Mental Health Crisis

Hospital Admissions of Children With Eating Disorders Surge 70% Since Pandemic

The number of children being admitted to hospital with an eating disorder has surged almost 70% since the pandemic began, according to official figures, with psychiatrists warning they are being overwhelmed by the numbers needing help. The Telegraph has the story.

Experts said repeated lockdowns and periods of isolation had caused “devastating” effects on children’s mental health, fuelling a sharp rise in anorexia and bulimia. They said such uncertainty had left many children feeling they had lost control of their lives – a factor which can provoke eating disorders.

Charities warned that those admitted to hospital were only the “tip of the iceberg” as the vast majority of those suffering eating disorders do not receive care as an inpatient.

The NHS provisional data show 4,238 hospital admissions for children aged 17 and under between April and October last year. The figure is a 69% rise compared with the same months before the pandemic, when there were just 2,508 admissions.

Overall, the data show there were 23,302 admissions for eating disorders among all age groups in the financial year 2020/21, up 21% on the 19,244 admissions among all age groups recorded in 2018/19.

Provisional data for April to October 2021 show there were 15,941 admissions so far among all age groups, suggesting 2021/22 will be the highest year yet for those of all ages.

Dr Agnes Ayton, the chairman of the eating disorders faculty at the Royal College of Psychiatrists, said: “The hidden epidemic of eating disorders has surged during the pandemic with many community services now over-stretched and unable to treat the sheer number of people needing help.

“We are at the point where we cannot afford to let this go on any longer.”

Worth reading in full.

Canadian Study Shows Online Learning Increases the Risk of Depression and Anxiety in Children

Researchers at the Hospital for Sick Children in Toronto, Canada have found that online learning dramatically increases the likelihood that a child will suffer from psychiatric issues such as anxiety or depression. Their study also found that the more time a child spent in front of a screen and the less time spent with others due to lockdowns has caused an increase in mental and behavioural problems for young people. MailOnline has more.

Learning online, rather than in a classroom, comes with an increased risk of depression and anxiety for older schoolchildren, according to a new study. 

Researchers analysed parent-reported mental health outcomes for more than 2,000 school-age children living in Canada at the time of the Covid outbreak.

For the study, the experts, from the Hospital for Sick Children in Toronto, explored links between different types of screen use and mental health.

They found that there was a clear link between parent-reported anxiety and depression in older children, who were having to use a screen for education. 

“These findings suggest that policy intervention, as well as evidence-informed social supports, may be required to promote healthful screen use and mental health in children and youth during the pandemic and beyond,” the team wrote.

The scientists behind the study also found that increased TV watching and gaming in younger children during the outbreak led to higher levels of depression, anxiety, behavioural problems and hyperactivity. 

There was no increased risk of these conditions in children with Autism Spectrum Disorders, according to the experts.

They say this could be due to their already higher level of screen use, and lower level of social interaction. 

“The Covid pandemic has resulted in major changes in the daily routines of children,” the researchers said.

This was “primarily because of the imposed public health measures related to distancing, isolation, and school closures”, the team explained.

The amount of time children and young people spent on screens increased dramatically, through television, gaming, video chat and online learning. 

To understand what impact this could have had on the mental health of young people, researchers examined a number of cohort studies.   

This study included 2,026 children with an average age of 6 and roughly split evenly between male and female participants.

Higher TV or digital media time, including gaming, was linked to higher levels of behavioural problems and hyperactivity in children aged two to four years-old, they discovered.

In older children and youth, with an average age of 11 years-old, watching more TV and gaming was linked to higher levels of depression, anxiety and inattention. 

Worth reading in full.

Lockdown Restrictions Have Accelerated America’s Youth Mental Health Crisis, Says Surgeon General

The U.S. Surgeon General Vivek Murthy has said that an already existing youth mental health crisis has been amplified over the course of the pandemic. Targeting lockdown restrictions directly, Murphy referred to the “devastating” impact which school closures and a lack of socialisation have had on the mental well-being of America’s children and young adults. The Mail has more.

While youth mental health had been a growing concern before the pandemic with increased rates of depression, anxiety, and suicidal ideation, Covid has exacerbated this trend into a crisis, Murthy said.

