As the nation slowly comes out of lockdown, the prediction that the pandemic will be accompanied by a wave of mental illness is now backed up by figures. The Royal College of Psychiatrists has warned that England is now “in the grip of a mental health crisis” as a result of the Covid pandemic. It is also clear that young people are bearing the brunt of the mental health crisis.
The College analysed data from NHS Digital and the Office for National Statistics (ONS) comparing April to December 2020 with the same period in 2019 and found:
80,226 more children and young people were referred to CYP mental health services, an increase of 28%, to 372,438;
600,628 more treatment sessions were given to children and young people, up by a fifth on 2019 to 3.58 million;
And 18,269 children and young people needed urgent or emergency crisis care, an increase of 18% to 18,269.
The analysis also found that adult mental health has suffered during the pandemic; until March 2020 about one in 10 adults in England suffered from moderate to severe depression, but that had doubled to almost one in five by last June.
Adrian James, the college’s president, said: “The extent of the mental health crisis is terrifying, but it will likely get a lot worse before it gets better. Services are at a very real risk of being overrun by the sheer volume of people needing help.”
Back in October 2020, the Centre for Mental Health used a model to predict that nationally, in England, up to 10 million people (almost 20% of the population) will need either new or additional mental health support as a direct consequence of the crisis. 1.5 million of those will be children and young people under 18.
In March 2021 the IPPR report – State of health and care: The NHS Long Term Plan after Covid-19 – noted that there is not yet sufficient data on the effects of the second wave of the coronavirus pandemic, but think that it is “very likely to sustain and amplify the trends described” for the first wave.
The increase in mental health need stems from those who were denied care during lockdown; those whose health deteriorated and from new patients, flowing from the wider impacts of the pandemic, such as self-isolation and increases in substance abuse and domestic violence. However, a study published in March 2021 in Lancet Psychiatry found that overall one in three people who recover from coronavirus develop a neurological or a psychiatric condition within six months, which adds a whole new population to those needing treatment and care.
Mental health services in crisis before the pandemic
This tidal wave of patients requiring mental health services would be difficult enough to cope with if services had been sufficient pre-pandemic, but after over a decade of budgetary constraints mental health services were in crisis as the country entered the pandemic.
In November 2019, Mind released figures showing that in the previous 12 months the NHS in England cancelled 175,000 CAMHS appointments – 25 per cent more than in the previous year.
This tightening of eligibility criteria was confirmed by a Pulse survey of GPs in which nearly 30 per cent said the rules governing CAMHS referrals had become stricter, with only one in five NHS mental health trusts now accepting appointments.
It’s surely no coincidence that the number of A&E attendances by young people with a recorded diagnosis of a psychiatric condition has almost tripled since 2010. Or that an increasing number of GPs are now advising parents to seek private mental health care for their children.
Figures show that the number of mental health beds had also slumped, by nearly 3,000 since 2013, leading to local issues of availability. In November 2019 the Royal College of Psychiatry (RCP) published a report claiming that, to offer appropriate levels of care to patients in their local community, more than a thousand extra mental inpatient beds were needed.
The staffing statistics were no better: in 2013 there was one mental health doctor for every 186 patients accessing services, and one mental health nurse for every 29 patients. By 2018 those figures had dropped to one for every 253, and one for every 39, respectively. No surprise really, given that – in 2017-18 alone – 23,686 mental health staff left the NHS.
In March 2021, the Royal College of Psychiatrists highlighted the cuts to services for alcohol and drug addiction which are leaving thousands of young people unable to access help. The College found that £26m (37%) in real terms has been cut from youth addiction services in England between 2013/14 and 2019/20, with eight of the nine regions in England making real terms cuts.
How are mental health services coping?
The short answer is – not well.
In January 2021, the Royal College of Psychiatrists warned that Mental health hospitals in England are operating at capacity. A December 2020 survey found that 85% of the 320 psychiatrists who took part said there was more pressure on beds compared to the same time last year. The vast majority (92%) estimated there were less than 5% of beds available in their trust, while the recommended threshold is set by the College at 15%.
Psychiatrists were having to consider sending patients out of area, which can harm patients, or delaying admission and treating them in the community.
In March 2021, leading clinicians told the HSJ that there is ‘no capacity anywhere’ to deal with an unprecedented surge in admissions of children with mental health problems. If there are no specialist beds then children with eating disorders had to be left on children’s wards in general acute hospitals, where they are unable to receive adequate specialist treatment.
What has the government done?
Prior to the pandemic the 2019 NHS Long Term Plan had allocated £2.3 billion for improvements to mental health services. At the time this was considered insufficient; in January 2020, the BMA appealed for at least a doubling in funding over the period of the long-term plan (from 2019/20); overall mental health spending in 2020/21 stood at £14 billion, so this would mean a rise to over £25 billion by 2025.
In August 2020 Andrew Molodynski, BMA Mental Health Lead, said that although mental health services are not currently ready for such a surge in demand (and perhaps never have been) “hope is not lost” if actions are taken now to prepare mental health services to help those in need.
The government does not appear to have heeded the warnings from those involved in mental health services, however.
Some extra money has become available through a £10 million fund announced by NHS England in mid-September, however the money is only for community initiatives, in particular those aimed at suicide prevention.
In the spending review in November 2020, there was little that could be said to really tackle the challenge of mental health services. Rishi Sunak gave around £500 million to address waiting times for mental health services; £165 million capital funding ring-fenced for 2021-22 to replace outdated mental health dormitories with single en suite rooms; and £4.3 million to be used for green social prescribing. This comes to around £670 million, and as Vicki Nash, Head of Policy and Campaigns at the mental health charity Mind, said:
“ [the funding] is some way short of estimates that due to increased demand mental health services will require more than £1bn a year for the next three years, to deal with the long term fall out of the pandemic.”
The IPPR believes that much more than £500 million will be required to adequately expand mental health capacity. Its estimate is that £3–4 billion will be needed.
Experts in mental health services are already beginning to question where the £500 million has gone. In April 2021, the Royal College of Psychiatrists was calling for the additional £500m (including the £79m for children) promised for mental health to urgently reach the frontline to help tackle the crisis.
What about the staffing shortages?
Any extra funding for mental health services is of no or limited value without sufficient staff to deliver the care. A survey conducted by the British Medical Association (BMA) just before the pandemic began found 63% of mental health staff worked in a setting with rota gaps, and 69% of these said such gaps occurred either most or all of the time.
The BMA reported that there has been little growth in the mental health workforce in England over the last 10 years, with many of the key staff groups either remaining at a similar level since 2009 or declining. There has been a loss of 7,000 nurses, health visitors and midwives and 6,000 clinical support staff since 2009.
The pandemic has put severe strain on staff. The annual NHS staff survey reported in the BMJ in March 2021 found that around a third of staff said that they were considering quitting their job, and a fifth indicated that they may leave the health service completely.
What now for mental health services?
The government’s 2019 Long Term Plan aimed to expand mental health services and improve primary and community mental health care, so that two million more people would be able to access mental health support each year by 2023/2024. The budget for this was £2.3 billion. Now a whole new population is in need either of new support or extra support. In light of this, an extra £500 million is unlikely to make much of an impact.
The IPPR estimates that to adequately resource the elective care backlog and the rise in mental healthcare demand will cost an additional £2.2 billion per year until 2025/26. The government, however, has only committed a one-off £3 billion to this, which will certainly not be sufficient.
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