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Table of Contents
Year : 2023  |  Volume : 5  |  Issue : 1  |  Page : 84-86

A Pandemic Presidency: How RCPsych Responded and How we Take forward the Recovery

Royal College of Psychiatrists, London, England

Date of Submission09-Mar-2023
Date of Acceptance09-Mar-2023
Date of Web Publication26-Apr-2023

Correspondence Address:
Dr. Adrian James
Royal College of Psychiatrists, London
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wsp.wsp_9_23

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Having become President of the Royal College of Psychiatrists in July 2020, Dr. Adrian James had a first-hand experience of how the health-care system in England responded to the pandemic. This article explores the College's response to COVID-19's impact on mental health services and how they worked to support psychiatrists and patients alike. It also reflects on how the long-term implications of the pandemic on mental health are just starting to come to light, as well as some of the new challenges facing psychiatry worldwide.

Keywords: COVID-19, guidance, mental health, pandemic

How to cite this article:
James A, Gibbons E. A Pandemic Presidency: How RCPsych Responded and How we Take forward the Recovery. World Soc Psychiatry 2023;5:84-6

How to cite this URL:
James A, Gibbons E. A Pandemic Presidency: How RCPsych Responded and How we Take forward the Recovery. World Soc Psychiatry [serial online] 2023 [cited 2023 Jun 10];5:84-6. Available from: https://www.worldsocpsychiatry.org/text.asp?2023/5/1/84/374627

Although quietly and largely away from the public eye, mental health services and psychiatry have been central to the health-care response to the COVID-19 pandemic.

The abundance of data collected throughout the pandemic has shown that hundreds of thousands of patients have been admitted to hospitals with COVID-19, and as of Friday, January 13, 2023, 217,705 people were reported to have COVID-19 on their death certificate in the UK.[1]

However, only recently has the true impact of the pandemic on the nation's mental health started to come to light. The National Audit Office's 2023 report Progress in improving mental health services in England highlighted that 4.5 million people were in contact with National Health Service (NHS)-funded mental health services during 2021–2022, a historically high figure.[2]

Going back to the beginning, it was announced just 2 months before March 2020 that I would be the next President of the Royal College of Psychiatrists. In July of that year, my “pandemic presidency” began, and I was thrown into what would be one of the most challenging periods in the NHS's history.

The College had already begun working in partnership with NHS England and others to publish comprehensive guidance – as well as podcasts and videos – on our website for clinicians on how to deliver mental health services in the middle of the pandemic. We started to publish this guidance within days of the first lockdown, and it was viewed almost 500,000 times during 2020 – with 21% of those views coming from overseas.

Among this guidance was the important work of the College's Task and Finish Group, which was convened in April 2020 to explore the disproportionate impact of COVID-19 on Black, Asian, and minority ethnic health-care staff. The group looked to rapidly produce guidance and recommendations for risk assessment and mitigation to protect them in mental health-care organizations across the UK.

Despite so much adversity, the College itself continued to provide its vital services. One of the most considerable projects ever run by our College was the digitization of our examinations which saw us deliver the biggest virtual clinical examination by a medical royal college. On top of this, we switched our traditional model for supporting our quality network members from an in-person model to one that was virtual. We even set up a COVID-19 Mental Health Improvement Network, on behalf of the NHS, to support mental health teams to share and learn from each other and maintain and improve safety in response to COVID-19.

We now know that having an existing severe mental illness (SMI) or a severe intellectual disability can be a risk factor for both contracting COVID-19 and becoming seriously unwell with it. Throughout the pandemic, the College engaged positively with the UK government to ensure that people with SMI or severe and profound intellectual disability were not forgotten in prioritization for the COVID-19 vaccine. We also supported action to ensure uptake among these patients, including promoting the work of organizations like equally well.

I am incredibly proud of the extensive time and dedication put in by the College to support members and patients alike.

Throughout the latter part of 2020 and beyond, it was becoming ever clearer that the intensive work of psychiatry and mental health services was only just beginning.

In October 2020, a Savanta ComRes poll of 513 British adults diagnosed with a mental illness revealed that two-fifths of patients waiting for treatment contacted emergency or crisis services, with one in nine ending up in A and E.[3] It was becoming obvious that many people were not getting the help they needed quickly enough.

In March 2021, the College showed that there was a “hidden epidemic” of eating disorders caused by COVID-19. A paper analyzing data from HOPE Provider Collaborative found that the average number of referrals increased by 20% from March 2020 to November 2020, when compared with data from July 2018 to February 2020, and waiting times also increased.[4] We consistently called on the government to urgently address the surging numbers of people needing help.

One group that has been particularly affected by the pandemic is children and young people. Eighteen months after the first lockdown in the UK, 190,271 0–18-year-olds were referred to children and young people's mental health services between April and June, up 134% on the same period the previous year and 96% on 2019.[5]

Now, despite the acute disruption of the pandemic slowly coming to an end, we know that an estimated 1.2 million people were on the waiting list for community-based NHS mental health services at the end of June 2022.

We simply cannot ignore these eye-watering figures. Mental health recovery is likely to be a long road without sufficient resources to support it.

I truly hope that the collective hard work from the College over the last 3 years has put us in a good place to take forward the recovery. I have been blown away by the progress we have still managed to make on my four presidential priorities: parity of esteem, championing equality, diversity and inclusion, supporting the workforce and sustainability.

