New guidance to mitigate the psychological effects of social distancing

New guidance published in The BMJ today during Mental Health Awareness Week has outlined guidance for primary care workers on the best-evidenced methods to mitigate the psychological effects of social distancing. Recommended interventions include remote consultations and social prescribing, such as online exercise and dance classes.

The new guidance, written by academic clinicians at St George's, University of London, St George's University Hospitals NHS Foundation Trust, the University of Birmingham and Boston University School of Public Health, will help primary care workers around the world to identify and support those most in need of support during the pandemic.

While the benefits of social distancing to reduce spread of the virus are well known, more needs to be done to identify and mitigate the psychological and mental health impact of these measures.

Evidence from previous pandemics has shown that social isolation can have negative impacts on people's mental health, including stress, anxiety and depression. A lack of social interactions can also lead to loneliness, which has been associated with adverse effects on mental and physical health, including premature death. Those most at risk include elderly populations and those with underlying health conditions.

The guidance recommends that primary care workers should consider screening patients for conditions like loneliness, depression and anxiety using existing widely used questionnaires and tools, helping to identify the most at-risk individuals proactively.

Once patients have been identified, the guidance advises treatments including routine reassurance, self-care advice, online support and possible referral to mental health services or secondary care. Considering the current restrictions, remote consultations and social prescribing options are also recommended.

Social prescribing is the use of non-medical interventions and community support to help people improve their wellbeing. The authors advise that activities such as online exercise classes, virtual choirs and painting classes can all help and provide a cost-effective approach to preventing a range of physical and mental health conditions. Other interventions include welfare calls, mindfulness and meditation, as well as receiving support from volunteers for activities such as shopping.

While social distancing is inevitable to prevent spread of coronavirus, these restrictions are likely having a huge negative impact on people's mental health. Our guidance is intended to support the primary care community, so that the best evidence-based interventions can be used to help those most in need.

Social prescribing, ranging from one-to-one coaching to online yoga classes and choirs, can make a big difference. The benefits of social distancing are clear, but it's important to consider the consequences of these measures and respond proactively to protect people's mental health."

Dr Mohammad Razai, author on the paper from St George's, University of London

This latest guidance follows on from a previous publication by the same academic group on the best ways to handle potential coronavirus cases in primary care. The guidance was developed into an online Futurelearn course called "Managing Covid-19 in General Practice," which has had more than 20,000 subscribers from almost 200 countries. The new guidance on mental health will be included in the next iteration of the course, starting in June.

Academics and clinicians at St George's, University of London are stepping up their efforts in tackling coronavirus. The UK's specialist health university has recently launched a Coronavirus Action Fund to support research in response to the coronavirus pandemic and continue work to improve health.

Professor Jon Friedland, Deputy Principal (Research and Enterprise) at St George's, University of London, said: "The University is mobilising clinical, diagnostic and underlying scientific research so that we can help the effort against Covid-19.

"Our aim is to improve treatments and outcomes for patients, with our experts working to develop better and faster diagnostic tests and to evaluate drugs to treat the disease as part of broader national trials. St George's researchers are also working to understand the virus and how the human immune system responds to it, to guide future development of immunotherapies and vaccines."