A woman stands in front of a projected image of numbers and technology-like but blurry objects. The image has an atmosphere of loneliness.
Chronica (2018) Sophie Hoyle and Swan Meat. © Hydar Dewachi Performance with a live set by Swan Meat, and biofeedback-controlled video projections, 27 minutes. Part of the Jerwood Staging Series curated by Lauren Houlton.

COVID-19 and healthcare inequalities: it shouldn’t take a pandemic to listen to marginalised voices

The lockdown is having a significant impact on those with mental health problems and has worsened systemic inequalities.  Sophie Hoyle asks why it takes a global crisis to bring these issues to the fore.

For many, the COVID-19 crisis is exacerbating existing mental health conditions; their hypervigilant reactions may be going into overdrive, amplifying existing levels of fear and anxiety with new ones related to the virus, or new threats that lockdown may bring. Accident and Emergency services are overwhelmed with people in mental health crises, and there are fears of a potential increase in suicide rates. Health Anxiety may worsen as well as Obsessive Compulsive Disorder if you have issues around contamination and handwashing.

Many people with Post-Traumatic Stress Disorder (PTSD) and Complex-PTSD  have had varying reactions. Situations of uncertainty and being out of control can lead to feeling ‘helpless’ and trigger flashbacks, especially in this current context of a pandemic where (for many) there is no precedent or existing framework for being able to cope and adapt, and it is beyond even the comprehension of authority figures like the government or scientific community. Mental health support groups for PTSD and related Anxiety Disorders are now available online, and among the conversations are how the crisis and lockdown are exacerbating pre-existing symptoms and behaviours, while also perhaps leading to other confusing or surprising emotional responses.

PTSD is classed as an anxiety disorder that can develop when someone experiences or witnesses a traumatic or ‘extreme’, often life-threatening, experience (e.g. physical or sexual violence). Complex PTSD (c-PTSD) is more likely to occur if multiple traumatic events happened over a longer time period, if they happened earlier on in life, and if the violence or harm occurred from someone close to you (domestic violence, child abuse, negligence). C-PTSD is likely to affect many more people in the population than those currently diagnosed, and impacts a higher proportion of marginalised social groups, like ethnic minorities, LGBTQI+, and working-class people or those living in poverty, who face long-term structural inequalities. C- PTSD has been proven to affect people on a physiological level, including their immunological development, which is an additional risk in the current pandemic.

The ‘vulnerable’ throughout this crisis is, therefore, a term that includes those struggling with both their physical and mental health. Having your movements restricted to the household can mean significantly different things for different people, where home isn’t necessarily a safe space for everyone. You could be trapped in household with abusive partners or families, experiencing or witnessing domestic violence, abusive relationships or child abuse. Deaths from domestic violence have already doubled during the UK lockdown.

Though you may not be currently experiencing this, home may still be a place of flashbacks and memories. Refugees and asylum seekers may be reminded of having survived conflict, of being trafficked, tortured or kidnapped. Those in asylum detention centres and prisons, who are already marginalised, are further side-lined in the current government approach to the crisis, leading to unsafe and unliveable conditions. Homeless people may be in hostels or shelters that are unsafe for them or are now stuck in what was meant to be temporary accommodation. People in precarious employment have lost work or zero-hour contracts have been terminated.

“Transferring meetings, appointments, and work online and offering Remote Access to live events, has shown that society can provide what some disabled people have been demanding for years; but it shouldn’t take a global pandemic for people to listen to disabled and other marginalised communities.”

All ‘non-essential’ healthcare has been cancelled or deferred, but this can include treatment for chronic pain and hormones and gender transition operations, for example, which may not be classified as immediately ‘urgent’, but impact mental health, nonetheless. Referrals for a new therapist or psychiatrist that people may have been waiting months or years for would have been put on hold. Even if you are still continuing to receive therapy for c-PTSD, it can be a big shift to video or phone calls, which may affect those without access to technology, or phone credit.

The technology divide is pertinent right now and can put people at further risk if they aren’t able to inform themselves on how to protect from the virus or treat their mental health. It can disrupt therapeutic relationships, where in c-PTSD building trust and continuity over the long-term is essential and enabling the choice and agency of the patient is key.

But some people with c-PTSD have said that they feel comparatively calm or stable during this current period of crisis; as hypervigilance and risk-assessing behaviour is so part of daily life, to have an external situation that actually ‘matches’ your internal levels of crisis can be oddly calming. Here, your experiences and reactions are proportionate to the current external situation, a locatable ‘threat’ in the present, and one that others can identify and acknowledge. It can feel very different to struggling with something in isolation, when you have experiences that your friends, family, and wider society may find harder to connect to or understand. There is now a ‘rational’ reason to feel and behave a certain way. This wider social awareness and evidence of collective organisation and action in such a short time period can be affirming.

Though however positive, these volunteer groups aren’t enough to counterbalance the longer-term cuts to welfare services by the current government that had led to widespread use of food banks and reliance on charities and activist groups to provide basic food and services. In the UK, there were already many deaths of disabled and other vulnerable people whose lives were dependent on benefits that had been unjustly cut off by the government, and the COVID-19 crisis may increase this.

Moreover, there are visible tensions arising already in public spaces like shops and parks about behaviour, protocol and who to ‘blame.’ Panic-buying and stocking up can spread fear and begin to make other people feel panicked, where individual anxieties can create collective anxieties, and vice versa in a feedback loop. When there is a lack of clear government plan of action (like in the UK), this can increase the anxiety further. When people are feeling so helpless in face of a not-fully-known threat, it may feel easier for people to reclaim agency by demonstrating power on a micro-level: shouting at people, threatening to report or actually reporting people to police. However, this amplifies already existing social inequalities, where police powers which disproportionately target BAME communities continue to have a visible impact in determining who has the right to be outside without question.

One small benefit of this crisis may be that it has demonstrated that some disability access requirements can, in fact, be met. For some people with disabilities or illnesses who are able to work from home or be supported by their network, this shift to online work and services may have actually made their lives more manageable. Commuting or travelling to healthcare appointments and therapies can be overwhelming, as part of an ableist culture that prioritises certain forms of face-to-face interaction, and yet simultaneously doesn’t provide fully accessible public transport for disabled people to do so. Transferring meetings, appointments, and work online and offering Remote Access to live events, has shown that society can provide what some disabled people have been demanding for years; but it shouldn’t take a global pandemic for people to listen to disabled and other marginalised communities.