing concerns about mental health and work/life balance, have prompted a rethink on working hours.

For some, a shorter working week means compressing forty working hours into four days instead of five.  Others argue that a truly progressive four-day week involves fewer hours at work, with no reduction in pay.

While many employers may recoil at the prospect of paying the same wage for fewer hours, a growing body of evidence presents some strong arguments in favour of this approach:

  • Studies of working hours reductions have demonstrated increases in productivity over four days to compensate for the loss of the fifth working day.
  • Employees with reduced hours spend less time on inefficient tasks, such as meetings.
  • Fewer hours can mean less stress, greater work-life balance and increased motivation.
  • A 2020 study by Autonomy found that a four day working week could potentially reduce energy consumption for the extra non-working day by 10% and emissions intensity by 15%.
  • A shorter working week could have positive effects on gender equality.
  • Maintenance costs can be reduced if all employees are out of the office for an additional day each week.

The four-day week in practice: lessons from New Zealand

In May, New Zealand’s prime minister, Jacinda Ardern encouraged employers to consider the four-day working week as one of the ways the country’s economy could be rebuilt following the Covid-19 pandemic. She suggested that reductions in working hours could boost productivity and domestic tourism and improve work/life balance.

In fact, one New Zealand firm has already demonstrated the positive effects of a shorter working week. In March 2018, financial services company Perpetual Guardian began a two-month trial in which its 240 staff worked four eight-hour days, but got paid for five. The experiment was monitored by academics at the University of Auckland and Auckland University of Technology.

The findings from the trial showed that supervisors were able to maintain performance levels, and most teams recorded a marginal increase. Meanwhile, employees reported improved job satisfaction and a better work/life balance. In addition, many employees expressed a sense of greater empowerment in their work because of the planning discussions that preceded the trial. The success of the trial has now resulted in the four-day week being adopted as company policy at Perpetual Guardian.

The cost of cutting hours

Another working hours trial, in Gothenburg, Sweden, involved nurses in a care home being offered the chance to work six-hour shifts instead of eight, on full pay. While the trial resulted in improvements in staff satisfaction, health and patient care, the city had to employ an extra 17 staff, costing £1.4m. Critics of the scheme said the need to pump additional taxpayers’ money into the trial proved that it was not economically sustainable.

Cost is a potential stumbling block to further working hours reductions. A 2019 report from the Centre for Policy Studies (CPS) estimated that the cost to the UK public sector of moving to a four-day week would be £45 billion if attempted immediately, or £17 billion assuming generous productivity gains from shorter hours. The authors argued that such costs would require spending cuts in public services or substantial tax rises.

However, the Autonomy think tank has put the net cost of a 32-hour week at no more than £5.4 billion. Autonomy has also pointed to improvements in job quality for millions of public sector staff, the creation of 500,000 new jobs and reductions in the sector’s carbon footprint as potential benefits of shorter hours.

Burnout or rethink?

In October 2020, the 4 Day Week Campaign, Autonomy and Compass published Burnout Britain, looking at the impact of longer working hours. The report noted that over the past three years the length of the working day has increased steadily, resulting in a 49% rise in mental distress reported by employees. Women are experiencing particular pressures, with 43% more likely to have increased their hours during the Covid-19 crisis.

The report warned that beyond the coronavirus pandemic, the UK faces another serious public health emergency:

“…as well as an impending recession and mass unemployment, we are heading into an unprecedented mental health crisis”

The existing evidence suggests there’s a strong case to be made for reductions in working hours. Apart from the potential productivity gains and improvements in the quality of life, there are savings to be made in the costs of treating mental ill health caused by overwork.

Even so, government and employers will require further proof of the tangible benefits of a shorter working week before committing to permanent changes.

Crisis often accelerates change, and the Covid-19 pandemic has injected new urgency into the debate. Remote working, restrictions in the workplace and the threat of mass unemployment have demonstrated the need to reconsider the old rules that only months ago seemed set in stone.

We are still a long way from Keynes’ vision of a 15-hour week. But 2020 has shown that shining a light on previously unthinkable alternatives to our current ways of working is not only possible, but essential.

Further reading: more on working conditions from The Knowledge Exchange blog:

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