Lea Milligan is the CEO of MQ Mental Health Research, Chair of the UK’s Mental Health Funders Forum and a member of the All-Party Parliamentary Group on a Fit and Healthy Childhood. With a career spanning the juvenile secure estate, alternative education and healthcare, Lea brings a focus on making research work for those most in need. MQ’s vision is to create a world where mental illnesses are understood, effectively treated and one day made preventable.
The 2020 NHS digital survey, that took place just at the start of the pandemic, showed a rise over three years from one-in-nine to one-in-six school-aged children having a diagnosable mental health illness. Suicide was recognised as the leading cause of death between 5-19 year-olds and has been rising for the best part of 10 years.
Yet, children and young people’s mental health is not the focus of research today, despite the fact that 75% of all mental health problems develop before the age of 18. Children’s mental health services account for less than 1% of all NHS spending. Health services for children and adolescents are under huge strain. One-in-four children referred to specialist mental health treatments are turned away and 75% have such long waits it has a detrimental impact on their mental health. That average wait time has exceeded 12 months in recent years.
Mental health research spending has been flat for the best part of a decade in the UK, while less than 4% of that figure is on prevention of mental illness. To put it in context, around £9 is spent on research per person with a mental health diagnosis, compared with £300 per cancer patient. This huge inequality between physical and mental health was evident well before the pandemic began.
Some 12 months from the start of the first lockdown here in the UK, people have very different experiences. Children and young people, through a number of different research projects, have been highlighted as some of the most vulnerable groups in terms of impacts on mental health, as well as women, groups from low socio-economic backgrounds and particularly those who had recently faced financial crises.
Between 12-25% of children and young people lacked some of the tools or elements of engagement they needed in order to properly participate while schools were closed. The NSPCC reported an all-time peak of a 32% increase in distress calls to their helpline during the first national lockdown.
There have been some groups that started well and continued to do well, but those that started from ‘further back’ have continued to be challenged. Yet without significant change in understanding of children and young people’s mental health in Government, there is unlikely to be much change in the future.
So what is needed in order to make a brighter future in a post-pandemic world? MQ has launched its new research plan with three thematic areas that we believe need investment. The first, entitled ‘Thriving in a post-pandemic world’ is focussed on understanding the impact of the pandemic and setting out the next steps for young people, in regard to the workplace and mental health inequalities.
The second is entitled ‘Gone too soon’, looking at the best way to invest more money into research which can reduce the mortality gap, whether due to death by suicide, or to the interplay between physical and mental health. Those with a mental health diagnosis on the whole die 15 years earlier than mentally-healthy peers because of co-morbidity between physical and mental health.
A recent post-hospitalisation Covid report covering the first 1,000 patients hospitalised in the pandemic, showed the links between contracting Covid, i.e. a physical, respiratory illness as it was then understood and the ongoing, lasting impact. Some five months on, 25% of those people had a diagnosis of depression and 12% a diagnosis of post-traumatic stress disorder (PTSD).
The third area we refer to as ‘Out of the shadows’. This looks at radical treatments for depression. This condition is expected by 2030 to be the biggest burden of disease worldwide. Research shows that depression is indeed on the increase within children and young people.
At the start of 2021, we invested a further £750,000 into three new fellowships. One is looking specifically at the impact of the Covid-19 pandemic as a stressor on young people’s mental health. The second is concerned with a new treatment for Borderline Personality Disorder, delivered in the community. The third is investigating mental health impacts on autistic individuals as they transition from adolescence into adulthood.
MQ is also carrying out policy and advocacy work. We have sponsored a report by the All Party Parliamentary Group entitled The Covid Generation: a Mental Health Pandemic in the Making1. This involved working with over 25 researchers, all of whom submitted evidence for the report. That brings together all of the thinking that is out there and presents a way forward in terms of policy recommendations.
In partnership with the Royal Foundation we are looking at the inequities of mental health research exacerbated by Covid-19. We recognise that black females in particular are almost non-existent in research studies. There is therefore much more to be done to ensure fully representative data in understanding the true impact of something like the pandemic.
The way forward
Everyone has heard the political aspiration to ‘Build Back Better’. It is a wonderful, alliterative phrase, but to really make that a reality, we have to take a holistic approach and a ‘whole child’ approach. There must be greater access to routinely collected data, so that there is a more ‘live’ approach to understanding the impact of policies on children and young people. Ultimately, though, there has to be greater investment in mental health research: it is as simple as that.