A report by the National Audit Office finds that NHS mental health services are struggling to meet rapidly rising demand
"The government must commit to putting in place new access and waiting time standards for the full range of mental health services. We also need a longer-term plan to sustain the progress the NHS has made in expanding mental health services since 2016, and to build a workforce that’s fit for the future. " Andy Bell, interim chief executive, Centre for Mental Health
Funding and staffing levels for mental health services have increased over the past five years, but not enough to keep up with the rise in demand, a report has found.
The report by the National Audit Office (NAO), Progress in improving mental health services in England, found that the NHS mental health workforce increased by 22% between 2016/17 and 2021/22, and that the number of people receiving mental health support had risen from 3.6m to 4.5m during the same period. The mental health service budget has risen to £12bn, or 9% of the whole NHS budget.
Despite these achievements, demand is rising more quickly than the NHS’s ability to meet it. The report shows that referrals to NHS mental health services have increased by 44%, from 4.4 million people in 2016/17 to 6.4 million in 2021/22. NHS England estimates that eight million people have mental health needs but are not in contact with NHS mental health services. There were also an estimated 1.2m people on the waiting list for community-based NHS mental health services at the end of June 2022, while an estimated one in four people aged 17- to 19-year-olds had a probable mental disorder in 2022, increasing from 10% in 2017.
The service is missing important targets. “For children and young people’s services, NHSE reported that before the pandemic the NHS was on track to treat the higher numbers of people it planned to, but for 2021-22 it was 3% below target for 0- to 17-year-olds,” the report says. “For talking therapy services, the number of people accessing the service was below target before the pandemic, while in 2021-22, 1.2 million people accessed the service, 22% below the target of 1.6 million.”
Eating disorders present a particular challenge. “For eating disorder services for children and young people,” the report says, “the NHS has not yet met the standard it aimed to achieve from 2020-21 and, following surges in the number of children and young people with eating disorders, waiting times increased further during the pandemic. During April–June 2022, 68% of children and young people who were urgently referred to eating disorder services were seen within a week, against a standard of 95%.”
The NAO notes that, despite promises to end the practice of out-of-area placements, an average of 600 people a month are being sent far from their homes for inpatient care.
The major constraint to improving and expanding services, the report says, is a shortage of staff. Its survey of mental health trusts, it says, “highlighted particular concerns about shortages of medical and nursing staff, and psychologists, and a wide range of reasons for shortages. These include problems recruiting and retaining staff, a high turnover of staff between service areas, and competition from health and non-health sectors.”
Responding to the report, the Centre for Mental Health, a think tank, said the figures showed there was an urgent need to invest in preventing mental ill health and further improve treatment, especially for children and young people forced to wait and travel long distances for care.
Andy Bell, the Centre’s interim chief executive, said: “While we welcome the increase in staff, funding and use of waiting time standards for some mental health services, it is clear that these improvements cannot keep pace with rapidly increasing demand. The government must commit to putting in place new access and waiting time standards for the full range of mental health services. We also need a longer-term plan to sustain the progress the NHS has made in expanding mental health services since 2016, and to build a workforce that’s fit for the future. As well as an urgent need to address the disturbing gaps in service and quality, especially for children and young people and for marginalised groups, we need an equally urgent focus on tackling the causes of mental ill health like poverty, poor housing, racism and discrimination.”
The report from the National Audit Office paints a worrying picture of mental health services struggling to cope with rising demand. The biggest barrier to improvement is a shortage of staff, with trusts experiencing difficulties both in recruiting and retaining staff. A workforce plan that sets out a strategy for improving both recruitment and retention is now a matter of urgency, but the NHS also needs to progress with its plans for better community mental health services that could support people before they reach crisis point.