Irish Times mental health survey: We are recovering from a ‘mass trauma event’

“Reduce close human contact. That is how the virus is spread.” In his speech to the nation on St Patrick’s Day 2020, that’s what taoiseach Leo Varadkar asked us to do. In a pandemic, we would have to, “social distance”, said the WHO. Our lives and the lives of others might depend on it.

Signage, queues, stewarding, face masks, hand gel, PPE, school, college and childcare closures, working from home, Zoom, “cocooning”, cancellations, travel bans and visitor restrictions slowly reprogrammed how we lived and and how we loved. Commuters, joggers, singers, visitors, the postman, single mothers at the supermarket with kids, teenagers, colleagues, team mates, classmates, friends, even our grandchildren were a potential threat. To a pregnant friend, immunocompromised brother, or a parent, we were the threat. “Come together as a nation by staying apart” – for almost two years, in an unprecedented health emergency, that is what we did.

Then suddenly, overnight on the night of January 24th, 2022, with little warning, it was “over”. With the rate and severity of infection reduced, we didn’t need to keep our distance any more. Our collective efforts saved many thousands of lives, Taoiseach Michael Martin told the nation, as the country opened up. It was “time to be ourselves again”, he said. But after two years of distance and loss, can we ever be ourselves again?

An Irish Times survey of mental health professionals in Ireland reveals that many of us are changed by the experience of the past two years. Some of us are hurting badly. Responses to the survey from members of the Irish Association of Counselling and Psychotherapy (IACP), the Irish Council for Psychotherapy (ICP), the Psychological Society of Ireland show that demand for counselling and therapy services has doubled or trebled in the past two years.

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Therapists in some parts of the country cannot meet demand and worry for those they are turning away. Some therapists themselves are burnt out. The responses from more than 130 psychotherapists, psychologists and counsellors provide a snapshot of how living through a pandemic has impacted people of all ages, including mental health professionals themselves.

Galway-based psychotherapist Kate Kearney describes the effect of the pandemic on us as a "collective trauma". "Trauma is anything that shakes our sense of self. The sense of what we believe to be sure about the world, it was rocked for everyone right at the same time," says Kearney. Many trying to keep down a job, homeschool children, run a household and care for others while trying to keep Covid-free have had little time to process the extraordinary events in real time. Others feared stopping to do so might destabilise them. As the country and the world emerges, emotions pushed to one side are now being processed.

Restrictions in hospitals and nursing homes meant loved ones died without family at their side. Changed funerals meant the usual grieving rituals couldn’t take place. One therapist speaks of a client prevented by restrictions from holding her dying mother’s hand. “She says she will never get over it and in a sense, we can’t give that back to her. I think there is a quality to this exit [from restrictions] for those who are bereaved, it is a bit like they are really forgotten now.” Another speaks of a clients’ trauma from giving birth alone.

Dublin-based psychotherapist and trauma consultant Johnny Moran describes the pandemic as a "mass trauma event" in which everyone reacted differently. "The nature of trauma is that people go into survival mode in the trauma, but like an earthquake, the mental health damage comes in the aftershock. This will become more prevalent as the pandemic fades."

'There are quite a few 11-year-olds at the moment who are just refusing to go back to school, they just keep themselves in their room'

The impact of the pandemic on young people is a legacy that mental health services will deal with for decades to come, therapists say. Studies show an increase in young people suffering from declining mental wellbeing. Worry, anxiety, depression and concerns over missing their friends and school emerged in one UK and Ireland study of 2,000 young people. In one Dublin paediatric hospital, referrals to child and adolescent mental health services (Camhs) increased by 180 per cent in November 2020 compared with previous years. This data is echoed by respondents to our survey.

Psychoanalytical psychotherapist Dr Colman Noctor, who works with children and adolescents, says they have suffered immeasurably from restrictions. He has seen a ten-fold increase in requests for support. "The impact of mask wearing, pods, school closures and missed developmental opportunities are not visible due to the pervasive nature of the impact of the societal changes. Developmental delay is not visible immediately, if we fail to recognise this we will be making a huge mistake."

