One of the region's biggest NHS trusts has a new boss - and he's hoping to "get on the front foot" and begin tackling the "huge surge" in demand the pandemic has seen for mental health support.
James Duncan is the new chief executive of the Cumbria, Northumberland, Tyne and Wear NHS Trust - which is one of the largest mental health and learning disability trusts in the country.
After more than 20 years at the Trust, he's stepping up to the top job to replace the retiring John Lawlor - and though he accepts Covid-19 has exacerbated a "really challenging" situation in both mental health and learning disability care, he's keen not to dwell on how hard things may be and to instead begin tackling the backlogs.
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Speaking to ChronicleLive, he said: "We all know that the pandemic has had a massive impact - and the message to get across is that the impact it's had on vulnerable people has been disproportionate, too. There are two pandemics happening. There's this massive impact on the vulnerable, massive disruption for them.
"And it's all the fear and anxiety. That's where our space is - supporting the vulnerable is where we work and what we do."
He explained that with issues like addiction among those exacerbated by the pandemic, it was a priority to help tackle what he called a "national disgrace" - that "over the last ten years deaths arising from addiction have been going up year on year".
"With addiction we have seen a huge decline in the support available - and we are seeing the impact of that now - and one of the big worries for the coming years is how that's been exacerbated by the pandemic. We need to get out of a blame culture and recognise that people need support in the community."
James, who lives in Gateshead, added that - like elsewhere in the health service, demand for care had rocketed and that this was especially pronounced in some areas.
"As you will know, we are experiencing real pressures developing on services. For example, in children and young people's services, demand has gone through the roof. It's increased massively. And that's going to be related to young people having been isolated, having been stuck away from friends [during the pandemic]."
James said that while CNTW had done its best to keep services going through the Covid-19 crisis - and to do as much face-to-face as it could, this had not always been possible.
"Particularly at the beginning of the pandemic, we had to do a lot virtually," he said. "We have tried to do as much face-to-face as possible but the demands have been significant. But we've seen that across the board.
"Unfortunately what we are tending to see is people presenting with more complex issues because they have had to deal with things themselves and not come forward during the pandemic."
For many years the availability of hospital beds for mental health patients has been a contentious issue - a recent study from Newcastle academics found the number of beds available for psychiatric patients had fallen by 93% since 1960.
While the new chief exec said he recognised a "particular pressure on inpatient beds at the moment", he said: "One of the key things to focus on is having a 'rights-first' approach. Admission to an inpatient unit should be because it is absolutely required - whereas often people can be admitted because we don't have the right support in the community. We will be doing a lot of work with our partners to ensure that community network of support is there."
He said CNTW was looking to improve the mental health referral process and to work with primary care, local authorities and charities to ensure people aren't "bounced around the system".
"We've done lots of the groundwork but with the pandemic there are things it's been really hard to get off the ground.
"It's absolutely with the priority to be helping someone to return to the community as quickly as possible. I really don't think it's an issue of too few beds - it's how do we manage those pathways to make sure people can recover as quickly as possible and do so as close to their families as communities as they can be."
James said "about 98%" of the people supported by CNTW were cared for in the community. He explained that the same philosophy - of trying to ensure, where possible people were cared for out of hospital and as close to their family as possible - was applicable to caring for people with illnesses such as eating disorders and people who may have complex learning disabilities or autism.
The idea of working more frequently in collaboration with other organisations was one of James' priorities, he said.
"Now's the time time to put our hands up and build back and power our recovery.
"I don't mean that just around managing recovery and waiting times. It's about the whole practice of psychological wellbeing. We need to get back on top and be feeling confident in our ability to cope.
"There are a lot of things we are working on that's been hard to take forward during the pandemic. We have been doing a lot of reflection, a lot of talking.
"It's not just what we do here at CNTW, it's what we do in partnership with the voluntary sector and working with GPs and the local authorities. Recently we have been putting a lot of effort into looking at what we can do working with the voluntary and community sector."
He spoke of how initiatives such as implementing "mental health support teams" in schools around the region would hopefully help catch the warning signs of mental health conditions in young people - before they worsened.
"Some of this will take time. There's not a magic solution to solving the pressures on our services but we have to think about how we manage the medium and long-term," he said.
"That's very much going to be about working in partnership with other organisations rather than simply doing things ourselves."
James also spoke of how the pandemic had had a huge impact on the NHS trust's staff. He said: "It's really hard for our staff.
"There's been a lot of absence, particularly during the most recent wave - with a lot of people having to self-isolate. And they are all people too. We all have families and we've seen the impact on people around us."
The incoming boss said he was passionate about "changing the conversation" around people with learning disabilities, autism and complex needs. He said the Trust was doing everything it could to be an autism-friendly organisation.
Speaking about how often inpatient care could exacerbate difficult situations for people with complex needs, he added: "Sometimes people call it 'challenging behaviours'. But often it's the environment that's challenging, not the person. So again the challenge is how do we best support someone to live in their own communities. We need to work with people who have the most complex needs."
