New data has shown that across Great Britain, mental health services have experienced a dramatic rise in the number of referrals in the last year. Many mental health organisations have responded to those figures by urging action by the UK's devolved governments. But how are the different UK governments currently planning to tackle the rise in referrals? And the underlying Covid-19 mental health crisis?
Mental health services are under pressure
Referrals to mental health services and urgent crisis care in England have reached their highest point in two years, with some local NHS clinical commissioning groups seeing demand double.
Figures collected by the BBC Shared Data Unit show that nearly 300,000 referrals were made in March 2021, a rise of 19% from the same time the previous year.
At the early stage of the pandemic, the numbers show that referrals plunged as people struggled to access services but have only rapidly accelerated since.
Geoff Heyes, MIND’s health of health policy, urged the UK government to act on one of the root causes of poor mental health. He said: "When you see those figures reaching record levels, it's a real alarm bell for problems elsewhere in the system, where people aren't getting support quickly enough."
“Our fear is that more people will be struggling because of the economic impacts that we have yet to see.”
“Furlough has protected a lot of people from the financial impact of this crisis. We know that's coming to an end. We know that things like the £20 for universal credit top-up is coming to an end. And those things will have an impact on people's mental health because living in poverty is a big risk factor of having poor mental health.”
In Wales, the BBC analysis showed that referrals slumped by 72% during the early months of the pandemic, and national figures had returned to pre-pandemic levels by March of this year.
Although, the national figures gloss over a mixed picture. The data shows that some NHS Boards are dealing with 47% more referrals to mental health services than before the pandemic, while others still refer around 20% fewer people than in 2019.
Glenn Page, senior policy and campaign officer for MIND Cymru, said:
"There are certain groups that have been particularly negatively affected throughout this, and targeted and urgent action is needed to address that.”
“I’m talking about people living in poverty, children and young people, people with the existing mental health problems and people from black and minority ethnic communities as well… What we need to see for mental health services is a much greater investment so that there is the capacity and resources within those services to meet existing and future demand."
Similarly to Wales, BBC figures for Scotland show that while national referrals have returned to pre-pandemic levels, some NHS Boards have seen mental health referrals more than double, and others have seen referrals fall by more than 50%.
Although many Scottish mental health campaigners have predicted that in areas where there has been a decline in referrals, there may later be a surge in untreated mental illness. They have warned that initial regional reductions in referrals during the early stages of the pandemic can potentially manifest in later increases in crisis referrals due to people’s mental ill-health being left untreated.
Billy Watson, chief executive of Scottish Association for Mental Health, commented:
“The danger is that people will become more mentally unwell [if] they wait… All the evidence would suggest that they will wait longer, and they were already waiting probably too long in the first instance. So that has the potential to manifest itself as an increase in crisis [referrals].”
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How are the UK governments responding to the mental health crisis?
In March of this year, the UK government announced an extra £500m on top of a long-term investment of £2.3b to ensure that there would be support available for anyone in need of mental health support in England. The £500m investment called the Mental Health Recovery Action Plan aims to support 1.6m people in 2021/22, with the £2.3b being part of a longer-term strategic goal for the NHS to address mental health problems.
A spokesman for the Department of Health and Social Care said: “Our mental health recovery action plan – supported by £500 million – will ensure we offer the right support in 2021/22 to help people with a variety of mental health conditions, including bringing forward the expansion of integrated primary and secondary care for adults with severe mental illness.”
The Scottish government has allocated £29.3m to NHS Boards to improve Child and Adolescent Mental Health Services (CAMHS) and have committed to meeting the standard of 90% of mental health referrals starting treatment within 18 weeks.
Kevin Stewart, Minister for Mental Wellbeing and Social Care said: “We will continue to work with NHS Boards to support the development and implementation of their local recovery plans and to target investment to improve access to CAMHS and Psychological Therapies. We will monitor [referral numbers] closely and expect all Boards to meet the 90% waiting times standard by end March 2023.”
The Welsh government has allocated an additional £42m for mental health support and have refreshed and outlined in their Together for Mental Health delivery plan to respond to the impact of the Covid-19 pandemic.
A Welsh Government spokesperson commented: "We have provided an additional £42 million this year for mental health support, and our Programme for Government makes it clear that we will continue to prioritise investment in mental health services. We also have a dedicated Deputy Minister for Mental Health and Wellbeing to drive forward further improvements.”
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Interlocking crises: is extra funding for NHS mental health services enough?
Rethink Mental Illness deputy chief executive, Brian Dow, responding to the BBC figures, commented that funding and investment should be considered more holistically and should not be “limited to the NHS”. But instead, he said that the figures indicate that the current crisis in the social care sector needs to be concurrently addressed to support people with mental health difficulties in their local communities.
He said: “[The increases in referrals] is made worse by cuts to social care, which plays a vital role in supporting people severely affected by mental illness to live independently and prevent them from needing inpatient care. The shortcomings of mental health social care place further pressure on NHS services and comes at huge cost to people living with mental illness and their families.”
“[The] figures indicate increased need and should be monitored very carefully to ensure the right funding and resource is in place. But this isn’t limited to the NHS. Until adequate social care funding and resource is in place to support people to live independently and prevent them from reaching crisis, pressure on the NHS will continue to grow. It’s imperative that the government address the crisis in social care as soon as possible.”