Even for the most resilient among us, the global restrictions brought about by the Covid-19 pandemic have proved challenging. Although the mental health of the majority of people remained stable during the trials of the past couple of years, certain sections of the population have been more vulnerable to deteriorating mental health as a result. Recent analysis by the UK Government’s Office for Health Improvement & Disparities showed that women, young adults and those with pre-existing conditions were among the groups most likely to have experienced greater anxiety and worsening mental health while the lockdowns were in place – at a time when mental health services were more difficult to access, with in-person appointments particularly affected.
“The first effect was a sudden reduction in referrals and hospital admissions for common, or even severe, mental health problems as people remained at home during the lockdowns and didn’t attend appointments,” explains Dr David Oyewole, medical director and consultant psychiatrist at London’s Nightingale Hospital, which specialises in mental health. “Also, those providing mental health services were unable to run their usual outpatient facilities.”
Unsurprisingly, the easing of Covid restrictions saw a reversal in the situation as both private and National Health Service clinics were inundated with requests and referrals. Dr Oyewole reports that requests for new patient assessments at the Nightingale Hospital increased by around 30%.
“One particular area in which there has been a surge of referrals is in adult ADHD,” he says. “This is likely to be because people had to transition to working from home, without the kind of structures that you get in the office, so that mild to moderate symptoms of ADHD that could otherwise have been handled became far more prominent and disturbing for individuals.”
The feeling of isolation while lockdowns were in place and the uncertainty over their duration were, perhaps, an obvious cause of increased mental health issues. However, the removal of restrictions also brought its own problems. “The initial anxiety about how long the lockdowns would last added to some people’s feelings of being isolated, depressed and anxious. The loss of freedom and desire to be free contributed to the deterioration and difficulties in general mental health,” says Dr Oyewole. “For some, this was replaced by anxiety about society opening up again, being allowed to return to work and what that really meant. So, in a way, people
have suffered both during the restrictions and in the opening-up.”
For those seeking help with a mental health problem that has occurred or has been exacerbated during the pandemic, Dr Oyewole offers guidance on the methods of approaching the Nightingale Hospital for assistance. “On our website we have a form so that people can fill in information online to enquire about our services, or even to describe some of the difficulties they may be having if they don’t quite know which way to turn,” he explains. “Of course, all of this information remains confidential. Alternatively, our patient services department is available by phone. We can then help patients to find the right service, whether at the Nightingale or elsewhere. Also, we have always received referrals from general practitioners, some of whom have also built up relationships over time with our consultants.”
The first step on any patient’s journey is a detailed assessment, which is normally carried out by a specialist consultant psychiatrist, who will explore the patient’s background and make a specific diagnosis or, in some cases, a range of diagnoses. “An individual treatment plan can then be agreed and implemented by the consultant,” says Dr Oyewole. “Other individuals may also be involved with this, but all with the agreement and consent of the patient.”
Support from family members can benefit those receiving treatment mental health issues, and the Nightingale offers various levels of support for patients and their relatives. “Some parents or spouses prefer and are able to join the patient in consultations with their specialist and that can be very helpful and supportive,” explains Dr Oyewole. “Of course, that may not be suitable for everyone, and relatives or carers can have separate appointments with specialists, where the patient has agreed and given consent.”
Group support can also be helpful for patients, such as when dealing with addictions and eating disorders. Following a period of conducting group sessions via video conferencing due to Covid restrictions, there are plans to return to in-person meetings. However, one area in which remote video calls remain a useful tool is in carrying out initial assessments for patients outside the UK. The Nightingale Hospital, which has provided services for international patients for several decades, can offer online assessments without the need to attend an appointment in person, where there is agreement between the patient and their specialist.
Video conferencing can also play a role in aftercare for overseas visitors. When patients are discharged they are given a summary of their diagnosis and the treatment received, as well as their agreed aftercare plan. This summary is also provided to their specialist at home, and guidance on discharge planning can include video conferencing with both the patient and their specialist.
“We also provide a pharmacy service that can send out a patient’s medication directly to their home address, if required, on a repeat prescription basis,” concludes Dr Oyewole. “This can be helpful where a patient may not have a local source for their medication.”
For more information on mental health services at the Nightingale Hospital, visit www.nightingalehospital.co.uk