A new report from the National Audit Office finds that demand for mental health services exceeds the capacity of the NHS to meet them
“Bed occupancy levels are consistently unsafe, children are being cared for in the same wards as adults, and people are waiting for hours and even days in A&E for urgent mental health care. These are the signs of a collapsing mental health system." Gemma Byrne, head of health policy and campaigns, Mind
Millions of people in England with mental health problems are not seeking NHS help, and those who do seek help often face long delays and a “poor experience,” according to a new report from the National Audit Office (NAO).
The report says that long waits for care are likely to continue for several years because soaring demand will continue to outstrip the ability of mental health services, which are severely understaffed, to provide treatment.
It found that an estimated eight million people with mental health needs are not in contact with NHS services, and that 1.2 million people are waiting for help from community-based mental health services.
The NAO praised NHS England for expanding the amount of care that patients with psychological conditions can access since 2016, as part of a government plan to give mental illness “parity of esteem” alongside physical conditions. Its achievements have included expanding the mental health workforce, introducing new services, treating growing numbers of people and introducing new waiting time targets.
Despite these achievements, however, the report found that mental health services “are under continued and increasing pressure and many people using services are reporting poor experiences”. Among those particularly likely to find the service inadequate are the under-18s, the LGBT community, minority ethnic groups and people with more complex needs.
One of the major challenges the service faces relates to workforce. Although the mental health workforce grew by 22% between 2016-17 and 2021-22, the NHS recorded a 44% increase in referrals over the same period. In 2021-22, 13% of mental health staff – 17,000 people – left the service.
Too many children and young people referred to an eating disorders service are waiting too long for help, the report says. The NHS is meant to ensure that 95% of under-18s with a suspected eating disorder are seen within a week – but in April-June 2022 only 68% did so.
An NAO survey of 33 of England’s 54 specialist mental health trusts found that, in response to severe pressure, most trusts had allowed waiting times and lists to increase, while 15 had raised the threshold for how ill people had to be before they got care and six had cut back the services they offered. Meg Hillier, chair of the Commons public accounts committee, said failure to treat patients quickly could have damaging lifelong consequences: “I am concerned that children and other vulnerable groups are more likely to have a poor experience of treatment, if they manage to obtain treatment at all.”
Rosena Allin-Khan, the shadow mental health minister, described the report’s findings as “sorry indictment of the state of mental health services after 13 years of Conservative governance,” adding: “Waiting lists for mental health treatment are soaring, and health inequalities are growing. The government is haemorrhaging experienced NHS staff in the mental health workforce – it’s a mess of the government’s own making. Patients are being failed.”
Gemma Byrne, head of health policy and campaigns at mental health charity Mind said the report showed that mental health services were struggling: “Bed occupancy levels are consistently unsafe, children are being cared for in the same wards as adults, and people are waiting for hours and even days in A&E for urgent mental health care. These are the signs of a collapsing mental health system.” She called for “bold political leadership and understanding of the scale of the country’s mental health emergency.”
The National Audit Office report confirms what many working in the mental health sector and service users already knew: the service is vastly overstretched, with demand exceeding supply. The numbers are stark, however, revealing that there are more than one million people currently waiting for help from community-based mental health services. The situation is exacerbated by workforce problems, with 13% of staff leaving in a single year. The problem can be remedied to some degree by introducing more measures that allow people to help themselves, such as Limbic Access, the new AI chatbot that can triage people on waiting lists. Ultimately, however, we agree with Gemma Byrne of Mind that the problems need to be addressed with “bold political leadership”. The service needs more staff and more investment, and this will require a well-thought-out long-term strategy from government.