COVID-19 AND IT’S EFFECTS ON MENTAL HEALTH AND EDUCATION IN THE UK- part 4 of 8
4-Mental Health Part 2
NYA’S INSIDE OUT REPORT
Another study that released its findings on 18th August was the Inside Out report by the National Youth Agency (https://nya.org.uk/2020/08/inside-out-nya-brook/).
They say the pandemic has created a crisis of confidence for many young people, uncertain of their future. Its impact is far-reaching and has compounded existing inequalities…….The crisis has hit vulnerable young people the hardest. It is essential that the right services are there to support them. The report, ‘Inside Out’, reveals young people’s health has suffered with:
· A decline in vulnerable young people’s mental health almost three times the national average in response to COVID-19 (again, in line with what other studies noticed)
· Over one million young people have been lost to youth services during COVID-19, many unknown to formal services and not accessing health services. (which was also seen by Young Minds, and a BBC article with case studies)
· The loss of wrap around support and access to age appropriate health services with the closure of some smaller clinical services, walk-in clinics and youth centres.
· The lack of group activities in schools and youth services, made worse by the closure of summer schemes, restrictions on leisure and outdoor activities, including local parks.
· The lack of clear guidance for young people from trusted sources can lead to risky behaviour, poor sexual health, abuse, trauma, bereavement, addiction and anxiety.
These 4 factors leave vulnerable young people feeling alone and unmoored from their usual support systems and therefore more likely to feel suicidal or to engage in behaviours that they normally wouldn’t. The fall-out of such behaviours (including but not limited to substance dependency and abuse, mental trauma, pregnancy or STDs) will have long-term consequences that make life more of a struggle and may be regrets that are difficult or impossible to come back from. As well as the consequence for the individuals or groups involved, there is an effect on society as a whole:
· The considerable strain this places on health services, already over-stretched, and an over reliance on online services for health advice and support.
There is then much incentive to do something about mental health provision here in the UK, as the National Youth Agency and others have identified. They have also identified the need for youth workers to be given a key worker designation so that they can work as before and begin the recovery period. The confusing and contradictory public health messages have been identified by others as a cause of great stress, so clarity is definitely needed in general. Some messages have been made for young people (examples- near the end of the school year in July, near results days, towards the end of the summer break) but these are too few and it certainly would have been and will be beneficial for young people to be kept reliably informed on issues that matter to them. Knowing that the government is aware of your issues and that it has a plan is a reassuring notion that has been lacking throughout the pandemic, so it would certainly be good for them to step up in this regard.
The result is that young people, while at lower risk from infection by COVID-19, are put at much greater risk of other physical or mental health issues. Therefore, the National Youth Agency (NYA) and young people’s health charity Brook have joined the Children’s Commissioner for England to call for:
1. Clear and ongoing public health messages specific to young people
2. Keeping services for young people open with ready access where it is safe to do so
3. Mobilising youth workers as critical workers alongside health and education professionals
BBC REPORT ON YOUNG PEOPLE STRUGGLING TO ACCESS THERAPY
This is a more in-depth look at the effect of lockdown on mental health provisions and those needing support. It expands on the worrying Young Minds statistic that 31% of their survey respondents found it hard to access therapy but were in need. It comes from August 13th so is around the same timeframe as both Inside Out (above) and the Young Minds report (see 3- Mental Health Part 1).
Intro and general observations: On 23 March 2020, life as we know it changed.
Lockdown was announced to try and stop the spread of coronavirus, and as a nation we found ourselves confined to our homes. Appointments were cancelled, meetings with friends were indefinitely postponed — and some medical treatments, including those for mental health, became harder to access.
Much has been said on the effect of lockdown on people’s mental health, with psychiatrists warning of a ‘tsunami’ of cases as lockdown eases, and for some young people, the support they relied on to keep themselves well seemingly dried up overnight.
A study by the BACP (British Association for Counselling and Psychotherapy) and Roehampton University suggests there has been a noticeable reduction in counselling services for young people and children during lockdown, with counsellors who provided services in colleges and schools saying the hours of therapy they provided before lockdown (on average around 13 per week) dropped to just over one hour a week after restrictions were introduced.
The results, seen exclusively by BBC Three, also showed the top reason for the reduction in therapy was that the organisation they worked at had physically closed. The third most common reason was that the organisation reduced the counselling services on offer because of lockdown.
Of the 742 counsellors and psychotherapists, who practice across the UK, who responded, all felt that greater recognition of mental health as a critical service was needed to ensure young people get the help they need….
