The mental health workforce has grown – but it’s less experienced

The mental health workforce has expanded significantly since 2010, but staff are now less experienced, research has found.

A report by the King’s Fund, entitled 360-Degree Review of Mental Health Services, says that since 2017, the mental health workforce has seen a year-on-year expansion in numbers. Between 2010 and 2023, it grew by 23%. Growth was unevenly distributed across staff groups, however, and vacancy rates for NHS mental health staff are higher than for other parts of the NHS.  In September 2023, there were 28,600 vacancies, representing 19% of the total workforce.

While the number of therapists and support staff increased by 45%, the number of mental health nurses, the largest staffing group overall, grew by just 3%.

In psychiatry, specialisms in old age and learning disabilities, have “consistently been unable to fill all available placements, limiting future capacity,” the report found. The number of child and adolescent psychiatrists grew by 22%, but this was “insufficient to address growing vacancy rates,” the report found.

High numbers of staff are newly qualified

The King’s Fund also found the increased staff numbers is being driven largely by the growth in numbers of newly qualified staff. In 2010, 15% of psychiatrists were “junior” but by 2022 this had increased to 27%.

The report added: “Changes in the level of staff experience and skill mix of services have led to concerns about being able to provide safe and effective care.”

It notes that increases in the number of nurses have been mainly in community settings, while the number of nurses in inpatient settings has fallen to a level that impacts on the quality of care. “This reflects the focus over the past 15 years on reducing the number of inpatient beds and expanding community-based mental health services,” the report says.

Stephen Jones, the Royal College of Nursing head of practice and professional lead for mental health, told HSJ: “The NHS Long-Term Workforce Plan needs the number of training places for mental health nursing in England to increase by 93% by 2031-32, yet the number of applicants to study nursing has fallen by 26% in just two years. This should sound alarm bells in government and across health and care.”

The staff shortages have an impact on patient care, the report says. Its analysis of Care Quality Commission (CQC) inspection reports found that staffing problems are a factor in all those services rated as “requiring improvement” or “inadequate”.

Staff regularly work extra hours

“One of the most common impacts for patients on wards was that they could not access staff when they needed them,” the report says. “Patients also reported not having one-to-one sessions, not receiving medication on time, and activities being cancelled due to insufficient staffing. Staffing issues also impact on community services, where a lack of qualified staff leads to long waits and undermines the service’s ability to provide safe care.”

The King’s Fund analysis of CQC inspection reports also shows that in inpatient services, staff regularly work extra hours or additional shifts. “Some staff felt they were put in a position where they had to help other wards, but this meant they were working in environments (and with patients) they were unfamiliar with,” the report says.

The report coincides with a decision by NHS England to overhaul its mental health leadership. Its national clinical director for mental health, Professor Tim Kendall, has left, and it is recruiting its first ever medical director for mental health and neurodiversity.  The job advert for the new role says: “NHS England is looking to this role to support continued transformation in services and improved outcomes for people with mental health needs.”

It adds that the post holder will provide clinical leadership on care quality, developing “future strategies beyond the NHS long-term plan”, and medical workforce transformation; and work with other directors to engage clinicians.”