This document provides an overview of mental health impacts from COVID-19 presented by Jim McManus, Director of Public Health for Hertfordshire County Council. It discusses how COVID-19 has negatively impacted mental health through multiple pathways from mild to severe for all populations. It also outlines a "public health" approach with three tracks of priorities: 1) public mental health, 2) social identity and community recovery, and 3) building back in a fairer way that addresses economic and social justice. The presentation emphasizes the need for a holistic, multifactorial response considering different populations, the lifecourse perspective, resilience, and addressing mental health as a wider public health issue.

1. www.hertfordshire.gov.uk
www.hertfordshire.gov.uk
Mental Health
LGA Leadership Essentials Event
July 2021
Jim McManus
Director of Public Health, Hertfordshire County Council
Visiting Professor, University of Hertfordshire
Vice-President, Association of Directors of Public Health (www.adph.org.uk)
Past Chair, Behavioural Sciences and Public Health Network (www.bsphn.org.uk)

2. www.hertfordshire.gov.uk
Syndemic Impacts not Pandemic
Long Covid

3. www.hertfordshire.gov.uk
What do we know about Mental
Health and Covid-19?
It has multiple impacts
from mild to severe
affecting all
populations
Some MH need which
existed before covid
has not been dealt
with and has
worsened (Pre-Covid
Baseline)
Some MH need has
been caused by
Impact of Covid
Long Covid (est
40,000 people in
Herts) has
neurological and
psychological impacts
Post Traumatic Stress
in staff and responders
Anxiety returning to
work
A recent HPFT exercise agreed we
need a “public health” approach but
there will be demand for MH services
too
Centre for Mental Health Models
have projected needs and this was
used in ICP work Suggests 202,676
people with moderate to severe forms
of the seven common mental health
disorders post Covid
Slide below is one ready reckoner I wont refer to but
West Berkshire also have produced a good one

4. www.hertfordshire.gov.uk

5. www.hertfordshire.gov.uk
PHE Report Infographic….Syndemic Impact on BAME Communities

6. www.hertfordshire.gov.uk
Mental Health as a Public Health Issue
A substantial and partly preventable
burden of mental ill health
A substantial set of resilience
challenges (Syndemic Lens)
A substantial set of grieving and
loss issues (Syndemic Lens)

7. www.hertfordshire.gov.uk
Public Mental Health Priorities in a Pandemic
https://www.adph.org.uk/2020/10/protecting-our-
communities/
The “Psychological
Contract” of Trust and
Confidence
The Syndemic Lens –
multiple impacts, multiple
responses (Singer, 2009)
Resilience - Hope –
Grieving - Recovery –
Renewal

8. www.hertfordshire.gov.uk
The Psychological Contract
https://www.adph.org.uk/covid-19/covid-19-resources/

9. www.hertfordshire.gov.uk
Key Public Health Perspectives for a
Syndemic of COVID and Mental Health Impact
Different
Populations,
Different Issues
Lifecourse
Perspective
Syndemic Lens
Self Care
Resilience
Early
Identification
and Response
Behavioural
Science
Normalise, DO NOT MEDICALISE
Meaning, Hope, Questions of Ultimate Concern, Spirituality, Faith

10. www.hertfordshire.gov.uk
So how do we do this? Triple Track
of Priorities and some guides
1. Public Mental Health Priorities
– Disaster Psychology. Public MH. Centre for MH.
Grieving
2. Social Identity “Social Recovery” Priorities
– Social Identity
3. Economic and Social Justice : Build Back Fairer
Priorities
– ADPH and Marmot would be my go to guides

11. www.hertfordshire.gov.uk
Track 1: Public Mental Health Priorities
Ensure people with clinical levels of need get service provision respond to clinical need
with a recovery focus
Recover some fundamental things we need and have lost. Good end of life prep for
relatives. Good Bereavement support. Normalise grieving as work and make it easier
Psychological resilience and wellbeing in Organisations (workforce) – traumatised
workforce, collapsed economy
Resilience, recovery, grieving and pro-social culture among population at large – get
upstream, pre-clinical with grieving
Address specific issues for each lifecourse stage in a preventive way – intervene using
existing settings and systems to reinforce positive identity and coping

