As the first wave of Covid-19 overwhelmed hospitals, mental health provisions were severely disrupted, resulting in a backlog of cases and a flurry in demand for new referrals. But while experts warn the already overstretched sector will be unable to deal with the immense strain on its services without additional funding, the government remains obtusely quiet on the matter.
A report commissioned by the NHS Confederation (a membership body for the health service) in August warns that demand on mental health services could rise “above-pre-Covid-19 levels”, with providers predicting a 20% increase in demand across all services. In response, the Royal College of Psychiatrists (RCP) has raised alarms about how such an increase would impact providers, warning that they will “lose out” on vital funding “if concerted, targeted action is not taken” – a concern which carries extra weight given that mental health providers often receive a disproportionately lower amount of funding compared to other public healthcare providers.
Whilst alarming, these predictions can hardly come as a surprise given that they proceed a flood of warnings from mental health charities, along with worrisome health statistics. The Centre for Mental Health predicts that 500,000 more people will experience mental ill-health over the next year, while self-reported surveys paint an equally grim picture.
Previously healthy adults were twice as likely to experience depression during the first lockdown when compared to June last year; meanwhile, in April more than a quarter of 17,452 people reported clinical levels of mental distress. This has prompted mental health charity Mind to declare a “mental health emergency”, arguing that it is “crucial” that “mental health and wellbeing are put at the centre of the UK Government’s ongoing [Covid-19] recovery plans”.
Fears for the future.
So strong are these fears of a tsunami of mental ill-health, that even members of the Conservative party – which has historically supported cuts to mental health services – wrote a letter to health secretary Matt Hancock opposing a blanket ban on household mixing during winter for its mental health implications, claiming it would “condemn thousands of local people to loneliness and isolation”.
Despite the pressure from his own party, calls from scientists to rethink his approach, push back from the public and Imperial College London announcing that the R (reproduction) rate for the virus has dropped, prime minister Boris Johnson has claimed there is “no reasonable alternative” to “lockdown enforcement”. This hardline stance is already being enacted through local lockdowns across the north of the UK.
But while a nationwide lockdown is still unlikely at this stage, a winter of social restrictions could result in the predicted demand on mental health services being surpassed. We only have to look back at the first wave to see evidence of this.
A global survey by the World Health Organisation (WHO) found that the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide, despite the demand for care rising. Amid calls for an increase in mental health funding (on average, countries were spending less than 2% of their national health budgets on mental health prior to the pandemic), Dr Tedros Adhanom Ghebreyesus, director-general of WHO, urged world leaders to “move fast and decisively to invest more in life-saving mental health programmes”.
In the UK, Mind has echoed WHO’s warning and implored the government to invest in services, as their emergency Covid measures – such as the furlough scheme, better statutory sick pay and emergency housing – wind down, likely resulting in “more people… fall[ing] through the gaps.”
A pre-existing problem.
Of course, the mental health crisis in the UK was well underway before the pandemic hit. In 2019, the suicide rate for men hit a two-decade high. Even back then, it already seemed unlikely that the NHS would reach its goal of “a national 10% reduction in suicides by 2020/21”. But now, faced with the extra challenges of the pandemic, which divests attention and money away from mental health services, meeting such a target seems like a pipedream.
As it is, being able to offer even basic support to all those in need is a challenge. Mental health charity Samaritans has rolled out an emergency funding appeal due to extra strain caused by the pandemic and reports having to respond to a new call every six seconds.
Despite all of this startling evidence, it is unlikely it will convince the government to provide adequate investment for mental health services. Indeed, the party’s 2019 manifesto commitment to treating mental health with the “same urgency” as physical health has yet to be realised. Thus far, the government’s only attempt to address charities’ cries for support during the pandemic has been to award £4.2m to various mental health charities and £5m to the Mental Health Consortia. But according to the NHS Confederation, this meagre amount “will not make up for the reductions in funding [that mental health charities] have [previously] faced”.
And while government funding for mental health has increased in recent years, experts claim that current investment is simply not enough to cope with the rising demand brought on by the pandemic.
Currently, there isn’t enough staff, resources or time for mental health providers to cope with the backlog of disrupted admission and new cases. And while simply throwing money at a broken system won’t fix it – especially when the health secretary apparently doesn’t have time to attend meetings on mental health – it’s an important step in dealing with the problem.
Making a plan.
In order to effectively deal with the backlog, it is crucial the government takes a more holistic approach, which considers barriers to access, the diversity of needs in the population and the reality of resources. In taking on this extremely complex problem, it must begin by addressing the NHS Confederation’s “serious concerns” that the £2.3bn of funding for mental health services announced in 2019 will not cover the increased demand. The RCP echoes this fear, recommending that an additional £2.96bn be ring-fenced for mental health NHS trusts between 2021 and 2025.
Meanwhile, staffing issues must be urgently addressed. In May, Matt Hancock reiterated his commitment to his party’s pledge to hire an additional 50,000 NHS nurses, despite Boris Johnson admitting that only 31,000 of these nurses will be new recruits.
In another half-baked attempt to remedy the problem of understaffing in the NHS, the Conservatives have pledged £20m to help graduates train as mental health social workers. However, it’s highly unlikely that this sum will do much to change the fact that 90% of people think they’re at risk of being attacked or injured in jobs in the mental health field, or that one in four (24%) students drop out of nursing degrees.
This, focus on onboarding, however, fails to address the very specific ways in which coronavirus has impacted mental health provisions. While getting more people into mental health work is undoubtedly important, given the current circumstances, retaining those already working is arguably even more so – particularly as social distancing measures mean that providers will be working at a 10-30% reduction in staff capacity.
With this in mind, the government must ensure it enacts a proper plan to remobilise services with the wellness of workers in mind, as healthcare leaders have witnessed burnout among mental health nurses.
Needless to say, it’s not just staff who suffer in an under-resourced and underfunded system. Patients are at the heart of mental healthcare, which is why the government must make a plan to support the NHS in removing debilitating barriers to access to free support. Digital therapy is not suitable for some people, which means that a portion of those who had their face-to-face care cancelled could risk slipping through the cracks.
Furthermore, as the NHS grapples with ever-growing waiting lists and people increasingly turn to charity crisis lines for support, the government must ensure that it pays more than lip service to those organisations bearing the brunt of the disruption to normal services – although this is only a short-term solution as crisis hotlines are run by volunteers who are not trained to provide care.
With so many hurdles to overcome in building an adequate mental health system, the Tories need to offer more than disproportionately poor funding and grandiose, empty pledges.
If the government continues to bury its head in the sand, it’s likely that the long-term mental health impacts of this year will be felt for years to come – and could cost more lives than the virus itself.
Sian Bradley is a freelance journalist and editorial assistant at Journo Resources.