As we navigate our way through the second national lockdown for England and beyond, we must not lose sight of the impact of the pandemic on mental health and the need to take into account the increasing pressures facing mental health services now, as well as over the longer term.
Great strides had been made, and promising further plans put in train, to increase investment in mental health services and deliver on aspirations to improve quality and access, following a decade of campaigning by the sector and the dedication of those leading and working in it. However, COVID-19 has accelerated mental health trends and intensified the challenges facing mental health services as a consequence.
Mental health trust leaders were already reporting to us a significant increase in demand and the severity of new referrals back in June.Deputy Chief Executive
Many mental health trust leaders were already reporting to us a significant increase in demand and the severity of new referrals back in June, and last month's NHS figures showed demand and activity for mental health services across the country at an all-time high. The monthly figures for care contacts in 2020 have been above the 2019 equivalent throughout the course of the pandemic. Recent data from the NHS Benchmarking Network also showed bed occupancy in most specialties back close to pre-COVID-19 levels. Anecdotally, trusts have also reported significant increases in demand for early intervention services, often linked to the wider impacts of COVID-19 such as economic hardship.
Given this backdrop, it comes as little surprise our latest survey of mental health trust leaders found nine in 10 were concerned about the impact of seasonal pressure over winter on their trust and local area. One trust leader said that "for the first time the surge in demand is starting to overwhelm [their trust's] services". Another told us "[mental health] activity levels are growing exponentially now so any additional surge in winter will be incredibly challenging to deliver, especially as the money that has arrived for the accelerated crisis response goes nowhere near covering the actual costs".
Mental health trusts are currently working hard to meet a series of important objectives and targets set centrally for the remainder of the financial year.Deputy Chief Executive
Mental health trusts are currently working hard to meet a series of important objectives and targets set centrally for the remainder of the financial year. These include fully resuming psychological therapies services, retaining the 24/7 crisis lines for all ages rapidly set up at the very start of the outbreak, as well as maintaining the growth in the number of children and young people accessing care.
However, only one in four mental health trust leaders felt these were achievable. They stressed that meeting these objectives depended largely on the scale of: winter pressures; the second wave; and surges in demand for mental health services. Trust leaders also stressed the need for clarity on funding and investment for the sector. One trust leader stressed the quality of services is very much "subject to funding keeping pace with demand".
Looking further ahead, only three out of 10 trust leaders told us they were confident that their trust had the capacity to meet demand for mental health services over the next 12 months. Mental health trusts are having to factor in providing services for a new and unknown level of mental health need as a result of the outbreak and meeting this on top of existing demand will be extremely challenging, as we warned earlier this year. One trust leader told us "[their] forecasting work is giving some big numbers and it's not just these 12 months but over a five year period – this is a sustained increase in demand across all mental health services. So this is not going to go away."
And of course, we must remember that the demand mental health trusts were facing for their services prior to the pandemic was already far outstripping their capacity – despite the substantial progress made in recent years, with new services and higher levels of investment. Without prompt and effective action from government and national policy makers, the direct and indirect effects of the pandemic could make the longstanding care deficit in mental health much worse.
We will not potentially be able to provide services to everyone who needs them in a timely way.Combined mental health trust, learning disability and community trust chief executive
The new challenges around delivering services in the current context are compounded by the longstanding neglect and underinvestment in the mental health estate. While the most recent announcement of funding to eradicate mental health dormitories is welcome and it's good to see tangible, first steps are being taken to begin addressing the state of mental health facilities, the dialogue around mental health remains unequal and significant challenges still face the sector.
These challenges are rooted in the historical, structural disadvantage the sector has suffered compared to physical health provision, which was exemplified most recently by the prime minister's announcement on investment in new hospitals that almost entirely overlooked the needs of mental health trusts. Acute hospitals were also given extra money in the spring to send patients that needed physical health care for treatment in independent hospitals, but NHS mental health trusts were not able to do the same for the people needing their services.
The needs of mental health services must be adequately prioritised in future plans.Deputy Chief Executive
The needs of mental health services must be adequately prioritised in future plans. This means fully and promptly funding, on a sustainable basis, the rapid expansion of services needed to meet the extra demand for mental health care and support. Adequate investment to maintain and build on the steps being taken to grow the mental health workforce, and the sector receiving its fair share of capital funding, are both also crucial. National policy must not only focus on increased support for mental health, but public health and social care too.
If we fail to provide the support mental health services need, we are storing up significant problems for the future, at great cost to individuals, their families and wider society. We can and must not let that happen.
This blog was first published in the BMJ.