Dr Kate Lovett, Dean and chief academic officer of the Royal College of Psychiatrists, writes that urgent and ambitious investment is necessary to end the postcode lottery of available mental health services; and to fully address the looming mental health crisis caused by Covid-19 and its related economic downturn.
Trigger warning: This article discusses suicide and self-harm.
Working as a frontline psychiatrist means I see the damage and destruction done to the lives of people waiting months for mental health treatment.
Take 24-year-old Joanne (not her real name). She was filled with hope when she was referred to mental health services for PTSD. But that hope turned into despair and desperation as the weeks of waiting for treatment rolled into months and then years.
- See also: ‘I need urgent help’
- See also: I have experienced or witnessed something traumatic’
Her illness didn’t wait though, it got worse. Suicidal thoughts began to consume Joanne’s thinking and she was subsequently detained under the Mental Health Act; something that could have been avoided had she got the help she desperately needed at the time she first came forward - unfortunately, stories like Joanne’s are far too common.
Research from the Royal College of Psychiatrists found that people are waiting months, sometimes even years, between their initial assessment and starting treatment for their condition. They understandably assumed their initial assessment was the beginning of a programme of regular treatment, not the start of many months left in limbo on a hidden waiting list.
While left waiting for treatment, people’s lives can begin to crumble. And often their illnesses get worse - jobs are lost, relationships breakdown, and financial problems mount up.
John lost his job after trying to take his own life. Neither crisis nor community services thought he was their problem. For two years he was told neither could help him, even though his self-harming was more frequent and the cuts to his arms not so easily hidden by his clothes. He stopped going out, would not shower for weeks, and lost weight because he couldn’t face going shopping.
The Government needs to be ambitious in its plans for frontline services
Unfortunately, I hear these types of stories far too often. The looming mental health crisis fuelled by the pandemic and the recession means my colleagues and I could be hearing a lot more stories like these in the future.
The toll that Covid-19 is taking on the nation’s mental health means more than ever we need a stronger mental health workforce and more psychiatrists working in the NHS. The numbers of medical students and doctors choosing psychiatry has increased in recent times, but much more needs to be done.
Government needs to be ambitious and double the number of medical school places by the end of the decade, increasing their intake to 15,000 by 2029. The schools with plans to deliver the best undergraduate experience in psychiatry should receive the lion’s share of the extra places, which will generate nearly 5,000 extra psychiatrists and ensure the NHS has the sustainable psychiatric workforce it needs for the future.
When we talk to trainees, often the biggest challenge they describe is working in under-resourced services. Whilst there have undoubtedly been improvements in some parts of our services over recent times, we still have a long way to go.
As well as funding for workforce and training, we need NHS organisations to find practical ways of ensuring careers are attractive and rewarding, to improve workplace facilities and to encourage those who have left the workforce to return to work. And we also need to make sure we are recruiting to posts around the country so that patients aren’t unfairly waiting for an appointment based on their postcode or having to travel miles from home for treatment.
Mental illness hasn’t gone away during Covid-19. And neither have psychiatrists. But without urgent government action on workforce, funding, and infrastructure - waits for potentially life-saving treatment will only get worse.