Schools and childcare facilities that closed for “at least two weeks” on March 12th, 2020 didn’t reopen again until September. On breaking for Christmas that year, children didn’t fully return to the classroom until mid-March. Indeed Irish preschool and primary school children were away from school and its opportunity for social interaction for far longer than the international average, says the OECD. Over this winter and spring, isolation periods for children who had possible Covid -19 symptoms, who were close contacts and those testing positive, meant lengthy absences continued.

Psychotherapist Diana Radeva, a member of the Irish Council of Psychotherapy says the impact on children on the cusp of their teenage years, is devastating. She practices in Cork having previously worked in the NHS and with CAMHS. "I've been 20 years in this job and I've never seen anything like this before. They are 11 now… they were nine. It is a significant period of their life. It is just at the threshold of adolescence where anxieties are quite high.

“Once they got out of the ways of managing that, they are finding it very hard to face the world and to think about their position in the world again. It is so very scary.” From January 2021, she saw a dramatic increase in those seeking support.

Children in that tween period deal with a lot of internal anxieties, says Radeva. In lockdown however, normal anxieties went unchecked by reality. “When these anxieties increase, our contact with reality is often quite reassuring because whatever we fear, it is not that scary when we get feedback from the world and from the people around us. This kind of keeps us connected. When we are on our own, we don’t have that constant reality check.”

School refusal is common and parents are at their wits end, says Radeva. “There are quite a few 11-year-olds at the moment who are just refusing to go back to school, they just keep themselves in their room, keep to the basics and have no interest in interacting with the world. It is something I never observed before the pandemic.” For most of these children, anxiety and school refusal did not exist before the pandemic.

Many children have lost motivation to be around others, says Radeva. “Once you get yourself into that position, which in a way is comfortable because you don’t have to face things, you don’t have to get out of your comfort zone. You live in the illusion that you can just stay that way. They have lost a kind of motivation.”

Unlike teenagers who had experienced some of the highs and freedoms of that phase of life before the pandemic, and longed for them again, those younger never experienced it are now unmotivated to do so. “They don’t experience discomfort like older children, like 15-year-olds – they found it really hard that they couldn’t meet their friends and socialise, they experienced a lack of it and wished to return to it – but younger children didn’t even get to that stage, to test themselves in the world. They just tried to block [out] living.”

'I've had three of them tell me over the past while they feel like they haven't finished [college]. They did one year, then they were locked up for the remaining two'

Parents feel “frustrated, helpless and powerless”, she says. “They don’t understand it and they are angry at the same time. These might be some of the feelings that the children experience themselves that they communicate to the parents by making them feel that way because deep down, these children are inevitably quite angry and let down by us.”

Radeva’s sentiments are echoed by other survey respondents who report anxiety, school refusal and lack of social motivation amongst those who missed vital rites of passage. Radeva is seeing higher incidences of self-harm and suicidal thoughts in her practice too, mostly in adolescents aged 14 to 20.

“They were at an age, mentally, where they had to get out and start to have relationships and all these encounters that are developmentally asked of them. It is what their nature tells them to do, and then we told them to do the opposite.”

“I am all for the protection of the vulnerable, but I think the price we are paying is way too high. The children have become victims of this. I don’t think we are seeing it as such, I don’t think we can even look into it because it is so frightening. I am not undermining people who have suffered or died from the virus, but the consequences I think personally may exceed the damage the virus has done.”

Psychotherapist Sara McNamara works in the north east and is a member of the Irish Association for Counselling and Psychotherapy. She says demand for therapy at the centre where she works has trebled. She says young people in their early 20s are presenting with anxiety, depression, low mood and suicidal thoughts. "The amount of suicides that we have heard in the area in the past two years, it is extremely high." says McNamara. Young people are coming to appointments upset by this and needing to talk."You can't lock people up and basically tell them the outside world isn't safe without expecting repercussions."

