UK must brace itself for ‘inevitable’ rise in mental illness, medic warns

The UK must brace itself for an “inevitable” rise in mental illness as a result of Covid-19, the new president of the Royal College of Psychiatrists has warned.

In his first interview since taking up his post, Dr Adrian James said there would be “multiple layers” to the fallout from the coronavirus pandemic, both for people with pre-existing mental health conditions and those who have never suffered before.

He said NHS frontline staff needed support, while those recovering from Covid-19 should be screened for issues such as post-traumatic stress disorder (PTSD).

And he warned that waiting lists for treatment would now rise substantially, including for young children and older people.

“There will be very significant mental illness consequences of Covid, and we need to be ready,” he told the PA news agency.

Dr James said the pandemic had exacerbated problems for some people with pre-existing conditions, including anxiety and depression, but as the country went into lockdown, fewer had sought help due to fears over catching the virus.

But demand had now begun to rise again, which would stretch services, he said.

“A lot of need was sort of suppressed,” he said.

“And then of course you can only do that for some time. As we know happens with people with mental illness if you don’t treat early, it becomes more acute and you present in crisis.

“There’s the people who should have been receiving treatment who didn’t receive treatment, and their conditions will worsen and their need will be even greater.

“You’ve also got the people who through Covid are developing mental illness.

“Some people have been very directly affected, people who have been on a ventilator, the rates of post-traumatic stress disorder are very significantly higher.

“Then you’ve got people who have lost people or been very worried that they’re losing people.

“And of course, grief within Covid has been very much more complex because people sometimes weren’t able to provide any support to each other.

“People were told that somebody was going to die within 24 hours. On some occasions they actually got to see their loved ones, but on other occasions they didn’t.”

Dr James said the virus itself appears to affect the nervous system, with reports of psychosis in people with no prior history of the illness, and others suffering a dementia-like syndrome.

Those recovering from Covid-19 therefore face possible multiple mental health issues, he said.

“They run the risk of a whole variety of mental illnesses. Obviously you’ve got PTSD that can be resistant to treatment unless you treat it early.

“We recommended that everybody who’s been on a ventilator is screened at the point of discharge and is screened a month afterwards.

“People are also finding that they’ve got muscle pains and aches over a long period of time and can’t get out and about, which obviously helps in terms of your mental health.

“I think anxiety, depression, PTSD are among the issues people could face.

“And of course the sort of support that people would otherwise get, it’s been much more difficult.”

Dr James said the “next stage” of the fallout will include the “economic effects and the social determinants of mental illness, which we know are very, very powerful”.

He added: “I think everybody agrees this is going to be a very challenging time in terms of the economy, jobs and poverty, with emerging signs that it’s people who were poor before Covid who are going to be affected even more.

“The scene is being set for multiple layers.”

Referrals to mental health specialists for treatment will now shoot up as a result of Covid, Dr James said.

“I think it’s an absolute certainty,” he said.

“I don’t see that there is any other way of looking at it, if you look at what we know about the social determinants of ill health and you know the other direct and indirect effects of Covid.

“The early signs are that there has been an increase in demand, it is a unique situation really.

“I think we can be pretty confident that demand will will grow very, very substantially.”

Cash must now be pumped directly into mental health, to put it on an equal footing with physical health, Dr James said.

“Mental health services have been traditionally underfunded so they weren’t in the most resilient place (beforehand).

“There has been some welcome investment in perinatal liaison services, and some money now going into older adult services.

“But we need to make it an absolute priority that the money that’s been promised doesn’t suddenly get diverted into non-mental health services.

“The Government said at the beginning they would fund whatever the NHS needs to fight Covid.

“And what can sometimes happen is that that is interpreted as being the direct physical effects, and people forget about the mental health effects.

“We want to hold the Government to account and say, when there are mental health consequences, they need to be funded so that people get the service that they need.”

Dr James said it was too early to say if there would be an increase in suicides, adding that fuller data was needed.

He also said there was no data yet on how Covid-19 may have impacted on the number of people suffering specific disorders, including obsessive compulsive disorder (OCD), where symptoms can include compulsive hand-washing, cleaning and a fear of germs.

For health and social care staff, peer support was very important but some people would still need professional help, he said.

“It has been very trying,” he said. “I think for staff who have seen people die and sometimes found themselves the only source of support without friends and family there, that clearly has its toll.

“And that’s why we’ve also been saying that we need to be very careful about how the system boots up again.

“We need to keep checking that staff are in a position to do that.”

Dr James called for greater investment in staff in the long term, plus more cash for buildings, some of which are in a terrible state of repair.

“We need to invest in the workforce, invest in the buildings, and actually learn lessons now so that in the future, if there’s a big shock to the system whether it’s a pandemic or an economic shock, that mental health services are not already playing catch-up,” he said.

“We know from the last adult morbidity surveys that only a third of people who could benefit from evidence-based treatments are actually getting those treatments.

“That wouldn’t be tolerated in cancer and it shouldn’t be tolerated in mental health.”