Mental health services in the wake of COVID-19 and opportunities for change

Professor Kelly carries out a detailed analysis of the likely mental health needs in the context of coronavirus infectious disease 2019 (COVID-19).¹ The pandemic has indeed evoked a strong response in support of mental health provision worldwide in view of the realisation of both its direct and indirect effects on psychological function. In the UK, COVID-19 offers an opportunity to revisit the current state of mental health services and develop ways to maximise healthcare delivery.

Pre-existing declining performance indicators, serious shortage of skilled workforce and the increase in demand have taken a toll on mental health services in recent years.² This is the backdrop of the 2019 new funding bill in the UK, the ‘long term strategy for the NHS in England’, which might not be as generous as initially believed.³ Awareness of the repercussion of COVID-19 on mental health is increasing as data becomes available. The unpreparedness towards the pandemic, the necessity to shift resources towards COVID-19, and recent data suggesting collateral casualties in those patients with cancer and other conditions (whose priorities have become secondary to the pandemic),⁴ alarmingly suggest that shortcomings in mental health service provision may lie ahead.

Based on the documented psychosocial consequences of the severe acute respiratory syndrome (SARS) persisting beyond the duration of the infection,⁵ a surge in COVID-19-related mental health problems is likely. The global scale of the magnitude of COVID-19 compared with SARS is much higher, 4,528:1 (and increasing) according to John Hopkins University (on 14/10/2020, 38,204,270 vs. 8,437 established cases).⁶ These alarming figures, suggest that there is an urgent need for service planning to ensure that resources are proportional to the level of demand and sufficient to address inclusively all the individuals at risk (patients, those with pre-existing physical and mental health conditions, the general population and healthcare workers).⁷ While championing for the extra resources, similarly to China,⁸ community mental health teams would need to shift to online consultations for the foreseeable near future. This approach would greatly facilitate the assessment of individuals in quarantine or isolation, whereas online self-assessment tools could improve efficiency by screening participants in need of secondary-care mental health services. Patients with COVID-19 and individuals with pre-existing physical and mental health conditions could be routinely screened for common mental health symptoms as part of discharge planning and hospital-based liaison teams could be involved with overt or high-risk cases.⁸

In view of the work pressure affecting health workers, it would seem advisable to create a confidential mental health support online service to specifically provide information and address their psychological needs. Computer-based apps could deliver brief interventions to enhance mental health resilience while providing ad hoc practical information.^{8, 9} Aside the immediate changes to address mental health needs, COVID-19 will most likely define a new way of working in mental health for generations to come.