Antidepressants, primary care, and adult mental health services in England during COVID-19

The National Health Service (NHS) of England publishes monthly data on national appointment¹ and prescribing activity² in general practice. The total number of appointments in this setting from April 1, 2020, to Sept 30, 2020, was 122 250 549, a 16·51% decrease from the corresponding period in 2019 (146 432 604). This period in 2020 comprises all the data available to date following the first UK COVID-19 lockdown, which began on March 23, 2020. The number of antidepressant prescriptions made in general practice between April 1, 2020, and Sept 30, 2020, was 38 609 032, 3·94% higher than the corresponding period in 2019 (37 144 303). Since child and adolescent mental health services take responsibility for antidepressant prescribing in children, these prescriptions were received by adults.

NHS England also publishes monthly data on the number of people in contact with NHS-funded mental health services (including secondary care and NHS psychological therapies services [IAPT]),³ and the number of new referrals to those services.⁴ The average monthly number of people in contact with adult mental health services between April 1, 2020, and Aug 31, 2020, was 930 576, a decrease by 14·80% from the corresponding period in 2019 (1 092 275). In addition, the average monthly number of new referrals to adult mental health services between April 1, 2020, and Aug 31, 2020 (283 338) decreased by 10·02% from the corresponding period in 2019 (314 885).

In summary, since the beginning of the first UK COVID-19 lockdown, the rate of antidepressant prescribing in general practice substantially increased, whereas the number of people in contact with adult mental health services, and the number of referrals to those services, substantially decreased, compared with the corresponding period in 2019. Furthermore, 2020 represents a considerable anomaly in the trends of these domains since such data have been available since 2015.1, 2, 3, 4

These data suggest the predictions that mental health would be severely affected by COVID-19 were correct.⁵ They also indicate that this increased burden of mental ill-health is being disproportionately managed by pharmacological treatments in primary care, without a corresponding increase in mental health service interventions. Crucially, these findings appear to be explained by reduced rates of referral to mental health services, rather than reduced capacity of these services to provide care.

Although a referral from primary care is required to access some adult mental health services, patients might self-refer to IAPT. The reduced rates of referral could be due to concerns of both patients and primary care practitioners about over-burdening an already-stretched NHS. These concerns appear to be unwarranted and must be urgently corrected with strong and clear messaging for the impact of COVID-19 on mental health to be optimally addressed.