For example, during the pandemic, the number of children and teenagers reporting symptoms of depression and anxiety doubled, according to one study of 80,000 youth around the world.

Children from minority communities and those at socioeconomic disadvantages, as well as those who lost a parent or caregiver to Covid, are at higher risk for Covid-related mental health conditions, the Surgeon General’s report found.

The Surgeon General’s advisory provides recommendations for improving mental health through increasing mental health care access, addressing economic and social barriers that contribute to poor mental health, and more.

In the decade prior to Covid, youth mental health has become a growing concern for doctors and public health experts, and the pandemic exacerbated this concern.

A new report from the U.S. Surgeon General’s office (released Tuesday) provides statistics on youth mental health, as well as recommendations for how to address this challenge.

“Mental health challenges in children, adolescents, and young adults are real and widespread,” said Surgeon General Vivek Murthy in a statement about the report.

“Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide, and rates have increased over the past decade.”

For young people, mental health conditions may be caused by both biological factors and environmental factors.

These environmental factors can include relationships with family members, relationships with peers, neighbourhood safety, and social and economic inequalities, according to the Surgeon General’s report.

Prior to Covid, up to one in five children between the ages of three and 17 years-old had a mental, emotional, developmental, or behavioural disorder.

This number has increased sharply over the last 10 years, according to the report.

From 2009 to 2019, the share of high school students who reported feeling sad or hopeless increased by 40%, to more than one in three students.

The share of high school students seriously considering a suicide attempt increased by 36 percent, while the share creating a suicide plan increased by 44%.

The Covid pandemic has added further hardship and stressful experiences for America’s young people.

“The Covid pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating,” Murthy said.

Covid caused schools to close across the country, disrupting opportunities for learning and socializing with peers.

In addition, many children who relied upon school for access to healthcare and social services had those services disrupted.

Numerous children also faced housing and food insecurity as their parents and caregivers went through job loss due to the pandemic.

Worth reading in full.

Lockdown Loneliness Has Cost Australia $2.7 Billion AUD Per Year

Researchers from Curtin University in Perth have uncovered that Covid restrictions have exacerbated feelings of social isolation, leading to negative health outcomes which have cost Australia $2.7 billion AUD per year. This accounts for $1,565 AUD for each person who is lonely, with young people and those living on lower incomes being impacted the most. The Guardian has more.

Report co-author Astghik Mavisakalyan, an Associate Professor at the Bankwest Curtin Economics Centre, said lonely people had worse general and mental health outcomes. “They’re more likely to smoke, more likely to drink more and exercise less,” she said. “They see their GP more frequently, as well as visit hospitals more frequently.”

The report estimates that the overall average cost associated with each person who becomes lonely in Australia is $1,565 AUD a year.

The researchers measured social connectedness based on four key areas: the nature and frequency of people’s social interactions, available social supports, interpersonal trust, and socio-economic advantage.

“In the period from 2010 to 2018, there has been a 10% decline in connectedness,” Mavisakalyan said.

Social isolation was most prevalent among vulnerable populations, including those who are disabled, socio-economically disadvantaged, or from culturally and linguistically diverse backgrounds, the report found.

There was a worrying link between poverty and loneliness, Mavisakalyan said. The analysis drew comparisons between individuals “who are very, very similar in terms of their host of characteristics but are different in terms of their income”.

Even when all other factors were controlled for, the loneliness gap between the richest and the poorest was significant, suggesting “poverty may also lead to the social exclusion of individuals”, Mavisakalyan said.

Women scored higher than men on social connectedness across all ages, but also reported being lonelier than men, particularly girls under 17 years-old and women older than 65 years-old.

“The figure of up to $2.7 billion AUD per year associated with loneliness provides a strong economic case for investing into initiatives that mitigate loneliness in our society,” Mavisakalyan said. “Participation in activities that create meaningful connection with others and a common purpose should be a priority.”

Unsurprisingly, face-to-face interactions and community participation dropped throughout the pandemic.

That Covid has had an outsize effect on young people “comes out very vividly in our analysis”, Mavisakalyan said.

Worth reading in full.

Cases of Psychosis Soared Over Past Two Years of Lockdowns

Data shows an increasing number of people suffering from hallucinations and delusional thinking over the past two years in England (and across the world) during which time our lives were plagued by the social isolation caused by numerous lockdowns. The Guardian has the story.

