Looking at a lost year

Late last week, HSJ published a story revealing huge drop-offs in referrals to children and adolescent mental health services and improving access to psychological therapies programmes.

This came as a surprise to some, who envisioned the covid-19 crisis and social isolation restrictions being a recipe for worsening mental health.

Experts said there was no clear answer for why referrals and subsequent activity had dropped off a cliff edge.

One factor could be that people are reluctant or unable to see their GPs, through which most referrals are made. Another could be thresholds changing as services struggle to offer routine support.

There may also be positive drivers, for example, schools and universities being closed, meaning less anxiety for some students.

Whatever the reasons, the lull is surely only temporary.

With many preventative services in the community having to limit what they can offer, there is a risk that, in a few months’ time, the NHS will experience a surge of people in mental health crisis.

Services such as community eating disorders, early intervention in psychosis, and core community services will need close attention.

Rallying together

Mental health workers, along with those in most other sectors, have rallied round to support pressures in acute services.

From trusts setting up mental health emergency departments as an alternative to accident and emergency, sending out junior doctors to assist the acute front-line, or using their wards as intermediate covid-19 care beds, the sector has stepped up to the collaboration plate.

The alternative A&E model is an interesting one, and, if it becomes a permanent fixture, could address the many reported problems within acute emergency departments for people in a mental health crisis.

However, there are also fears over mental health services falling to the sidelines in this crisis.

Many mental health trusts are already treating patients who’ve either tested positive for covid-19 or have very clear symptoms.

There could be three key problems for them as the situation escalates.

First, the estate is not exactly prepared for a significant loss of its bed base to covid-19. This not only impacts providers’ ability to safely “cohort” covid-19 patients, but also impacts current mental health patients.

Second, there are clear limitations on trusts’ ability to provide physical care if a patient becomes critical. HSJ learned recently of the death of an inpatient, who had covid-19 symptoms and died waiting for an ambulance in one of the capital’s mental health trusts. It isn’t clear whether this was registered in NHS England’s official data.

The third problem is the sector is still low on the priority list for supplies. Last week, sources for one of the largest independent providers warned their organisation had just a day of personal protective equipment supplies left.

Another senior NHS source raised concerns over their organisation’s ability to access oxygen supplies, as the acuity of covid-19 patients they’re having to manage increases.

Long-term plan priorities

Mental health, largely, came out as one of the winners when the long-term plan money was being divvied up.

This was supposed to be the year in which groundwork on bolstering crisis and community care was made. However, amid the crisis, there is understandably a fear covid-19 will derail all the gains made by the sector in recent years.

Last month, NHS England and NHS Improvement, in a letter seen by HSJ, set out expectations for this year’s long-term plan priorities.

It indicated commissioners will still uphold the mental health investment standard, and the ambition to continue with most of the core LTP priorities.

However, a number of targets would be placed in the “activities to consider slowing down or deferring to later in 2020-21” column.

These included assurance against national IAPT performance standards and two-week waiting time for early intervention in psychosis services

NHSE/I is yet to officially stand down its target to eliminate out of area placements by 2021, but I would suggest it is only a matter of time.

Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.