Coronavirus (COVID-19): mental health - transition and recovery plan
This plan outlines our response to the mental health impacts of COVID-19. It addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health.
Evidence
Throughout the pandemic, we have engaged with a wide range of mental health stakeholders and experts, as well as with those leading and working in NHS Mental Health services. This engagement has helped shape our response, both in terms of identifying what needs to be done, and how it should be implemented.
We have sought stakeholders' views on where we should focus our attention. This has helped set the direction and priorities of this plan as we continue to respond to Covid-19. We will maintain ongoing collaboration with stakeholders and partners as we move forward.
What we have heard from stakeholders closely aligns with the emerging body of evidence on the mental health impacts of Covid-19[1],[2],[3]. The Scottish Mental Health Research Advisory Group has a critical role in translating research findings into advice for the Scottish Government.
The initial findings of the Research Advisory Group can be summarised into the following key themes.
| Key Theme |
Sections of this Plan which respond to this theme |
|---|---|
| Emerging evidence suggests a deterioration in population mental health and wellbeing pre and post Covid-19[4]. There are indications of adaptation over the lockdown period (for example reductions in anxiety levels), but also of longer lasting challenges for mental health and wellbeing. One of the early impacts of Covid-19 was a higher level of distress. Over time, there is expected to be a worsening incidence of mental health disorders. Rates of traumatic reactions, substance misuse, self-harm and suicide are expected to increase. |
Section 11 – Distress Interventions
Section 16 - Mental Health Services |
| Studies have shown that there are groups in the population who are at higher risk of experiencing negative mental health impacts due to Covid-19. These include younger adults; women; those living on low incomes and individuals with pre-existing mental health conditions[5]. There are other groups whose mental health seems to have been particularly affected by the impacts of Covid-19, for example people in shielding and those whose employment has been adversely affected. We need to monitor and understand emerging evidence on the mental health impacts of Covid-19 on other groups where there are known health inequalities, including people from minority ethnic backgrounds. |
Section 2 – Employment
Section 4 – Socio-Economic Inequalities Section 7 – Women and Girls' Mental Health Section 8 – People With Long-Term Physical Health Conditions and Disabilities Section 9 – Older People Section 16 - Mental Health Services |
| A combination of social factors (such as loneliness and social networks/friendships) play a key role in the impacts on mental health and well-being, in addition to economic pressures (such as finances or employment). There is a relationship between increased mental distress and a range of factors related to spending more time at home, including loneliness, childcare, home schooling, working from home and receiving care from outside the home5. |
Section 2 – Employment Section 4 – Socio-Economic Inequalities Section 5 – Relationships Section 6 – Children, Young People and Families |
| There is growing evidence that interventions, such as social distancing, stay at home guidance and school closures, have likely had an adverse effect on the mental health and wellbeing of children and young people[6]. Loneliness has been a particular challenge. Some have reported benefits for their mental health. Vulnerable children and young people, and those with challenging home environments, are more likely than others to have had experiences during the pandemic that are associated with a risk to mental health and wellbeing, such as disruptions to support. There also appears to have been a general worsening of mental wellbeing in older girls particularly. |
Section 5 – Relationships Section 6 – Children, Young People and Families Section 7 – Women and Girls' Mental Health Section 16 - Mental Health Services |
| The economic and employment impacts of Covid-19 are likely to have a significant effect on the public's mental health in the coming years, and these impacts are likely to be unevenly distributed. An Institute for Fiscal Studies briefing indicates that if the economic downturn is similar to that experienced after the 2008 financial crisis, the number of people of working age suffering poor mental health in the UK would rise by half a million[7]. |
Section 2 – Employment Section 4 – Socio-Economic Inequalities |
| Traumatic experiences of Covid-19 in hospitals and care homes could lead to mental health problems (including PTSD) for patients, residents and family members[8]. Staff working in these settings may also experience negative mental health impacts[9]. We also need to monitor and understand emerging evidence on the longer term impacts of having Covid-19 or caring for those who have it. The circumstances associated with the pandemic may increase the numbers of those who experience prolonged and severe grief symptoms, which may require intervention. Normally around 7% of people experience a complex reaction but we may expect this to be higher8. |
Section 9 – Older People Section 10 – People Who Have Suffered Bereavement and Loss Section 13 – Clinical Rehabilitation and Recovery from Covid-19 Infection Section 14 – A Long-Term, Trauma-Informed Approach to Recovery |
| There are indications of a potential widening in mental health inequalities as the impacts of Covid-19 interact with pre-existing risk and protective factors for mental health. If we are to successfully tackle factors that contribute to persistent health inequalities, there will need to be commitment to cross-Government work, as well as work across the public and third sectors. This will help empower communities to provide the right help and support. |
Section 3 – Ensuring Equity and Equality Section 4 – Socio-Economic Inequalities
|
| A joint focus will be needed on both population wellbeing and on mental ill health. The evidence base is still developing, but suggests there is a need for whole population approaches, alongside targeted support for at risk and vulnerable groups. In particular, we need a continued focus on tackling the factors which contribute to mental illness and distress. |
Section 1 – Whole Population Mental Health Section 2 – Employment
Section 4 – Socio-Economic Inequalities Section 8 – People With Long-Term Physical Health Conditions and Disabilities Section 11 – Distress Interventions |
