When the Covid-19 pandemic began, people working in the trauma field knew the psychological toll would be colossal. In the spring of 2020, I began interviewing professionals about the mental health fallout of the pandemic, specifically its impact on frontline medical staff. During the first wave, two in every five intensive care staff in England reported symptoms of post-traumatic stress disorder.
That work continued for almost a year, during which time a second wave hit and the initial traumas were exacerbated. But it wasn’t only frontline workers who were experiencing trauma symptoms: Covid has posed perhaps the biggest threat to mental health in England since the second world war. Now, at the tail end of 2021, the pandemic is still not over. The NHS forecasts that nationally, there will be 230,000 new cases of PTSD as a result of Covid-19.
It is not only social care and medical staff who will be affected. Those who lost loved ones, and those who have been very ill or hospitalised (35% of Covid-19 patients who were put on a ventilator go on to experience extensive symptoms of PTSD) may also suffer. Then there are those living with the effects of domestic and sexual abuse, which may have worsened due to lockdown, and children and young people whose lives changed immeasurably due to our shift to a state of emergency. I imagine that some women whose birthing experiences were marked by the pandemic will also be experiencing symptoms.
Unfortunately, the current system is still not fully equipped to deal with this explosion in trauma cases. The Royal College of Psychiatrists says the NHS is already facing the biggest backlog in its history of those waiting for mental health help. As of September, 1.6 million people were waiting for treatment, and the college says that more funds than those committed to by the government are desperately needed, including for extra psychiatry training places. Record numbers of children and young people – almost double pre-pandemic levels in the months leading up to September – are seeking access to mental health services, while a report by Buttle UK warns that a generation of children, especially those on low incomes, faces years of trauma and mental health problems as a result of Covid-19.
Although PTSD is still very much associated with veterans in the minds of the public, there does seem to be a broader comprehension of the condition and its symptoms than there was before the pandemic. It is not a mental health condition that made headlines much in pre-pandemic times, and media coverage has no doubt made people more aware of its existence. The “trauma bible” The Body Keeps the Score, by Bessel van der Kolk, has been a regular feature in the bestseller charts, and new books and memoirs are being commissioned by publishers. Among younger people, trauma memes and tweets proliferate, and there appears to be less stigma in talking about what PTSD actually entails, with terms such as “trigger” and “depersonalisation” or “derealisation” becoming more commonly used.
Unfortunately some of these words, especially trigger, have also become co-opted as part of a culture war which paints those who experience “triggering” as being oversensitive. The ignorant response to Labour MP Nadia Whittome taking time off work due to post-traumatic stress earlier this year, which included comments that she couldn’t have PTSD because she hadn’t been in a war, shows how much work still needs to be done.
While it’s positive to see increased discussion of this issue, more in-depth and empathic media exposure would be beneficial, including firsthand accounts of the disorder. What use is knowing the terminology if it isn’t unpinned by an understanding of what having PTSD actually feels like? So many sufferers I have spoken to only began to realise that what they had was a real, treatable mental health condition when they read about others’ experiences or heard them speak.
A trauma sufferer may experience the symptoms of depersonalisation – a dreamlike, detached state of being outside yourself and floating through life at a distance from it – without realising that this might have anything to do with the traumatic events that they lived through. Or they might be having horrific nightmares which, on the surface, share little in terms of content with what happened to them. Anthologies such as Trauma, which was published by Dodo Ink last year and to which I contributed, show how diverse and multifaceted a mental health condition PTSD can be.
As ever with mental health, greater awareness can only be a good thing, but it must also be underpinned by real structural support and change. What good is it if, after finally recognising that her symptoms might be PTSD and that effective treatments are available, a patient then spends months and months languishing on a waiting list? With PTSD, early support is absolutely key to your chances of recovery, and yet the system is facing an unprecedented backlog.
The saddest thing about all this is that PTSD is eminently treatable, but the longer the pandemic goes on and the longer people are kept waiting, the more difficult it will become to do so. Volunteer therapists were used to plug the gaps in services, but they need to make a living. One of the things I heard about most in my reporting is how further Covid waves have compounded the initial trauma to result in, for some, complex or type two PTSD. That is usually seen in war veterans and victims of child abuse – people who have been exposed to repeated, sustained traumas. It is more difficult to treat and has poorer outcomes.
The explosion of post-traumatic stress disorder is a medical emergency, and a further strain on our creaking services. Without proper action and investment, it is a national mental health crisis in the making.
Rhiannon Lucy Cosslett is a Guardian columnist