COVID and the prospects for Mental Health

March 2021

About The Speakers

Dr Mary Docherty (HF 2018/19) is a Consultant Liaison Psychiatrist in an innovative service integrating mental health provision into care for individuals living with long term cardiac and respiratory conditions. She is co-leading the National Confidential Enquiry into Patient Outcomes and Death’s (NCEPOD) study into the physical health care of patients in inpatient units. Other current roles include Organisational Development Lead with Maudsley Learning and Co-investigator on NHS Check – a National Study tracking the impact of the pandemic on the mental health and well-being of NHS staff. She designed and lead the Wave 1 King’s College Hospital Staff Support Programme currently shortlisted for the HSJ Workforce Initiative of the Year Award. During her fellowship, Mary studied the implementation of integrated primary care, mental health and social care for individuals with complex needs at the New York State Psychiatric Institute at Columbia University.

Dr Parashar Ramanuj (HF 2015/16) is Consultant Psychiatrist and Clinical Lead of the London Spinal Cord Injury Centre and Chief Medical Information Officer at the Royal National Orthopaedic Hospital (RNOH). During the pandemic, the RNOH transformed into a COVID step-down and rehabilitation facility. He is also a Senior Fellow at the research institute, RAND Europe and Clinical Director for Mental Health Programmes at Imperial College Health Partners. He conducted two major projects during his Harkness Fellowship year based at Columbia University in New York and the New York State Psychiatric Institute focused on the integration of mental and physical health services for people with serious mental illness and the development of outcome metrics for mental health services.

Summary

Parashar RamanujOne year on from The World Health Organization declaring the outbreak of COVID-19 as a pandemic, two recent Harkness Fellows Dr Mary Docherty and Dr Parashar Ramanuj,  working on the front line as psychiatrists during this crisis,  shared what they have learned about the implications of the pandemic for mental health and wellbeing,  and initiated discussion amongst participants.

Using ‘case studies’ of professionals, patients and people generally, they explored the wide range of ways the pandemic has affected mental health and wellbeing. This included a very serious case of mental illness caused by having COVID-19, through the dilemmas of so many people about balancing the desire to help with the knowledge that if they became ill it would put their family at risk, to an example where the lockdown has helped a patient deal with long term mental health issues, reducing some pressures and giving focus to recovery.  The speakers touched on some lessons to be learned from previous historical pandemics and key issues about support to NHS staff during the peak periods of bed use and as the pandemic continues.  There has been a  growth in public awareness of mental health needs, whether lockdown induced, COVID-19 initiated, or present before March 2020.  However, there was a nervousness in the discussion about whether this focus and any funding would be lost when the growth of waiting lists for physical conditions is fully understood.   An important point was discussed in reply to a question about support for students;  the need to recognise the difference between emotion and disorder,  to not over-pathologise people’s reactions to the circumstances created by the pandemic, whilst still prioritising support for the growing mental health need.

Further reading can be found as follows:–

The adverse mental health consequences of COVID-19 ( publication mentioned in the presentation) was published in the Lancet Psychiatry and the link to it is here: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext.  Based on American data, this research showed that there’s a bi-directional relationship between mental illness and COVID, in that having one increases the risk of the other (indeed schizophrenia is the biggest risk factor after age for death from COVID, more even than obesity – that’s from a different study). The majority of those who were diagnosed with a mental illness after COVID had had a psychiatric diagnosis before COVID, but in 6% (so about 1 in 15) the diagnosis was new. This is double the incidence seen after influenza. The study was extensively covered in the international media, e.g. here in Reuters: https://www.reuters.com/article/uk-health-coronavirus-mental-illness-idUKKBN27P34P?edition-redirect=uk

COVID mental health and well being surveillance report- ie what is the state of the nation, also mentioned in the presentation.   https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-surveillance-report

The state the organisation was in at the start will greatly influence what follows… https://www.kingsfund.org.uk/blog/2020/06/covid-19-supporting-workforce-mental-health

Mixed signals about the mental health of the NHS workforce’, messages from good and bad science on the health and well-being of workforce www.thelancet.com/psychiatry Vol 7, December 2020 Page 1009. Lead author D. Lamb.

An article about Moral Injury- ‘the psychological distress that results from actions, or lack of them, which violate someone’s moral and ethical code. ‘Managing mental health challenges faced by healthcare workers during Covid-19 pandemic’  Authors, Greenberg, Docherty et al.  www.bmj.com 26 March 2020

Position Paper – Priorities for research put forward by an interdisciplinary group of 24 world leading experts, including people with lived experience of of a mental health issue. Position paper- lays out some of the scope of issues and research questions – www.thelancet.com/psychiatry Vol 7 June 2020 Page 547