Beyond the lockdowns: Lessons learned from Leicester's COVID story
The impact of COVID-19 on mental health
The COVID-19 pandemic had an extreme effect on the population’s mental health and the long-term psychological effect is still unknown. For some populations, the effects of the pandemic were short lived but for others, they experienced greater long-term risk of worsening mental health. These populations at risk include:[i]
- people living with mental health problems, whose access to services has been interrupted
- people who live with both mental health problems and long-term physical conditions that put them at greater risk of the virus
- women and children exposed to trauma and violence at home during lockdown
Level of need
Estimates suggest 43,625 working age adults (aged 18-64 years) had a common mental health problem and 3,772 older people (aged 65 and over) had depression in Leicester in 2020 [ii][iii]. The number of patients on the clinical registers for mental health treatment in GP practices can be used to estimate levels of common mental health problems in the community. Prior to the COVID-19 pandemic, as of March 2020, Leicester City GP practices recorded 4,426 patients on a clinical register for Mental Health treatment. This means about 1.05% of the GP practice population were having mental health treatment. Men were slightly more likely than women to be on the register, but this varied with age. In younger ages (20 to 54 year old) there were more men on the mental health register whereas in older age bands (55 to 85+ year old), women were more likely to be on the register.[iv]
Like all health issues, mental health problems are not equally spread throughout the population and inequalities in mental wellbeing exist. The map below highlights the variation in Mental Health diagnoses throughout the city. It shows significantly higher rates of mental health patients compared to the Leicester average in New Parks, Braunstone, Eyres Monsell, Saffron, Highfields, North Evington and Belgrave.
Figure 1: Mental Health Patient Register by Middle Super Output Area in Leicester (2019/20) [iv]
As of March 2022, the number of patients on the clinical register for Mental Health treatment was 4,475 patients, equating to an identical 1.05% of the GP practice population compared to pre-pandemic times. [v]
When looking at treatment for depression specifically, the percentage of the population aged 18 years and above recorded with depression increased throughout the pandemic both nationally and locally. In Leicester City, the prevalence increased from 10.2% to 10.8% from March 2020 to March 2022, which in real world terms is equal to an additional 2,500 patients being treated for depression. The national prevalence has increased at a faster rate, from 11.6% to 12.7%. Throughout this time, the prevalence of depression in Leicester City has remained significantly lower than the national average. [iv][v][vi]
Figure 2: Trend of Recorded Depression Prevalence in Leicester GP data and England, 2019/20 – 2021/22 [iv][v][vi]
It’s important to note that this is only a snapshot of the current picture and it is likely to be an underestimate of level of need in the population since not everyone will be seeking treatment.
It is difficult to estimate the future demand for mental health care as we move into post pandemic times. Estimates suggest that the prevalence of common mental health disorders in the working age population is expected to increase by 1.2% in 2025 and by 5.6% in 2035. The prevalence of depression in older age groups are expected to rise even further by 13.6% in 2025 and 39.1% in 2035. However, due to cost of living crisis and the known impact of economic recession on rates of depression, anxiety, substance abuse disorders and suicidal behaviour, it is likely that demand will go above and beyond these estimates.[vii]
How are you, Leicester?
As always, it is important to recognise the impact of the COVID-19 pandemic in exacerbating and further entrenching existing health inequalities. All local recovery plans must include mental health recovery, with an eye on the disparities across the population.
This survey also reported that people’s perceptions of their mental wellbeing were more varied than their perceptions of their physical health, highlighting the complexity of what people feel constitutes an individuals’ mental health status compared to physical health. However, a higher share of “very good” health responses for mental health were received than for physical, suggesting more people felt happier with their current mental health than physical. [viii]
The main factor reported by Leicester City residents influencing mental health and wellbeing were finances.[viii] A national study highlighted links between worsening mental health and concerns over finances or employment and deteriorations in these factors post pandemic.[x] It is important to be mindful that the experience of the pandemic may have reduced individuals’ resilience to further crises, with some people less able to cope. This places greater urgency on concerns of the consequences of the cost-of-living crisis for mental health for our residents.[ix]
Things like access to healthcare and living environment were mentioned by survey respondents as likely to influence mental health.[viii] During the pandemic, housing conditions and access to green spaces will have impacted on mental health differently depending on where individuals lived and their type of accommodation. Those in crowded homes or with less access to outdoor space would have been more greatly affected by restrictions during lockdown.[x] A local community engagement project with older individuals and mental health service-users highlighted that a key challenge of the pandemic was the difficulties vulnerable populations faced in accessing the health and social care support they required. This finding underlined the importance of vulnerable populations having alternative tools and ways of accessing supporting services to maintain their health and wellbeing.[xi]The importance of community connection
During the pandemic, digital connection and digital literacy played an important role in creating connections, promoting better wellbeing and sustaining mental health, for both the older and mental health service user populations. Using technology, such as video calls, has been proven to have the potential to promote better mental health, wellbeing, as well as reduce alienation and loneliness [xiii][xiv] and should be continued, if face to face options are not possible. The council’s programme ‘Let’s get digital’ aims to help people get online and feel confident in their digital skills so that they can take advantage of remote support offers. More detail on this programme, and other activities to help bring people together can be found on our website.
