Recovery JSNA: Mental health and emotional wellbeing
The World Health Organisation defines mental health as:
“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Mental ill-health is a broad term which encompasses a wide spectrum of difficulties ranging from everyday stress and worry through to severe depression or acute psychosis. The spectrum spans conditions managed mainly by primary care and community organisations, to conditions that are almost exclusively managed by highly specialist referral centres.
Before the pandemic mental health disorders accounted for almost a quarter of the total burden of ill health in the UK.
Good mental health is an asset and is also linked to good physical health – both of which support positive social and economic outcomes for individuals and society. Poor mental health is strongly associated with social and economic circumstances, including living in poverty, low-quality work, unemployment and housing.
The risk of experiencing mental ill-health is not equally distributed across our society. The distribution of infections and deaths during the COVID-19 pandemic, the lockdown and associated measures, and the longer-term socioeconomic impact are likely to reproduce and intensify the inequalities. This can contribute towards the increased prevalence and unequal distribution of mental ill-health in the general population.
There is a well-documented burden of mental health disorders following disasters, including evidence from previous viral outbreaks. This suggests, that COVID-19 and the response to the pandemic could have a significant impact on the nation’s mental health through increased exposure to stressors. Furthermore, front line staff are likely to see an increased prevalence of mental ill health due to the additional pressures placed on them during the pandemic.
This chapter will cover the following topics:
The national strategy for mental health “No Health without Mental Health” highlights the following points:
- ·At least 1 in 4 people will experience a mental health problem at some point in their life
- ·1 in 10 children aged 5 to 16 years has a mental health problem
- ·1 in 6 adults have a mental health problem at any one time
- ·1 in 10 new mothers experiences postnatal depression
- ·Almost half of adults will experience at least one episode of depression during their lifetime
- ·Mental ill health represents up to 23% of ill health in the UK and is the largest single cause of disability
- ·People with severe mental illnesses die on average 20 years earlier than the general population
- ·The NHS spends around 11% of its budget on mental health. This is almost double the amount spent on cancer
- ·The estimated cost of mental ill-health in England in 2009/10 was £105 billion
Source: Extracted from gov.uk on April 2021.
Impacts on mental health due to the pandemic
There are many factors which have a negative impact on peoples mental health as a result of the pandemic:
- ·Being admitted to hospital
- ·Long COVID Symptoms
- ·Suffered a bereavement and not being able grieve in usual ways.
- ·Post traumatic Stress caused by working conditions
- -Children and young people with less social connection
- -Domestic Abuse
- -Extreme isolation either through shielding or loss of regular contacts
- -Loss of opportunities for young people
While these impact the general population, the impact on people with a pre-existing mental health diagnosis is likely to be greater.
Drivers of worsening mental health during the pandemic:
- ·Social Isolation- Lockdown has brought social isolation to many, particularly people living alone or those who have been shielding
- ·Job and financial losses- The economic impact of lockdown has hit people unequally, causing immediate impacts on mental health
- ·Housing insecurity and quality- During lockdown, people have spent far more time than usual in their homes. Quality of housing and the opportunities it affords – including personal and outdoor space – are highly variable
- ·Working in front line services- Evidence from past outbreaks, as well as early evidence from this pandemic, indicates that we are likely to see an increase in mental health problems such as depression, substance misuse and post-traumatic stress disorder for front-line health and care workers
- ·Loss of coping mechanisms- The pandemic has diminished many of the mechanisms people typically use to cope with stress
- ·Reduced access to mental health services- The Royal College of Psychiatrists reports almost half of psychiatrists have seen increases in urgent and emergency cases during lockdown but also that a similar proportion have seen falls in routine appointments
The Mental Health Foundation has highlighted the divergent experiences of the pandemic that are surfacing in different populations:
- ·Young adults 18-24 were:
- -More likely to report stress arising from the pandemic than the population as a whole.
- -More likely than any other age group to report hopelessness, loneliness, not coping well and suicidal thoughts/feelings
- ·People in later life who are isolated:
- -The resilience of people in later life has been visible in the findings from our study, with only 6% of people age 70 and over reporting not coping well.
- -However, specific issues exist around older people (over 60) and loneliness which were already there before lockdown and are now exacerbated with lockdown and shielding
- ·Unemployed and those in insecure employment:
- -Although, the proportion of the population reporting anxiety in studies has fallen some what, this has not been the same for all section of society such as those that are unemployed.
- -The unemployed seem to have much higher levels of hopelessness. In addition, the proportion the unemployed reporting suicidal thoughts/feelings is around 24%, more than double the whole population.