| Pre-Covid-19, rising public awareness and demand for mental health treatment and support was outstripping supply There will be challenges in meeting new levels of demand, and in gearing back up, changing and reshaping services. However there will also be opportunities for improved, and more person-centred, approaches to personal wellbeing and mental health service delivery. There have been many successes in terms of how services have been reshaped. Some of these changes will remain in place, or will be further developed to better meet need in a person-centred way. We will support individual Boards and all Boards collectively for the foreseeable future to ensure patients across Scotland receive an acceptable and improving level of service despite the ongoing challenges to delivery of the pandemic. |
Section 16 - Mental Health Services |
| Studies have shown that there are groups in the population who are at higher risk of experiencing negative mental health impacts due to Covid-19. These include younger adults; women; those living on low incomes and individuals with pre-existing mental health conditions[5]. There are other groups whose mental health seems to have been particularly affected by the impacts of Covid-19, for example people in shielding and those whose employment has been adversely affected. We need to monitor and understand emerging evidence on the mental health impacts of Covid-19 on other groups where there are known health inequalities, including people from minority ethnic backgrounds. |
Section 2 – Employment
Section 4 – Socio-Economic Inequalities Section 7 – Women and Girls' Mental Health Section 8 – People With Long-Term Physical Health Conditions and Disabilities Section 9 – Older People Section 16 - Mental Health Services |
| A combination of social factors (such as loneliness and social networks/friendships) play a key role in the impacts on mental health and well-being, in addition to economic pressures (such as finances or employment). There is a relationship between increased mental distress and a range of factors related to spending more time at home, including loneliness, childcare, home schooling, working from home and receiving care from outside the home5. |
Section 2 – Employment Section 4 – Socio-Economic Inequalities Section 5 – Relationships Section 6 – Children, Young People and Families |
| There is growing evidence that interventions, such as social distancing, stay at home guidance and school closures, have likely had an adverse effect on the mental health and wellbeing of children and young people[6]. Loneliness has been a particular challenge. Some have reported benefits for their mental health. Vulnerable children and young people, and those with challenging home environments, are more likely than others to have had experiences during the pandemic that are associated with a risk to mental health and wellbeing, such as disruptions to support. There also appears to have been a general worsening of mental wellbeing in older girls particularly. |
Section 5 – Relationships Section 6 – Children, Young People and Families Section 7 – Women and Girls' Mental Health Section 16 - Mental Health Services |
| The economic and employment impacts of Covid-19 are likely to have a significant effect on the public's mental health in the coming years, and these impacts are likely to be unevenly distributed. An Institute for Fiscal Studies briefing indicates that if the economic downturn is similar to that experienced after the 2008 financial crisis, the number of people of working age suffering poor mental health in the UK would rise by half a million[7]. |
Section 2 – Employment Section 4 – Socio-Economic Inequalities |
| Traumatic experiences of Covid-19 in hospitals and care homes could lead to mental health problems (including PTSD) for patients, residents and family members[8]. Staff working in these settings may also experience negative mental health impacts[9]. We also need to monitor and understand emerging evidence on the longer term impacts of having Covid-19 or caring for those who have it. The circumstances associated with the pandemic may increase the numbers of those who experience prolonged and severe grief symptoms, which may require intervention. Normally around 7% of people experience a complex reaction but we may expect this to be higher8. |
Section 9 – Older People Section 10 – People Who Have Suffered Bereavement and Loss Section 13 – Clinical Rehabilitation and Recovery from Covid-19 Infection Section 14 – A Long-Term, Trauma-Informed Approach to Recovery |
| There are indications of a potential widening in mental health inequalities as the impacts of Covid-19 interact with pre-existing risk and protective factors for mental health. If we are to successfully tackle factors that contribute to persistent health inequalities, there will need to be commitment to cross-Government work, as well as work across the public and third sectors. This will help empower communities to provide the right help and support. |
Section 3 – Ensuring Equity and Equality Section 4 – Socio-Economic Inequalities
|
| A joint focus will be needed on both population wellbeing and on mental ill health. The evidence base is still developing, but suggests there is a need for whole population approaches, alongside targeted support for at risk and vulnerable groups. In particular, we need a continued focus on tackling the factors which contribute to mental illness and distress. |
Section 1 – Whole Population Mental Health Section 2 – Employment
Section 4 – Socio-Economic Inequalities Section 8 – People With Long-Term Physical Health Conditions and Disabilities Section 11 – Distress Interventions |
| Pre-Covid-19, rising public awareness and demand for mental health treatment and support was outstripping supply There will be challenges in meeting new levels of demand, and in gearing back up, changing and reshaping services. However there will also be opportunities for improved, and more person-centred, approaches to personal wellbeing and mental health service delivery. There have been many successes in terms of how services have been reshaped. Some of these changes will remain in place, or will be further developed to better meet need in a person-centred way. We will support individual Boards and all Boards collectively for the foreseeable future to ensure patients across Scotland receive an acceptable and improving level of service despite the ongoing challenges to delivery of the pandemic. |
Section 16 - Mental Health Services |
We know that this will be a fluid situation as we move forward, and our understanding of people's mental health needs will continue to evolve in the months and years ahead. Our mental health response will therefore continue to be flexible and adaptable. It will continue to evolve over the short, medium and long term, and will continue to be informed by the work of the Mental Health Research Advisory Group.
The six dimensions outlined in the Scottish Government's Mental Health Quality Indicators will be the basis for defining and measuring successful change and renewal, as well as measuring changes to the mental health of the Scottish population. We will take an approach which is person-centred, safe, effective, efficient, equitable and timely.
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