‘There are no good options’

One year on from the UK’s first Covid-19 lockdown, psychology is still to the fore in our fight against the virus. With vaccinations being rolled out in many countries we have perhaps reached a critical juncture in the role psychology can play in bringing us out of the current crisis. We spoke to psychologists who have been doing some of this important work – in advising governments and tackling misinformation – and asked them about their experiences over the past year, as well as the limits of their knowledge.

Here on The Psychologist several readers and others in the field have contacted us to downplay the seriousness of the virus and to express concern over the impact of national lockdowns and school closures. Dr Stuart Ritchie (King’s College London) has co-founded a website – covidfaq.co – to counter some of the most common arguments made by Covid sceptics, using evidence. These include the claims that Covid is only as deadly as the flu, that lockdowns cause more deaths than they prevent, and that children do not spread the virus.

Ritchie said although he could understand why psychologists who focus on mental health were concerned about lockdown effects, we should adopt a more nuanced position on impacts. ‘What I can’t get my head around is why they’re so sure that any detrimental trends in mental health in the past year are due to lockdown specifically, rather than to the effects of there being a terrifying once in a Century pandemic occurring. I don’t think you need to be a psychologist to know that seeing hospitals overloaded and family members suffering and dying would have a terrible effect on people’s mental health – and that’s what lockdowns are trying to prevent (even if many of the policies don’t quite fit with each other, or the government has screwed up on lots of things – which they certainly have!). It’s strange that people can’t see that there are no good options, rather than trying to make out that our lockdown policy is the cause of all the psychological problems people are reporting.’

There is undoubtedly a balancing act at play in the global response to Covid – each option to tackle the virus brings its own challenges. The psychologists we spoke to told us that we should acknowledge these challenges even if, at present, they cannot be resolved. Professor Sarah-Jayne Blakemore (University of Cambridge) often takes to Twitter to raise concerns about the effects of school closures on children, adolescents and young adults, and the crucial importance of reopening schools fully as soon as it is safe to do so. She is perhaps unusual amongst psychologists in terms of receiving some pushback from those who support lockdowns. She told us: ‘I have had shocking replies saying things along the lines of “you’re trying to kill teachers and their families and children”. I’ve had to respond: “Something that shouldn’t need saying and yet sometimes does: It is possible to care deeply about both Covid and the horrendous infection and mortality rates and the educational and mental health consequences of children and young people not being in school or seeing their friends”.’

Blakemore acknowledges that schools would not be safe to open with community transmission at current levels. ‘Professors Russell Viner and Chris Bonell are the two scientists who work with children and young people and are on SAGE, and it seems they’re saying with a heavy heart that right now is not the right time to open schools fully.’ Blakemore points to Professor Devi Sridhar and Anne Longfield, the Children’s Commissioner, as other voices making nuanced arguments about the balance between the public health strategies aimed at reducing the spread of Covid and the importance of schools being ‘first to open and last to close’. ‘But nuance is often lost on social media,’ she says, ‘views become very polarised.’

Expertise in parts
Professor Susan Michie (UCL), a member of both SAGE and Independent SAGE, said managing pandemic transmission and effects required a multifaceted approach. ‘Enabling behaviour by educating, training, persuading and using the environment to support behaviour change, and working to protect and mitigate harmful effects on people’s lives, including their physical and mental health. Psychologists have an important role to play within this, but no group of psychologists can take on all of it; they have expertise in parts. It is important that all psychologists work for the public good, recognising that their input is only a small part of the total psychological and broader public health input.’

Blakemore pointed out that cherry picking data can be an issue when discussing Covid, given that research findings on issues such as transmission in schools are evolving on a near-daily basis. ‘This is a problem of science generally, that you’ll always be able to find a study that backs an argument, but when it’s such a new area one study comes out one day, and another completely contradictory study comes out the next day, but they’re the only two studies… take your pick! There are so many areas around this virus that we won’t really understand for probably years to come.

There is an opportunity, Blakemore said, for psychologists to prove the importance of the discipline during the pandemic and many psychologists worldwide have already made a huge difference in countries' approaches to tackling the virus. ‘But if data about rates of mental ill health are taken as evidence to support an ‘anti-lockdown’ stance, that’s just too simplistic. And for psychologists like me, and Dr Duncan Astle and colleagues in Cambridge who just published longitudinal data on mental health in young people over the last year, it makes us slightly nervous about saying anything about it because we don’t want our findings or what we say about them to be used in that way.’