I have remained determined that mental health should be placed on an equal footing to physical health throughout COVID-19. Through my meetings with the Secretary of State for Health and Social Care, Chief Medical Officer Chris Whitty, and leaders within the NHS, I ensured that the effect of the pandemic on mental health was made crystal clear. Importantly, I know that my counterparts in the Devolved Nations have also done the same.

Through the College and partners influencing work, the 2020 Spending Review committed £500 m for a COVID-19 Mental Health Recovery plan to help address waiting times for mental health services, give more people the mental health support they need and invest in the NHS workforce. This went some way to making a difference for people with mental illness. However, we continued to campaign for more long-term investment in mental health buildings, the workforce and funding for patients discharged from the hospital.

It was through our Equality Action Plan, published in January 2021, that the College set out how it planned to promote equality and equitable outcomes for College members, staff, mental health staff, and patients and carers. Having embedded our College values of Courage, Innovation, Respect, Collaboration, Learning, and Excellence – which promote respect for diversity – we are committed to promoting equality and equitable outcomes and remain opposed to all forms of discrimination.

I have personally contributed to the work of the NHS Race and Health Observatory, supporting their ambition to improve equality in health care. As a College, we have been working toward tackling the differential attainment of different groups of doctors through piloting and evaluating training support and engagement activities. We also launched the Advancing Mental Health Equality Collaborative, which aims to help mental health-care providers to reduce inequalities in their local areas.

We practice what we preach, too. The College has been recognized as the UK's 90th top employer for LGBTQ+ inclusivity and awarded Stonewall's Gold Award, recognizing our commitment to equality, diversity, and inclusion.

We know that the pandemic has taken its toll on health-care staff worldwide, with mental health and well-being, particularly affected. The College has played its role in supporting staff, in part, through the launch of the Enjoying Work Collaborative, which supplies opportunities for health-care teams from across the UK to use quality improvement techniques to help their staff gain more enjoyment from the vital work that they do.

Alongside this, we have been supporting the recruitment of more psychiatrists through our Choose Psychiatry campaign. In 2022, it entered its 6th year and extended its remit to encourage core trainees already working in the profession to remain, by Continuing to Choose Psychiatry, too.

In October 2020, despite being in the middle of fighting the COVID-19 pandemic, the NHS became the world's first national health system to commit to becoming “carbon net zero.” Understanding that action should be taken now, the College published its position statement declaring a climate and ecological emergency in May 2021. This set out a series of pledges for the College to work toward and recommendations for the NHS, the UK government and medical education, and academic and research organizations.

I am so pleased that we took this crucial step to highlight the devastating health impacts of the climate crisis. In October 2022, it was announced that as part of a cross-sectional survey examining health organizations sustainability credentials, the Royal College of Psychiatrists was named as second in the leaderboard of 28 other UK health organizations in terms of the action it has taken.[6]

Unfortunately, we are now facing other challenges to mental health at home and abroad. During the College's 2022 International Congress, I said that the cost-of-living crisis poses a threat of “pandemic proportions” to mental health. Food insecurity, fuel poverty, debt, and the loneliness that come with it are likely to increase pressure on mental health services.

Furthermore, the College has been responding to a series of crises abroad. We were incredibly shocked and saddened by the events unfolding in Ukraine and we have been working hard to ensure we give the most effective response we can to the crisis. In April 2022, we launched a new resource to support the mental health of asylum seekers and refugees, which we hope will support those facing a humanitarian crisis and ongoing conflict. We have also used our body of knowledge to respond to the unfolding crisis in Turkey/Syria, Afghanistan, and the floods in Pakistan.

Yet, it is the lessons we have learned from the last 2 years that have placed us in good stead for the future.

We are in a better position to respond to disasters.

We also know how to look at and deal with inequalities – the work of the College's new Public Mental Health Implementation Centre does just that.

The demanding work to digitize many functions of the College means we are a more modern and thriving organization than before.

We have built up an enormous wealth of expertise, which I hope will help many others.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

England Summary Coronavirus (COVID-19) in the UK; 2023 Available from: https://coronavirus.data.gov.uk/. [Last accessed on 2023 Feb 13].  Back to cited text no. 1
National Audit Office. Progress in Improving Mental Health Services in England; 2023. Available from: https://www.nao.org.uk/wp-content/uploads/2023/02/Progress-in-improving-mental-health-services-CS.pdf. [Last accessed on 2023 Mar 21].  Back to cited text no. 2
Two-fifths of Patients Waiting for Mental Health Treatment Forced to Resort to Emergency or Crisis Services; 2020. Available from: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2020/10/06/two-fifths-of-patients-waiting-formental-health-treatment-forced-to-resort-to-emergency-or-crisis-services?searchTerms=mental+health+crisis. [Last accessed on 2023 Feb 14].  Back to cited text no. 3
Hidden Epidemic of Eating Disorders Because of COVID-19, New Research Finds; 2021. Available from: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/03/01/hidden-epidemic-of-eating-disorders-becauseof-covid-19-new-research-finds. [Last accessed on 2023 Feb 13].  Back to cited text no. 4
Record Number of Children and Young People Referred to Mental Health Services as Pandemic Takes its toll; 2021. Available from: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/09/23/record-number-of-children-and-young-people-referred-to-mental-health-services-as-pandemic-takes-its-toll?searchTerms=children+pandemic. [Last accessed on 2023 Feb 13].  Back to cited text no. 5
Cooke E, Cussans A, Clack A, Cornford C. Climate change and health scorecard: What are UK professional and regulatory health organizations doing to tackle the climate and ecological emergency? J Clim Chang Health 2022;8:100164.  Back to cited text no. 6


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