“I work with a lot of those in their early 20s and they are very frustrated. They have been doing college in their bedrooms and they just can’t understand what is happening.” The pandemic turned the college place and campus life they had worked hard to achieve into something little differentiated from their Leaving Cert year, with students continuing study from a teenage bedroom in the family home. Therapists speak of a “missed opportunity to embrace adulthood”.

“I’ve had three of them tell me over the past while they feel like they haven’t finished [college]. They did one year, then they were locked up for the remaining two. They are finishing their time in college but they don’t feel like they are finished,” says McNamara.

What should have been a formative period has now ended, its friendships, travel and romances never to be recovered. Some who could return to college when restrictions eased have not, says McNamara. “There is huge social anxiety. Suddenly they are told ‘off you go, mix yourself up there with 800 people’. It’s not that easy.”

Psychotherapist Stephanie Regan works in private practice in North Dublin. A member of the Irish Council for Psychotherapy and with some 30 years in practice, she says the biggest spike in those seeking her help are aged 28-34.

“They were young professionals in nice jobs who were on the upward rise, feeling they had got their life in order. Suddenly they were back in their childhood bedrooms with their teddies behind them doing Zoom calls,” she says. When restrictions hit, a house share or a support network dispersed, feelings of uncertainty and fear took hold, or parents wanted them home. Life as they knew it stopped. For some, moving home worked well, others didn’t find it easy.

'Most partners are both working full time these days, but when the pandemic happened, there seemed to be a prioritising of Dad's job'

“They found it terribly depressing and felt very stopped in life,” says Regan. A greater proportion of their life was stopped than those older, she says. “It’s a time of relationship-making, falling in and out of love, moving towards some certainty. Two years snapped out of that is a big slow down.” She encourages those struggling whose employers offer counselling through an employee assistance programme (EAP) to avail of it. “The information will never for any reason go back to their employer. Confidentiality is 100 per cent intact.”

For those married and in relationships, the pandemic has taken a toll, too. Dealing with a deadly virus and homeschooling children, while trying to work, wasn’t anyone’s idea of “happy ever after”. Covid-19 restrictions meant support networks, the office, activities – once a release – were cut off.

“You go out, you do your day, you come back, you bring something to the chat. You meet someone for coffee, you are bringing back news, you are sharing a bigger life,” says Regan. In the initial stages of the pandemic, relationship issues weren’t aired as couples hunkered down.

“They didn’t really want to acknowledge their problems while they were in them, they just needed to get through this thing. It was only as they headed into their third lockdown, they began to really seek help,” says Regan. She worked with couples, trying to get them to create breaks to separate from each other.

Some couples have too harshly criticised their relationship for faltering under unprecedented strain. “I think even the best of relationships have not blossomed in the pandemic,” says Regan. Many who struggled, with help, can get back to a good place.”I would really encourage couples to row back on any big decision, to slow down. Let the champagne of life, the bubbles come back, because relationships have missed that.”

For other relationships, counselling was “too little, too late”, she says. “There were a lot of relationships where the fault lines were there before the pandemic and they did not survive. And maybe some relationships need to end and should end and the pandemic brought if forward a little.” Other therapists report increased clarity for couples of their having problems.

Diane McDonald is a psychotherapist and member of the Irish Association for Counselling and Psychotherapy and the Irish Council for Psychotherapy. She works with individuals and couples in West Dublin. The closing of schools and childcare for long periods magnified the double burden of working and caring, particularly for mothers, she says.

“Most partners are both working full time these days, but when the pandemic happened, there seemed to be a prioritising of Dad’s job,” says McDonald. “Actually, he will take the office space, he’s working from 9am to 5pm and can’t be interrupted and Mom would be down at the kitchen table trying to do Zoom calls and homeschool.”