I personally find it baffling that physical health provisions were kept running but mental health ones closed. The government has made plans for reopening gyms and schools as normally as possible, but many mental health services have remained in lockdown conditions. Surely this isn’t right? It was clear that mental health was hardly a priority before lockdown (despite the performative celebration of World Mental Health Day and others) but this is a new low. There can be no health without mental health. The collective trauma we have experienced during the pandemic means that mental health services are being inundated with new cases and deteriorations, yet this has gone unacknowledged. The UN and Dr Petsanis were right to warn of a burgeoning crisis. There may be time to fix it, but we can’t say that the UK heeded the advice. As Young Minds and NYA said in their reports (and backed up by the counsellors and psychotherapists in this article), mental health must be a priority. It is in need of funding and reform. As with mental health issues themselves, ignoring this problem will not make it go away.
A case study: 23-year-old Ella lives in the New Forest with her mum. She had been seeking dialectical behavioural therapy (DBT), a special kind of therapy designed for borderline personality disorder, since before lockdown, and says she was unable to get the help she needed as pressure on services increased.
“Just before lockdown I was just finishing my degree. My mental health started to deteriorate because it was quite hard, but I was getting private support. I hadn’t had much luck in the past with the NHS in this area so we moved over to private to get help that way. The counselling was good, but it wasn’t the DBT therapy I needed, so my mum and I decided to try the NHS route again rather than keep spending money on private,” she says.
“I’m lucky that my GP is fantastic. Things had got pretty bad in terms of feeling very low and suicidal. My GP said I needed specialist help. I was referred to a local place called Anchor House for therapy.”
After an initial consultation, Ella was hopeful she’d be referred for a course of DBT — something Anchor House does offer — but they told her it wasn’t possible.
“When lockdown was imposed, my mental health completely crashed. I’d finished my degree, I’m off work, and I’ve got nothing, I’m sitting in the house all day every day. I was in tears and begging my GP to put me on the course of DBT there. Now, they’ve got such a bigger influx and can’t help everyone, but I felt like deaths will be on their shoulders — people aren’t coping, I’m not coping, and if they’re just saying no, it’s pretty bad.”
Ella’s wellbeing plummeted further when she received a letter in May telling her she’d been discharged from the service. “That was the worst bit, it was like a knife in my heart. I couldn’t understand that,” she says. “When I next went to the GP, I did ask for them to explain to me why I’d been discharged. She said it’s not great but they don’t have much say in it, and even if they were to refer me back, the same thing would happen. She said especially now during lockdown they’re more in demand than ever.”
Instead, Ella was told she could self-refer to other voluntary services in the area, but she’s reluctant to do that for fear that the support they offer might not be right for her.
Unfortunately, stories like Ella’s are far from uncommon and there is little the services can do to help without guidance, recognition and funding.
Dr Claire Corbridge, Consultant Clinical Psychologist and Divisional Lead for Psychological Therapies for South West Hampshire — where Anchor House is — told BBC Three: “Coronavirus has had a significant impact on our service users and the services we provide. During this time we have offered alternatives such as online resources or individual sessions via telephone or video call. We also continued to offer face-to-face appointments, but only where it was clinically necessary to protect our patients and staff.
“Unfortunately due to the restrictions put in place to protect patients and staff, there has been disruption to some therapies which rely heavily on face-to-face group sessions, for instance Dialectical Behavioural Therapy (DBT). Those attending groups at the time of lockdown were offered the option to continue this via one to one remote appointments. Unfortunately, some groups were put on hold at the beginning of the crisis. In June, the Trust began using a secure online platform to offer online groups, and we are in the process of resuming our group programme.
“We recognise how difficult the last few months have been which is why we would urge anyone who is struggling or needs support, to reach out for it. We would encourage anyone who isn’t satisfied with our service to get in touch with us directly so we can try to address any concerns and find a way to help.”
Ella plans to do just that — she says she will be writing to Anchor House outlining her concerns, and hopes to get the support she needs as lockdown eases.
The only problem with this advice is that it relies on the patients getting in touch. I know that can be far from easy, due to the combination of low motivation for any tasks and the fact that many mental health issues convince sufferers they are undeserving of help or that it’s not necessary. These are the people who will be tragically left without support and potentially lost to the system. I certainly hope Ella and others are not in that situation.