As well as understanding the distinct difficulties faced by these populations in the pandemic, our engagement work highlighted the level of resilience in the face of adversity that exists throughout our local population. Many individuals coped through the pandemic’s restrictions by taking up new pass times such as gardening or finding alternative ways of living by getting more in touch with nature.[xi]
Working with communities
During the COVID-19 pandemic it was our privilege to work with many different communities in Leicester, and to be inspired by and to learn from their inventiveness and resilience in the face of adversity. Here are just a few examples of some of the work done over the past two years:
Care leavers are one of the groups who were hardest hit by COVID restrictions. Given that they are already at risk of social isolation and financial hardship, the extended period of lockdown made things particularly difficult for this group of young people. Recognising this, the Young People’s Council and Care Experienced Consultants created a social media campaign called “Quaranteen’s” to help support young people living through lockdown.
As part of the “Community Vaccine Champions” scheme, administered by the department for levelling up, housing and communities, Public Health engaged with 28 groups during the pandemic who had reach into local communities and who felt able to tackle vaccine hesitancy within their populations. One of the groups that we engaged with was “BrightSparks”. This is an arts in mental health group dedicated to improving the prognosis of mental health service users and in promoting positive images of mental health through programmes of artistic activities, performances, exhibitions and publications.
‘It has been my pleasure working with Edd Quick and the Public Health Team at Leicester City Council to promote COVID Vaccination Awareness to the Mental Health Community. It has had such a positive impact on our Mental Health Service Users to know that they are valued by the Council and welcomed at events such as The Riverside Festival. You cannot underestimate the value of this work and the fact that lives may have been saved’ Tim Sayers MSc RMN Project Manager BrightSparks: Arts in Mental Health Group & Arts in Mental Health Co-ordinator Leicestershire Partnership NHS Trust.
Leicester City Council have also worked closely with Arts in Mental Health Co-Ordinator’s at Leicestershire Partnership NHS Trust during and post pandemic. Their work has been essential in delivering an evidence-based recovery model of care by allowing service users to develop positive creative identities whilst engaging in meaningful artistic activity. These projects have been highly successful in engaging ‘hard to reach’ and vulnerable mental health service users. Examples of their work include informal arts workshops, ukulele-based workshops, creative writing groups, ‘Open Libraries’ and a creative gardening group to name but a few.
“What a wonderful project to be involved with! To work with the great Vishal Joshi producing beautiful artworks which will be promoting COVID vaccination to the mental health community. Big thanks to Leicester City Council for giving us this opportunity.” Mental Health Service User Artist Member of The ArtSpace Arts Group based at The Attenborough Arts Centre.
“A couple of weeks ago we saw a goldfinch and a bull finch in the garden, it’s a kind of oasis. It's nice to have a peaceful space in the middle of the city. A lot of us don’t have our own gardens.” Green Room Gardeners
“The most important thing for me is that I feel safe, respected, and am in a place where I am not judged.” Arts in Mental Health Attendee
Our sources
[i] The Centre for Mental Health (2020) COVID-19: understanding inequalities in mental health during the pandemic. Available at: CentreforMentalHealth_CovidInequalities_0.pdf
[ii] Institute of Public Care (2022) Projecting Adult Needs and Service Information. Available at Projecting Adult Needs and Service Information System (pansi.org.uk) Based on the report Adult psychiatric morbidity in England, 2007: Results of a household survey, published by the Health and Social Care Information Centre in 2009
[iii] Institute of Public Care (2022) Projecting Older People Population Information. Available at Projecting Older People Population Information System (poppi.org.uk)
[iv] NHS Digital (2020) Quality and Outcomes Framework, 2019-20. Available at: Quality and Outcomes Framework, 2019-20 - NHS Digital
[v] NHS Digital (2022) Quality and Outcomes Framework, 2021-22. Available at: Quality and Outcomes Framework, 2021-22 - NHS Digital
[vi] NHS Digital (2021) Quality and Outcomes Framework, 2020-21. Available at: Quality and Outcomes Framework, 2020-21 - NHS Digital
[vii] Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–824. Erratum in: Lancet Psychiatry. 2021;8(7):e16. Review
[viii] Leicester City Council (2022) How are you, Leicester? Health and Wellbeing Consultation.
[ix] The Health Foundation (2022) The continuing impact of COVID-19 on health and inequalities. Available at: The continuing impact of COVID-19 on health and inequalities - The Health Foundation
[x] The Health Foundation (2021) Unequal Pandemic, Fairer Recovery - The COVID-19 impact inquiry report
[xi] De Montfort University (2022) Community Engagement: Social Isolation and Coping with COVID-19 in Leicester
[xii] Melam, C., & Sanderson, J. (2021). How social prescribing has adapted during the COVID-19 pandemic. NHS Confederation. Available from https://www.nhsconfed.org/articles/how-social-prescribing-has-adapted-during-covid-19-pandemic
[xiii] Havers, R., Durrant, H., & Bennett L. (2021). The role of communities and the use of technology in mitigating loneliness during the pandemic. Wales Centre of Public Policy. Available from https://www.wcpp.org.uk/publication/the-role-of-communities-and-the-use-of-technology-in-mitigating-loneliness-during-the-coronavirus-pandemic/
[xiv] Liddle, J., Pitcher, N., Montague, K., Hanratty, B., Standing, H., & Scharf, T. (2020). Connecting at local level: Exploring opportunities for future design of technology to support social connections in age-friendly communities. International Journal of Environmental Research and Public Health, 17(15), 5544. https://doi.org/10.3390/ijerph17155544