The House | To prepare for national emergencies, we must build resilience into our mental healthcare system

(John Eveson / Alamy)

3 min read1 hr

A fight in which mental health, despite progress, does not have parity of esteem with physical health – mental health makes up around 20 per cent of NHS cases but receives less than 10 per cent of funding; and a fight in which the policy response is still lacking. Had Mind and others not campaigned hard for its inclusion in the inquiry, mental health would have been an afterthought again.  

It’s true the Covid-19 pandemic created a mental health crisis in several different ways. But it’s also true that in many ways it simply turned up the heat on what was a slow burning crisis already in motion – overstretched services already unable to meet growing demand.  

As the pandemic hit, thousands who were already receiving support saw that help delayed, disrupted or moved out of reach just when they needed it most.  

Module 10 of the inquiry mattered because it finally took mental health seriously on its own terms. But if this moment is to mean anything, we must confront an uncomfortable truth: the UK’s mental health system was vulnerable long before the pandemic, and in many respects it is more vulnerable now.  

We must also be honest about who paid the highest price. Racialised communities, people in poverty and disabled people faced disproportionate risks and poorer outcomes. Women and girls were exposed to higher levels of abuse at home.  Young people missed key milestones, saw their education disrupted, and were isolated from their friends. Inequality isn’t a footnote; it is the central story of the pandemic.  

It’s also an uncomfortable truth that people with severe mental illness were more likely to find themselves in situations that exposed them to the virus, which they were also more likely to die from.  

Why did the system bend so quickly under pressure? The mismatch between the burden on the NHS and funding meant services were already stretched before the first lockdown, and the shock of Covid-19 pushed a fragile system closer to the edge.  

The result was longer waits, higher thresholds, exhausted staff and inconsistent quality at the very moment demand surged. Funding alone will not fix this. We need both spending and structural reform for the mental health system to work.  

We must design for the inevitable surge in mental health problems during national emergencies in the same way we plan for acute bed capacity in winter. This means ensuring that every base is covered, including infection control guidance for mental health; building social connection into public health planning; and equipping health systems to deliver hybrid mental health care.  

We need to embed voluntary and community sector partners, like the federation of local Minds, into local and national planning. These organisations are rooted in communities, understand the unique needs of the people they serve and know how to respond effectively.  

It is essential we protect the people we know are at higher risk. The data was there before the pandemic. We need mandatory equality impact assessments built into national emergency planning to ensure that all groups receive the appropriate support.  

This needs to form part of a shift towards building trusting therapeutic relationships between patients and professionals and delivering holistic care and support. Getting this right will allow us to build a resilient system for crises we will inevitably face in the future, and also help to create a mental health system that provides accessible and high-quality care right now.  

Module 10 was a moment of national reckoning with what happened, what went wrong, and how we avoid the mistakes of the past. The inquiry’s recommendations can shape a lasting legacy: a resilient, compassionate and effective mental health system that delivers the support people need, in calm and in crisis alike. That is the least we owe people.  

Dr Sarah Hughes is CEO of the charity Mind