There's a worsening mental health recession

There’s a worsening mental health recession

Employee assistance programs are usually pretty boring business. For the past few decades, employers have been paying EAP providers to set up hotlines that their employees can call if they need help with personal issues. The idea is to provide short-term support – a handful of counseling sessions, for example – to help staff deal with mild problems before they become serious.

But this year, EAPs have found themselves dealing with a growing wave of complex mental health issues presented to them by people with nowhere to go.

“We were never meant to be a crisis line,” says Bertrand Stern-Gillet, who runs Health Assured, the UK’s largest EAP provider with more than 80,000 customers. But he says ‘high risk’ calls have now become a daily occurrence, ranging from child or adult protection concerns to someone who ‘could have taken a significant amount of pills or been standing on a bridge’. The company is hiring more employees and managers to try to cope with the growing complexity and emotional intensity of the job.

Andrew Kinder, manager of mental health services at Optima Health, another EAP, hosted a webinar on bereavement for a client’s employees. He was expecting around 40 attendees, but 1,200 tuned in. “People were actually sharing quite a lot of experiences about what they had been through,” he says.

The use of antidepressants is also on the rise. In 2021/22, 8.3million patients received at least one prescription for antidepressants in England, according to NHS data, up 22% from 2015/16.

Column chart of number of patients prescribed antidepressants (mins) showing that last year more than 8 mins received at least one antidepressant prescription

What’s going on? On the positive side, people have become more comfortable discussing their mental health and asking for help. It’s an improvement on the past when “we had this underlying need that wasn’t even talked about,” says Vicki Nash, policy manager at mental health charity Mind.

But it is clear that this is not the whole story. The loneliness, worry, grief and financial problems caused by Covid-19 and associated lockdowns appear to have taken a toll on the mental health of people around the world.

In the first year of the pandemic, the global prevalence of anxiety and depression increased by 25%, according to the World Health Organization. In the UK, young people are of particular concern: one in nine children aged 6 to 16 had a probable mental disorder in 2017; in 2021 it was one in six, according to NHS data.

At the same time, mental health services in many countries have been disrupted by the pandemic and have had to cope with increased demand. In the UK, waiting for treatment has become so common that Greater Manchester has set up a service called ‘Waiting Well’ to support people while they wait. But the longer people have to wait, the worse they tend to get. Nash says people can be turned away because they’re not sick enough to qualify for treatment, “so they have to wait until they get dangerously sick.”

A study of the experience of people on waiting lists interviewed a woman who said, “I didn’t shower, I didn’t get out of bed because I thought in my head, I thought maybe if I stay in bed long enough someone will come and cut me and then I’ll get help.

Stern-Gillett of Health Assured says some GPs tell patients to contact their EAP provider if they have access to it, as they are “more likely to get some sort of support faster than NHS pathways”.

On top of that, the UK has now been hit by a severe surge in inflation and a likely recession. The people most vulnerable to a sharp decline in the standard of living are those whose incomes are low and precarious. They’re also more likely to have poor mental health — issues that often compound each other.

A recent report by the Joseph Rowntree Foundation highlighted the striking link between antidepressant use and deprivation: in 2021/22, more than twice as many patients were prescribed antidepressants in practices in the poorest areas. more deprived areas of England than in the less deprived areas.

Column chart of number of patients prescribed antidepressants by IMD* decile showing that antidepressants are more commonly prescribed in poorer areas

The problem with relying more on employers to provide mental health support during this time is that not everyone has access to such programs. People on low wages, with precarious contracts or without work at all are less likely to benefit from such a safety net.

They will need as much help as the cash-strapped state can spare. Some interventions don’t need to be very expensive, such as integrating talk therapy with debt counseling. Other policies that would help are already on the table but need to be implemented, such as government plans to make life in the rental sector less precarious.

Leaving people to fend for themselves will create more problems, both for them and for the economy as a whole. Already, a growing proportion of people say they are too sick to work. Although the over 50s are the main driver of this trend, there is also a worrying increase in inactive young people. For them, the main cause of long-term illness is mental illness, phobias and nervous disorders, up 24% since 2019.

Economic problems are difficult for people at the best of times, and this is not the best of times. How well or badly we handle this moment will have ramifications in the future.

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