Date published: 7 March 2022


It’s been a long wait, but restrictions are being lifted across the UK, travel borders are opening and life for many is starting to return to what it was like before the pandemic. It seems an appropriate time to address our next big challenge, and how we address the impact and aftermath of the COVID-19 virus.

We’ve all been through so much, from losing people close to us, to the pressures of working on the frontline, the impact of being locked down and living with restrictions that were alien to many of us. So, what happens now? What will be our biggest challenge as Mersey Care and the NHS emerge from one of the most testing periods in their histories?

I’ve written before about our fears that mental health services could face an unprecedented surge in demand once society returns to a normal way of life. According to a report in The Guardian recently, both the NHS Confederation and the Royal College of Psychiatrists want an urgent recovery plan to combat “a second pandemic” of mental health issues like depression, anxiety, psychosis and eating disorders.

This would certainly tally with our research and projections of how the pandemic may affect our ability to deliver our services effectively to our many and different communities. Based on excellent work by Dr Joshua Tepper, who is the strategic advisor for the Ontario Ministry of Education, we tried to plot out what we believed would be the four phases of the pandemic.

You’ll see from the illustration below we anticipated an initial surge of deaths and pressure on services followed by an impact on resources and a backlog in acute treatment and surgery. The next phase would be the impact on long term conditions and those with more complex issues and finally the rise of mental illness. This was very early thinking and we may have got some of the timelines slightly wrong, but the trends are probably right.

Graph of Health Footprint of the Pandemic over time

This is particularly evident in evidence we have collected across our children’s and young people’s services. Work undertaken by Mersey Care in October last year highlighted they were one of the largest groups at risk of future mental health demand due to the pandemic.

A project is currently underway to understand the needs of children and young people across Cheshire and Merseyside, which will provide insights into the level of current mental health need. It will highlight any issues with the transitional service from Children’s and Adolescent Mental Health Services (CAMHS) into adults’ mental health and aims to improve integration between providers and the wider health and care system.

A recent survey from the Young Minds Charity bringing together the views of 2,438 young people aged 13-25, between 26 January and 12 February 2021, uncovered worrying concerns among our children and young adults. It found that:

  • 67 percent believed the pandemic will have a long-term negative effect on their mental health
  • Among young people who believe they have needed mental health support during the pandemic, 54 percent received some form of support (e.g. through NHS mental health services; school or university counsellors; helplines; charities).
  • A further 24 percent had looked for support but not accessed any and 22 percent had not looked for support.
  • Among respondents who are at school or college, 55 percent said there was a counsellor or mental health support team available in their school and 23 percent disagreed.
  • Among respondents who are at school or college, almost half (48 percent) did not think their school was focusing more on wellbeing and mental health than usual.

We’ve noticed an increase in demand for children’s and young people’s services which is reflected across nearly all areas of our organisation. As an example of this, there were 4,600 visits to the Urgent Help section of our website in the last month alone.

You may recall our 24-hour crisis lines were set up earlier than anticipated to cope with the increased mental health issues caused by lockdown and the virus. As with most new services, demand was high from the start but even taking that into consideration, the surge in its use since then reinforces our decision to establish them as a key tool in our delivery of urgent help services (see infographic below).

Changes in the demand for mental health services since COVID-19 - NHS infographic

Colleagues who work in our mental health services, whether it’s with young people or adults, won’t be particularly surprised by these figures. All of you will know demand increased as the pandemic took hold, but I want us to move away from the traditional way of thinking about mental and physical health as separate conditions.

I’ve written and spoken before about the importance of caring for the ‘whole person.’ We’ve now started to talk about the concept of connected mental health, in other words it’s connected to lots of things. It’s not just your physical community, your environment and your affluence, it’s also connected directly to your physical health.

There’s absolutely no point us treating someone for depression when the mental illness may well be caused because of long term physical health condition. Imagine someone who is very active who suddenly loses their mobility – there’s every chance that will affect their mental health, therefore we must treat both conditions together.

I wrote recently about the importance of population health management and this is one of the major reasons why we must operate differently. Within the NHS we need to think about people as they actually operate in real life rather than in the classical silos we’ve historically put them into through healthcare. A real focus on prevention is required, we must use insight and data to help our frontline teams better understand current health and care needs and predict what local people will need in the future.

Thanks again for all your efforts

Prof Joe Rafferty CBE (he/his/him)

Chief Executive