NHS Reset: Shifting the curve - managing mental health in the aftermath of COVID-19

We know that the COVID-19 pandemic will continue to have huge implications for the mental health sector, long after the physical health crisis has subsided.

The current crisis is expected to leave us requiring far higher levels of mental health support as a society, both for those with existing conditions due to a deterioration of their mental health during the pandemic, and from people newly needing support due to the pandemic’s wider impacts.

Preparing to meet demand

Since lockdown restrictions began to ease, mental health leaders like myself have reported referrals increasing to above pre-pandemic levels. 

As society begins to cope with the bereavement, trauma and financial insecurity that COVID-19 has introduced, it is clear that demand will remain at this elevated level for quite some time, with the Centre for Mental Health estimating that an additional 500,000 people will require support for their mental health in the next two years.

While we know that our sector will require intensive support and investment in order to meet this elevated demand, what is also clear to me is the need to foster mental wellbeing within our society in a way that will build resilience and result in fewer people needed to access services. 

There is much to learn from the strategy of ‘flattening the curve’ that has been applied in managing the physical health emergency presented by COVID-19.  There is a crucial opportunity here to build wellbeing and resilience within our society to prevent the escalation of mental ill health.

49 per cent of the population felt anxious or worried in June due to the pandemic. In the past, due to stigma, we might have ignored such issues or left them undealt with until they presented in more acute forms of distress, requiring higher levels of intervention. 

We should expect and plan to respond to a significant increase in demand for mental health support while also taking steps to reduce the level of need for clinical-level interventions to ensure services are not overwhelmed and that those with the greatest needs are able to get help in a timely way.

Fostering wellbeing

It is important not to confuse distress and trauma, which are normal reactions to adversity, with enduring mental health problems that require ongoing clinical intervention.

There are many groups who, in differing ways, are going to come out of the pandemic with experiences of significant distress. Whether this is a result of social isolation, grief or bereavement, experiences as key workers, or the impact of sudden economic dislocation and loss. Such experiences are risks factors for the development of mental illness, but they are not necessarily translated into ongoing issues and we can intervene to reduce the resulting burden of enduring problems.

To do so we need an effective, dynamic, research-informed public mental health strategy, coordinated at national and regional level but delivered locally with consistent messaging on how individuals can protect their wellbeing and process difficult experiences. 

One message will need to be to encourage people to see any distress they are feeling as normal and talk openly about it. Sharing issues in a supportive environment is often an effective first line of response. This message, though, needs to be presented through a wellbeing lens, which avoids pathologising distress and which supports personal and collective agency in looking after our mental health. 

Working in partnership

Statutory providers in the NHS and local government should work with partners in the voluntary sector to ensure the best use is made of all the resources available to support those in distress. 
We know that partnership working with voluntary and community sector organisations will be crucial in ensuring that people are able to access the support they need. But we also know that charities have been hit hard by the effects of lockdown and will require increased financial support to continue their important role in bolstering NHS services.

This strategy needs to be innovative and adaptive as services have shown themselves so capable of being in the first weeks of the pandemic. We need to learn from experience and be prepared to develop new models of service to meet new needs and to respond to existing needs presenting at greater scale. 

Paul Jenkins is chief executive of the Tavistock and Portman NHS Foundation Trust and chair of the Mental Health Network board. You can follow Paul, the trust and MHN on Twitter @PaulJThinks @TaviAndPort @NHSConfed_MHN

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