We face mental health crisis like no other

UK must prepare for the worst, as stigma and fear of burdening NHS stores up a parallel national epidemic

Usually it is the patients in front of me who I worry most about. But right now, I’m most worried about the patients I am no longer seeing. I work as a psychiatrist in a community mental health service in the South West, and the usually steady flow of people referred to me has slowed right down. This phenomenon is widespread. A recent survey of the Royal College of Psychiatrists’ members saw 45 per cent of doctors report reductions in routine appointments across the UK.

While the lockdown has put many things on hold, there is sadly no pause button for mental illness. The UN last week warned that the pandemic will probably lead to an “upsurge” in the number and severity of mental illnesses. The same survey found that 43 per cent of psychiatrists have seen a rise in patients needing urgent or emergency support. One colleague told me recently that they are seeing far more new faces of people in crisis. But meanwhile, contact with their regular patients has dropped off

I fear the commonly held misperception that NHS services not directly dealing with treating Covid-19 have closed down is now so ingrained that people only seek support when they hit rock bottom. We urgently need to get the message out that mental health services are very much open, keen to help and are in this for the long-haul.

The people I work with are often hard to reach. By definition, this period of isolation has made contact harder. Many precious support networks have been disrupted. GPS, who usually refer most of my patients, have also seen a drop-off in patients, often as people want to avoid “bothering the doctor”.

Of the people I am currently seeing, many are extremely unwell with symptoms of severe mental illness: serious changes in their moods, belief systems and hallucinations. Life events associated with Covid-19 have triggered this or led to a relapse for almost all of them.

Already tough, stretched and uncertain finances are now even tougher, more stretched and more uncertain. Relationships, previously strained or not, are now all feeling lockdown pressures. Routines have disappeared. Day-to-day contacts which provide important support are no more. And all the while people are living with the background fear of catching a deadly disease.

We have quickly adapted to the situation, with virtual appointments and staff working round the clock to set these up. But technology is no panacea; some patients are uncomfortable with video calls or are unable to use them. In particular, many patients lack a safe place in which they can speak freely. This crisis has exposed the stark reality of digital disadvantage.

Recognition of mental illness has transformed recently. But the pandemic has revealed that traces of stigma remain entrenched, including in the minds of those affected. A survey by Rethink Mental Illness found a third of patients hadn’t attended their usual appointments, with worries about burdening the NHS a key reason, despite eight out of 10 patients reporting a deterioration in their mental health.

For my missing patients, and the thousands more across the country whose unmet needs are growing as we speak, we need to send a clear, united message that no one should be shamed out of seeking support for mental illness, especially not now.

It is also essential that staffing and funding for mental health services are “front and centre” in future, as the UN advises. Investment must be prioritised so services can cope with a surge in mental health cases after the Covid-19 peak is passed.

The human spirit is extraordinary. I have been moved by the courage and resilience of the people I look after on a daily basis. I have personally been encouraged by their heartfelt concern for NHS staff. And I seriously hope for the best possible outcome in this situation. But while travelling hopefully, we must be ready to face the worst. Preparing to deliver first-class mental healthcare is key.

Unlike the coronavirus, there is no vaccine on the horizon to reduce the impact of the pandemic’s mental health consequences. The needs will be immense.