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1. Here's a Twitter thread about the latest pre-print paper from @MentalHealthPRU: Experiences of living with mental health problems during the COVID-19 pandemic in the UK: a coproduced, participatory qualitative interview study https://www.medrxiv.org/content/10.1101/2020.11.03.20225169v1
2. Our review of the global literature on early impacts of Covid-19 and 'lockdown' in people with pre-existing mental health problems reported deteriorations in symptoms, impacts of loneliness/social isolation, and lack of access to services and resources https://link.springer.com/article/10.1007%2Fs00127-020-01924-7
3. More positively, were reports resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community.
4. The @MentalHealthPRU survey of mental health staff reported immediate infection control concerns for inpatient staff and challenges of new remote ways of working for community staff. Rapid adaptations/ innovations in response to the crisis were found. https://link.springer.com/article/10.1007%2Fs00127-020-01927-4
5. Staff had concerns about many groups of service users, incl people with conditions exacerbated by pandemic anxieties/social disruptions; those experiencing loneliness, domestic abuse, family conflict; those unable to follow social distancing rules or engage with remote care.
6. People with mental health difficulties have been writing personal accounts of the pandemic. https://madcovid.wordpress.com/mad-covid-diaries-2/ But there was a need for systematic investigations of the views and experiences of the pandemic of people living with mental health problems/receiving care.
7. In response, we conducted a participatory, coproduced qualitative interview study. Methods were adapted to respond to the challenges of working during the pandemic, with all planning, training, support, recruitment, interviews, analysis and writing conducted remotely.
8. A large number of lived experience researchers worked across all aspects of the project and conducted all interviews. The make-up of the teams is described in the paper. We obtained ethical approval to recruit up to 50 adults with pre-existing mental health problems.
9. We sampled purposively via community orgs and social media to achieve diversity re diagnoses, use of mental health services, and demography eg age, gender, ethnicity, sexuality, and from rural and urban areas. We reviewed our sample and targeted ads to increase diversity
10. Interviews were conducted by Lived Experience Researchers using videoconference or freephone on MS Teams. For analysis, we sought to integrate experiential knowledge into the interpretive process, using thematic analysis, coding, charting, reviewing & workshops. All online!
11. Results were produced through an iterative process of analytical writing, with university researchers and LERs working together in small groups to write analytical narrative around exemplary quotes, before refining each theme through team discussion and rewriting.
12. Of the 49 people, most (69%) were female, 78% were age 25-54 years, and two-thirds (69%) identified as heterosexual. A majority (53%) were White British, with 14% Black/Black British and 12% Asian/Asian British (12%) The majority (86%) reported current or recent service use.
13. Five key themes were identified, each with inter-related subthemes reported in the paper.
1. Impact of COVID-19 on everyday life and mental health
2. Impact of changes to mental healthcare
3. Psychological impact
4. Relationships and (dis)connections
5. Unequal impact
1. Impact of COVID-19 on everyday life and mental health
2. Impact of changes to mental healthcare
3. Psychological impact
4. Relationships and (dis)connections
5. Unequal impact
14. Existing mental health difficulties were exacerbated for many. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to community.
15. Remote access, including digital solutions, provided continuity of care for some but barriers for others. People from black and ethnic minority communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health.
16. People with pre-existing mental health conditions experienced serious disruption to their access to, and the quality of, mental health care as a result of the pandemic. The opportunities and challenges of remote mental healthcare were an important aspect of our findings.
17. While for some people, telephone and digital support provided continuity of care, for others there were issues around access to technology, maintaining therapeutic relationship remotely, and digital interfaces exacerbating difficult feelings or mental health symptoms.
18. Inequalities in impact were widespread, including BAME groups’ fears about poorer health outcomes, inequitable treatment, experiences of stigma resulting from perceived link between ethnicity and COVID-19, and direct experiences of racism and the trauma which that invoked.
19. Many responded to difficulties in accessing mental health care by developing their own coping strategies, finding new sense of purpose, turning to other sources of support including the voluntary sector, and finding new ways of connecting to others and to community.
20. Our findings accord with international literature; that the pandemic has exacerbated existing mental health difficulties for many during lockdown, whilst offering a sub-set of individuals relief from some of the stressors of pre-pandemic life.
21. The experiences described reflect the relatively early days of the first wave of the pandemic in the UK, but highlight the need for planned, sustainable, evidence-based adaptation of service provision to minimise further harmful impacts.
22. We suggest that experiential knowledge and service co-design should be at the forefront of future endeavours, with service providers and researchers working in partnership with community organisations and people who use mental health services.
23. Thanks to the whole team and all who promoted and took part in the study. Do read the paper which includes rich quotes, more in-depth descriptions of the themes, and supplementary data. Cheers. 
https://www.medrxiv.org/content/10.1101/2020.11.03.20225169v1.full-text
https://www.medrxiv.org/content/10.1101/2020.11.03.20225169v1.full-text
