Caring at a Distance? Patient Sovereignty and mental health, post-COVID

This paper will critically examine the shift in not only the underlying theory, but the expectation and delivery of mental healthcare in the wake of COVID-19. In the first instance, this paper will show how the COVID pandemic has fundamentally shifted how people look at what is valuable not only in, but more importantly about human life. This shift, it will be argued, has moved towards valuing the sheer act of survival above and at the direct cost of the quality of that life – the human flourishing or eudaimonia of Aristotle. The impact of this shift on mental health has the potential to be catastrophic, as well-being is sacrificed to maintain the survival of populations. While it is not in the remit of this paper to provide a morally prescriptive judgement on the rights and wrongs of this ‘mass triage’, it is important to highlight this shift and its impact.
Yet this is not the only impact that the pandemic is having on mental health. Alongside the issues stated above, public expectations of healthcare (and especially mental health) have changed dramatically. In a time where the very notion of the expert has become eroded, patients demand greater agency in their own healthcare. Navigating a healthcare system which is agentic in essence is difficult in any area, but these difficulties become even more pronounced when speaking about mental health. This is compellingly exemplified in the proliferation of telemedicine services, which include the electronic transfer of prescriptions, ‘E-Pharmacies’ and the ‘virtual’ pharmacist, as well as ‘E-Clinics’ and the ‘digital’ prescriber (see Hall and Antonopoulos, 2016). Although risks such as the buying of counterfeit or substandard medicines exist, the demand for such treatments highlights important societal trends. These include the rise in ‘expert-patients’ who self-diagnose online for healthcare purposes, to bypass professional gatekeepers and governmental structures in the belief that cost cutting exercises are in place, consequently rendering individual care as inadequate (see Hall and Antonopoulos, 2016). Such ‘expert-patients’ also profess cynicism towards large pharmaceutical corporations and public health care systems (Hall and Antonopoulos, 2016). Moreover, patients are observed as being ‘sovereign consumer-citizens’ who are independent, capable of choice and self-governance (see Hall and Antonopoulos, 2016). In this sense, the Internet acts as a mechanism in which this self-governance can crystallise, where patients can access information on health and illness, purchase medicines, and discuss experiences with others, such as on dedicated forums as a form of cultural support (see Hall and Antonopoulos, 2016). Research has shown that mental health patients are an expressly at-risk group of consumers pursuing illicit medicines. The Internet therefore has altered how individuals and patients manage their healthcare choices. Patients are increasingly consumers, who question professional proficiency by utilising their lay knowledge and experience to contest traditional means of obtaining treatment (Sugiura, 2018).