Written evidence submitted by Mind (DEL0066)

Introduction

  1. We're Mind, the mental health charity for England and Wales. We believe no one should have to face a mental health problem alone. We provide advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding.
  2. This initial submission is based on early information and insight gathered through our network of independent local Minds, engagement with the mental health sector and initial findings from our public survey about the impact of Covid-19 on mental health. Although it is too early to understand the full impact of Covid-19 on the delivery of mental health, the response highlights initial areas of concern. We have also included suggested questions for the Committee to ask representatives from the Department of Health and Social Care (DHSC) and NHS England (NHSE). 
  3. We are continuing to gather evidence on the impact of Covid-19 and will submit more detailed evidence in due course.

How to achieve an appropriate balance between coronavirus and ‘ordinary’ health and care demand  

  1. The need to stop the spread of the coronavirus is clear – as is the scale of the challenge facing the NHS to treat the many thousands of people ill with Covid-19.  Many of these people needing care will also be people who have had mental health problems and we applaud the efforts of NHS England (NHSE) staff to treat and care for people fighting this disease.
  2. While we recognise the need to prioritise staff and resources to tackle Coronavirus, it is vital that people with mental health problems are still able to seek support for their mental health. In the immediate response to Covid-19 NHSE understandably entered crisis-response mode, and we have heard evidence that this resulted in vital mental health services being scaled back and people being unable to get support. Although it is still too early to understand the full impact of this, this is likely to have led to people becoming more unwell and more likely to reach crisis point. Further information about this is set out below.
  3. We are also keen to ensure that some actions NHSE have taken as part of the immediate response to Covid-19, do not become the new normal, as they risk lowering the standard of care for those of us with mental health problems. For example, we are aware some reporting measures have been relaxed to accommodate the immediate pressures services are under, such as around the collection of some data. While this temporary move may be justified, data is vital for effective decision-making and the overall accountability of mental health services.
  4. There are likely to be other changes in service delivery too, including limits on the amount of engagement and consultation with people who use services. For example, where services have transitioned from face-to-face support to digital platforms, it is important that people receiving support are consulted as to whether receiving support in this way is appropriate or possible for them.
  5. The UK Government and NHSE must take steps to ensure that mental health services can continue to delivered as far as possible and return to normal standards of service delivery as soon as practical. A key part of this relies on support for the mental health workforce to ensure as many of the workforce continue to be available as possible. Although some of the workforce, particularly junior doctors, have been moved to other parts of the NHS, for those who remain in mental health services it is vital that they have access to Personal Protective Equipment to enable them to continue to do their jobs. The UK Government should also ensure that sufficient testing is available to prevent NHSE staff from isolating unnecessarily.

Suggested questions for the Committee to ask DHSC and NHSE:

Meeting the wave of pent-up demand for health and care services that have been delayed due to the coronavirus outbreak

  1. As highlighted above, it is likely that many people with mental health problems are not receiving the support that they would otherwise have received. Difficulty in accessing this support, particularly support in the community, is likely to result in people becoming more unwell and more likely to reach crisis point. In Mind’s survey of over 7,500 adults about the impact of Coronavirus on mental health, over one-third of respondents said difficulty getting help for their mental health problem had made their mental health worse.[1]
  2. Digital alternatives to face-to-face support may enable some people to continue to access vital support at this time. However not everyone will have access to the technology or have the right skills to enable them to receive support via digital channels. We know that people with mental health problems, along with disabled people more widely, are disproportionately likely to be digitally excluded and according to data from the ONS, 22% of disabled people have never used the internet compared to 9% of the population as a whole.[2] Others may also not feel comfortable talking about their mental health online or may not be in an environment where they are safe to talk about their mental health.
  3. Worryingly, early indications suggest a number of mental health services have seen a significant drop in referrals at this time. The Health Service Journal reported a significant decrease in referrals to both Child and Adolescent Mental Health Services (CAMHS) and to Improving Access to Psychological Therapies (IAPT). Some IAPT commissioning leads reported a decrease of 30% in referral rates and one CAMHS provider reported a 50% decrease in referrals since the Coronavirus crisis began.[3] It is not yet known the full causes for this but it may be due to people being unaware that mental health services are available or feeling unwilling to approach the NHS at this time.
  4. It is vital that the UK Government and NHSE continue to communicate the importance of people looking after their mental health at this time and encourage people to seek support if necessary. In particular, we are pleased to see Public Health England publishing guidance and raising awareness through the Every Mind Matters campaign and we urge the UK Government to continue to invest in this, now and in the aftermath of the crisis.

Suggested questions for the Committee to ask DHSC and NHSE:

Meeting extra demand for mental health services as a result of the societal and economic impacts of lockdown

