Are mental health services exploiting the pandemic?

The impact of the COVID-19 pandemic worldwide should not be minimised. Official counts of death may substantially underestimate true death rates, but even these figures show COVID-19 has killed more than 4.5 million people (see article). The grief and disruption to communities and livelihoods is significant.

Understandably there is concern about the impact on people's mental health, not least because of lockdowns to prevent deaths (see previous post). The COVID-19 Mental Disorders Collaborators have recently published a systematic review in The Lancet of what they say is data reporting the prevalence of major depressive disorder and anxiety disorders during the pandemic. However, there were very few surveys that met their inclusion criteria from low and middle income countries. And, most of the surveys used symptom scales that only estimate probable cases of depression and anxiety. And as the authors say, they assumed the predictive validity of such scales remained constant between before and during the pandemic. However, as they also admit, this assumption has the potential to bias their estimates. To quote from them, "For example, high scores on anxiety disorder symptom scales might reflect a natural psychological and physiological reaction to a perceived threat (ie. the COVID-19 pandemic) rather than a probable anxiety disorder".

Similarly, Rethink yesterday released information (now corrected although not sure if there has been sufficient adjustment) suggesting "Symptoms of psychosis soared during pandemic", and this news story was taken up by the media (eg. The Guardian). It's not clear to me that these figures may in fact be due to an artefact, because of how first episodes of psychosis have been counted (eg. see twitter conversation).

What I want to comment on is how people seem to want to use the pandemic to obtain more funding for mental health services. I'm not saying mental health services are well funded. But data by NHS digital suggests numbers of adults in contact with mental health services are not yet back to pre-pandemic levels (see my tweet). Nor is it clear how extra funding would be used, as psychotropic medication and psychological therapy are not necessarily indicated to deal with the stresses and strains of the pandemic. Mental health services do need to be realistic about what they can do to help people (see eg. previous post).