12. www.hertfordshire.gov.uk
Track 2: Key skills for Recovery – Social
Identity Theory
Horizon scanning
Sense making of multiple strands of information
Influencing
Articulating clearly tasks and issues for the system
Being able to iterate measures
Leadership – Authenticity, Compassion, Discernment, Agility, Self-Care
Facing in different directions
Monitor Public Fears and Concerns – Formal Survey (Herts) and Elected Members

13. www.hertfordshire.gov.uk
Track 2:
(continued)
Community
Recovery and
Cohesion
I wont refer to
this slide, it’s
for reference
1. Build on every bit of what civil
society has done. Saturate
people with social norms of
co-operation
2. Visible, Authentic,
Compassionate Leadership
3. Social support intimately links
with social identity – reinforce
and work with it. Understand
and work with group norms
not again
4. Evidence based and pre
tested communications
strategies. And Listen don’t
just transmit
5. Identify and use trusted
leaders
6. Build shared identities
7. Build narratives of possibility
“We can”
8. Accommodate the Public Urge
to Help
9. Keep Listening
10. Be careful on lessons from
radicalisation. These can
backfire
• Multiple lessons – twelve
lessons from Drury et al
which should be read
carefully (some of them on
list on left)
– Frontiers |
Facilitating
Collective
Psychosocial
Resilience in the
Public in
Emergencies:
Twelve
Recommendations
Based on the Social
Identity Approach |
Public Health
(frontiersin.org)
• Lessons from Leadership
Psychology
– Authenticity
– Compasision
– Discernment
– Agility
– Self-care . ADPH
briefing in draft

14. www.hertfordshire.gov.uk
Track 3: Build Back Fairer
Phase it: Respond,
Recover, Rethink.
Who has born the worst
burden? Systematic
analysis of what can help
recover using syndemic
lens
Leadership attitude and
approach – “we”
“inclusion”
Harness the wisdom and
capabilities of
community groups for
their communities

15. www.hertfordshire.gov.uk
Build back fairer
I wont refer to this slide it’s for reference
1. ADPH recently published it’s “Living in a covid Endemic
environment guidance” Living with Covid
2. This morning Centre for MH Published a key report on MH
Need
3. Key PH Issues – stigma, knowledge, access – a PH approach
– feels like some areas still focusing on how many more RMNs
will we need
4. Collective trauma, covid displaced and covid generated need (
the need generated by long covid and worklessness are just
two examples) – multiple whammies
5. Work together on a population approach – multifactorial
approach to stigma, resilience, coping, early intervention, and
stratify people
6. Until every workplace, school , community and setting is a
mental health promoting setting we will not win. So LAs and
Place come to the fore

16. www.hertfordshire.gov.uk
Key Tasks and Context for Organisations
Make your community, organisation and events covid
safe to model safety
• Learn to live with covid as a community
Learn to
Live
Help people build confidence in managing risk
Confidence
Your organization’s capabilities and role in recovery. Make every workplace a
positive psychosocial space
Articulate
Help people grieve, be alert to mental health issues
Care and
Connect
Help people vision the next two years hopefully.
Hope

17. www.hertfordshire.gov.uk
Business Support from Public Health
• Make schools as safe as possible
• Keep the County Open for Business
– Events advisory Group
– Focus on what CAN be done safely
– EG Music Events
• Guidance Hub
• Compliance Visiting
• Funding for business support (eg taxi screens, bus
screens)
• Infection Control Training (eg taxis)
• Growth Hub Wellbeing Post with LEP
• Growth Hub Psychosocial Skills Manual for
Advisers on Wellbeing so people stay well
• PTSD Training for Care Providers
• Purchase Local where possible

