Psychiatric inflation factors: COVID-19 anxiety syndrome
At the start of the pandemic, we predicted that the psychological impact of COVID-19 and the national lockdown could trigger further psychological harm in personal injury claimants already dealing with the physical or mental consequences of an accident, and expose compensators to additional claims inflation.
In a similar vein, as we hope to soon reach the end of lockdown measures, we consider the current evidence of the psychological impact of the pandemic and what it means for personal injury claims handling.
COVID-19 anxiety syndrome
One study early in the pandemic looked at research undertaken from previous outbreaks such as SARS and Ebola and identified a risk of PTSD symptoms from COVID-19 in specific groups of people, namely:
- Those admitted to hospital with COVID-19 and particularly those admitted to ICU
- Family members of those who died of COVID-19
- Healthcare workers who cared for COVID-19 patients who were seriously ill or died
- Emergency workers.
A more recent study by South Bank and Kingston Universities has found a more general pattern in a proportion of the population of generalised anxiety and depression, particularly in younger groups and the most at risk groups for catching COVID-19, such as those with diabetes, asthma and other chronic conditions. Researchers have sought to classify this ongoing fear of contracting the virus as a cluster of symptoms called COVID-19 anxiety syndrome, which persists regardless of whether the person has been vaccinated or not. It is estimated that this could affect as much as 22% of the population and make it difficult for those people to fully re-integrate once all restrictions are lifted.
It should be noted that COVID-19 anxiety syndrome is not a condition recognised by either of the main classifications systems (DSM-V and ICD-11) but, alternatively, is currently being used as a tool to aid research and to assist with identifying appropriate treatment. There are calls from some treating clinicians and researchers for COVID-19 anxiety syndrome to be recognised as its own diagnosis.
One of the risk factors for mental health problems is a pre-existing history of mental illness. The pandemic has exposed a significant number of people to heightened anxiety, PTSD or depression, creating a larger cohort of psychologically vulnerable people in the general population. As life starts to return to a new normal and accidents occur, the claimants of the future may potentially be more vulnerable to adverse psychological consequences as a result of the impact of the pandemic on their long-term mental health. Under the eggshell-skull rule, those claims for psychological injury resulting from an accident will be compensatable, even if the underlying psychological vulnerability stemmed from the pandemic.
As has been widely publicised, the pandemic has had a significant impact on the provision of healthcare services via the NHS, and mental health services are no exception. A press release from the Royal College of Psychiatrists in October 2020 showed a significant delay between initial assessment and a second appointment for those with mental illness. Most notably, waiting times for treatment from PTSD were up to two years for depression and anxiety were up to four years. During the intervening delay, 39% reported a deterioration in their mental health, with 89% reporting that it affected their daily life including financial difficulty, problems at work and job losses.
It is therefore more important than ever for compensators to engage with claimants early in order to consider rehabilitation needs and offer appropriate treatment for psychiatric conditions, to prevent deterioration and consequential losses. One of the positives to come from the pandemic is the normalisation of remote treatment, in particular talking therapies. An April 2021 study of the impact of telehealth during coronavirus found that it was equally efficacious as in-person treatment, and that patients were more likely to complete the course of telehealth treatment compared with treatment in-person.
As we reach the full lifting of restrictions in the UK, it is apparent that COVID-19 will have a lasting impact on the mental health of a significant section of the population, leading to greater psychological vulnerability following an accident, longer recovery periods and greater disruption to daily living. If psychologically injured claimants are awaiting treatment on the NHS, then compensators may achieve better claims outcomes by identifying claimants who have suffered psychological harm and considering rehabilitation funding for private therapies, including from the growing number of telehealth providers that are revolutionising conventional treatment pathways by increasing accessibility and patient choice.