There was a 75% increase in the number of people referred to mental health services for their first suspected episode of psychosis between April 2019 and April 2021, NHS data shows.

The rise continued throughout the summer, with 12,655 referred in July 2021, up 53% from 8,252 in July 2019.

Much of the increase has been seen over the last year, after the first national lockdown, according to data analysed by the charity Rethink Mental Illness. More than 13,000 referrals were made in May 2021, a 70% rise on the May before when there were 7,813 referrals. …

A study earlier this month found that anxiety and depression around the world increased dramatically in 2020, with an estimated 76 million extra cases of anxiety and 53 million extra cases of major depressive disorder than would have been expected had Covid not struck. Women and young people were disproportionately affected, the researchers said.

Psychosis can involve seeing or hearing things that other people do not (hallucinations) and developing beliefs that are not based on reality (delusions), which can be highly distressing. It can be a symptom of mental illness such as schizophrenia, bipolar disorder or severe depression, but psychosis can also be a one-off, potentially triggered by a traumatic experience, extreme stress or drug and alcohol misuse.

Despite the continued pressure on mental health services, Rethink Mental Illness is highlighting the importance of rapid access to treatment to prevent further episodes of psychosis and reduce people’s risk of developing severe mental illness. …

Brian Dow, the Deputy Chief Executive of Rethink Mental Illness, said: “Psychosis can have a devastating impact on people’s lives. Swift access to treatment is vital to prevent further deterioration in people’s mental health which could take them years to recover from.

“These soaring numbers of suspected first episodes of psychosis are cause for alarm. We are now well beyond the first profound shocks of this crisis, and it’s deeply concerning that the number of referrals remains so high. As first presentations of psychosis typically occur in young adults, this steep rise raises additional concerns about the pressures the younger generation have faced during the pandemic.”

Worth reading in full.

300 People a Day Go to A&E with Depression

As patients struggle to access face-to-face appointments with their GPs, figures show that more than 300 people a day are attending A&E departments complaining of depression – a sign both of the deepening mental health crisis and the inability of the NHS to cope with it. The Telegraph has the story.

NHS Digital data show that, in the year to March, “feeling depressed” was a patient’s main complaint in 114,000 attendances at NHS emergency departments in England – an average of 312 a day.

Mind, the mental health charity, said it was “deeply concerning” that so many people across the country needed emergency care for this reason.

The data refers to chief complaints, which a clinician views during a patient’s first assessment as the main reason that led them to seek emergency care. It is not an official diagnosis.

Feeling depressed was the 28th most common reason of nearly 150 recorded for attending an emergency department nationally in the last year, coming above puncture wounds, back injuries, coughs and sore throats. …

Pennine Acute Hospitals NHS Trust, in the North West, saw the highest number of A&E attendances for people presenting with feeling depressed as their main symptom (4,785), followed by University Hospitals Birmingham NHS Foundation Trust, which recorded 3,950, and Manchester University NHS Foundation Trust, with 2,525.

Different figures show “depressive disorder” was listed as the first suspected or confirmed diagnosis in 83,500 A&E attendances at NHS trusts across the country in 2020 to this year, making it the 25th most common diagnosis of hundreds recorded.

A patient with this diagnosis may not necessarily have been listed as “feeling depressed” in their initial assessment.

Leila Reyburn, the policy and campaigns manager at Mind, said: “It is deeply concerning to see so many people feeling so mentally unwell that they need to go to A&E. This is supported by data which shows an increasing number of people, including children, being treated by the NHS in a mental health crisis.”

Worth reading in full.

More than 50% Increase in Number of Children Going to A&E with Serious Mental Health Issues since Start of Lockdowns

We are told that healthy children should be vaccinated against Covid to benefit their mental health. If only our leaders had taken an interest in this before imposing school closures and wider lockdowns which have helped to bring about a more than 50% increase in the number of children going to A&E with serious mental health issues. The Telegraph has the story.

More than 2,243 children in England were referred for specialist mental health care from emergency departments in May this year, compared with just 1,428 in May 2019.

Experts say children have struggled with schools being closed and without face-to-face interaction with their peers.