She is seeing anger, resentment and burnout amongst women. “Kids are used to Moms remembering the details. The other thing is, Dad can get very irritable and cross when interrupted so kids go towards the more amenable parent. It is a generalisation, but that’s what I’m noticing,” says McDonald.

Indeed her observations echo Eurofound research that pandemic restrictions exacerbated gender divides in employment and domestic labour to the disadvantage of women. Mothers of small children bore the brunt of the impact.

Among parents of children aged up to 11, Eurofound data confirms that work–life conflicts troubled women more than men. Almost a third of these women found it hard to concentrate on their work, as against a sixth of men, while family responsibilities have prevented more women (24 per cent) than men (13 per cent) from giving the time they wanted to work. Work also impinged on family life: 32 per cent of women in this group said that their job prevented them from giving time to their family, against 25 per cent of men.

'The woman who has literally just given birth, there is the shock to suddenly have that baby beside her, and then after what her body has gone through, she was totally alone'

Mothers asked employers for flexibility, rearranged and juggled. Fathers met employers’ tacit expectation to work as though there was no pandemic with childcare somehow magically occurring. “I think it brought to the fore things that are already in relationships,” says McDonald. The continuing necessity for children who have possible symptoms and those who test positive to remain off school for lengthy periods means, though schools are open, the juggle continues and perhaps now with even less understanding from employers.

Another subset of couples that has struggled is where one partner of whichever gender travelled for work, says McDonald. “With that taken away, the changes seemed to have rocked the boat an awful lot,” she says. “If a woman is going away for work trips, that is an opportunity to tune back into her needs or to focus on work. Or if he went away, the person at home liked to have a well-run ship. That distance seemed to be a really important glue that held things together. When that was gone, couples struggled,” says McDonald.

Forced togetherness has seen intimacy take a hit, therapists in the survey noted. “There is a lot of focus on couples having closeness and connection, but actually the need for distance can be really underestimated,” says McDonald. “We can’t actually desire what is in our face all the time. We want to want and to miss each other. In terms of intimacy, I could see much less intimacy happening over time because people were sick of each other. The last thing people wanted to do was to get closer.”

Couples and families who differ on vaccination and vaccinating their children have also been challenged. “I’ve seen that cause quite a bit of strain, particularly as society started opening up,’’ says McDonald. “One person is getting really cross because everyone else is going out for dinner and enjoying things and their partner doesn’t want to get vaccinated. That created resentments and rifts.”

Therapists are concerned for people’s relationships and mental health for the coming year. “Personally I am turning away 19 in every 20 inquiries I get due to being fully booked,” one says. “There will need to be a space to acknowledge the collective trauma we have all gone through when this is over – as right now we are all still in survival mode.”

Suzanne O’Connor is a Bray-based psychologist and psychotherapist specialising in maternal mental health. She is a member of the Irish Association for Counselling and Psychotherapy and the Psychological Society of Ireland. She says women were hurt by maternity hospital restrictions.

“Partners not being able to attend any of the prenatal appointments, there was a lot of trauma around that after baby arrived,” says O’Connor. “Going for a scan on your own and somebody saying, ‘Oh, I’m not sure about that…’ Any sort of bad news, even if it turns out not to be bad news, to hear it by yourself or to be stuck making a decision on your own, that was hard.”

Partners only allowed to attend the final stages of labour and having to leave shortly left mothers feeling vulnerable. “They needed someone else there with them,” says O’Connor. “The woman who has literally just given birth, there is the shock to suddenly have that baby beside her, and then after what her body has gone through, she was totally alone. That has come up again and again.”

Partners may carry regret too, she says. “It’s that bond, that connection, that being able to be with the woman they love and the feeling that they couldn’t support them the way they wanted to.”

