Since the emergence of the coronavirus (Covid-19), widespread concern has been raised about the impact of the pandemic and lockdown measures on mental health. We’ve updated our QualityWatch mental health indicators, looking at longer term trends in the quality of NHS mental health care. But what has happened during the pandemic so far, and what does this mean for mental health services in the future?
Symptoms of common mental health conditions increased
The Opinions and Lifestyle Survey asked adults about symptoms of depression between June 2019 and March 2020, and again in June 2020. Between June 2019 and March 2020, 10% of adults were experiencing moderate to severe symptoms of depression. In June 2020, this had almost doubled to 19%.
Self-reported feelings of anxiety spiked in adults at the start of the first lockdown in March. Over the summer, as lockdown measures were eased, anxiety fell but consistently remained at a higher level than in 2019. In October and November, levels of anxiety increased very slightly. While the impact of the second lockdown on mental health remains to be seen, this indicates a worrying picture of worsening mental health.
Fewer people were able to access services during the first lockdown
While survey data shows an increase in symptoms of common mental health conditions, during the first lockdown fewer people were referred to mental health services.
Treatment and support for common mental health conditions such as depression and anxiety is provided by the Improving Access to Psychological Therapies (IAPT) programme. Patients with more significant needs are treated by secondary mental health services.
Between February and April 2020, the number of new referrals to IAPT decreased by 61%. The number of referrals to NHS funded secondary mental health, learning disability and autism services decreased by 39% over the same time period.
This corresponds to a considerable fall in the number of GP appointments and referrals during the first lockdown. It may indicate that fewer patients presented at their GP surgery, or that fewer referrals (including self-referrals in the case of IAPT) were made following GP appointments.
The severity of cases seen in secondary mental health services changed
Alongside this decrease in the number of referrals, the caseload of patients accessing secondary care services changed. 43% of psychiatrists surveyed in May reported an increase in urgent and emergency cases and 45% said that routine appointments had decreased.
For patients who were able to access secondary mental health care during the pandemic, the way appointments were carried out changed. Face-to-face appointments were replaced with telephone or video appointments, although most staff surveyed in crisis services reported that home visits were continuing where necessary. This is important as remote appointments are not always appropriate or accessible for the most vulnerable patients.
The change in caseload raises concerns that patients were unable to access support until their condition had worsened. Some patients may have put off seeking support due to worries about using NHS care during the pandemic. For others, the switch to remote appointments may have acted as a barrier to accessing services.
What does this mean for mental health services?
Not everyone who experiences symptoms of a mental health condition will need professional support and treatment. However, the increase in symptoms combined with the fall in GP referrals suggests that mental health services will have to prepare for a future surge in demand.
The drivers of this demand can be split into three groups. Firstly, deferred access to care from people who would have been referred with mental health conditions that pre-date the first lockdown. Secondly, deterioration of symptoms among people with existing mental illness. And finally, from people who have developed mental health conditions due to the wider impacts of the pandemic.
Measures implemented to control the spread of the virus, including restrictions on socialising, limit the availability of informal sources of support, such as from social networks and peer support groups. This could place further pressure on formal services.
Mental health services have been underfunded for many years and were under considerable strain before the pandemic. The recent Spending Review announced a welcome £500 million of funding for mental health to address waiting times, expand support to reach more people, and invest in the workforce. However, estimates suggest that the costs associated with the predicted increase in demand could be as much as an extra £1 billion per year.
The impact of lockdown measures on some of the wider determinants of mental health, such as employment and social isolation, are likely continue for many months. As people’s experience of the pandemic has varied widely, existing inequalities in mental health are likely to be exacerbated. Mental health services may continue to feel the effect of the pandemic for a long time.