NHS Reset: Mental health and COVID-19: Preparing for rising levels of distress | Paula Lavis and Andy Bell

Andy Bell and Paula Lavis

NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic.

In this blog, Paula Lavis of the Mental Health Network and Andy Bell of the Centre for Mental Health, look at the predictions for mental health needs of England’s population and highlight forecasting tools and modelling work to support systems in working out the additional demand and costs for their populations.

There is good evidence that the pandemic is already increasing the number of people experiencing mental health difficulties in England, but the consensus is that the peak is still to come. Any increase in mental health problems is devastating on a personal level, but also puts significant demands on already stretched mental health and other support services. The challenge for commissioners and providers is how to accurately estimate any increase in demand as a result of COVID-19.

The Centre for Mental Health estimates that about ten million people may need new or additional mental health support because of the pandemic. This is a high figure, but the number of people experiencing mental health problems before the pandemic was already high. If we think about all the challenges people have faced, then it is not such a surprise that the pandemic is impacting on our mental health. People have experienced employment issues, missed out on education, experienced isolation, complex bereavement, have been traumatised as a result of being on a ventilator, as well as other social-economic concerns and the long-term impact of having the virus. It is not just about patients; health and care staff have experienced traumas and stresses, and many are feeling burnt out. The Centre for Mental Health estimates that over 200,000 healthcare workers will need treatment for their mental health.

There are a number of different sources all suggesting we will see a significant increase in the number of people seeking mental health care. The NHS Confederation surveyed its members and found that nearly 72 per cent of NHS leaders thought that they were expecting to see a significant increase in the number of people seeking support for mental health issues. Systems own modelling work is also suggesting an increase in demand of around 20 to 30 per cent.

Impact on services

While mental health services did not close during the pandemic, they weren’t receiving as many referrals, often because people were reluctant to access NHS services, certain referral routes, such as schools, were closed, people did not feel comfortable or couldn’t access online services. This backlog has resulted in suppressed demand. Unfortunately, this has probably resulted in some people’s mental health problems getting worse. 

Systems are also expecting a rise in demand which is created directly or indirectly by COVID-19. This “surge demand” refers to people who were not in contact with mental health services prior to the pandemic. 

The Centre for Mental Health and NHS colleagues have produced a very useful forecasting tool based on the best available evidence, to help systems work out what the additional demand and cost is likely to be. The national forecast using this modelling tool is that up to ten million (almost 20 per cent of the population) will need either new or additional mental health support as a direct consequence of the crisis, and 1.5 million of these will be children and young people. The tool allows systems to add their own data so they can estimate the increase in demand they are likely to see.

The Mental Health Network and the Mental Health Commissioners Network at the NHS Confederation have hosted webinars on modelling demand. These have helped share good practice on local modelling and forecasting.

Mersey Care NHS Foundation Trust commissioned the Strategy Unit to model a system dynamic approach linked to the population and emerging evidence. They estimated that demand for mental health services over the next 24 months could increase by 28 per cent, and this excludes people in the suppressed demand group. 

Bristol, North Somerset and South Gloucestershire CCG and their partners have also undertaken local modelling. They worked with their system to develop a methodology to look at what the demand would be across the whole system, so including health, social care, and public health. They estimated a 30 per cent rise in need and put together a plan and business case, which was approved by the CCG and other system partners. It focuses on both prevention and on strengthening systems; and they identified a number of financial risks, such as an increase in out-of-area placements, if they did nothing.

We know the numbers do not reflect the extent of suffering people are going through. Nor do they tell of the inequalities that place an extra burden on communities that are already bearing the brunt of the virus and higher levels of psychological distress before it all started. That is where local knowledge and working arm-in-arm with communities will be so important to inform responses around what people want and need.

What this data and important modelling work highlights is that the pandemic continues to have a significant impact on our mental health. We cannot ignore this. The system needs adequate resources to ensure a proactive, timely, compassionate and effective response to help people before they reach crisis point.

Paula Lavis is policy manager at the Mental Health Network. Follow the organisation on Twitter @NHSConfed_MHN

Andy Bell is deputy chief executive at the Centre for Mental Health. Follow him on Twitter @Andy_Bell_

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