This is the 2020/21 edition of State of Care
The impact of the pandemic on people’s mental health is well recognised. The Centre for Mental Health has estimated that up to 10 million people, including 1.5 million children, are likely to need new or additional mental health support as a direct result of the crisis.
Over the last year, Mind and Rethink Mental Illness have reported an increase in demand for their services. For example, in the 12 months since the first national lockdown was announced, Rethink reported a 175% increase in demand for advice and information on their website.
- Mind: Mind warns of 'second pandemic' as it reveals more people in mental health crisis than ever recorded and helpline calls soar
- Rethink Mental Illness: Demand for mental health advice soars in year after first lockdown
But the pandemic has not affected everyone equally, with some people more at risk of developing mental health problems due to their social and economic circumstances. Research published by the Mental Health Foundation in July 2020 highlighted that among those disproportionally affected by COVID-19 were young adults, older people, people with pre-existing mental health problems, people with long-term conditions, single parents, transgender people, those unemployed or in insecure employment, those from Black and minority ethnic backgrounds, and women.
Through our Give Feedback on Care service between April and December 2020, we heard that when some people sought help for their mental health from primary care services, they reported issues including feeling ignored by the GP or not having their symptoms taken seriously. People with mental health needs also felt that they could not get a referral to a specialist from their GP because of a lack of capacity in community mental health services.
Not being able to access the right care and support when it is needed increases the risk of individuals’ mental health deteriorating. This is a long-standing challenge, which has been exacerbated by the increased demand on mental health services due to COVID-19.
A long wait for mental health care
After around nine months of experiencing anxiety and depression, while she was extremely apprehensive about seeking help and was unclear where to seek it from, Meira eventually made the decision to seek advice from her GP. Meira’s GP suggested that she self-refer to IAPT (Improving Access to Psychological Therapies), as they believed this would be the quickest route. Following her self-referral, Meira waited around four months to be contacted.
At this point, Meira received a telephone triage call from an IAPT consultant who advised her that it would be more appropriate if she sought support from a psychologist and would need to go back to her GP to be referred. Meira was extremely frustrated at this point and disheartened to have waited so long, while still struggling with anxiety and depression.
Meira’s GP referred her to a psychologist at her local mental health clinic. Her first appointment, which was face-to-face, went well until she was told she would need to wait several more months to receive the psychological support she needed. This wait ended up being over six months, during which there were no check-in calls, either by her GP or by the mental health clinic. This left her feeling hopeless and desperate.
Meira began ‘talking therapy’ in the autumn of 2020, which was virtual due to the pandemic. She found this extremely odd given the deeply personal, sensitive and private information she was divulging over a computer screen. Meira felt that, although the virtual appointments gave her the flexibility to access support without depending on public transport or others to drive her, being able to meet the therapist in person would have been more comfortable, and she would have liked the option to choose.
Meira found that communication deteriorated during the pandemic, as she was having to check that individual appointments had been made, report instances of not receiving booking confirmations, and highlight invalid or broken virtual links to therapy sessions.
Meira would like to have seen the GP and the psychologist communicating with each other to allow the latter to understand her journey with treatment and medication as she waited for therapy.
Interview with a member of the public
Our inspection teams have raised concerns about people being admitted to mental health services with more severe mental ill-health. They have also told us about people presenting in emergency departments and acute trusts struggling to find appropriate places for them due to a lack of suitable provision.
Through our provider collaboration reviews, we have heard of many examples where systems and providers have recognised the increasing demand and put in place adaptations to meet this need. For example, to reduce attendance at emergency departments, we heard of pathways being redesigned so that people with acute mental health needs were diverted to a more appropriate setting. Front door screening at hospitals aimed to ensure that people were either directed to the right place in the building or were directed to a different service or a different place. Systems also told us about new phonelines that had been set up during the pandemic, including 24/7 mental health crisis lines, to improve access. However, our inspectors have expressed concern that solutions put in place to address challenges with support and access would disappear after the pandemic has subsided, even though the issues remain.
As with other areas of health care, we saw that the increased use of digital technology had a positive impact for some people. This included for example, the use of online mental wellbeing apps. Video calling was also beneficial for some people as it made it easier for people, for example those with chaotic lifestyles, to keep scheduled appointments. However, the use of digital technology was not accessible or suitable for everyone, and excluded some, with the importance of face-to-face appointments still recognised.