A year of covid-19: Alliances, lessons, and learning for the mental health sector

As we start to ease out of lockdown restrictions in the UK, it is without doubt that the past year has shown the NHS at its best.

Throughout the pandemic, everyone working in the health sector has demonstrated dedication, adaptability, and innovation. I’ve seen this within my own team in a low secure unit. They’ve been delivering care while managing infection prevention and control, adapting to non-verbal communication when wearing masks and looking after patients with covid-19.  

But the past year hasn’t been without its challenges.

At the start of the pandemic, psychiatrists were reporting extreme shortages of personal protective equipment (PPE) which placed them at heightened risk of virus infection. Staff were terrified, a sentiment that now will resonate with many.

Mental health wards operated at reduced capacity due to social distancing and staff being unwell or self-isolating.

More people than ever before are in contact with mental health services and there are a significant number who are becoming increasingly unwell due to existing gaps in provision. We know that psychiatrists are reporting an increase in urgent and emergency cases following covid-19 lockdowns. With many restrictions still in place, it is likely that the true scale of the problem is yet to unfold. 

On top of this, the UK has been exposed to a prolonged period of isolation and economic uncertainty and it is clear there will be an increase in demand for mental health services as a result. According to the Centre for Mental Health, up to 10 million people in England may need either new or additional support for their mental health as a result of the pandemic. It is essential that this provision is available for them.

There is also emerging evidence that covid-19 can directly affect the brain. Recent NICE guidance on “ongoing symptomatic covid-19″ or “post-covid-19 syndrome” (or long-covid) has highlighted that neurological and psychiatric symptoms can be a part of this. With so many people having been infected with the virus, we must pay close attention to how these symptoms progress and ensure there is sustained partnership working between mental and physical health services.

Funding can certainly help with all this. The £500m promised for mental health at last year’s spending review is vital money that will support services through the pandemic and help them to address the growing waiting lists. Children and young people have been uniquely affected by the pandemic and the £79m boost to their services is much needed. The further £87m allocated for discharge funding will go some way in ensuring that those who are well enough can be helped back into the community.

Still, without a steady supply of funds we won’t be able to address longer term needs.

The challenges of infection prevention and control in an ageing mental health estate—much of which pre-dates the NHS—have shown how essential increased government capital funding is for mental health trusts. Buildings should have the highest standards of safety, not just for patients and staff, but to also prevent nosocomial transmission.

We need to continue to provide active national support to healthcare staff, who have given us so much, through a sustained and coordinated approach to mental health and wellbeing during the recovery period. This must take into account the needs of Black, Asian and ethnic minority staff, who have been at increased risk from covid-19, and experience multiple inequalities, highlighted by the recent WRES report. 

A multi-year settlement for workforce training and education to allow us to support the expected increase in demand is crucial in making all this happen. Fundamentally, mental health services will not be able to function without the workforce that is essential to their operation.

Without doubt, this has been a year of unparalleled working across the health and care sector. I’ve been struck by how our partners across the NHS and Medical Royal Colleges have worked shoulder to shoulder with us to highlight mental health need, and help keep mental health services going throughout the pandemic. 

The pandemic’s subsequent ramifications—particularly on the mental health of the nation—are just beginning to rear their head. 

My sincerest hope is that as the pandemic recedes this joint working will continue, and the challenges we now face in the mental health sector are not forgotten.

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

Competing interests: none declared.