Those who are motivated to seek support will hopefully have better outcomes. One interesting consequence of the closure of traditional support systems is the move towards self-help and apps. In my view this is as much a result of life slowing down and people having more time to reflect and work on themselves as it is a reflection of the turbulent times. Despite this being a clear indication of people working on their mental health and resilience, it does make me worry for those who are not computer literate- how would they get the support they need?
It appears there has been an increase in people taking their mental health into their own hands — a representative for apps Clear Fear, Calm Harm and Combined Minds, which are made by the teenage mental health charity stem4, said that there was a 20% increase in downloads between late April and mid-May, and that the Clear Fear website saw a 98% increase in users. Stem4’s ‘Resilience in Teenagers’ web page saw visitors grow by over 800%…….
That’s why campaigns like WeWill, that want long-term improvements to mental health provision in their area, are so important. While people are making do, it doesn’t mean things are OK. In fact, if this government is to have lofty aspirations of a better Britain, this should definitely be on the agenda.
Lockdown’s impact on mental health is concerning students and young people nationwide. In Maryport, Cumbria, a campaign called We Will — part of the Ewanrigg Local Trust, a voluntary organisation working to improve various services of the local area — is calling for a mental health contingency plan as lockdown continues to ease.
“We’re concerned that the need for young people to access specialist mental health support during and after Covid-19 is likely to increase exponentially,” campaign officer Kate Whitmarsh explains. “We know that young people find it really difficult to ask for help. They think that lockdown and the lack of face-to-face contact with teachers, employers and health workers has made it harder for trusted adults to spot the signs of a young person who is in need of help and to then make referrals.”
Something else We Will wants to see — similar to the counsellors who took part in the University of Roehampton’s research — is for mental health to be higher on the agenda. They’re calling for every school to have a governor responsible for mental health. With schools and colleges due to reopen fully in September, the group predicts a spike in mental health problems.
“Every teacher we have spoken to is dreading a huge spike in referrals of young people to mental health services this September,” one unnamed activist said.
An NHS England spokesperson said that mental health services had continued during lockdown, with additional “online and telephone support and the establishment of 24/7 open access all age crisis services”.
“The pandemic has turned lives upside down and for some people it will have put greater strain on their mental health, and while some people will have had understandable concerns about seeking help during the lockdown, NHS services, including face to face appointments, have been open to people who need them, despite the Covid-19 outbreak,” they said.
For those who struggled to get support during lockdown, the prospect of things getting easier and services resuming as lockdown eases offers some hope — but whether the future of mental health support will be largely online remains to be seen.
Again, while NHS England is correct that provisions were offered where possible, I am surely not alone in not having coped with remote therapy. It is far from good enough. I am hoping for mental health to be made a priority as soon as possible, and for the mental health services to be more accessible and better funded. These changes would be long overdue, but better late than never. It is certainly true that we cannot expect children to return to school, adults to return to work and life in general to resume until there are measures in place to deal with the fallout. Any recovery plan worth its salt should include mental health services.
REPEATED ASSESSMENT OF MENTAL HEALTH IN PANDEMICS (RAMP) STUDY
One study that I have participated in is RAMP (repeated assessment of mental health in pandemics). On 30th July, their newsletter revealed some statistics that had come out of the initial weeks of the study. They present 2 sides of the pandemic- worsening mental health, yet increased community participation and caring for others. The latter is sadly overlooked in other studies, so I felt it worth mentioning. This is indicative of a more inclusive and caring society post-pandemic, which would be most welcome, especially if the government’s policies became more caring too.
· Most RAMP participants are from England
· Over 2/3 of people have reported a worsening of mental health symptoms. Actual figures for ‘worse’ are 71% for depression and 69% for anxiety and for OCD
· Over 9000 acts of kindness (volunteering, assisting neighbours etc.) have been reported
MONEY AND MENTAL HEALTH POLICY INSTITUTE’S WORK
To kick-start such a revolution in society, the Money and Mental Health Policy Institute has already begun making waves (as they announced to supporters on 7th August). Recognising that many people are suffering financially due to a reduced income during the pandemic, they have committed to making free debt advice more accessible. Being bored at home can make people more likely to gamble, so they also decided to help advertising firms and the government to understand the links between poor mental health and gambling problems or susceptibility to advertising. In a bid to help the vulnerable (very much in step with our more caring society), they liaised with OFCOM when they decided to publish guidance on how phone and internet companies can treat vulnerable customers fairly. It is hoped that these changes will go some way towards easing the burden on those with mental health and/or money problems during and after the pandemic.