The spotlight mental health didn't need

Twelve months ago, as we entered 2020, the world looked a very different place. There was a semblance of a plan from the UK to leave the European Union, Trump continued to be Trump and a million miles away in China, a little known virus was causing some local noise in the Far East.

For the majority of people going about their business, these overseas problems seemed far away, both in distance and also in impact. Boris Johnson and the Conservatives had just won a huge election result on the back of some Brexit promises, an 'oven-ready' deal and plenty of bluster about an optimistic future.

Little did anyone know how our world would change.

In 2019, mental health was still not 'main stream'. Despite Mental Health First Aid (MHFA) having been launched in the late 2000s, this was still a taboo topic, something that happened to other people. Organisation like Time to Change had been tirelessly campaigning for people to talk more openly about mental health, running large national and eventually international programmes such as Time to Talk day alongside charity partners like Mind and Rethink Mental Illness, in an effort to end the stigma.

Within the NHS, the Improving Access to Psychological Therapies (IAPT) services had been making steady progress over the last years, with a number of private providers also getting in on the increasing demand for counselling and therapy. One of the largest providers, CBT Clinics was bought out by a Private Equity firm recently, demonstrating the increasing investor appetite for these organisations.

Digital meanwhile had been undergoing something of a revolution, long gone were the days of just Calm and Headspace, weekly it seemed there was a new app, a new promise of better wellbeing and mental health. Remote services, e-Learning were all growing at their fastest ever rate.

Despite all of this, fundamental questions remain. Do current approaches work and has it made any difference?

This may seem a controversial one but it is a necessary one that is already being debated in many circles, including professional ones. Many a psychologist has gone to battle with a psychiatrist, or vice versa, regarding the efficacy of a particular intervention or therapeutic modality, openly challenging the notion of a 'proven' evidence base. Anti-depressants continued to be another grey area, while our knowledge about them increased, so did the questions.

But then Covid happened.

Suddenly, the world was in chaos, millions were in crisis and there was an unprecedented surge in demand for mental health and wellbeing services. To say the industry wasn't prepared would be an understatement of colossal magnitude, but in fairness most industries weren't ready.

Mental health and wellbeing found itself thrust into the spotlight, rather unexpectedly for sure, but has it been beneficial?

For all the investment in mental health services pre-pandemic, there was precious little, if any, evidence that it was having an impact. Numbers of suicides were flat or up, workplace stress was on the rise, more and more people were being prescribed anti-depressants and waiting times for those seeking treatment were higher than ever.

So if the current approaches weren't working before Covid, what makes anyone think they will work during, or in the aftermath of this pandemic. The evidence base often talked about isn't as robust as one might think. Yes people get better after the 6-8 sessions they might receive, but how are they doing 6 months later, or even a year later? Experienced psychotherapists will tell you that it takes about a year before you start to see meaningful and sustainable change, but that isn't an option for most people, nor is it routinely offered.

It's no good having a plaster that stops my finger bleeding, but when I take it off I start bleeding again.

Mental Health First Aid (MHFA) is much praised by practitioners and often the budget holders who signed off the purchase orders to procure these services, but first aid isn't supposed to benefit the first aider, it's supposed to benefit the person in need of first aid. The evidence base for the latter is strangely quiet for MHFA.

Wider mental health services and solutions already needed to address some fundamental questions a long time ago. Like what actually works versus what are insurance companies or the NHS willing or able to fund. What are the learnings, what needs to be changed, what needs to be improved and what is the 'real' evidence base.

The professional community needed to be aligned, not still debating the fundamentals, these days often on Twitter!

Covid19 is here, it's not going anywhere fast, but for mental health and wellbeing it was a spotlight nobody in the sector needed just yet. In years to come there may be some tough questions asked, and people will expect answers.

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