Are we seeing a second wave? The effect of a second lockdown on patient access to mental health treatment
The much anticipated second wave of coronavirus cases was thought to bring with it a rise in mental health difficulties. As early as mid-October, public health researchers were flagging the mounting evidence for a global surge in mental health problems following a similar trajectory to the second wave in Covid-19 deaths. The cumulative effect of loss of life in communities and disruption due to quarantine and social distancing measures is multi-dimensional affecting businesses, families, incomes, education, healthcare and virtually every facet of our lives. But now, at the end of November, to what extent is this translating into a surge in demand for mental health treatment in the UK and how likely are UK mental health services to become overwhelmed? We examine the data from across our 40+ online CBT contracts in the UK to bring some answers – and offer some options for IAPT services considering how to accommodate potential surges and spikes.
There has been much discussion about forecasting Covid-suppressed demand, where those who would have or were otherwise seeking treatment either postponed or cancelled. A question mark remains about the extent to which these people will come back into the system and over what time period. There is also the impact of the Covid-generated service users whose mental health was not causing them difficulty until Covid – estimated at around 22% by the Centre for Mental Health. Work is underway to develop baseline measures to help predict how both Covid-suppressed and Covid-generated mental health cases might impact future demand and one example of an NHS recommended model providing insight is a study of changes in depression and anxiety over the first lockdown in a population of 60,000 UK adults*.
Contrary to the expectation of a steady ‘wave’, our referral data show bursts of activities and rapid spikes. These relate to local changes in tiers and, of course, the recent national lockdown. Through October and November, these spikes led to a 20%+ increase in self-referrals week-on-week, but these steady weekly figures masked a much more fast-changing picture at CCG level.
In some of our smaller contracts, referrals as much as doubled in a week – a surge our 700 UK-wide therapists can easily accommodate, but which is much harder for local therapist teams to manage, whilst continuing to triage and treat patients quickly.
As the second national lockdown was announced at short notice, we found in areas in which we have a self-referral contract (where we see patient referrals immediately, rather than experiencing a lag time while they are triaged via a provider) referrals initially went down and then began climbing. It appears that rapid changes in restrictions suppress referrals briefly while lives and workplaces are catch up with logistical changes but then the impact of restrictions triggers more people to seek help.
But these data are by no means clear and it is still early days in this second wave of Covid cases. The response to changing government restrictions is having an unpredictable impact on referrals across contracts, making it difficult to plan capacity. The Centre For Mental Health has published a forecast modelling toolkit to help local areas predict additional demand for mental health services. Clearly those changes in restrictions are themselves unpredictable too!
Are we seeing the predicted surge in mental health cases based on our data at ieso? Cases are certainly rising but in an unpredictable series of spikes. We are definitely seeing an increase and a return to pre-Covid level referrals but there is no indication of nation-wide tsumani at the time of writing. However, at a local CCG level, these spikes are likely to be creating challenges in managing demand and we expect that volatility to continue.
ieso’s Head of Business Development, Nii Wallace-Davies adds: “Working with our provider partners across IAPT, we are seeing a varied picture. Some areas have seen significant increases in referrals compared to this period in 2019 whilst others are slightly below or back to pre-Covid referral levels. Demand is definitely growing in all areas. In addition to this all our partners are reporting significant increases in the complexity of patients presenting. These patients often take longer to treat which reduces clinical capacity within services. Coupled with growing demand, we are planning for a challenging Q4 (January-March 2021) with many of our provider partners.”
With over 700 BABCP accredited therapists and a patient services and supervisory team which is used to delivering high quality service at high volumes, ieso is well placed to handle these unpredictable spikes in demand. To help IAPT services plan for potentially higher demand and short-term spikes, without having to commit resources, we are offering the ieso fully managed online CBT service with no minimum contract size or duration. This means any IAPT service can put extra capacity in place, without committing any budget at all.
This forms part of our Autumn Offer to the NHS, which we published in The Times Future Of Health Supplement in September 2020. Online CBT with ieso is exactly the same as face-to face in almost every way*. Patients work 1:1 with their therapist but the conversation is typed instead of spoken. Research has shown that people are just as likely to recover this way, and many people have said they found it less daunting and easier to be open. Find out more about online CBT with ieso or contact us to book a conversation.
*Fancourt et al, (2020), Trajectories of depression and anxiety during enforced isolation due to COVID-19: longitudinal analyses of 59,318 adults in the UK with and without diagnosed mental illness
*Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., ... & Peters, T. J. (2009). Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. The Lancet, 374(9690), 628-634.
