On the 25th of March, NHS England released guidance for mental health providers about how they should manage capacity and demand during the COVID pandemic. It stated that…
“COVID-19 and the national measures being announced to delay the spread of the pandemic will inevitably have significant impact on both demand for and capacity to deliver support for people with mental health needs, a learning disability or autism”
It goes on to say that “…staff within mental health/learning disability and autism providers may need to make difficult decisions in the context of reduced capacity and increasing demand.”
Given this guidance, we wanted to know if COVID-19 has impacted upon people’s ability to access and receive community mental health services. We asked our twitter followers to tell us about their experiences. From the response we received by email, tweet and by direct message, it appears that service accessibility and provision is variable across the UK. Some people are continuing to receive secondary and primary care services remotely. However, the majority of people who made contact told us that their routine Community Psychiatric Nurse (CPN), Community Mental Health Team (CMHT), psychiatrist and / or therapy appointments have been cancelled. In contrast to NHS England’s guidance, we were told that these appointments are not being conducted remotely, but have stopped altogether. We cannot do justice to everyone’s experiences in this short piece, however, we include some personal testimonies with permission below.
M received a letter 2 weeks ago to inform her that her local Early Intervention Team were cancelling all routine appointments, with no provisions being made to deliver these remotely: “The letter made me very concerned for OTHER service users because it does not give any patients a ‘back up’ plan or any decent access to appropriate medical care. All it said was that patients could “ring the EIT” if needed, and it gave the numbers for Samaritans etc. This is just not good enough.”
N told us that his community psychology service has now become an emergency-only service, which has resulted in his premature discharge: “I’ve just been discharged from seeing an NHS clinical psychologist for a formulation that was supposed to last 4-5 sessions after only 2 because they are “moving to an emergency-only service”. I was told that they are going through a process of looking at everyone on their caseload and giving people a traffic light – red, amber or green depending on their level of risk and then discharging ‘green’ people. I honestly feel sorry for whoever has to go through their caseload and decide who to discharge.”
Charlie told us that their Community Mental Health Team (CMHT) has cancelled all routine and scheduled appointments (in person and remotely), with only duty and crisis appointments now available: “CMHT stopped completely, I still get therapy appointments through a tertiary specialist team but that’s only over the phone. I’m supposed to have weekly individual and group sessions but because of budget reasons that’s already dropped to individual every two weeks and weekly group, and because of COVID it’s looking like it’ll drop further. They haven’t found a way to do groups yet, either.”
Lucy has recently been discharged from a day treatment unit as a result of COVID, she says:
“The acute unit I was in closed two days before the schools did. I would have had daily home visits but my husband had suspected covid so we had to self-isolate. I was then discharged from acute back to CMHT but with no CPN or CC. It’s been super hard and while I’m just about keeping afloat, I’m terrified about what will happen if I take a downturn.”
Anna had been waiting for a long time for therapy and had started a course which she was required to complete before she could receive more specialist services. This course has now been suspended: “it took me so long to get anything from nhs after being discharged from IAPT for being too mental….I was mostly trying to complete this brief interventions course to get access to further help for probable OCD, which my private counsellor isn’t able to help with. It’s the people who don’t have that extra support who will have got the same letter who my heart completely breaks for.”
Whilst services are being cancelled, NHS England’s guidance states: “The Chancellor of the Exchequer said in Parliament that, “Whatever extra resources our NHS needs to cope with coronavirus – it will get”. Therefore financial constraints must not and will not stand in the way of taking immediate and necessary action – whether in terms of staffing, facilities adaptation, equipment, patient discharge packages, staff training, elective care, or any other relevant category.”
Unlike the recruitment drives we have seen to meet demand and capacity in services that are dealing directly with COVID-19, no similar attempts have been made to ensure the needs of people with a mental health condition are met during COVID-19. Accessing mental health services before COVID-19 was extremely difficult. Now, with reduced capacity and increasing demand, people will be left without support at a time when they need it the most. Without a rapid and comprehensive government led strategy to increase community mental health services’ capacity, many people with mental health conditions / illness will face increased isolation and risk; there will be preventable deaths. Like the virus itself, parity of esteem remains nowhere to be seen.
In the coming days and weeks, @MadCovid we will be publishing a series of interviews which will shed further light on the lived experience of people with pre-existing mental health conditions / illness during the COVID-19 pandemic. Watch this space.