Written evidence submitted by the Royal College of Psychiatrists (DEL0038)
How mental health services are coping during the pandemic?
It’s critical that people know that NHS mental health services are still open. Our members in the front line are reporting significant reductions in patient referrals – especially in child and adolescent services. Those who fail to get the help they need now, will inevitably become more seriously ill. This is particularly concerning for deadly mental health conditions such as Eating Disorders, which have a higher mortality rate than many cancers. The College is also monitoring early signs that child and adolescent suicide rates may have risen since the lock-down began.
Many mental health providers reacted quickly to change the way services act in response for the crisis. Our survey found that around a quarter (24%) of members are currently working an 'altered timetable due to reconfiguration of services'.
During the COVID-19 pandemic, it is essential that those who use mental health services continue to get the care they need. Remote consultations, using telephone calls, audio and video will be become far more widespread and there are moves to exponentially increase capacity for this in the coming weeks.
From our survey we have found that around 17% of Psychiatrists are currently working remotely which may involve remote consultations with patients
The College has published online resources for people with a mental illness and their carers on issues such as medication and how to manage their conditions during the crisis.
A survey by the College has found that Psychiatrists are being forced to put themselves and their patients at risk, delivering care without adequate PPE or access to tests for themselves, their families or their patients[i].
One Psychiatrist surveyed said “There are extreme shortages of PPE and most of us are at risk. Only very limited supply is obtained and most of the time frontline staff are refused risking their lives. Staff are terrified and afraid.”
Our survey has shown that a significant proportion of psychiatrists are concerned that they are not able to access the level of PPE set out in the guidance.
The regional breakdown is as follows:
Many of our members have to work in old buildings unsuitable for keeping patients with COVID-19 isolated with 1,176 patients having to share mixed dormitories[ii]. Some of our members have expressed concerns about the potential impact the lack of adequate PPE is likely to have. Some of the worst responses to our survey included members saying that:
The other major concern raised by our members is that they were unable to access tests for themselves, their families or their patients if they have concerns if they have COVID-19. The current Government guidance states that any NHS worker or their family member with suspected COVID-19 should be able to access testing and that tests should be given to anyone with suspected symptoms in an inpatient setting.
When our members across the UK were surveyed (15-17th April) we found that:
These findings match the research by NHS Providers who found that mental health leaders felt that they were significantly disadvantaged in the process of accessing tests[iii].
How we can we support people’s mental health after the initial peak?
It seems inevitable that once the pandemic is past its peak, there will be an increase in demand for mental health services. This is because of pent up demand caused by the fall in referrals now and by the consequences of lockdown, economic uncertainty and the trauma of contracting or losing loved ones to Covid-19. We expect an increase in people suffering from anxiety or other conditions such as PTSD. There is strong evidence that financial difficulties are linked to higher levels of mental health problems, so the economic effects of the lockdown are likely to further exacerbate problems[iv].
Mental health services, which are overstretched at the best of times, will come under even more pressure. One of the biggest causes of this is a lack of trained staff. To meet the promises already made for mental health care, reduce vacancies and cover retirements we need an additional 4,370 consultant psychiatrists by 2029. The recent census by the Royal College of Psychiatrists showed the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years.
It is important that the commitments made in the Five Year Forward View for Mental Health and the NHS Long Term Plan are not forgotten. Between them they promised significant increased investment in mental health services which would make a big impact on the lives of many patients. While some targets are bound to be missed this year as services struggle to cope with COVID-19 we will need to redouble our efforts to make sure we get back on track.
[i] The Royal College of Psychiatrists issued a survey to its members working in the National Health Service across the United Kingdom. It was in the field from Wednesday 15 April until the morning of Friday 17 April. 1,685 completed responses were received out from across the UK of a total available sample of c12,900, which equates to a response rate of 13%. This includes 1,384 from among members based in England.