Adrian James: Planning for the long term impact of covid-19 on mental health

We must resource and plan for action to meet upcoming demand

It’s becoming clear that the impact of covid-19 on our mental health will be felt for years after the virus has been brought under control. The ramifications will likely be pervasive and long-lasting—they won’t just fall in line with case rates once the pandemic starts to recede, or even stop when it finally ends.

Isolation and loneliness, fear of the illness, reduced access to services and economic instability have all had a deeply adverse effect on people’s lives. More people are now in contact with mental health services than ever previously recorded by the NHS. Forecasts from the Centre for Mental Health suggest that up to 10 million people could need new or additional mental health support as a result of the pandemic, including 1.5 million children.

The potential for mental health problems during or after an acute covid-19 infection, especially for people with “ongoing symptomatic covid-19” or “post covid-19 syndrome” (also known as “long covid”) is also becoming clear. Neurological and psychiatric symptoms are highlighted in recent NICE guidance, and are being further explored through the Coronerve project. Research from the United States has found that almost one fifth of those diagnosed with covid-19 received a psychiatric diagnosis within the following three months. We need to pay very close attention to how these symptoms progress in people experiencing them. In light of what we know so far, establishing sustained partnership working between mental and physical health services is critically important.

A traumatic experience with covid-19, either through having severe illness, or seeing a loved one become very ill and in some cases lose their life, can hit people very hard. There is an increased risk of PTSD, anxiety, and depression after admission to intensive care. Others are dealing with complex grief reactions after the death of loved ones, especially in sudden or traumatic circumstances.

Furthermore, having an existing severe mental illness (SMI) or a severe intellectual disability can be a risk factor for both contracting covid-19 and becoming seriously unwell with it—threatening both physical and mental health. This is why we advocated successfully for those with SMI and severe and profound intellectual disabilities to be included on the list for vaccine prioritisation.

Mental health services are struggling to cope with the vast numbers of people currently in need of support, either because they have been directly affected by the virus or because they are feeling overwhelmed and exhausted by the pandemic.

Despite recent progress, there are still long waits, problems with access to specialist services, and big workforce shortages. We simply can’t afford to have more people become increasingly unwell during and beyond the pandemic due to lack of proper care and treatment.

While the recent government funding injection for England is welcome, if it’s non-recurring, we won’t be able to address longer term needs. 

A top priority for longer term funding is the mental health estate, as many of our buildings are outdated, dilapidated, and unsafe. We need increased government capital funding so that NHS mental health trusts can ensure the estate is fit for purpose.

We must also work to bolster community and specialist mental health services across the board, for both adults as well as children and young people, with a focus on supporting and retaining the staff needed to run them. Ongoing support for healthcare staff is vital in the context of covid-19, particularly for those who may have been directly affected by the illness or are from vulnerable groups such as Black, Asian and minority ethnic communities. To ensure we can overcome the stark challenges associated with workforce shortages, the government must also take the bold step of doubling medical school places to help us meet demand.

Ultimately, the link between covid-19 and mental health is complicated, but we are learning more every day. We must resource and plan for action to meet upcoming demand, ensure adequate care environments, and support our workforce or services could be stretched beyond their limits. We should address this challenge with open eyes and be realistic about what is needed.

Adrian James in president of the Royal College of Psychiatrists. Twitter: @DrAdrianJames

Competing interests: none declared.