2021: A Year In Mental Health Through The Eyes Of Therapists

2021 has been challenging, to say the least. The year kicked off in lockdown, still in a global pandemic with the vaccine rollout yet to begin. The news was hard to watch, too. Coronavirus wasn’t the only problem we faced: at the start of January pro-Trump protestors swarmed the Capitol building in Washington as Congress was meeting to confirm Democrat President-Elect Joe Biden's electoral college victory. Then in March, while we were still in lockdown, a young woman named Sarah Everard went missing. It was shortly uncovered that she had been kidnapped and murdered by a serving Metropolitan Police officer. There were thousands of COVID-19 deaths. And then there was the chaotic withdrawal of US and NATO troops from Afghanistan.

Of course, it didn't stop there. The point is that on top of the unique and – to use a word that’s more than a little triggering at this point – unprecedented pressures of living through a pandemic, there’s been a lot to contend with in just one year. Studies have confirmed that the mental strain of living through it all has been huge, with reports of people experiencing post-traumatic stress disorder (PTSD), anxiety or depression all surging. 

We aren’t out of the woods yet and the stark truth is that NHS mental health waiting times are long, with services under strain, and not everyone can afford to pay privately for support.

"I've been a therapist for 40 years and there is no doubt that what we are seeing right now is a crisis. The fantasy that the future is predictable has been blown open. The pandemic has shown people that you can make plans but you can't count on them. We have to work through this and come to a new kind of understanding.

"I am particularly concentrating on young people and teenagers. Being in lockdown and deprived of contact with their peers has had significant consequences. You gain your identity through your teenage years through peer interactions; halting that has been hard.

"I know that we will all get back on track, we have to adapt. It is a hard and challenging time but it is also a time where it's possible for us to adapt."

"The most common themes coming up in my practice are strained relationships, difficulty in planning (loss of sense of agency) and digital fatigue. Many relationships have been challenged because of having to share space and having fewer external sources of support or activities. A lot of couples have broken up over this time. Many clients have struggled with the lack of control over their daily lives. Having to abide by rules is a stark contrast to how much choice we usually have. Many people in therapy have described digital exhaustion – too many online meet-ups, workshops and screen time in general.

"That – digital exhaustion – has presented one of the biggest challenges in 2021. People experienced a digital revolution – e-commerce boom, ubiquitous social media, masses of online news/content – during the pandemic at the same time that some of our basic needs were unmet, namely social connection and physical contact.

"This paradox of digital abundance and social restrictions was a significant challenge to many and continues to be.

"Moving forward, I would advise people to keep and nurture meaningful connections with fewer people. A key ingredient for healthy relationships is active listening, something which one should look to do more often. Although giving to others boosts our wellbeing, self-care is an important base. Continue to do things that keep you healthy be it exercise, eating well or pursuing hobbies. Aim to regulate your use of digital media – filter the content you consume, and try to use your limited time wisely online. Stay grounded by tempering your expectations – life is subject to change at any moment. Of course allow yourself to enjoy the highs but be prepared for the lows, too."

"There has been a huge surge in people seeking help for increased anxiety, stress and depression this year. People with pre-existing anxieties have tended to see a worsening of their problems, and people that did not have these issues before are now reporting increasing issues. The number of obsessive compulsive disorder (OCD) referrals has also gone through the roof.

"Much of this OCD is electively cultivated by pandemic factors, for example, 'contamination' worries, excessive hand washing with bleach or cleaning the surfaces in your home eight hours a day. But interestingly also other types of OCD such as checking, worrying about having 'bad' or 'inappropriate' thoughts and anxiety about perfectionism and 'doing things just right' has also gone up massively. The issue here is the background effect of uncertainty, increased feeling of responsibility and other stresses related to the pandemic. People often find that they get tied up in perfectionistic rituals because it gives them an illusionary feeling of control over the uncertainty and threat that they can't control out in the wider world. It can also be a trap that we can fall into – focusing on tiny things that might feel more controllable or fixable in the face of overwhelming stress and anxiety.

"However, as a psychologist what concerns me most is a more generalised and subtle increasing level of irritation, annoyance, agitation, anxiety in the population as a whole. We are tired, depleted of energy and fractious. As humans we are actually pretty good at coping with short-term stress in a predictable time frame. The particular issue now is that the time frame is uncertain and the outcome is uncertain. It results in a state of chronic exhaustion resulting from being in a state of perpetual stress.

"It is important that we don't feel isolated with these experiences or, worse still, misinterpret and internalise these experiences as meaning that we are 'failing'. When we misinterpret this as a failing in ourself we can feel huge amounts of additional anxiety, shame and stigma. Instead of blaming ourselves it can be useful to understand how stress affects our nervous system as this offers us a kind of framework to understand the different reactions that we might experience. When we take on board that these responses, such as irritability, anxiety and tension, are just normal biological reactions to tricky life circumstances, we have less need to label ourselves with words such as 'weak' or 'pathetic' or beat ourselves up (or others) with other negative self-talk.

"If you are working predominantly from home it's especially important to find ways to make a break from work life. For many people this used to be the commute home that made a defined break between work and personal life. One thing that I get my clients to do straightaway is to 'bookend' the day with a non-negotiable activity that remakes the definition between personal and work life. Preferably this could be something that involves action or exercise such as going for a walk or a run. Then make it non-negotiable that between the bookends you do work and outside those times you schedule personal or relaxing activities. Without this demarcation our nervous system (non-conscious bits of the brain) do not get downtime. This leads to burnout. Employers also have a big role to play here by crushing the assumption that we should be available 24/7 and making it explicit that we are not expected to be answering emails late into the evening. By having employees that have defined work and home lives they will have more effective and productive employees."