Since the beginning of the Covid-19 outbreak, mental health has received a lot of attention but the focus has been largely on the mental health of NHS staff and care workers, and the impact of lockdown on the population’s mental health and wellbeing rather than on people with existing mental health problems.
On 27 April Matt Hancock announced that the NHS was once again ‘open’ starting with restoration of priority services such as cancer and mental health. But for those working in mental health services, the idea that they had ever stopped providing care was another example of a lack of understanding of the needs of people with mental health problems and the care being provided to support them.
During the first few weeks of the Covid-19 outbreak and at the outset of lockdown, mental health services went through a period of rapid transformation. Inpatient wards were reconfigured to isolate those with suspected or confirmed cases of Covid-19, and, where possible, to provide separate facilities for these groups. Some staff were redeployed from community services to support additional staffing needs of inpatient units and to acute hospitals to support the wider response. Many community-based mental health services were merged to ensure they were able to continue to support people despite staff sickness and absence, and in some cases, services deemed to be non-critical were temporarily closed. And within services patients were prioritised – directing available capacity and resource to those deemed to be most at risk or for whom clinical intervention was necessary by nature of the treatment they were receiving. There was wide variation in approach across providers and in different services – but the scale of change cannot be under-estimated.
A national survey sought to capture the experiences of staff in mental health care during this period. Staff described their experience as having to deal with "multiple rapid adaptations and innovations".
A national survey sought to capture the experiences of staff in mental health care during this period. Staff described their experience as having to deal with ‘multiple rapid adaptations and innovations’. For those working in inpatient and residential settings, concerns around infection control were most salient. Wards in many mental health hospitals are ill equipped to enable isolation and social distancing, while measures to reduce infection, including access to personal protective equipment (PPE) and restrictions on social contact and visitors, have an impact on the therapeutic nature of care and increase stress for staff and patients alike. In community and crisis care settings, staff concerns reflected the difficulties that reduced numbers of face-to-face contacts have presented in providing sufficient support, in addition to the closure or reduced access to services in the community which they previously depended on to support people. The switch to new ways of working – including reconfiguration of teams and adoption of new technologies with limited training and support – has also proved to be a significant challenge.
For many people requiring mental health support the impact of changes due to Covid-19 has been equally dramatic. While the majority of the population experienced a deterioration in their wellbeing at the start of lockdown, the largest effects have been among those who already reported lower levels of mental health and those with diagnosed mental health problems. A survey of people with severe mental illness conducted by Rethink found that 79 per cent of respondents said their mental health had got much worse as a result of the pandemic and the measures to contain it, and 42 per cent said this was because they were getting less support from mental health services. A similar survey conducted by Mind found that 25 per cent of those people who report trying to access services within a two-week period were unable to. Although there is evidence that some people have been reluctant to access help through usual routes for reasons that may include concerns related to Covid-19 as well as fear of burdening the NHS – as lockdown eases, psychiatrists are reporting an increase in people in need of urgent and emergency care.
[The accounts of those with lived experience of mental health problems] are often emotive and challenging, compassionate and insightful – but importantly the voices shared here and more widely demonstrate the vital opportunity there is for learning.
The data speaks for itself but, as with staff, it is the lived experience of those with mental health problems that highlights the reality this has had on people’s day-to-day lives. In this realm projects such as Mad Covid have played a key role in providing a space for people to share their voices. These accounts are often emotive and challenging, compassionate and insightful – but importantly the voices shared here and more widely demonstrate the vital opportunity there is for learning. As the lived experience commentary which accompanies the survey of staff experiences highlights, ‘It is reassuring that so many of the concerns of staff are shared by those who use services.’
For both staff and those who need mental health support, the experience has often been one of services being established overnight and of services being unavailable, of rapidly adopting new ways of engaging and of challenges to providing the quality care that people deserve. Mental health services are no stranger to transformation, but previous, often technocratic planning exercises around how care could be delivered have largely failed to deliver high-quality care based on people’s needs. Remedying these past failures requires organisations to learn from the present by ensuring that future plans are founded on the experiences and involvement of those providing and receiving that care.