Although an exit route from the Covid-19 pandemic may now be in sight, Alison Kenyon of the Leeds and York Partnership NHS Foundation Trust feels its legacy will be with us for some time to come and there is much work still to be done to mitigate the long-term impacts, including a looming mental health crisis among the population and health and social care staff.
While the nation waits optimistically for news of further updates regarding the recent successful vaccine trials, Thursday brought with it a bitter dose of reality and a stark reminder that as a nation, we are very much not out of the woods yet. This came as health secretary Matt Hancock appeared before the media to set out which regions would be subject to the harshest restrictions under the government’s revised three-tier framework, which is expected to be in place until March 2021.
In the hours before the news emerged that West Yorkshire would be plunged into Tier 3 and subject to the most stringent measures, while the city of York and wider North Yorkshire would find itself entangled in Tier 2 from December 2, Alison Kenyon, associate director of the Leeds Mental Health Care Group within the Leeds and York Partnership NHS Foundation Trust and specialist in mental health and disability services, spoke exclusively to The Leaders Council of Great Britain & Northern Ireland to share her experiences of the pandemic and what the impact of Covid-19 could mean for the future of the health service and our mental wellbeing.
The impact of Covid on mental health services
While the pandemic did initially put several routine health services on hold as resources were redirected toward the frontline of fighting the virus, Kenyon began by explaining that this trend was not seen within mental health services.
Kenyon outlined: “The difference in mental health services as opposed to physical health during recent months is when people are ill with Covid and need hospitalisation, they are admitted to acute hospitals because they’ve needed more support. With mental health it isn’t the case, we admit people who struggle with mental wellbeing and we have not found our physical capacity being stretched, so we’ve continued many of our services at full capacity through the pandemic and we have noticeably had a number of our service users suffering from Covid, some of whom have sadly died. We have also had a number of staff who have sadly passed.”
In the early stages of the pandemic, Kenyon recalled that there was an obvious decrease in the number of admissions referrals within the mental health service, yet this respite only proved temporary as the many months of restrictions within the community and forced closures of facilities and businesses began to take a toll on people’s mental health, fuelling an increase in demand as the year went on.
“The incidence of Covid within the mental health trust and our service users are probably similar to incidence within the community. We were not in a situation where we were bringing Covid patients into our facilities and we were seeing a drop-off in the number of referrals for admission over the first wave. However, since the second wave and the reintroduction of harsher measures, we are seeing an increase in demand for mental health and disability services across the board and there are a number of factors behind that.”
Proceeding to outline these factors, Kenyon added: “Predominantly, demand for our services is increasing because the infrastructure of support in the community has stopped. So, more people with serious and longstanding mental health conditions who have managed their condition themselves thanks to help from community support, have been coming in to see us because they’ve relapsed during the pandemic to the extent that admission has been needed. When we have spoken to these patients and their carers, they’ve mentioned factors such as swimming pools and libraries and other community facilities closing. Lockdowns and restrictions mean these people cannot socialise and meet friends in coffee shops and their work environments have changed too. The wider support infrastructure has ceased and that is what is impacting them.”
A looming mental health crisis?
In spite of the prime minister’s optimism that the concept of lockdowns will become obsolete by Easter once vaccination programmes have hopefully commenced, Kenyon believes that the social impact of the pandemic will continue to be felt for some time to come, especially with regards to people’s mental health.
She elaborated: “This pandemic won’t just affect those who have had Covid. It will impact staff and volunteers within healthcare services and the general public. We foresee significant increases of people who will be reporting issues with their mental wellbeing going forward, and this will become a significant burden on society with the demand for general practice and private mental health services, as well as services provided by the third sector. I feel this won’t be over for quite some time yet.
“I think delivering a mass vaccination programme will be key to helping us get out of the pandemic first, but even then we’ll either need to continue to live a restricted lifestyle for some time to come, or we’ll subconsciously do so of our own accord. I think we will see some changes to social behaviours in the long-term. We will see people wearing face masks voluntarily, people restricting how often they go out and what social situations they involve themselves in. So, society will be impacted for a long time.”
Although the demand for mental health services is likely to continue to rise, Kenyon remained hopeful that the pandemic will make people more willing to discuss their physical and mental health openly.
“Over recent years having a mental illness has become more socially acceptable. People are more willing to talk about it and I think there is a long way to go, but people are talking about mental health more as a result of this, and they are willing to be open and discuss their struggles in lockdown and isolation. A lot of research is currently underway to assess the impact of Covid on people and it is important we do this, because it isn’t just about the impact of the virus, it is about what we can then do to address that impact. A major boost though is that people do seem to be taking health more seriously.”
What has recent mental health research uncovered?
“We do anticipate that between now and March, there will continue to be consequences on people’s employment status and finances which are going to have a knock-on effect on mental health. It does appear from research currently being undertaken that the impact on young people is far greater than anticipated and it is important that we pay attention to that as a health service to ensure we provide the right types of interventions.
“With young people in particular, mental conditions can become more serious going into adulthood and more intervention may be needed further on down the line.”
While the initial outbreak did press the pause button on much medical research, Kenyon revealed that as the pandemic has worn on the situation has changed as more mental health research projects have been launched to chart how the crisis is affecting mental wellbeing and those already suffering with mental illness.
Kenyon said: “Studies are being undertaken currently to assess the effectiveness of the way we have changed the delivery of mental health services through Covid and that is hugely important. Through the pandemic, we have continued delivering our care intervention digitally through mediums such as telephone and virtual platforms like Zoom or Teams.”
Unfortunately, the remote delivery of services has not proven to be a one-size fits all approach, as research has shown.
Kenyon continued: “We are also seeing from research and personal experiences that there are some people who we cannot reach using digital platforms. There is now a whole new discussion being had about digital poverty and people not being able to access our services through lack of a certain device or home Wi-Fi. I find it quite interesting that in this day and age, we take access to digital technology as a given, and yet we aren’t all privy to it.”
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