People requiring support and treatment for their mental health are at risk of not getting the care they need and their conditions deteriorating due to increased demand brought about by the coronavirus pandemic, and constraints in what services can deliver.
While the peak of coronavirus has largely passed in England and efforts continue to contain localised outbreaks, health leaders have warned that the peak in demand for mental healthcare in England is yet to come and that the sector needs intensive support and investment to be ready to manage it.
In a report out today (Wednesday 12 August), the NHS Confederation has found that providers of mental healthcare moved quickly and responded effectively to protect patients and adapt their services at the start of the pandemic, for example by setting up 24/7 crisis phonelines and implementing digital approaches at pace. This was while public and political attention was focused largely on how acute hospitals would be able to cope with the admissions due to the virus.
During its peak, providers saw a 30-40 percent average reduction in referrals for mental health support but this was only temporary, with some providers now reporting the number of patients that they are treating is higher than pre-pandemic levels, and we expect this will rise sharply due to the backlog and because of the broader impact that the pandemic is having on the population’s mental wellbeing.
Some providers are predicting a 20 per cent increase across all of their mental health services, while also facing a 10-30 per cent reduction in how many patients they can care for at once because of the required infection control and social distancing measures.
To put this into context, a service that has 183 beds and receives 363 referrals for specialist inpatient mental healthcare in a typical month would see an increase of 72 admissions per month, but if their capacity is reduced by 10-30 per cent due to protocols around coronavirus, they could have around 20 - 50 fewer beds in their service to treat patients.
The Centre for Mental Health has estimated that an additional 500,000 people will require support for their mental health in the next two years, while it has been reported that there was an increase in people Googling about self-harm during lockdown, which can be an indicator for a higher risk of suicide.
Added to this, concerns are growing about the resilience and retention of frontline mental healthcare professionals, particularly among BME staff who are at greater risk from COVID-19, with burnout and workforce shortages continuing to play on health leaders’ minds. The NHS People Plan had a strong and welcome focus on supporting the wellbeing of staff, but there are major workforce shortages across mental healthcare - pre-pandemic, 27,000 additional staff were needed to meet the existing commitments of the Long Term Plan and Five Year Forward View for Mental Health and without additional staff, these concerns will worsen.
In response, the NHS Confederation is calling for members to be supported nationally to understand how demand for mental health services will vary from area to area as the pandemic continues and for appropriate financial and staffing resources to be allocated. Building on how local organisations have worked together so far, integrated care systems should also help lead these efforts.
Also, the body is calling for a national recruitment campaign focused specifically on attracting people into mental healthcare roles, and for increased funding for mental healthcare, including capital investment to support the expansion of digital approaches and to modernise physical estates.
While widely supported at the time, the £2.3bn that was allocated to the sector until 2023/24 in the NHS Long Term Plan will not be enough to improve services and also cover the costs associated with coronavirus, including implementing infection control requirements, developing digital technology solutions, hiring additional staff and on personal protective equipment.
Sean Duggan, chief executive of the NHS Confederation’s Mental Health Network, said:
“Although being away from the political spotlight, mental health services across the country have faced unprecedented challenges due to coronavirus which they have responded to remarkably by innovating and moving to different ways of working to protect their patients and staff.
“But we must not be fooled into thinking that the worst is behind us. There is a rising tide in demand for NHS-funded mental healthcare associated with the pandemic, which we expect to remain high for some time and will be felt long after the physical health crisis across acute and community care subsides.
“Providers are facing this with reduced capacity across their services, with significant funding constraints, and with a workforce that is close to burnout due to vacancy levels and the pressures placed upon them.
“If these issues are not addressed, it could overwhelm services and lead to people having to wait longer for mental health support and their conditions deteriorating.
“Above all else, the Chancellor must stay true to his promise and give the NHS whatever it needs and for mental healthcare services, that means recognising that the crisis is far from over.”
Elsewhere in the report, the NHS Confederation is calling for:
- A cross government approach to supporting the mental health of the nation as many of the determinants of mental health, such as housing, employment, debt and personal relationships, are outside of the NHS’s direct control.
- An enhanced and national approach to suicide prevention, targeted to those most at risk, to be led by Public Health England.
- A long-term and sustainable settlement for social care, which recognises the specific requirements of working age adults with mental health needs
- Increased financial support for charities that have been hit hard by the pandemic and that support NHS mental health services, in addition to the £5m that the government announced in May.
Brian Dow, Deputy CEO at Rethink Mental Illness said, "The widespread impact of this pandemic has placed an unprecedented strain on the nation's mental health. There should be no doubt that, without the proper prioritisation of resources and availability of services, tens of thousands of people will feel the long lasting effects of not being able to access the right care when they need it.
"As this report highlights – the long term impact on the nation’s mental health from the pandemic demands a qualitatively different approach. Better integration, longer term funding and building on the innovations that have arisen because of the crisis ought be the cornerstones of a sustainable recovery."