Lay Summary

During the COVID-19 pandemic, we contacted 367 people with severe mental ill health to ask them about their physical and mental health, health risk behaviours (smoking, drinking, exercise and diet), access to the internet and NHS health services. We found that when people’s mental health didn’t get any worse, their physical health generally didn’t get worse either. For people whose physical health got worse, they were also likely to be doing less exercise, eating less fruit and vegetables, smoking more and drinking more alcohol. When asked about health services we found people had a better experiences of face to face appointments than with phone or online appointments. Crucially we also found that almost half of people with severe mental ill health did not have basic digital skills. This is important because we have learnt that supporting people with severe mental ill health to maintain physical activity and maintain a daily routine, as well as increasing digital skills, can help prevent further health inequalities.

Background

The COVID-19 pandemic has had major implications for mental health and those with existing mental health problems are most at risk. Furthermore, COVID-19 has exacerbated existing inequalities. People with severe mental ill health (SMI) are a group who already experience significant health inequalities and are less likely to take part in online surveys due to lack of access to digital technology. It is therefore important to understand the experiences of people with SMI to mitigate against a further increase in health inequalities.

Methods

A sample of people with SMI, who were members of an existing cohort and had consented to being contacted about future research, were telephoned and invited to take part in a survey. Sampling was by age, gender and ethnicity. People who wished to take part were offered the option of completing the survey over the phone, online or having a hard copy sent in the post. Participants answered questions about physical and mental health, health risk behaviours, digital connectivity and access to health services.

Results

367 people were recruited to the study between July 2020 and December 2020. Whilst there was a mixture of experiences, people who did not experience a deterioration in their mental health were less likely to experience a deterioration in their physical health. In addition, people reported a deterioration in their physical health were more likely to report an increase in health risk behaviours. Being able to maintain a daily routine was a protective factor with regards to both physical and mental health. People who were seen face to face for health care appointments were more likely to state that their needs had been met compared to those who had their appointment on the phone or online. 61.6% of our sample reported being limited users or no users of the Internet; the main reasons for that being lack of interest in the Internet or finding it too difficult.

Conclusion

COVID-19 is likely to lead to an increase in health inequalities for people with SMI. Maintaining physical health and a daily routine are protective factors, therefore supporting people with their physical health and daily routine is important to mitigate against an increase in health inequalities. Furthermore, as many people with SMI lack digital skills, ways to increase digital skills in this group need to be explored.