The isolation of maternity leave was exacerbated by the Covid-forced separation from family and friends. “There is a sense from mothers of missing things like the first-time handing the baby to Granny,” says O’Connor. She advises parents who are struggling with feelings of trauma and loss to seek counselling. “Have the space where you can just divulge everything that happened and kind of come to a stage where you can understand it all and be at peace with it.”

'Due to inadequate ICU and hospital beds, most of the public health service provision shut down to manage Covid'

Some respondents to the survey report being inundated by demand and the complexity of cases. One respondent is currently on stress leave. “I am lucky to be employed by an organisation with good occupational supports, but the vast majority of psychotherapists in Ireland are self-employed and not supported by the State. I worry for colleagues’ capacity to manage.”

Therapists note a ‘sense of responsibility’, a ‘duty of care,’ and the exhaustion that can come from ‘holding a knowledge and awareness of others’ distress’. “I’ve got a good salary and I need every penny of it to take care of myself, the work is exhausting,” one notes. “I know therapists in other organisations who get paid about a third less and work more hours. Staff are burning out because they are not being cared for.”

Therapists in private practice realise those attending are the lucky ones. The profession is deeply concerned about public mental health waiting lists and those not seeking help at all.

The snap removal of public health restrictions in January took everyone by surprise. The rules evaporated overnight. This was the normality we longed for, but normality doesn’t feel safe for some. Survey respondents note high levels of anxiety.

"There is a huge cohort of people from adolescents to adults who are really anxious about Covid and sort of bewildered at the speed it has 'ended'," says psychotherapist Cliodhna Ryan. A member of the Irish Association for Counselling and Psychotherapy, she works in private practice in Cork.

“I think re-entry into the world and doing things they haven’t done in two years, there is huge anxiety and anger,” she says. For those naturally more introverted, there had been comfort in lockdown. The expectation of having to go back to crowded environments with physical contact is causing anxiety, she says.

'The pandemic shone a spotlight on systematic problems in the public health service that had left Ireland incredibly exposed and vulnerable in a pandemic'

After two years of home working, reacclimatising to the office with in-person contact, increased social expectation and possible exposure to infection fills many with dread. “There is definitely a cohort of people that are delighted to be heading back to the office again, but there is another that is really unsure about it, all the way up to ‘I’d really prefer not at all’,” says Ryan.

Employers will need to make space for a wide range of reactions, she says. “People will need to be patient with themselves and with each other. If we are seeing someone who is backing out of the canteen because it is their perception there are too many people in it, well that’s okay. To make a bit of space for those feelings is the challenge.” She advises compassion for others and self-compassion too. “I might be, I’ll take a step forward and then, do you know, I might need to take a step back. It is really a balance.”

Dublin-based psychotherapist Monica Haughey says the pandemic has changed peoples' values, they want to be able to shape their lives and employers must listen. "Companies have to be more family-friendly and take a more human-centred approach. Accommodate them and staff will be happier and more productive."

There is a return to State exams too. This is a missed opportunity to incorporate the pluses of “hybrid” assessment over a “make-or-break” exam, some therapists say. “I firmly believe that the Leaving Cert and the way our children are educated forms a significant root of the crisis among young people,” one notes. A therapist working with third-level students agrees. “I see people come into university in first year just burnt out, highly stressed and anxious. They are exhausted by the age of 17.”

“The pandemic shone a spotlight on systematic problems in the public health service that had left Ireland incredibly exposed and vulnerable in a pandemic,” says Johnny Moran. “Due to inadequate ICU and hospital beds, most of the public health service provision shut down to manage Covid,” he says. The knock-on effect on waiting lists will lead to worsening health amongst the population and deaths.

Many therapists call for increased investment in mental health services including greater public education on protecting our mental health. "Minding mental health requires a systemic response from all tiers of society," says psychotherapist Madeleine Connolly. "Everyone has vulnerabilities. The past two years has highlighted how we all rely on having at least one person to talk to and to lean on when feeling out of our depth with what life throws in our path."