Robert Halfon, the Conservative MP and the Chair of the Education Select Committee, called for schools to remain open to stave off a mental health “catastrophe”.

NHS data reveal that nearly 27,000 children are being prescribed antidepressants each month, up more than 8% from 2019. While most are teenagers, 25 a month are aged six or under, and more than 1,000 are aged seven to 11.

Waiting lists for Child and Adolescent Mental Health Services (CAMHS) have jumped by more than a third in some regions, according to NHS England Trusts.

The number of children admitted to acute wards with eating disorders more than doubled in the three months to June 2021, when compared with the same period in 2019.

Dr. Anna Conway Morris, a consultant child and adolescent psychiatrist, said the increase in A&E referrals “shows that the things that are likely to need CAMHS input, like eating disorders, or like more serious self-harm or suicidal thoughts, have increased”.

Paul Farmer, the Chief Executive of the mental health charity Mind, has written to the Health Secretary, Sajid Javid, calling for extra funding in order not to “betray the next generation”.

An NHS England spokesman said its mental health services were looking after record numbers of children “with over 420,000 treated since April last year”.

Worth reading in full.

Registered Suicides in England Fell in 2020 Because Inquests Were Delayed During Lockdowns

It was reported last week that despite fears of the mental health crisis prompted by the lockdowns leading to a spike in suicides in 2020, the number of people committing suicide in the U.K. did not rise after the first lockdown. While the provisional rate of suicides for 2020 is lower than that of 2019, this may be due to delays to coroner inquests, meaning the actual figure could be much higher, according to the Office for National Statistics (ONS). The Mail has the story.

Registered suicides in England fell in 2020 as inquests were delayed during the coronavirus pandemic, official data shows.

Some 4,902 suicides were registered across the country last year – giving a provisional rate of 9.9 suicide deaths per 100,000 people, the ONS said.

That represents a fall from 2019, when the rate was 10.8 suicide deaths per 100,000 people.

The ONS said the fall “most likely reflects delays to coroner inquests, because of the impact of the coronavirus pandemic, as opposed to a genuine decrease in suicide”.

The 2020 figures are provisional and will be finalised by the ONS in late 2021.

All deaths by suicide are investigated by coroners, with deaths usually registered around five to six months after they occur due to the length of time it takes to hold an inquest.

Of the suicides registered in 2020, more than half (51.2%) occurred that year. Some 3,674 involved males, and 1,228 females.

Between April and June 2020, during the first national lockdown, the provisional suicide rate fell by 36.1% compared with the same period in 2019.

The number of registered suicides in this quarter was the lowest since 2001.

This is most likely to be due to the impact of the pandemic on the coroner’s service, such as delays to inquests as the service adapted to social distancing measures, the ONS said.

The number of registered suicides increased in the second half of 2020, most likely due to inquests resuming, the ONS said. 

In November, the charity Rethink Mental Illness said the number of people turning to its website for support with suicidal thoughts had tripled in the first six months of lockdown. A new study also found that the lack of in-person treatments – because of lockdowns – has made mental health patients feel as though they “were missing out on care”.

The Mail’s report is worth reading in full.

Stop Press: A report from the Journal of the American Medical Association shows a decrease in U.S. suicides in 2020 by 2,700, from 47,500 to 44,800. But, at the same time, there was a substantial increase in the number of “unintended injury” deaths (an increase of 19,000 from 2019) which was “largely driven by drug overdose[s]”.

Dr Gary Ordog, MD, from the Department of Health Services in the County of Los Angeles (retired) said:

I was surprised by the suicide rate reported to have a major decrease in 2020. It seems from most other reports that the suicide rate has increased since the pandemic began. This may be explained by the fact that the category of “Unintentional Injury” had a major increase at the same time, and the fact that this category includes drug overdoses. As there is often inadequate history in a fatal drug overdose case, many of these may be purposeful and so suicidal. This would explain the perceived increase in suicide rate since the current pandemic began. Perhaps further analysis of the data would elucidate this incongruity.

Mental Health Patients Missed Out on Care Because of Lockdowns

The loss of face-to-face treatments has made mental health patients feel as though they “were missing out on care” over the past year of lockdowns, according to new research. For some patients, video calls made matters worse. The Observer has the story.

