By Sylvia Davidson and Paul Evans

Since the introduction of lockdown measures in March, there have been concerns about the effect of the pandemic on the nation’s mental health and the implications for the NHS’s already over-stretched services. Now it is becoming clear just how big the challenge is and how lockdown planning left many patients high and dry

Patients discharged

An analysis by Mind showed that 11,829 patients were discharged from mental health units in March 2020, a sharp rise from 9,836 the previous year and up by 2,441 compared to the month before lockdown, raising concern that vulnerable people were released into the community before they were ready.

A letter from NHS England Chief, Simon Stevens on March 17th, instructed NHS hospitals to clear as many inpatient beds as they could in preparation for Covid.

It is now clear that this blanket policy led to harm and risk for some mental health patients. Alison Cobb, specialist policy adviser at Mind said:

“NHS data shows that in March mental health trusts across the country followed guidance to discharge as many people as possible to clear space for Covid-19 patients, including patients detained under the Mental Health Act and those on acute wards.”

Among those affected was a 59-year-old man, suffering from paranoid schizophrenia who was released from a rehabilitation unit that is part of the Central North West London NHS foundation trust, against the wishes of his family. He then fled to Europe.

His daughter told the Guardian: “He wasn’t well and has now run away … when he was released into the community they should have made sure there was sufficient provision about how they were looking after him during lockdown,”

Mental health patients waiting for care were affected too. Norfolk and Suffolk Foundation Trust’s decision to send letters to 300 young people discharging them from the waiting list, was met with an outcry from patients and campaigners. At the time the organisation said it was a mistake, “a clerical error”. However, under questioning in a subsequent local council meeting the trust boss admitted that it was a deliberate decision, based on the organisation’s plan for the pandemic, and prompted by worries about potential understaffing because of Covid illness. The trust has since apologised, with Dr Dan Dalton, chief medical officer, saying: “This clearly was something where we got it wrong. I’m absolutely confident it was done for the right reasons.”

Surge in demand

In August, a report by the NHS Confederation, found that a surge in demand for mental health services had already begun and predicted that demand will be significantly higher than pre-Covid-19 levels.

A Survey by the Royal College of Psychiatrists agreed – 43% of psychiatrists have seen an increase in urgent and emergency cases following the COVID-19 lockdown.

Over all, the NHS Confederation report entitled “preparing for the rising tide” –  says that providers are predicting a 20% increase across all mental health services, and are dealing with a potential 10%-30% reduction in the number of patients they can care for at one time because of social distancing and infection control measures.

The Centre for Mental Health has predicted that an additional 500,000 people will require support for their mental health over the next two years.

The rise in demand stems from those who were denied care during lockdown; those whose health deteriorated and new patients, flowing from the wider impacts of the pandemic, such as self-isolation and increases in substance abuse and domestic violence.

Funding anxiety

With demand soaring there are “serious concerns” that the £2.3 billion for improvements to mental health services announced in the NHS Long Term Plan in 2019 is no longer enough. In particular the funding falls short on extra costs, such as PPE, infection control, locum and more permanent staff and ongoing costs related to new digital services.

NHS Providers, the organisation representing NHS hospitals, agree that rising demand must be met with an urgent and full commitment from the government;  “expansion in service provision” must be “fully and promptly funded, on a sustainable basis”.

NHS Providers had already noticed that demand was outstripping supply in mental health services, with its first survey of trust leaders since the start of the pandemic showing 61% increased demand for urgent or crisis care.

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. With around £8 million of the funding has been earmarked to bolster suicide prevention initiatives across 30 local areas during the 2020/21 financial year. The remainder is to be allocated to provide bereavement support for people after a relative or friend’s suicide.

Same storm different boat

Our collective mental health has deteriorated by around 8% as result of the pandemic according to research by the IFS, More than two-thirds of adults in the UK (69%) report feeling worried about the effect COVID-19 is having on their life, but the impact will not be felt evenly across society.

The Centre for Mental Health concluded that people with existing mental health difficulties and risk factors for poor mental health are likely to be affected disproportionately.

Those with historically poorer access to mental health services are the most at risk. And the well known determinants of inequality will become more influential as the economy worsens.

Children from the poorest 20% of households are already four times more likely to have a serious mental health issue by the age of 11 than those from the wealthiest 20%.

People who rent houses are more affected by financial anxiety and those on housing benefit are twice as likely to have mental health problems.

We know too that members of the BAME community are at greater risk from Covid.

Survey data shows that 42% of LGBT people would like to access mental health support during the pandemic, but 34% had medical appointments cancelled by providers.

Structural inequality, and differences in vulnerability to the virus and in access to services all demand a better strategic response from our local and national leaders.

The Centre for Mental Health, backed by a group of mental health charities believes:

“Plans for recovery must be made with mental health equality in mind. Government must prioritise race equality and support trauma-informed approaches for all people whose lives have been affected by Covid-19. Plans to modernise mental health legislation and invest in community support should be resumed and renewed at the earliest opportunity. “

It calls for action to ensure people with mental health problems get access to food and medicine and that “financial safety-nets” are available for those at greatest risk from the virus. In the longer term it calls for steps to prevent homelessness and to improve the benefits system.

Digital answers?

Providers are looking to digital services, used widely during lock down, to continue to help manage demand. However, The NHS Confederation warns that digital services are not appropriate for all patients, adding that patient experience must play an “integral role” when the sector is looking at which transformations to maintain post-pandemic.

Indeed, a YouGov poll published this week, commissioned by NHS Property Services, the government-owned company that owns a large proportion of primary care estate, found that 38% of people asked wanted face to face access to mental health and counseling services in their GP surgery or a local healthcare clinic. And in the age group 18-34, often considered to be those most digitally-able, almost half (48%) cited these as a key addition to their local healthcare facility.

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