Much is currently being written about the impact of COVID-19 on mental health, including references to an impending ‘mental health pandemic’. Although it is important that concerns about mental health are being raised, there is a risk that using expressions such as ‘mental health pandemic’ or making clichéd and generalised references to ‘PTSD’ or ‘suicidal risk’ generate unnecessary alarm and confusion.
At Grespi we hold the view that a cool-headed, clinically-based approach is necessary to evaluate the current situation and plan adequate responses. This is particularly important for claims assessors managing mental health claims.
Grespi clinicians have no doubt that fear of infection and psychological, economic and social concerns are having an impact on the mental health of the population. However, experiencing psychological difficulties does not automatically equate to suffering from mental health conditions in the diagnostic terms of the International Classification of Diseases and Related Health Problems – 10th edition (ICD-10).
This is because it is an evidence-based epidemiological fact that most people are able to recover from demanding psychological situations without developing mental health conditions.
On the other hand, stressful events, such as the pandemic, tend to expose pre-existing and underlying psychological vulnerabilities in ‘at risk’ people. This, in turn can trigger the development of fully-fledged mental health conditions – whether in the form of a first episode or a relapse of a past condition. It is therefore reasonable to assume that the accumulation of stressors over a period of time will result into a noticeable increase in the rate of ICD-10 mental health conditions during the next few months.
Should even a small increase in the rate of mental health conditions occur, it is highly unlikely that NHS specialist mental health services will cope, as they have been depleted of resources over a long time and have struggled to cope long before the pandemic. In addition, a recent initiative taken by NHS Trusts to divert entry-level psychological services (such as IAPT) to diagnosing and treating ICD-10 mental health conditions is very unwise, as specialist work goes far beyond their level of expertise.
In the private sector, counsellors/EAPs/basic-grade CBT therapists/charity ‘volunteers’ are referred to by the media as preparing for the expected spike of mental health conditions. This is a further source of concern as these services are not professionally equipped to provide specialist assessments and treatments for ICD-10 conditions.
Recommendation for claims assessors
Grespi clinicians strongly recommend that, when managing mental health claims during the next six-to-eight months, claims assessors should request psychiatric IMEs without delay. This is because untreated mental health conditions, combined with aggravating and/or perpetuating stressors (such as the psychological, economic and social impact of the pandemic), are likely to become more severe and quickly entrenched, making return-to-work prospects more difficult to materialise.
Dr Lorenzo Grespi and Dr William Badenhorst
1 June 2020