This has been a frightening time for nearly everyone. Those times when we forgot to be frightened about the present, we were anxious about the future. For those of us who have not been allowed out, it has sometimes been difficult not to get depressed, and many of us have missed the sociability of everyday interaction.
Inevitably the last 2 months have affected the mental health of millions of people. Those pillars of resilience that friends, family and social interaction provide us with haven’t been there to help us tackle our own demons.
And it continues.
Short of a vaccine the commonplace interactions that we enjoyed look a long way away. Holidays and meals together with friends may be fading from view into the far future.
All of this is bad for millions of people’s mental health. The complex interactions that we all juggle between genetics, lived experience and environment that keep us all feeling safe, have been given a good kicking.
So it’s no surprise that this May, more people than usual feel that their mental health is either fragile or a bit broken, and a few really fear for their ability to stay sane.
As we slowly emerge from the confinement of virus living, there will be many challenges for the NHS, and people with mental health problems will be one of the biggest.
And it will be vital that the nation meets this challenge with a quite different set of offers than it has provided with mental health services in the past. The tens of thousands of mental health professionals that would be required to provide today’s patients with the services of the past are simply not available. But this is not the main reason we need innovation. The enormous number of people with fragile mental health needs will require different services to those previously on offer.
This is not to acknowledge that there are already a significant number of people with really poor mental health, but there will be many more whose mental health has been made fragile by their experiences of both the virus and the consequent lockdown, and who will need some help to remove that fragility.
What we don’t want is for people who are hurting because of the virus and lockdown becoming dependent on mental health services for their long-term future. For the next few months the majority of mental health care provided must clearly be temporary and aimed at working with people to (re)build their own resilience.
To develop and provide those services the NHS will need to be much more open to wider assets in the community that can help to develop that resilience. In many parts of the country (but not all), the crisis has led to the development of greater collective community assets. Volunteers have been providing, from the corridors of blocks of flats, not just boxes of food, but a chat, and a reassuring voice. Grateful recipients of these interactions have described these volunteers as ‘life savers’.
This is not to suggest that these volunteers have become psychotherapists. But they have taken part in some very difficult conversations. Just as professional mental health workers cannot ‘wish pain away’ for their patients, so these volunteers cannot ‘magic’ away the mental health problems created by the virus. They have talked about, and to an extent shared, some of the pain.
So a first set of services for fragile people could be created, with the help of local mental health charities, by the mobilisation of local community assets. People who have learnt how to listen to strangers in pain can, with a little training, learn to listen to strangers in a bit more pain. Even if they still have to keep 2 metres apart. Conversation is vital for the many people whose fragility derives from confronting their anxieties on their own.
To do this the NHS will need to end its self-isolation and engage with local community organisations who can help it. And find the small amount of funding that they and mental health charities will need to both provide services and carry out training. In most cases that sum of money will be less than the annual cost of a few recently decommissioned ICU beds.
Next, across the country, social prescribing has become a normal pathway for helping people with mental health problems. Many more GP surgeries are now linked in to social prescribing services and many of the prescriptions for social activity, have been written for people with fragile mental health.
Many people with long-term conditions experience depression because they feel unable to do anything about the distress those conditions cause. Spending some time with others can help. Spending some time with others engaged in a physical activity – even if it means being 2 metres apart – can help more.
Social prescribing is still patchy but given that we will need to help with more people with fragile mental health the service needs to expand rapidly.
Another phenomenon of the crisis has been the increased use of communication platforms – with many more people spending time talking to other via the internet. Because we have not been able to physically visit our friends many of us have found different ways to socialise. One consequence of this change has seen some people (but by no means all) finding it easier to talk about difficult subjects in the more neutral environment created by smart devices.
Before the Covid crisis, more and more people were using the internet to get support from talking therapies, and for many this proved to be just as beneficial as physical encounters. So why not ask them about their lockdown experiences and find out if they have been getting used to telling their important stories to someone on a screen. Let’s see if we can use virtual help for more people with fragile mental health.
Finally, because of the crisis, there will sadly be people whose fragility has collapsed and who have become mentally ill. There will be more of them than before and we will need to have services prepared to diagnose them and we will need our most qualified people to carry out this triage.
This is why the services mentioned earlier are so very important. There is little point in deploying high level capabilities to triage patients if there are no services available to help them.
Everything we do must be directed toward returning as many people as possible to the same level of resilience as they were used to before the crisis.
It’s been a very bad time for very many people. One of the ways we as a nation and as an NHS, could allow this crisis to beat us would be if one of its legacies was many more people becoming long-term dependent on mental health services.
As a nation we have the assets to try to stop that from happening. To help people with fragile mental health, we must mobilise those assets. All of them.