Innovative and effective collaboration may have accelerated due to COVID-19, but so too has the number of people needing mental health support. Sean Duggan sets out a clear picture illustrating what’s needed to address the crisis.
Since the onset of the COVID-19 there has been concern about how it is impacting on people’s mental health and wellbeing. Rates of probable mental disorder in 5–16-year-olds increased from 1 in 9 in 2017 to 1 in 6 in 2020. In adults, 1 in 6 experienced some form of depression in summer 2021, which is still above pre-pandemic levels of 1 in 10. There is also good evidence that the pandemic has accentuated existing mental health inequalities, such as people living in deprived neighbourhoods being more likely to have consistently poor mental health during the early stages of the pandemic.
The toll of the pandemic
NHS organisations and partners have been working hard to estimate the increase in demand for mental health support and how much it will cost to provide the level of support required. Centre for Mental Health and partners have estimated that mental health services in England will need additional capacity for 8.5 million adults and 1.5 million children and young people; a total of 10 million people, who may need new or additional mental health support over the next three to five years, as a direct consequence of the pandemic. The Health Foundation has estimated that the impact of the pandemic on costs for mental health services will range from £1.6bn to £3.6bn within this timeframe.
The impact across the system
People with mental health issues do not just access mental health services. They may also require services such as primary care or urgent and emergency services such as A&E. People with mental health issues are three times more likely to attend A&E and one ambulance service has reported that they have seen a doubling in calls concerning mental health during the pandemic. A Tweet from the London Ambulance Service reported that, sadly, their crews were attending 37 suicides a day in 2020, compared to 22 in 2019. These additional pressures and costs will not just fall to mental health services, but also on the wider system, especially primary care.
Even before the pandemic, about 30 per cent of GP caseloads were associated with mental health issues. Speaking with the NHS Confederation’s PCN Network, they have reported that their members have seen a 50 per cent increase in mental health problems, and children and young people’s mental health is a particular concern.
This increase in demand is not just being felt in NHS mental health services
We are also concerned about some of the other impacts of COVID-19 and how they might increase demand for mental health support. People with long COVID are likely to experience symptoms such as depression and anxiety and some research has shown that they may be at higher risk of developing more serious mental health problems. In addition, about 30 per cent of people with long-term physical health conditions also have mental health problems. There is concern that people on elective waiting lists may be at a higher risk of developing new or exacerbating existing mental health problems.
The pandemic has particularly impacted on children and young people’s mental health. There has been a major increase in children and young people with eating disorders who have been very ill and have needed to be admitted to an acute paediatric unit.
This increase in demand is not just being felt in NHS mental health services. As well as primary care and other NHS services, voluntary sector services, independent providers including digital services, local authorities and the police are also all seeing an increase in demand.
Winter is a challenging time for the NHS, even without a pandemic, and we anticipate that the challenges this year will be even more pronounced. While lockdowns have been effective in preventing the spread of the virus, there is evidence that the lockdowns have impacted on people’s mental health and wellbeing. UCL's COVID-19 Social Study and Co-Space's study both found that symptoms of depression and anxiety were higher for both adults and children and young people during the lockdowns. Implementing preventative measures as an alternative to further lockdowns is likely to reduce some of this increase.
The real challenge now is to ensure that services can meet the mental health needs of those who need support when they first need it, and in a way that works for them
The Long Term Plan has paved the way for some amazing transformation work in mental health such as community mental health teams and better integration between primary care and secondary mental health services. The pandemic has made this more challenging, but it has also often necessitated innovative and effective collaboration between different part of the system. The real challenge now is to ensure that services can meet the mental health needs of those who need support when they first need it, and in a way that works for them. To do that, the sector requires sustainable funding that goes beyond that promised in the Long Term Plan, and of course we need to increase workforce capacity to provide and transform services.