Mental Health Matters: Watch out for that trend

Each prime minister has their banner cause for the NHS.

For Boris Johnson it was building projects, and now covid-19. For Theresa May it was children’s mental health, and for her predecessor it was dementia.

Ten years after David Cameron launched his national dementia strategy, new data suggests coronavirus has had a concerning impact on one of its key objectives; reducing anti-psychotic prescriptions to those living with dementia.

Nationally there was a vast improvement over the last ten years.

A government report in 2009 suggested around 25 per cent of dementia sufferers were being treated with anti-psychotics, and that two-thirds of prescriptions were not beneficial.

But statistics published since 2018 show a huge reduction to around 9.4 per cent.

However, the latest data from NHS Digital shows the rate jumped to 9.7 per cent in March 2020, and to 10 in April. May saw the percentage jump back down slightly to 9.8 – however this is still higher than it has been since at least October 2018.

Complex picture

Professor of Old Age Psychiatry at University College London, Robert Howard told HSJ the population of people with dementia, on which the PHE prescribing data is based, has for the past four to five years been a constant.

This is because the number of people with dementia dying each month has generally matched the number newly diagnosed.

However, during the pandemic two things happened. Diagnosis of dementia stopped and the number of people with dementia dying increased.

Those newly diagnosed are less likely to be prescribed antipsychotics, while those who’ve died were more likely to have severe dementia and so more likely to be given the drugs.

Professor Howard added: “What we saw in April, despite the fact that almost 17,000 people with dementia have died, when we would anticipate that normally only 10,000 would have died, and are taken out of the register data, you still see a statistically significant increase in the number of people with dementia prescribed antipsychotics.

“What I take from the figures is that the use of antipsychotics for people with dementia almost certainly did increase at the end of March, through to April and May. But it’s difficult to see the full scale of this increase because of the differential loss of people through the excess deaths.”

The data, although nuanced, appears to support anecdotal evidence from psychiatrists of increased requests for anti-psychotics during the lockdown.

Considering the lack of support care homes have had, and the fact that getting this particular group of people to social distance may be very hard, this isn’t a surprise.

While we don’t know if this increase in the prescription of antipsychotics will be a continued trend, it’s certainly something which should be watched carefully.

Older people’s mental health

Professor Howard, an older people’s psychiatrist, also warned: “It is often forgotten that older people may also suffer with severe mental health illness, for example, a diagnosis of schizophrenia and other mental health conditions, but don’t get the mental health support younger people do.”

Last week the Office of National Statistics published a report on public anxiety levels during the pandemic. The report noted a “marked change” in levels of anxiety among those aged 65 or older. Prior to the pandemic this group saw lower ratings compared to other age groups, but post pandemic, the ONS said “we are seeing the highest levels of anxiety amongst this group in lockdown”.

Older people’s mental health is a topic often neglected within the headlines, which have focussed more on children and young people. However, the mental health needs of this group will be an increasing concern for NHS trusts.

Many of those in older age mental health services will also be classed as “vulnerable” to coronavirus.

This will make the balancing act of offering appropriate mental health support with protecting against covid-19 transmission an even trickier task for this group compared to others. This will be coupled with the fact patients will often have dementia as well as severe mental health needs.

Several older age psychiatrists said privately they are seeing an increase in serious mental health problems among their patients.

One, based in a London inpatient unit, said their unit was already seeing admissions of older people whose mental health has worsened as a direct result of lockdown restrictions.

However, if the ONS’s data, and observations from clinicians are to be trusted, should a second wave come there could be a perfect storm brewing.

 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.