Written evidence submitted by BACP, UKCP, BPC (DEL0331)
BACP, UKCP and the BPC welcome the opportunity to respond to the Health and Social Care Select Committee’s Inquiry on delivering core NHS and care services during the pandemic and beyond. Collectively our three organisations represent over 65,000 counsellors and psychotherapists working across a range of settings and with clients of all ages. We support the highest possible standards, quality of care and public protection for the practice of counselling and psychotherapy, and each hold registers of practitioners accredited through the Professional Standards Authority’s (PSA) Accredited Registers Programme.
An estimated half a million more people are expected to experience mental health problems as a result of the impact of the pandemic and the unprecedented health and economic crisis (Centre for Mental Health, May 2020). Official data show that stress or anxiety have significantly increased since the beginning of lockdown, with depression and self-harm, including alcohol and drug misuse due to isolation, also having seen an unprecedented rise.
As part of our three organisations’ collective response to the COVID-19 crisis we have launched a campaign to maximise the role of counselling and psychotherapy in helping to support people through the pandemic, in both the immediate and longer term, ultimately helping to repair our shattered communities and lives; helping the nation return to normality. therefore one of our key asks of Government is that they work with us to develop a comprehensive mental health response to the crisis through a national strategy built with the expertise of the people who work on the mental health front line.
Many counsellors and psychotherapists have continued to play an important role throughout the pandemic supporting vulnerable people, including medical staff and other key workers. However, we also know that going into this crisis, counsellors and psychotherapists were a largely underutilised and undervalued workforce, that could be quickly and effectively mobilised to deliver the services the public may need.
COVID-19 has placed all sectors of the health service under immense pressure. The full mental health impact is yet to be felt but initial ONS data on the general population already shows that more than 4 in 10 adults (43%) say their wellbeing has been affected by the coronavirus pandemic and 29% of women and 21% of men feel that their mental health has degenerated as a result of COVID-19. Other reports indicate that mental health in the UK has worsened substantially since the beginning of lockdown especially for people from BAME backgrounds, young adults and women of all ages, groups that already had lower levels of mental health before COVID-19. Those who have suffered from serious COVID-19 complications will need psychological as well as physical help to recover personal losses.
There is ample evidence and research from previous pandemics to show that frontline healthcare workers are much more likely to develop symptoms of post-traumatic stress disorder (PTSD) and depression. The impact on NHS and social care workers has indeed been significant, with one in two healthcare workers across the UK feeling that their mental health has declined as a result of the pandemic (Care fit for Carers, IPPR, April 2020). Once they have the time and space to consider the impact of their experiences on their personal wellbeing, many of them may need focused and longer-term psychotherapeutic support to process the effects of the trauma and loss they have had to deal with.
The NHS’s early response to this crisis has been impressive, with many NHS Trusts quickly drawing from effective and well tested interventions after single episodes of trauma, such as natural disasters and terrorist attacks, or putting in place or signposting to existing psychological and wellbeing support for their staff. Where specific support was provided, many of those groups were run by some of our members and registrants (Supporting the NHS during COVID-19, June 2020). However, on the whole, this support was not as widely available as it could have been. Experienced counsellors or psychotherapists across the country could have provided more of the much needed interventions to support frontline staff. Collectively all NHS staff continue to suffer the professional and personal challenges of living with COVID-19 and its legacy.
This challenge has to be seen against a backdrop of growing waiting lists and waiting times to receive mental health treatment and support, that has grown exponentially as a result of the pandemic. For examples, although before the pandemic IAPT access rates had been improving through its recent expansion, certain demographics within the general population continued to be consistently underserved. Groups such as BAME and those with complex and chronic physical health conditions and older people have poor access rates to mental health services compared to the general population and they are also the ones most hit by the consequences of COVID-19. During lockdown many services were suspended and as a result of this, despite the growing anxiety and depression amongst the population, IAPT services saw referrals fall by at least a third compared with the previous year in March (NHS Digital). Secondary mental health care also had to reduce many of the services available.
The NHS mental health services entered this pandemic with significant workforce shortages; therefore it is reasonable to foresee that the system will fail to cope with the expected increase in demand for psychological support. It has become evident that the plan set out in the NHS Mental Health Implementation Plan 2019/20 – 2023/24 to increase the mental health workforce by 65% including the recruitment 5,610 additional psychological therapists will not be enough. The National Vision for the Psychological Professions, developed before the Covid-19 pandemic by the Psychological Professions Workforce Group at NHS England / Improvement and Health Education England with input by eight professional bodies, including ours, confirmed that the transformation in mental healthcare requires not just a major expansion of the psychological professions, but also developing and retaining the current workforce. This expansion and development must now take into account the challenges we will have to face as a result of the extra demands on the NHS mental health services so that people can receive the quality of care they need. There is a large and diverse pool of qualified and highly professional counsellors and psychotherapists that could quickly be integrated within primary and secondary mental health care. The ones who already work in the NHS should be valued for the comprehensive and diverse mental health services they provide for patients and staff.
We need a well-funded, clear and joined up action plan to deliver a comprehensive mental health response to COVID-19 and beyond.
BACP, UKCP and the BPC believe that a radical intervention to increase capacity beyond what is proposed in the NHS long term plan, to include specific action to support NHS staff, to provide trauma specific interventions, and reversing the trend that has seen complex disorders being dealt with at an hoc basis rather than with access to ongoing psychotherapeutic support, is urgently needed if the nation is to move towards recovery.