Mental health care in England a ‘national emergency’

Mental healthcare services are “overwhelmed” and unable to cope with the big increase in people seeking help since the pandemic, according to the NHS Confederation, which represents NHS trusts and other NHS bodies.

The organisation has collected evidence from NHS trusts showing that every year thousands of people undergoing a mental health crisis are being admitted to acute hospitals, even though the hospitals are not designed to deal with them. This is because there are no beds free in specialist psychiatric facilities or other help available.

People experiencing a mental health crisis are spending up to 50 hours in A&E because NHS support for them outside hospitals is so limited, NHS Confederation added.

“Mental health has slipped down the government’s set of priorities and patients and services are being forgotten. This is a national emergency which is now having serious consequences across the board, not least for those patients in crisis,” Matthew Taylor, the chief executive of the NHS Confederation, told the Guardian.

“People are coming to A&E and having to wait very long periods of time either to be admitted or found the right package of care for those needs in the community,” he added.

“NHS leaders say that this is now leading to thousands of patients being admitted to acute care beds when this may not be the right clinical setting for them and risks their mental health deteriorating further as a result.”

A lack of investment in community mental health facilities and places in supported housing facilities means that “there is simply nowhere else for people to be referred on to quickly enough, at which point the only viable option is an admission to acute bed,” Taylor said.

Hospital staff lack expertise in mental health

Leaders at acute hospitals expressed concern that their doctors, nurses and other staff were not well-placed to respond to all the needs of people suffering from severe episodes of conditions like depression or psychosis, because their expertise is primarily in managing physical illness.

One acute hospital leader told the Guardian: “We often reach a point where the whole [health] system agrees that the acute hospital is not the right place for the patient, but finding a better place is hugely challenging.

“The impact this has on the patient themselves, the staff caring for them and the other patients in the ward cannot be underestimated.

“The patient is being physically cared for but their mental health condition is often not improving and may be deteriorating in the noisy environment of an acute hospital ward.”

NHS England’s national mental health director, Claire Murdoch, has also said that services are severely under-staffed and that psychiatric hospitals are very close to full all the time as a result of an unprecedented demand for care.

“A lot of services are still struggling with staffing”, Murdoch told the Health Service Journal. About 20% of mental health nursing posts are unfilled, and mental health trusts rely more heavily than any other area of NHS care on locum doctors, according to evidence collected by Manchester University and shared with HSJ.

Murdoch, who worked as a mental health nurse and runs a major London mental health trust, also said the long delays patients faced accessing care meant that “the treatment gap is still too considerable”.

NHS England has delayed the introduction of new waiting time targets in mental health care for two years, because of concerns that a shortage of staff means they cannot be met.

A Department of Health and Social Care spokesperson said that the government was investing an additional £2.3bn annually to expand mental health services so an extra two million people can get support.” This funding was announced in 2019. The spokesperson also added that the NHS Long Term Workforce Plan, published earlier this year, sets out its ambition to increase the size of the mental health workforce by 73% by 2036/7.