Open to uncertainties
Professor Stephen Reicher (University of St Andrews), a member of SAGE and Independent SAGE, has become a familiar face on news channels across the UK. He told us he had not seen such an interest in psychology and the behavioural sciences for 40 years. ‘Discussions about risk perception, trust, social influence, once the preserve of the tutorial session, they’re now the stuff of talk shows. Moreover, the interest is not confined to the media. Policy makers and policy groups are now including psychologists where none were included before. And there is a genuine sense of respect and interdependence between the modellers, epidemiologists, virologists and ourselves: they can tell us what behaviours need to change to contain Covid, we can tell them how to try and change such behaviours.’

While this is good for psychological science, and public perception of psychology, Reicher said there are numerous challenges – not least tighter timescales in producing advice. ‘While we should be confident in the knowledge base we bring to the table, we should also be open about our uncertainties and even rethink our attitude to uncertainty. Our normal practice is to assume we know nothing until we are certain beyond reasonable doubt. But in conditions where life or death decisions have to be made without delay we may want to go on the balance of the evidence and also to apply new criteria such as the precautionary principle.’

Reicher also suggested that one of the main roles for psychologists should be to point out those areas where psychology does not apply. ‘For instance, much of the debate on adherence to Covid measures has assumed it is a motivational issue and that those who break the rules, say on self-isolation, choose to do so. This then leads to a focus on the errant individual and is associated with calls for tougher sanctions. Yet much of the evidence suggests that the problem is not one of will but of opportunity: having the resources to act as required. That is why deprived and vulnerable groups are far less likely to isolate.’

Covid has revealed the contribution psychology can make to society, Reicher said. ‘On the one hand, let us grasp that opportunity and ensure the lesson is not lost after the pandemic. There are many other actual or looming crises where we should be playing an equally important part – climate change, immigration and more. On the other hand, let us not overstate our contribution or counterpose it to that of others. When justifiable disciplinary pride slips over into hubris, triumph can also turn to disaster.’

The coming year
Psychology looks set to remain on the frontline of the battle against Covid. ‘A vaccine,’ Reicher told us, ‘solves nothing. It is people getting vaccinated that will affect the disease and its transmission. So, we need to address issues of vaccine hesitancy, why hesitancy is so much greater in some groups than others, how conspiracy theories gain traction, and how to impact all of these if the vaccine is to play its part. Moreover, once people are vaccinated we need to ensure that they do not become complacent and offset the biological gains by behaving in ways that increase the risk of transmission.’

‘The epidemiologists are obviously the vital people in all of this, this is their thing,’ said Blakemore. ‘But they’re not psychologists, and it’s a good thing there are psychologists there to balance that part out as well. To understand how human behaviour and societal behaviour affects things, and also how messaging affects behaviour. One area I do feel is lacking in the messaging is a psychologist who understands adolescents. Anyone who works with young people will tell you the way to encourage adolescents to make positive and good decisions is by including them in the conversation, and involving them in the design of advertising campaigns and slogans. Young people know what each other responds to – we don’t.’

And that issue of misinformation? ‘I don’t think I’m doing the Covid FAQ website as a psychologist,’ Ritchie said. ‘I think it’s just a matter of getting the facts right. A lot of the psychological questions that have been raised are quite interesting and more nuanced: “how has mental health fared?” (for which there’s conflicting evidence) and “how will being out of school affect kids’ learning?” (which, again, is very tricky to answer). They’re a bit different than outright-wrong statements like “it’s just as dangerous as the flu”. Sadly, a lot of people within psychology seem to have fallen back on the outright-wrong statements to try and back up their answers to the more nuanced ones.’

Blakemore concluded: ‘Most people who voice objections to lockdowns do so because they are deeply concerned about the harmful effects of shutting down the economy, limiting social contact and closing schools. But I think there are a small minority preying on people's vulnerability – hating the situation, wanting it not to be really scary, wanting freedom and being worried about their jobs and other stuff. You want someone in authority to say, “it's actually nothing to worry about. It's no worse than the flu. We can all go back to normal”. Wouldn't that be great?’

On 5 February, the British Psychological Society released a statement on its role in the Covid pandemic response, concluding: 'As a society, we remain committed to facilitating the positive contribution of psychologists to tackling this pandemic, by working together for the public good and looking towards the guided light of our values of scientific rigour, respect for diversity, and compassion.' 

Ella Rhodes and Jon Sutton

- You can find the Society’s coronavirus resources at www.bps.org.uk/coronavirus-resources and our collection of perspectives at tinyurl.com/psychmagcorona. We will continue to include some coverage in print, but in a fast-moving, relentless and somewhat overwhelming situation our website has advantages.