Agenda item

6.1

The Committee received a report which provided an overview of the Covid 19 Pandemic and the impact it was having on the emotional and mental wellbeing of Sheffield citizens.

6.2

Present for this item were Jan Ditheridge (Chief Executive, Sheffield Health and Social Care NHS Foundation Trust), Mike Hunter (Medical Director, Sheffield Health and Social Care NHS Foundation Trust), Dr. Steve Thomas, GP (Clinical Director, NHS Clinical Commissioning Group (CCG),  Sam Martin (Head of Commissioning (Vulnerable People), Sheffield City Council); Heather Burns (NHS Sheffield Clinical Commissioning Group), John Doyle (Director of Strategy & Commissioning, People Services Portfolio, SCC); and Councillor George Lindars-Hammond (Cabinet Member for Health and Social Care).

6.3

Steve Thomas introduced the report and highlighted the key issues arising from it.  He said that a substantial amount of work in the mental health sector had been done pre-covid, during and post-covid, as Covid-19 may be seen and portrayed as predominantly a respiratory virus, it can actually affect many organs and is a multisystem disease that can also be neuro-toxic. This can affect the brain directly and the consequences of Covid-19 clearly impact mental health and wellbeing.  Mental health and mental non-wellbeing was also being severely affected by Covid. There was an increase in first episode mental illness, for example anxiety, mood swings, depression, the consequences of loneliness and isolation, brought about by intergenerational adversity, education, employment and housing.  He said the risk of addictive behaviours has increased, including the use of alcohol and that there may be an impact on gambling with the use of online access having become more apparent and, as anticipated, there had been an increase in domestic violence.  He said there had also been a significant impact on those who had faced bereavement.  The Health and Wellbeing Board had requested a Rapid Impact Assessment (RIA) and this had been commissioned to help determine, and therefore plan for the anticipated increase in demand for mental health services.  One of the things that had become apparent throughout the Covid pandemic, were social inequalities.  There had been positive aspects of the lockdown in terms of mental health and wellbeing, by people spending more time reconnecting with families, nature, hobbies and activities and children feeling less stressed through not attending school. The Voluntary, Community and Faith (VCF) Sector had continued to provide emotional and practical support to those with mental health issues and offer independent mental health advocacy services and specialist mental health advisory services throughout the pandemic.  The Sheffield Psychology Board was looking to address the immediate emotional and psychological needs of frontline workers and those working in care homes and care workers, keyworkers, as well as the general public.  Over the past six weeks, over 200 people had been seen by the newly established Primary Care Mental Health offer that is currently being tested in four Clinical Network areas covering 200,000 of the Sheffield population and interventions made, with 40% of those interventions having been from the Black, Asian and Minority Ethnic (BAME) community.  The anticipated increase in mental health problem presentation as a result of Covid-19 was likely to see up to a 40% increase in demand for support.

6.4

Members asked a number of questions, to which responses were provided as follows:-

·                     Sheffield had seen an increase in domestic violence cases, however hard data regarding domestic violence was not clear and whether there had been an increase in cases during lockdown or whether numbers had been hidden due to people not attending A&E, GP surgeries or contacting the police.  It had been anticipated at the start of lockdown that numbers would rise due to people spending more time together but the true picture was not known.  Nationally there had been a massive increase in calls, but locally it had not translated into a flood of requests for help. 

·                     There had been an increase in the number of perpetrators who had been abusive towards their partners or ex-partners and had referred themselves to the Perpetrator Behaviour Programme aiming to change their behaviour and develop respectful, non-abusive relationships.

·                     There was an extended online counselling helpline available to children, aimed at providing stability during lockdown, although very few calls had so far been received but was starting to increase slowly.  It was anticipated that towards the end of September, referrals from CAMHS would start to come through and teachers can see social pressures.  Reference was made to the Door 43 Wellbeing Service, a service which offered support to 13-25 year olds on a range of emotional wellbeing issues, providing information, advice and guidance to young people experiencing issues such as low mood, stress and anxiety, loneliness, and who may have been particularly affected by the pandemic by the transition from primary to secondary school, transition to 6th Form, transition to university or the workplace and the lack of SATs, GCSE and A-Level examinations and results. 

·                     It was anticipated in the school return, that a whole suite of services would be put in place by the end of September by working with clinicians, CAMHS, MAST and school representatives to prepare for the return to school, to offer support and training for schools to create a healthy environment for children as well as members of staff.  Lots of measures were being put in place to help children get around school buildings safely, infection control and “bubbles”.

·                     The City Council had engaged in the Government’s “Everybody In” initiative and worked with a range of partners to accommodate all rough sleepers in either supported or hotel accommodation at the beginning of lockdown and this had proved very successful in getting the homeless off the streets.  Successes had been seen and a number of rough sleepers were ready to move into assisted accommodation, but not every rough sleeper wished to make that transition and some have drifted back into hanging around city centres.  The Government, through Public Health England, were providing resources to maintain the work that had been initiated, as it was not possible to leave rough sleepers in the accommodation that had been provided throughout lockdown. There are resources to sustain that work to offer a number of options to help maintain the support they have received and continue with that support.