Mental health patients found their conditions deteriorated during the pandemic because the NHS switched from in-person help to support by telephone, video and text messages, new research reveals.

Many reported a lower quality of care, according to a study by University College London; others had trouble accessing medication, had appointments cancelled or felt the loss of face-to-face help meant they “were missing out on care”.

Researchers led by Dr Brynmor Lloyd-Evans found that, for many patients, the switch to remote care heightened the isolation and loneliness they were already feeling because they could no longer see friends and family.

“People with pre-existing mental health conditions experienced serious disruptions to their access to, and the quality of, mental healthcare as a result of the pandemic. The opportunities and challenges of remote mental healthcare were an important aspect of our findings,” Lloyd-Evans and colleagues write in the journal Social Psychiatry and Psychiatric Epidemiology.

“While for some people telephone and digital support provided continuity of care, for others there were issues around access to technology, maintaining therapeutic relationships remotely, and digital interfaces exacerbating difficult feelings or symptoms associated with their mental health.”

After interviewing 49 people with mental health conditions in London about their experience during Covid’s first wave, the researchers found key issues included “inadequate access to mental health services”, “difficulties in day-to-day functioning” and “struggles with social connectedness”.

One patient said: “Lockdown has made me feel very angry. I feel the professionals used it as an excuse to stop offering appointments. I was seeing her every week and it’s been cut to every three weeks [by telephone].”

Another said of their therapist: “She did text me a few times: we keep conversation [by] texting but it is not good enough really.” Another, who was offered video calls rather than in-person help, said: “For my paranoia, they make it worse, so I tend not to do them.”

The Royal College of Psychiatrists, which recently said England is “in the grip of a mental health crisis“, believes the extent of the crisis “will likely get a lot worse before it gets better”.

Over one million more treatment sessions were given to adults between April and December last year (1,078,539), an increase of 8% on 2019. There were also 159,347 urgent crisis referrals made for adults, an all-time high, and an increase of 2% on 2019.

The Observer report is worth reading in full.

Extent of England’s Mental Health Crisis Is “Terrifying”, Psychiatrists Warn

England is “in the grip of a mental health crisis” because of lockdowns, according to the Royal College of Psychiatrists, and under-18s are “bearing the brunt”. The number of children being treated for eating disorders has reached record levels, as well as the number of people reporting being lonely. Here are the key findings:

~ 80,226 more children and young people were referred to CYP mental health services between April and December last year, up by 28% on 2019, to 372,438.  

~ 600,628 more treatment sessions were given to children and young people, up by a fifth on 2019 to 3.58 million. 

~ 18,269 children and young people needed urgent or emergency crisis care – including assessments to see if someone needs to be sectioned because they or others are at harm – an increase of 18% on 2019, to 18,269. 

The data on adults is equally bleak.

Over one million more treatment sessions were given to adults between April and December last year (1,078,539), an increase of 8% on 2019. There were also 159,347 urgent crisis referrals made for adults, an all-time high, and an increase of 2% on 2019. 

In November, the Government announced a £500 million support package for mental health services to aid the nation’s recovery from lockdown. The RCPsych has called for this funding – which includes £79 million for children – to reach the frontline as soon as possible. Dr Adrian James, the College’s President, says that services are at a “very real risk of being overrun” because of the scale of the mental health crisis.

“The extent of the mental health crisis is terrifying, but it will likely get a lot worse before it gets better.

“Services are at a very real risk of being overrun by the sheer volume of people needing help with their mental illness.

“While the recent funding announcement is welcome, we need this money to reach mental health services as soon as possible to tackle this crisis.”

The Chair of the college’s Faculty of Child and Adolescent Psychiatry added that services were already struggling before Covid struck and now face even greater queues for treatments due to the impact of school closures and the denial of social contact.

“Our children and young people are bearing the brunt of the mental health crisis caused by the pandemic and are at risk of lifelong mental illness.

“As a frontline psychiatrist I’ve seen the devastating effect that school closures, disrupted friendships and the uncertainty caused by the pandemic have had on the mental health of our children and young people.

“Services were already struggling to cope with the number of children needing help before the pandemic hit, and they risk being overrun unless Government ensures the promised money reaches the frontline quickly.”

Worth reading in full.