On a bright sunny day in early March, dozens of mental health activists in their distinctive red and yellow ‘Public Health Emergency’ T-shirts gathered outside the Public Health Agency (PHA) in Belfast to hand out coffees to PHA staff and passers-by. Their purpose was to highlight the need for urgent action by government on mental health and suicide prevention. Their lively chant, ‘Wake up and smell the coffee Minister Swann – Declare a Public Health Emergency!', reverberated along the length of Linenhall Street and beyond. People mingled and chatted, buoyed by the growing momentum behind the #123GP campaign.

Bunches of daffodils decorating the coffee table symbolised the collective hope shared by activists. That hope was that the crisis in mental health and suicide, widely acknowledged, would be recognised as such by the Department of Health and the Executive, that they would declare a public health emergency, triggering urgent action around budgets, services and waiting lists. In the words of Annie Davey, one of the #123GP activists “we are constantly being told to reach out and ask for help – we are asking for your help Minister Swann’.

Evidence of the scale of the problem was incontrovertible – 5.3% of the health budget spent on mental health (Freedom of Information response from Department of Health), the highest rates of suicide across the UK and Ireland, waiting times of several months for counselling, a post-code lottery for services and inadequate oversight and regulation of mental health services. All of this against the backdrop of a society emerging from decades of violent conflict, with the resultant high levels of largely unaddressed trauma.

The words of the UN Special Rapporteur on the Right to Health Dr. Dainius Puras, whom campaigners hosted in Belfast just months earlier, rang in their ears: ‘little short of a revolution is needed in mental health’. In response to the gathering momentum, spearheaded by #123GP activists, the newly appointed Minister for Health Robin Swann had indicated that mental health and suicide prevention were to be top priorities for him. Hope and expectation of change were in the air.

The fight for survival

Fast forward to just two weeks later and the entire world as we knew it had changed utterly. The COVID pandemic, until then still more of a distant concern, hit home with a ferociousness which could not have imagined. Worst case scenario modelling predicted that 15,000 people could lose their lives. The focus became first and foremost on survival and physical safety. In keeping with Maslow’s Hierarchy of Needs, the next priority was meeting basic needs. Government scrambled to put in place a response plan, both to the public health emergency but also to the impact of the pandemic on every aspect of our lives – including business, community, education, agriculture, entertainment, tourism and travel. On a daily basis the Executive announced new initiatives to be taken by the various government departments to deal with COVID. Additional funding was announced, bureaucratic red tape was lifted, new initiatives and services were put in place overnight. Positive responses that will help protect the most vulnerable groups included the suspension of all face-to-face social security assessments and a moratorium on all evictions of social housing tenants.

Psychological impacts of Covid

During those initial few weeks #123GP activists waited expectantly for a similar such announcement in relation to mental health and suicide prevention. Without question the psychological impacts of Covid and its aftermath will be on a scale not experienced in our lifetime. Covid will result in death and loss at a level difficult to comprehend, extreme poverty and destitution, increased domestic violence, relationship breakdown and burnout among essential workers.

Those most vulnerable in our society pre-Covid, due to a toxic mix of austerity, rampant greed, privatisation and structural discrimination, are now those at greatest risk from Covid.

NHS workers, who on the front line in the fight against Covid, are at particular risk of psychological distress and trauma. These impacts will in turn lead to increased incidences of PTSD, depression, anxiety and OCD. Those most vulnerable in our society pre-Covid, due to a toxic mix of austerity, rampant greed, privatisation and structural discrimination, are now those at greatest risk from Covid. Research has shown that people from ethnic minority communities in England are dying in disproportionately high numbers compared with white people.

A mental health service in crisis

Our pre-Covid mental health and suicide prevention services were utterly inadequate to meet levels of need. This was precisely why #123GP activists along with others had campaigned for so long and so hard for an increase in funding and services.

Recent data obtained by PPR from the Department of Health and Trusts indicates that at the onset of Covid we were in stand-still and in some cases a worsening situation. A Freedom of Information response obtained by PPR from the Department of Health on 7 April 2020, showed that in 2018/19 5.3% of the overall health budget was spent on mental health. Just under half of the Confidence and Supply money allocated for mental health, over which there has been minimal scrutiny, has been spent on what are described as ‘mental health inescapable’ rather than new initiatives.

There is little evidence of improvement in waiting times for talking therapies. Information obtained by PPR through Freedom of Information from the Western Health and Social Care Trust indicated that for over two-thirds of adults awaiting a mental health assessment, the 9-week waiting time target was breached. Over half of these waited longer than 18 weeks. The longest waiting time recorded was 1 year and 2 months. For over half of all adults waiting for Psychological Therapies the waiting time target of 13 weeks was breached. Again, the longest waiting time was 1 year and 2 months, or 430 days. #123GP has campaigned for a 28-day waiting time target.

Paradoxically mental health services, both at primary and secondary levels, may at the moment be experiencing a reduction in workload and waiting lists. However, this represents a false picture and can be explained by a number of factors including a mis-perception that all non-Covid services have been stood down, fear of contacting services and the fact that some people are in such crisis that they are not reaching out for help. If the experience of the conflict has taught us anything it is that it was only in the aftermath of those decades of violence that the true extent of collective trauma experienced became evident. This may well also be a similar pattern during and after Covid.