  1. As a result of the Coronavirus pandemic, we anticipate an increased number of people will experience poor mental health and will need access to mental health support. Almost two-thirds of respondents to Mind’s survey so far said their mental health had been worse in the last two weeks and this increases to 75% for people with Obsessive Compulsive Disorder, eating disorders or ‘personality disorders’.[4] We are particularly worried about the mental health impacts on those who suffer bereavements, those working on the frontline of health and care services, and those facing financial insecurity as a result of Covid-19.
  2. Mental health services were already struggling to meet existing demand and there are critical shortages within the mental health workforce. A survey of mental health staff by the BMA, published in January, highlighted that four in ten found their workload “unmanageable” or “mostly unmanageable” and over 50% said they were too busy to provide the care they would have liked to on their last shift.[5] These pressures will have been exacerbated during the Coronavirus pandemic and there may be long term implications for the mental health workforce, as junior doctors moved to other parts of the NHS may now be less likely to choose mental health as a career.
  3. To ensure mental health services can deal with the long-term implications of this pandemic, the UK Government must create a sustainable mental health workforce and we would urge the UK Government to publish the NHS People Plan as soon as possible. The UK Government should also be taking steps to support the mental health of the NHSE workforce as a whole, including the mental health workforce, to support them to deal with the additional stresses placed on them due to Covid-19. Polling by YouGov highlights that half of healthcare workers say their mental health had deteriorated since the Covid-19 crisis began and this may increase as the pandemic continues.[6]
  4. As part of workforce planning, NHSE should also be considering what additional skills and training may be needed to support mental health workforce to respond to additional demand. In particular, it is vital that the mental health workforce has the skills and training to be able to take a trauma informed approach to the delivery of services.

Suggested questions for the Committee to ask DHSC and NHSE:

 

Meeting the needs of rapidly discharged hospital patients with a higher level of complexity

  1. Mental health units were already under pressure before the pandemic. We recognise the potential health risks around Coronavirus for those left in hospital, however we are concerned that the drive to discharge all patients where safe and feasible could have left people at risk in the community.
  2. In a survey Mind carried out in 2017 about people’s experiences of leaving hospital, over one third of people said they were discharged sooner than they should have been, two out of five said that staff did not plan for their ongoing care and support, and one in four did not receive any support.[7] The risk of suicide is increased in the 2-3 days immediately following discharge when people are particularly vulnerable and the impact of isolation under lockdown, or reliance on family to stay safe, is likely to further complicate this.
  3. We’re concerned that the pressures of the pandemic for both individuals and services will create greater need among people discharged and greater difficulty in meeting these needs, especially given reduced capacity in community teams and temporary changes to the Care Act, as part of the Coronavirus Act.
  4. We would urge NHSE to ensure that ‘premature’ discharge is avoided at all costs. People should only be discharged when it’s safe to do so and they must be able to access ongoing support and care to keep them safe and support them to manage their lives and mental health.
  5. We are also deeply concerned about the easement of social care allowed for in emergency coronavirus legislation, and that less social care and lower standards risk becoming the new normal for people with mental health problems, who already find it difficult to get the support they need. We understand that the intention is for local authorities to maintain a full service as far as possible and only use the powers when absolutely necessary. However, considering the pre-existing strain on local authority social care teams and the additional pressures due to Covid-19, we are concerned that many local authorities will immediately resort to only meeting social care needs where they deem it necessary to avoid a breach of human rights.
  6. We welcome the guidance issued by DHSC to local authorities on social care easement and the emergency measures, but are concerned that whilst local authorities must have regard to the guidance, they are not legally obliged to follow it. In practice, we are concerned that it is unclear how local authorities will prioritise providing care, and how they will assess needs to prevent a breach of Convention rights. 

 

Suggested questions for the Committee to ask DHSC and NHSE:

 

Providing healthcare to vulnerable groups who are shielding

  1. Some people with mental health problems, particularly those with severe mental illness, are part of the shielding group. However, the use of ‘vulnerable’ has also caused confusion as there are many people with mental health problems who are not ‘vulnerable’ to coronavirus from a physical health perspective, but are vulnerable in other ways and will be facing specific challenges during lockdown. For example, their mental health may lead to them facing challenges accessing food and medicines at this time.
  2. We are urging the UK Government to put in place a cross-government plan for supporting anyone who may be vulnerable at this time, including those in the shielding group, but also those who face additional barriers for other reasons, including due to their mental health.

Suggested questions for the Committee to ask DHSC and NHSE:

Supporting mass testing and vaccination once they become available.

We are not answering this question in our initial submission.

 

How to ensure that positive changes that have taken place in health and social care as a result of the pandemic are not lost as services normalise.

  1. The crisis has increased public awareness of the importance of looking after your mental health and of the connections between physical and mental health. The UK Government should continue to build on this and as highlighted above, we would encourage the Government to invest in campaigns such as Every Mind Matters to highlight the importance of looking after your mental health.
  2. There have also been some innovations in the delivery of mental health services, including the move to making greater use of digital technology. Making greater use of technology has the potential to enhance the availability of mental health services, however as highlighted above it is vital that people are given a choice over whether this method is right for them.
  3. Finally, this health pandemic has highlighted how our mental health is affected by so many factors in our lives, including our physical health, our social connections, our financial security, our living situation, support through schools and the workplace. As we move on from the crisis the UK Government must recognise the importance of these connections and ensure there is a cross-government approach to mental health.

 

April 2020


[1] Mind survey of 7,570 adults about the impact of Coronavirus on mental health, Results from 23.4.20

[2]  https://www.goodthingsfoundation.org/sites/default/files/research-publications/ofcom_report_v4_links.pdf

[3] https://www.hsj.co.uk/coronavirus/major-drop-off-in-referrals-to-childrens-mental-health-services/7027373.article

[4] Mind survey of 7,570 adults about the impact of Coronavirus on mental health, Results from 23.4.20

[5] BMA Mental Health Workforce Report, January 2020

[6] IPPR Media Release, 23 April 2020

[7] https://www.mind.org.uk/media/18839049/leaving-hospital-minds-good-practice-briefing.pdf