I’d say that the rate of how much vaccines are talked about now is significantly lower, and covid doesn’t really come up anymore. But other medical illnesses come up—patients saying, “My doctor said I need to get this surgery, but I know who they’re working for.” Everybody has their concerns, but when a person with psychosis has concerns, it becomes delusional, paranoid, and psychotic.
I’d like to see more providers be given more training around severe mental illness. These are not just people who just need to go to the hospital to get remedicated for a couple of days. There’s a whole life that needs to get looked at here, and they deserve that. I’d like to see more group settings with a combination of psychoeducation, evidence-based research, skills training, and process, because the research says that’s the combination that’s really important.
Editor’s note: Sallee works for a large HMO psychiatry department, and her account here is not on behalf of, endorsed by, or speaking for any larger organization.
The epidemiologist rethinking how to bridge differences in culture and community
John Wright
Clinician and epidemiologist
Bradford, United Kingdom
I work in Bradford, the fifth-biggest city in the UK. It has a big South Asian population and high levels of deprivation. Before covid, I’d say there was growing awareness about conspiracies. But during the pandemic, I think that lockdown, isolation, fear of this unknown virus, and then the uncertainty about the future came together in a perfect storm to highlight people’s latent attraction to alternative hypotheses and conspiracies—it was fertile ground. I’ve been a National Health Service doctor for almost 40 years, and until recently, the NHS had a great reputation, with great trust, and great public support. The pandemic was the first time that I started seeing that erode.
It wasn’t just conspiracies about vaccines or new drugs, either—it was also an undermining of trust in public institutions. I remember an older woman who had come into the emergency department with covid. She was very unwell, but she just wouldn’t go into hospital despite all our efforts, because there were conspiracies going around that we were killing patients in hospital. So she went home, and I don’t know what happened to her.
The other big change in recent years has been social media and social networks that have obviously amplified and accelerated alternative theories and conspiracies. That’s been the tinder that’s allowed the wildfires to spread with these sort of conspiracy theories. In Bradford, particularly among ethnic minority communities, there’s been stronger links between them—allowing this to spread quicker—but also a more structural distrust.
Vaccination rates have fallen since the pandemic, and we’re seeing lower uptake of the meningitis and HPV vaccines in schools among South Asian families. Ultimately, this needs a bigger societal approach than individual clinicians putting needles in arms. We started a project called Born in Bradford in 2007 that’s following more than 13,000 families, including around 20,000 teenagers as they grow up. One of the biggest focuses for us is how they use social media and how it links to their mental health, so we’re asking them to donate their digital media to us so we can examine it in confidence. We’re hoping it could allow us to explore conspiracies and influences.
The challenge for the next generation of resident doctors and clinicians is: How do we encourage health literacy in young people about what’s right and what’s wrong without being paternalistic? We also need to get better at engaging with people as health advocates to counter some of the online narratives. The NHS website can’t compete with how engaging content on TikTok is.
