How to tackle the backlog of patients with mental health needs

The covid pandemic has led to a dramatic increase in the percentage of adults showing moderate or severe symptoms of depression. The Office for National Statistics said that more than 16 per cent of adults were affected in 2020 – compared to around 10 per cent in 2019. Those affected were more likely to feel stressed or anxious and worried about their future than in 2019.

Many of these people will need support and treatment from the NHS – and may not have sought it during the pandemic. In addition, financial pressures over the coming years may lead to more cases of depression.

Some will seek help from their GP and be referred onwards for treatment – often to the sort of “talking therapies” used in Improving Access to Psychological Therapies. But getting access to these is not always straightforward or quick, and patients can often present to their GP seeking help. In addition, patients can suffer low points but not be able to access support until their next IAPTs session.

So, what are the solutions? An HSJ webinar, in association with Ethypharm Digital Therapy, heard from Andy Bell, the deputy chief executive of the Centre for Mental Health who said: “I think what we increasingly realize is that covid-19 has been a collective trauma for us as a society.

“It obviously was and still is predominantly a physical health crisis, but it is also a mental health emergency that intersects with other things going on in society at the same time.”

He mentioned the impact on children and young people, the suppressed demand for mental health services as people stopped coming forward for help, and the longer-term effect on people affected by traumatic experiences during that time. In addition people were being affected by the cost of living crisis and other events such as the murder of George Floyd in the US and experience of racism.

“We think about 10 million people will need additional mental health support as a result of the pandemic,” he said, adding that health and social care workers were at very high risk.

But what does this mean for the NHS? Kate Lovett, a consultant psychiatrist and recruitment lead at the Royal College of Psychiatrists, said workforce was one of the biggest challenges at a time when more people were coming forward for help. “It’s a question for us as a society about whether we would ever want to invest sufficient resources to meet the demand,” she said, adding the world looked a very different place since the start of the pandemic.

There’s all sorts of ways in which people get excluded and rather than saying, well that means digital’s good or bad, it’s about thinking, well how do we orient services around people’s needs so that they get what they need

“So are we coping? I think we’re doing our absolute level best. I think we could do better in some areas. I think there’s an awful lot that can be done at a clinical level to manage waiting lists.”

As a GP, Jacob Cain said that patients with mental health issues were often the ones which required more of his time.

“I think most of my colleagues and I find that in an ideal world we’d love to sit and chat with people for half an hour,” he said, adding that the workforce to do this just wasn’t available.

“I have to then try and offer people certain treatments or cognitive behavioural therapy and then they ask me about waiting time. And the minute you tell them the reality of waiting times, it can be a real heart sink for them and myself.”

Helene Moore, general manager of Ethypharm Digital Therapy, made a distinction between the digital therapy Ethypharm offers and more general wellness and other health apps. The Ethypharm therapy was approved by regulators, with a CE mark, and had been shown to be clinically effective in trials, she said.

“Where we see a fit for a solution like this is really at the early stage of the patient pathway treating their depression. It gives these patients coming to the GP practice a tool that they can use within the hour.” she said.

“If you are able to offer something that will not require more workforce, that will break the cycle… this is a solution that can really relieve some pressure in the healthcare system all around the world, not just in the UK.”

Dr Cain, a GP at Bedworth Health Centre near Nuneaton, added: “I think with digital therapy there certainly has been a shift over the last couple of years. Actually, what I have found is that some people still want to come in for certain things, which is absolutely fine, but with mental health I’m finding a lot of patients don’t want to come in.

“They have expressed that in the past when they’ve had to come in for face-to-face appointments, it’s made them extremely nervous and they haven’t wanted to disclose so much. And it may take them three or four attempts of coming in before they actually disclose certain things to the GP.

“But I think digital therapy is something that’s going to become more and more useful… more people are more reliant on their phones, they have busy lives and actually they don’t want to engage sometimes with face-to-face therapy.”

Dr Lovett said digital therapies needed to be embraced where possible but warned that many people she saw were digitally excluded or had complex social situations.

“I think the key to all of this is patient choice and thinking about equity,” she said. “So, if we’re offering [a digital therapy] to one person we need to think about how we could offer that to another person who, for example, lost their phone. Could we offer them a booth in the practice to do that quietly and confidentially?”

Ms Moore said the issue of digital exclusion went beyond digital therapies and was already a recognised issue. But she added that deprexis – the therapy Ethypharm offers – was “a lower tech solution” and could be used without access to a smartphone – for example, through a desktop computer. One solution, which the company was looking at, was providing access to people through a public computer which allowed them to log in and out, maintaining confidentiality.

And for some people, a remote way of accessing mental health care can really open it up, reducing stigma and making it more convenient, especially for people in rural areas, said Mr Bell.

“There’s all sorts of ways in which people get excluded and rather than saying, well that means digital’s good or bad, it’s about thinking, well how do we orient services around people’s needs so that they get what they need? And it may be for some people, supporting people to have digital access might be a really good intervention,” he said.

This webinar was part of the HSJ Elective Care Recovery series and a recording is now available on demand. To watch click here to register.