Antidepressant use at all-time high as access to counselling in England plunges in Covid pandemic

Calls to mental health helplines and prescriptions for antidepressants have reached an all-time high, while access to potentially life saving talking therapies has plunged during the coronavirus pandemic, a Guardian investigation has found.

More than 6 million people in England received antidepressants in the three months to September, equivalent to more than one in 10 people and the highest figure on record.

This is thought to have been down to counselling services going online, which some doctors may have deemed inappropriate for certain patients, while some patients were reluctant to seek face to face help or add extra pressure to health services.

Concerns have been raised that vital early intervention treatment will not have been given, with experts saying the longer people wait for appropriate help the “more severe and complex their difficulties and their lives can become”.

Lucy Schonegevel, deputy campaigns director at the mental health charity Rethink, said there was a “big risk of antidepressants being prescribed with no support”, adding that such medications should “go hand in hand” with therapy.

Her concerns were echoed by mental health campaigner Natasha Devon, who said: “People are going to their GPs with symptoms of mental illness and being sent away with a bag of medication, having been put on an 18-month waiting list.”

Dr Esther Cohen-Tovée, who is chair of the British Psychological Society’s division of clinical psychology, said: “I’m shocked and extremely concerned about the massive extent of the reduction in referrals for psychological help during a time of huge anxiety, stress and distress for the whole population. This is even more concerning when there has been a huge increase in the prescription of antidepressants.”

She said psychological help “can be a lifesaver” and “the longer people wait, the more severe and complex their difficulties and their lives can become”.

Cohen-Tovée said an increase in resources for psychological services was urgently needed and if they were not provided the “impacts will be devastating”. She said they would add “to the existing and profound direct and indirect impacts of the pandemic itself … hampering our efforts towards recovery for individuals, families and communities”.

Dr Gary Howsam, vice-chair for the Royal College of GPs, said its members had reported an increase in the number of patients presenting with mental health concerns, including anxiety and low moods, during the pandemic.

“While for some, these symptoms may be mild, for others they could be risk factors for self-harm and suicidal behaviour and, as such, GPs take these concerns very seriously.

“An increase in antidepressant prescribing over the course of the pandemic is not surprising given the difficult circumstances people are living under and should not automatically be seen as a negative thing,” he said, adding that this indicates that those struggling are still seeking help.

There were 601,530 referrals to the Improving Access to Psychological Therapies in the six months to the end of August, according to the latest available data, 235,000 fewer than in 2019, a 28% drop.

Appointments for the most acute cases also fell. Hospital attendances across 10 mental health, psychology and psychiatric categories fell by 9% in the seven months to the end of September while first appointments fell by 26%. An NHS spokesperson said when non-acute cases were included the drop-off was less severe.

Experts said the fall was due to a combination of some people not being provided appropriate support, for example, group therapy, as services went online, a reluctance among some to come forward due to Covid concerns and service interruptions during the first wave.

When combined these figures point to an unmet need at a time of heightened mental health strain caused by Covid including isolation, lockdown, illness, bereavement and concerns over financial security and job losses. In July, the Office for National Statistics said the number of adults in Britain with depression doubled during the coronavirus pandemic.

There have also been indications of direct Covid impacts on mental health. A recent study found that one in five people who have had Covid-19 were diagnosed with a psychiatric disorder such as anxiety, depression or insomnia within three months of testing positive for the virus.

There are signs that the private sector and charities are absorbing some of the demand.

A spokesperson for Priory, a private mental health provider, said it had a quiet period at the height of lockdown but had since seen a “significant rise in referrals to our private acute services”, with a 70% increase in private referrals in October compared with October 2019.

However, Scott Weich, a professor of mental health at the mental health research unit at the University of Sheffield, said the current situation was not solely due to the Covid pandemic: “Years of austerity led to rising rates of psychiatric morbidity and, at the same time, reduced availability and access to care.

“What is clear is that it will take time to get back to where we were before the pandemic, let alone where we should be in terms of delivering high quality mental health services.”

An NHS England spokesperson said some people initially had concerns about coming forward for care but that mental health services remained open and referrals have returned to near pre-Covid levels.

“Talking therapy sessions which the public can self-refer on to for both face to face and online sessions and referrals are now rapidly increasing, while the establishment of all-age 24/7 crisis service helplines, and self-help websites such as Every Mind Matters can also aid those people going through a tough time.”

In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.