This article is part of our 'What's next? Key issues for the Sixth Senedd' collection.
What are the key challenges and opportunities for improving mental health and wellbeing in Wales?
There were serious, long-standing concerns about mental health services in Wales before COVID-19 hit. Several Senedd committees highlighted long waiting times, high thresholds for treatment, and gaps in service provision. There are new fears about the impact of the ongoing pandemic on the mental health and wellbeing of the population, and on some groups in particular.
The long-term effects of the pandemic on mental health are not yet fully understood. It’s clear that mental health has worsened, and there’s been an unequal impact on different groups. Young people and those living in poverty have been hit the hardest.
Mental ill health in Wales/UK
Impact of the pandemic
More than half of adults and three quarters of young people said their mental health was worse during the early months of the pandemic. It’s now clear that COVID-19 has had significant emotional impacts on the population. People have been exposed to greater levels of stress and anxiety as well as bereavement. They’ve also been less able to access their usual coping mechanisms (e.g. seeing friends and family, opportunities to exercise).
While the distress experienced by many could be described as a ‘normal’ response to an extraordinary situation, people may still have needs for support. In addition, those with existing mental health problems may have seen their symptoms deteriorate. In its December 2020 report, the Fifth Senedd’s Health, Social Care and Sport (HSCS) Committee emphasised that appropriate support must be in place for everyone who needs it. This must cover the range of mental health need - from low-level, early intervention support through to more specialist services and crisis care.
It’s recognised that the mental health and wellbeing of some groups has been disproportionately affected. These include:
- people with existing needs for mental health support;
- people on low incomes, or who have seen their employment status change or are self-employed;
- NHS and care workers, and other frontline staff;
- Black, Asian and minority ethnic communities;
- older adults; and
- children and young people.
Children and young people
During the pandemic, young people reported a range of issues including increased anxiety, loneliness, and more limited access to mental health and other services they usually rely on. It’s feared that the disruption to their education, employment and training opportunities could have a significant, long-term impact on young people’s wellbeing.
In October 2020, the Children, Young People and Education (CYPE) Committee published a follow-up to its landmark 2018 Mind over matter report. This sets out a ‘roadmap’ for improving emotional and mental health support for children and young people.
Key challenges and opportunities for the next Welsh Government
Managing a backlog of patients alongside increased demand for services
It’s expected to take several years for NHS services to recover and waiting times to return to pre-pandemic levels. Mental health was not in a strong position before COVID-19, with many people struggling to access timely, appropriate support. There’s been progress in some areas, such as the work in schools to improve support for pupils’ mental wellbeing. But there are still gaps in provision which previous governments haven’t managed to address. For example, access to psychological therapies across Wales remains a challenge.
Although mental health services in Wales were categorised as an essential service during the pandemic, many people were unable to access services or delayed seeking help. There are concerns about a potentially high burden of unmet need, and that some people with existing mental health problems may have become more severely ill.
The Welsh Government’s health and social care recovery plan (March 2021) cautions that the NHS could be overwhelmed with referrals for mental health support. Notably, it says this will be driven by the socio-economic impacts of the pandemic (rather than medical/specialised mental health needs).
Technology will play a greater role in the delivery of mental health services
During the pandemic, more mental health services have been delivered remotely with face-to-face appointments significantly reduced. Remote/online services may be effective at meeting some needs for support, but might not be appropriate or accessible to all. For example, around 13% of households in Wales have no access to the internet.
A recent evaluation of video consulting services suggests that there’s a “large appetite” for video consulting in Wales, with “high potential of sustainability and long-term use” beyond the pandemic. In the future, we’re likely to see a blended approach to mental health service delivery, with a combination of face-to-face and remote services. Addressing the ‘digital divide’ will be key.
Better mental health services are needed, but this won’t be enough on its own
A clear message from stakeholders is that ‘mental health’ does not just sit within the NHS - it is a much broader, public health issue. Preventing mental ill health spans government departments and all sectors of society. The Mental Health Foundation says:
Prevention of mental health problems is possible through effective societal, community and individual support, but it cannot happen within the health sector alone – action must be taken in the spaces where people are born, raised and live (in the home, in schools, their communities and workplaces).
A greater focus on mental health
In October 2020, the previous Welsh Government updated its mental health delivery plan to take account of the pandemic situation. It also appointed a new Minister for mental health and wellbeing. Its budget for 2021-22 includes increased funding for mental health services, and recognition that improving public mental health requires a whole-government approach:
Further investment in mental health can be seen across government, in line with our approach to prevention and protection of mental health and well-being, including employment support, debt advice, housing support, sports and access to green spaces.
In December 2020 the Welsh Government established the Together for Mental Health Ministerial Delivery and Oversight Board to strengthen governance arrangements around its mental health strategy and drive this work forward at greater pace.
Looking to the future
The increased focus on mental health has been broadly welcomed. But will this be enough to tackle the impacts of the pandemic and deliver the whole-system approach needed to improve mental health and wellbeing in Wales?
There is consensus that mental health has been chronically underfunded (not just in Wales but worldwide). Despite the high burden of disease from mental health problems, mental health receives a small fraction of overall health funding. An even smaller proportion of health research funding goes to mental health research. Concerns remain that mental health risks further de-prioritisation in the ongoing response to the pandemic and the recovery of routine healthcare services.
Greater parity between mental health and physical health has long been called for by the sector and by Senedd committees. There may still be a long way to go before we get there. Committed leadership, joined-up policy, and appropriate budget allocations will be key to improving public mental health and developing mental health services fit for the future.
Article by Philippa Watkins, Senedd Research, Welsh Parliament
