New research has found that the number of people seeking support from their general practice for mental health problems or self-harm dropped by more than a third during the first UK national lockdown.

Researchers, including Professor Carolyn Chew-Graham from Keele University’s School of Medicine, discovered that during the first full month of the UK-wide lockdown in April 2020, when many people were following the stay at home and protect the NHS order, the number of incidents of depression recorded by GPs dropped by 43%, anxiety disorders by 47.8% and prescribing of antidepressants also reduced by 36.4%.

The research, published in the Lancet Public Health, involved data from 14 million people registered at general practices across the four nations of the UK, and was conducted by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC) which is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust. The research was jointly funded by the NIHR and UK Research and Innovation as part of their COVID-19 Rapid Response Initiative.

Patients registered with practices in deprived areas, were observed to have the largest decreases in both help-seeking and referrals to mental health services. Additionally, the number of people presenting with self-harm was 37.6% lower than expected in April and the reduction was greatest for females and those aged under 45. Consequences of this unmet need could include increases in severity of mental illness, increases in self-harm and suicide, and widening of pre-existing health inequalities.

Professor Carolyn Chew-Graham, a GP in Manchester and Professor of General Practice Research at Keele University, said: "This research mirrors my clinical experience. Consultation rates reduced in April and May, with people following the ‘Save the NHS’ message. Since the early summer we have noticed increasing demand and, particularly, increasing distress in patients presenting to the practice.

“The impact of this work for primary care is that we need to make it as easy as possible for people who are distressed to consult their GP, but balance this with the need to keep footfall as low as possible in the practice, in accordance with NHSE guidance and Covid-19 restrictions. Primary care clinicians need to ensure that when consulting patients remotely, they offer time, empathy and understanding and encourage people to disclose their concerns, which both parties might find more difficult in telephone or video consultations. Managing risk and dealing with uncertainty are now even more important for primary care clinicians.”

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “It is widely believed that there was an increase in the number of people with symptoms of mental illness in April due to the extra pressures from the lockdown. However, our research has revealed a sharp reduction in consultations. GPs adapted quickly to the pandemic which can also be seen in our analysis of the data as diagnosis levels returned to near normal in England by September 2020, but this did vary for the other three UK nations.”

Dr Carr, continued: “We believe this research is so important because it shows the scale of the drop in the number of people seeking help, and, crucially, the treatment gaps, such as reduced referrals onwards to mental health services. By knowing where the treatment gaps are, steps can be put in place to address this and improve patient care and safety.”

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at The University of Manchester jointly led the research, and said: “It is understandable that people didn’t seek help at the height of the pandemic in the spring. However, GPs moved quickly to offer remote consultations for many appointments, and it is important that people seek support if they are worried about their mental health. The consequences of patients not receiving help when they need it could result in further struggles for those individuals.

“This research has shown how addressing delays in diagnosis and treatment for mental illness and self-harm needs to be a priority, particularly for the groups of people we’ve identified as experiencing the biggest treatment gaps. As we manage on-going fluctuations in Covid-19 rates, we hope our research findings can be used to inform public health messaging targeted at specific groups of patients which will help to improve patient safety in the near future.”

Professor Dame Til Wykes, senior NIHR mental health researcher, said: "As this research makes clear, now is not the time to suffer in silence. More than ever, people experiencing depression, anxiety and other mental health issues should seek the help they need from the health service, and family and friends".

“NIHR have recognised the challenges that mental health issues have posed during COVID-19 so have funded this project with UKRI as well other research to investigate and reduce the impact of the COVID-19 pandemic on mental health.”