The COVID-19 pandemic has created economic, health and social uncertainty and insecurity across the world. The emergence of new COVID-19 variants in London, rises in COVID-19 cases and deaths, and repeated returns to national lockdown restriction measures are a reminder of the unpredictability of this crisis.

It is currently not possible to determine the full impact on mental health and need for mental health services, but it is clear the effects are multifaceted. The uncertain nature of the virus and the restrictions in place impede on our natural and usual resources for wellbeing, as well as on our coping mechanisms and opportunities for social interaction. Data, research and insights collected have shown the detrimental direct effect COVID-19 is having on depression, anxiety, happiness, life satisfaction and loneliness levels across London, as well as the indirect effect on the factors which influence mental health and wellbeing, such as employment and income.

As the pandemic continues, it is necessary to recognise that the nuances of how uncertainty surrounding COVID-19 and the restrictions in place affect Londoners’ mental health and wellbeing in a way that is not necessarily straightforward or always obvious. In some cases, feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health and we need to be careful not to over-pathologise the natural process of how people are adapting to and coping with change.

However, existing inequalities have been exacerbated, leaving those who entered the pandemic vulnerable as a result of their socio-economic background and health status facing the most severe impacts. As the pandemic continues to evolve, its effects become more nuanced and the needs of Londoners become more pronounced and complex. This results in the requirement for a multi-agency approach that ensures that all Londoners who need help and support receive it.

There is clear evidence that the impact of COVID-19 has replicated and exacerbated inequality. Following a substantial period of rising case rates in London, leading to an increase in hospital admissions and deaths, it is important to reflect on what we have learned from the first months of the pandemic and about the effects of COVID-19 on health inequalities and what can be done to mitigate them.

Health inequalities are systematic, avoidable and unjust differences in health and wellbeing between different groups of people. They arise because of the conditions in which we are born, grow, live, work and age, which influence our opportunities for good health and how we think, feel and act. These conditions shape our mental health, physical health and wellbeing. They also influence our exposure and vulnerability to SARS-CoV-2 infection, our ability to manage the consequences of the disease, and how the control measures affect us.

Substantial inequalities exist across protected characteristics and socioeconomic position in relation to the impacts of the coronavirus pandemic in London. This is both in terms of risk of COVID-19 infection, complications and mortality, and in terms of the negative economic, social and psychological consequences of Government policies to mitigate the health impacts of the pandemic. These COVID-19 related inequalities have been caused by processes of marginalisation and oppression, which before the pandemic had led to well-documented social and health inequalities, inequalities that have been exacerbated during the coronavirus pandemic.

It is also important to acknowledge that years of structural racism and inequality has compounded mistrust, suspicion and fear between marginalised communities and power structures, creating a significant barrier for recovery. Unfair outcomes for population mental health as a result of the COVID-19 crises include: a greater deterioration in their mental health for BAME men, reports of disabled people feeling failed and ignored by the government and single parents having higher levels of stress, depression, and anxiety.

Findings from the community indicate that for many communities across London, the coronavirus pandemic is seen as the latest crisis event in a crisis trend – a steadily worsening series of situations faced by disadvantaged communities across London. This is both a cause and consequence of poor mental health, felt both directly and indirectly.