·                     The Homeless Assessment and Support Teams had worked throughout the crisis and there hadn’t been a complete stand down of face-to-face care in services. The decision to offer face-to-face service had been based on assessments of the whole situation carried out by doctors wearing full Personal Protective Equipment (PPE) and making sure they got the assessments they needed. The Early Interventions Psychosis Service, consisting of staff from a variety of disciplines, including nursing, social work, occupational therapy, and psychology, had held fewer face-to-face consultations, and contact had been made by telephone, although it would be disingenuous to suggest that not seeing people face to face there wouldn’t be a downside to that as seeing people was fundamental to what they do.

·                     Covid was an amplifier and magnifier of health and social inequalities.  The NHS Implementation Plan refers to everything that we are trying to put in place to measure and modify to take into account the effects of Covid on the most disadvantaged groups and also including BAME, in all services and mainstream mental health services.  In relation to the point raised about substance misuse, the evidence was not clear on this, although the use of alcohol has shown an increase.  Services were keen to carry on conversations to make sure we have the most resilient plans possible.

·                     The physical health of approximately 30% of those affected by Covid are thought to have long term health conditions but it was not known at present what the medium or long term health consequences were likely to be.

·                     Some of the frontline workers who had cared for and gave support to those affected by Covid, were now requiring support themselves.

·                     It was predicted that there would be a big demand for mental health support services across all ages and as yet, we have not seen the full mental health impact caused by the virus.

·                     One of the things resulting from the pandemic was the digital revolution platform.  St. Luke’s Hospice had championed an educational methodology called ECHO, allowing care homes to participate in a wide variety of training, for example on the use of PPE, dealing with social distancing and how to reintegrate visits from family and friends into care homes.

·                     Greg Fell, the Director of Public Health in Sheffield has set out clear guidance around visits to care homes.  The guidance sets out the only practical way of doing things and there may be times when there were clashes, but there was no easy resolution to this issue.

·                     Access to mental health services were currently at different levels, and prevention and promotion of wellness was of great importance.  The methodology may have changed, with increased use of video and telephone conference.  The Primary Care Mental Health Framework operates across 21 GP practices.  200 people who have been seen would traditionally not have accessed mental health services, due to being too complex for IAPT and not complex enough for secondary mental health services.

·                     There was a need to develop services to be able to see more people, and as we become confident in delivery of care we need to meet the challenge.  There was an opportunity to do something different and get on top of prevention through focussing efforts and resources into primary prevention so there wasn’t as much need for secondary care.

·                     The key was to stop looking at pre-covid and focus more on post-covid and carry out a review across all services.

·                     At present, initial assessments being carried out by GPs was via telephone or video conferencing, GPs then deciding whether someone needed to be seen face-to-face the same day, by proper use of PPE, then deciding what steps should be taken.  A number of people have been proactive in their choice, preferring telephone or video conferencing, reducing the need to travel or sit in a busy waiting room.

·                     The caseloads of workers in every Service have been risk assessed to ensure they aren’t taking on too much.

·                     For those with physical disabilities, there hasn’t been a large impact.  Phase 3 will request GPs to review at least two thirds of patients with learning disabilities.

·                     There is a difference in national funding regimes for mental and physical health - every time someone attends hospital presenting with physical health issues, the hospital gets paid. Mental health services aren’t funded in this way, which has resource implications.

·                     Mental illness and mental health problems account for nearly 25% of all the mortality and illness that the NHS deals with, yet only receives approximately 12% of the budgetary resources. This will only worsen as we continue to live with Covid-19.

6.5

RESOLVED: That the Committee:-

(a)       thanks Jan Ditheridge, Mike Hunter, Steve Thomas, Sam Martin, Heather Burns, John Doyle and Councillor George Lindars-Hammond for their contribution to the meeting;

(b)       notes the contents of the report and the responses to the questions;

(c)        is keen to see that the good practice and learning developed in mental health services through Covid19 is captured and built upon;

(d)       recognises that there is commitment in Sheffield to overcoming barriers to accessing mental health services, and will be looking for evidence that access to services is improving;

(e)       notes national issues around parity of esteem and insufficient funding for mental health; and expresses concern that it will be difficult for local areas to meet the anticipated increase in demand for mental health services due to Covid19, unless national government puts appropriate financial arrangements in place;

(f)        notes that digital solutions have been an important part of accessing services during Covid19, and as such, the City needs to address issues of digital exclusion;

(g)       supports efforts to improve how the mental health needs of Sheffield people are met, and recognises the importance of doing so; and

(h)       recognises that work is ongoing to analyse the impact of Covid19 on mental health in Sheffield, for example through the Rapid Impact Assessment, and looks forward to seeing an action plan to address the issues identified as a result of this assessment.