18. www.hertfordshire.gov.uk
Key Things for Public Morale – The Psychological
Contract with Residents – won’t refer to, for reference
Give People Hope and Confidence
Can DO
Motivation
Pro Social Behaviour, Enforcement ONLY in that context
Normalising the problems and reactions – “It’s OK not to be OK”

19. www.hertfordshire.gov.uk
Herts Work (alone or in Collaboration)
TOOLS ON
RESILIENCE
HTTPS://WWW.HERTS
MINDNETWORK.ORG/
YOUNG-PEOPLES-
HELPLINE
WWW.JUSTTALKHERT
S.ORG
BEHAVIOURAL SCIENCE
ADVICE
RESIDENTS’ LEAFLET,
COMMS
CENTRE FOR MH LEAFLET
STAFF WELLBEING
WORK
PUBLIC MENTAL
HEALTH CELL
BEHAVIOURAL
SCIENCE PODCASTS
TRAUMA
RESPONDERS
PTSD TRAINING FOR
CARE HOME
CHAMPIONS
We are happy to share these

20. www.hertfordshire.gov.uk
Jim.mcmanus@hertfordshire.gov.uk
Resources beyond these pages…

21. www.hertfordshire.gov.uk
Long Covid, Long
Consequences
• “Long Covid”
• Individuals who continue to have
Covid-19 symptoms which disrupt
their health
• Outside of the two-week period in
which they are believed to be
infected. (i.e. after time virus
should have cleared)
• Estimates (rough) 1.5% of those
infected persist with symptoms at
3 months
• Extreme fatigue
• Muscle weakness
• Hearing Loss
• Low grade fever
• Inability to concentrate Memory lapses
Changes in mood
• Sleep difficulties
• Headaches Needle pains in arms and
legs
• Diarrhea and bouts of vomiting
• Loss of taste and smell
• Sore throat and difficulties to swallow
• New onset of diabetes and
hypertension
• Skin rash
• Shortness of breath
• Chest pains Palpitations
• Heart Muscle Weakening
Source: Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19:
research needs. Lancet Infect Dis 2020; published online September 1.
https://doi.org/10.1016/S1473-3099(20)30701-5.
Source: https://institute.global/policy/long-covid-reviewing-science-and-assessing-risk

22. www.hertfordshire.gov.uk
• https://www.centreformentalhealth.org.uk/publications/supporting-mental-health-
during-covid-19-brief-guide
• https://www.hertfordshire.gov.uk/media-library/documents/public-
health/coronavirus/professionals-pages/autism-and-mh-offer-leaflet-for-children-
final.pdf
• https://www.watford.gov.uk/info/20286/coronavirus/1061/coronavirus_support_pages
/12
• https://www.healthyyoungmindsinherts.org.uk/parents-and-carers/covid-19-advice-
parents-and-carers
• https://www.healthyyoungmindsinherts.org.uk/schools/how-look-after-your-mental-
health-and-emotional-wellbeing-during-covid-19-outbreak
• https://www.justtalkherts.org/just-talk-herts.aspx
• https://www.hertsmindnetwork.org/coronavirus-update
Mental Health Resources
www.hertfordshire.gov.uk/coronavirus

23. www.hertfordshire.gov.uk
• BSPHN Behavioural Science Podcast
https://www.bsphn.org.uk/593/Podcast
• Public Mental Health COVID-19 Collaborative
https://khub.net/group/covid19-public-mental-health
• Centre for Mental Health
• https://www.centreformentalhealth.org.uk/
• British Psychological Society https://www.bps.org.uk/coronavirus-
resources
• PPMA Wellbeing Hub https://www.ppma.org.uk/coronavirus-
resource-hub-being-well-staying-well/
• CIPD Coronavirus MH and employees
https://www.cipd.co.uk/knowledge/culture/well-being/supporting-
mental-health-workplace-return
Some Resources

24. www.hertfordshire.gov.uk
Jim.mcmanus@hertfordshire.gov.uk