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Last week NHS England warned mental health trusts there could be a spike in demand on their services related to the coronavirus pandemic.

It is unknown when this spike might come, but the Royal College of Psychiatrists has told HSJ warning signs have already begun to show.

Dr Wendy Burn, president of the college, said some medical directors were reporting an “upsurge in really acute mental illness”.

She said: “One trust even said it needs to open more psychiatric intensive care beds - that’s quite a big thing and so, yes, there’s been an upsurge in acutely ill.”

Another mental health trust director in London told HSJ they were starting to see increased acuity, while a crisis care lead in the Midlands said their team was struggling to find beds for people.

The comments from Dr Burns and others are not surprising considering for the last two months many mental health services have been stripped back and can only offer telephone and digital consultation.

While staff may have done all they can to continue services, the current situation means they are unavoidably limited.

Inadequate estate

The current inadequate nature of the NHS mental health estate could hamper services if a surge in need does strike.

Before the pandemic, the lack of mental health beds and the poor condition of the existing estate was a commonly touted problem. The inappropriate existence of dormitory wards, for example, has been something NHS England has wanted to tackle.

Readers may remember Simon Stevens announcing plans to funnel cash from unused national funding pots to help eliminate dormitory wards and maintenance issues. HSJ has asked the national commissioner if it still intends to pursue this plan.

The existence of dormitory wards will be a major barrier to covid-19 infection control. If trusts are having to create ‘clean’ areas for new admissions, this could put huge pressure on the bed base.

If demand for mental health services becomes greater, while covid-19 is still in full force, will trusts be forced to limit admissions? There are signs this has already started to happen on wards for patients with eating disorders, according to RCPsych’s lead in this area.

Money matters

The long term plan funding for mental health has been backloaded, with biggest increases happening at the end of the five year period.

However, there are now questions about whether the pandemic and necessary response to it means the sector will need those larger increases brought forward.

If the backload does become more frontloaded, the NHS would need to find the workforce to match it. Unlike the government’s magic money tree, additional staff cannot be created out of thin air.

 Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.