- ·Single Parents:
- -Financial strain combined with greater isolation and loss of social support has put single parent families under duress.
- -Home schooling will have been much more difficult for single parent families than for those where the ability to share such duties exists
Source: Extracted from Mental Health Foundation in April 2021
Expected mental health impacts arising from COVID-19, direct and indirect: Adults
The Centre for Mental Health alongside NHS providers have developed a tool to help services plan for the likely increase in demand for services as a result of the pandemic.
Predicted additional Demand in adults
Predicted additional Demand in children
In 2019-20, there were around 42,100 patients registered with depression in Wiltshire. This is a slightly lower prevalence than seen in the South West and England.
In 2019-20, around 4,600 patients were newly diagnosed. Over a third of newly diagnosed patients were not reviewed within 56 days of the diagnosis in primary care. In 2018-19, that was around 1,600 patients.
Source: Extracted from NHS Digital 2019-20 QOF data in January 2021
A survey conducted by ONS asked people about their general well being. In 2019-20, around a tenth of the population were indicating moderate or greater depression symptoms.
In June 2020, this had increased in all age bands but had tripled in those aged 19 to 39 and doubled in those aged over 70.
Source: Extracted from Coronavirus and depression in adults, Great Britain - Office for National Statistics (ons.gov.uk) in January 2021
Personal Independence Allowance and Pyschiatric conditions
Personal Independence Payment (PIP), is replacing Disability Living Allowance (DLA), it can help with some of the extra costs people who have a long-term ill-health or disability can experience.
Wiltshire has a lower PIP claimant rate as compared to England and the South West region.
This is also true for claims relating to psychiatric conditions where the proportion in England and the South West is around 37% and the Wiltshire the proportion is 35%.
Source: Extracted from Stats Explore in January 2021
In October 2020, around 13,400 Wiltshire residents were in receipt of Personal Independence Payments, around 4,700 were for psychiatric conditions.
This represents around 35.2% of all claimants, during the pandemic the proportion of claims for psychiatric conditions has increased slightly from around 34.4% from October ‘19 to January ‘20.
Source: Extracted from Stats Explore in January 2021
In 2020 there have been 34 recorded suicides in Wiltshire, this is slightly lower than the number seen in 2019 but may not be fully recorded at this time.
Males account for over three quarters of suicides and this proportion has not changed.
Source: Extracted from Wiltshire Council on 10th of May 2021
Post Traumatic Stress Disorder (PTSD)
The symptoms of PTSD for many people are a profound sense of anxiety and a feeling of being constantly in danger (hypervigilance). They are also likely to re-experience the trauma, through flashbacks or nightmares. It is also very common for people with trauma-related symptoms to have sleeping difficulties such as insomnia as well as symptoms of generalised anxiety and depression.
The model shows that it is highly likely staff working on the front line response to the pandemic are likely to suffer from Post Traumatic Stress Disorder.
This is reflected in research prior to this pandemic and published in 2013 which shows in earlier pandemics there was increased rates of PTSD
This is further reflected in work at Kings College, London which surveyed ICU and anaesthetic staff in 6 English hospitals and found. Nearly half of intensive care unit (ICU) and anaesthetic staff surveyed reported symptoms consistent with a probable diagnosis of post-traumatic stress disorder (PTSD), severe depression, anxiety, or problem drinking.
Source: Sprang G. and Silman M. (2013) Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters, published online by Cambridge University Press
Children and young people
To prevent the Covid-19 crisis from exacerbating and further entrenching health inequalities, plans for recovery must be made with mental health equality in mind.
IAPT Services, in April 2020 only 57,814 referrals were made compared to 133,191 in April 2019, The latest figures from July show that referrals are recovering but are still down by 11% compared to last year. It is thought that it will take time for individuals to seek support and we are less likely to see an immediate increase.
Resilience refers to our ability to cope with the normal stress of life as well as being able to bounce back from crises. The Mental Health Foundation found:
- ·Most people (64%) stated that they are coping well with the stress of the pandemic.
- ·Almost nine out of ten (87%) who have experienced stress during the pandemic, are using at least one coping strategy.
Resilience strategies used by people during the pandemic:
- ·Spending time in nature
- ·Maintaining contact with friends and family
- ·Eating healthily
- ·Being aware of smoking and drinking
- ·Taking time to relax
- ·Being mindful
- ·Getting restful sleep
- ·Avoiding negative thinking
- ·Doing an enjoyable hobby