Mental healthcare provision ... and the pandemic.

An earlier blog article addressed mental health provision and the problems highlighted by the coronavirus pandemic. This article looks in more detail at the effects of the pandemic, the challenges that current funding proposals will have to address, and the implications for those in need of support.

While mental illness can affect anyone, any time and anywhere, it is a far more severe health problem among those who are poor or disadvantaged though unsuitable housing, poor education and a jobs shortage.

Data from the Office for National Statistics (ONS), gathered from a survey of 25,935 adults during the pandemic, shows that, during the first peak in spring 2020, double the usual number of adults, 19%, suffered depression. More recent figures suggest that even more, 21%, were affected during this year’s winter and spring lockdown.

Analysis of the data shows that, between January and March 2021, disabled people, extremely vulnerable adults and those living in deprived areas, were more likely feel depressed. Depressive symptoms more than doubled to 29% in adults aged 16 to 39.

ONS figures also reveal that the age-standardised mortality rate involving Covid-19 in England’s most deprived areas was 55.1 deaths per 100,000 people, compared with 25.3 deaths per 100,000 in areas which are better off.

A separate UK-wide, long-term study, Coronavirus: Mental Health in the Pandemic, led by the Mental Health Foundation, with the University of Cambridge, Swansea University, University of Strathclyde and Queen’s University Belfast, provides more detail on how financial equality effects mental health.

It shows that one in five people surveyed, 20.55%, and more than one third, 34.01%, in full-time work, worried about losing their job and a fifth, 19.70%, of jobless people had suicidal thoughts and feelings within two weeks of the survey, compared to 8.64% of those in work.

Middle-aged people had most financial concerns. Twice as many unemployed, 25.85%, did not cope well with the stress of the pandemic compared to those in work (12.25%), and more than one in ten, 10.93%, unemployed said nothing had helped them cope with pandemic stress.

A third, 32.66%, of adults were worried about their finances, such as bill payments and debt. A broad categorization confirms that those in lower socioeconomic groups, 35.11%, are more likely to have financial worries than people in higher groups, 30.81%.

Almost half of jobless people surveyed, 44.7%, worried about having enough food to meet their basic needs, compared to 29.32% of those in work.

Meanwhile, UK charity, Young Minds, says mental health is a significant factor in the lives of young people. One in eight children suffer a diagnosable mental health disorder and a sixth of those aged 16-24 suffer a common mental disorder such as depression or anxiety.

Young Minds says half of mental health problems manifest by the age of 14 rising to 75% by age 24. In 2017, suicide was the most common cause of death for boys, 16.2% of all deaths, and girls, 13.3%, aged between five and 19.

Nearly half of 17-19 year olds with a diagnosable mental health disorder have self-harmed or attempted suicide, rising to 52.7% for young women. A third of adult mental health conditions relate directly to adverse childhood experiences. Adults who experienced four, or more, adversities in their childhood are four times more likely to have low levels of mental wellbeing and life satisfaction.

The number of A&E attendances by young people aged 18, or under, with a psychiatric condition diagnosed has almost tripled since 2010.  In spite of these stark figures, less than one per cent the total NHS budget is spent on children and young people’s mental health services.

The findings of these studies means that the Government announcement this spring of £500m additional funding for a Mental Health Recovery Action Plan, is welcome.

The Mental Health Recovery Action Plan aims to specifically target people worst affected by the pandemic, those with severe mental illness, young people, and frontline NHS and care staff.

Under the plan, NHS talking therapies (IAPT services), which offer confidential treatment of anxiety, depression and post traumatic stress disorder (PTSD) will expand, helping 1.6m people access services in 2021/22, backed by an additional £38m.

The funding is intended to allow additional therapists to be trained to support patients with more complex mental health needs as a result of the pandemic.

People with severe mental illness should also benefit from enhanced community mental health services, backed by £58m for better co-ordinated support between primary and secondary care, including specialist mental health staff in primary care.

It is proposed that the funding will also accelerate expansion and transformation of community mental health services, enabling people with severe mental illnesses to access psychological therapies, improved physical health care, employment support, personalised and ‘trauma-informed’ care, medicines management and care for those prone to self harm.

The Mental Health Recovery Action Plan will also include £30m from NHSX to support mental health trusts to incorporate digital and remote working into service provision.

A total of £111m will also be invested with a view to providing long-term support for NHS mental health services to train enough staff to support two million more people accessing NHS mental health care and treatment by 2023/24.

The proposed funding is clearly welcome and, according to many, long overdue. The proposals perhaps, at least in part, acknowledge the need for 'levelling up' that became part of the government's agenda prior to the pandemic.

People struggling with their mental health, or working to help them in the NHS and elsewhere, will have their own views on why it has taken the worst global health pandemic and peacetime economic contraction for a century for the Government to act but, at long last, mental health provision in England and Wales looks set to receive something approaching the investment needed for many years.

The reality for those suffering the most serious mental health difficulties, is that their urgent requirements are measured in hours and days and weeks, rather than in months, years and decades. We hope that the spending commitments lead to a swift improvement in provision so that mental health care is valued and supported as much as other areas of the NHS.