# Trends in mental health referrals before, during and after the COVID-19 pandemic: retrospective population-based service evaluation in a single NHS trust

## TL;DR

This study examines how mental health referrals and activity in a UK NHS trust changed during and after the COVID-19 pandemic.

## Contribution

The study provides insights into the long-term increase in mental health service demand post-pandemic and highlights resource gaps.

## Key findings

- Referrals and clinical contacts dropped sharply during lockdowns but rose steeply afterward.
- The increase in mental health activity post-pandemic has been sustained over time.
- The surge in demand was not matched by increased resources in the mental health trust.

## Abstract

The COVID-19 pandemic caused by the SARS-CoV-2 virus was the biggest global health emergency in the past century. The impact of the pandemic on society, and demand for health services, especially mental health services is not fully understood.

We describe the change in activity in a single UK NHS mental health trust during and following the pandemic.

We conducted a retrospective service evaluation using a population-based referral rates and clinical activity for mental health disorders in Cambridgeshire over the period 1 January 2017 to 31 December 2023. We divided the time period into pre-pandemic period, during the pandemic, and post-pandemic months. A negative binomial regression model was fitted to the monthly rates to yield incidence rate ratios. Subgroup analyses were performed by age, gender, ethnicity, and level of deprivation.

There was a steep decline in both referrals and clinical contacts during the lockdowns with a subsequent and steep increase in these measures during the immediate post-pandemic period. Increased numbers of referrals and contacts have been sustained well into the post-pandemic period.

In a single county-wide mental health service in the UK, the prolonged and sustained increase in both referrals and activity post-pandemic was not matched by equal increase in resource to meet demand. Our findings may be useful to effectively plan mental health services before, during and after any future pandemics.