NHS mental health services are being left to fail, with patients and service users routinely struggling to access both urgent and routine care, mental health leaders are warning.
They say that a dearth of investment and a lack of government focus on mental health provision means that staff and services are stretched to capacity with many now under crippling and unsustainable pressure.
The government is being warned that mental health services cannot respond to this challenge on their own, and that ministers must urgently outline a new vision for the future of mental health care.
This should centre on the publication of a long overdue 10-year cross government plan for mental health, which has been kicked into the long grass and is leaving mental health services exposed.
The key elements of a new vision for mental health are laid out in a new report from the NHS Confederation and Centre for Mental Health.
The report calls for action across funding, workforce and delivering services in new and innovative ways, including offering more open access services to the public all of which would help to provide faster access to care. Without this action, mental health leaders say their services will continue to deteriorate.
Recent figures show a 16 per cent increase in people using NHS mental health services, and with a 30 per cent rise in use in under-18s.
This alarming rise in demand is having a knock-on effect across the rest of the NHS as evidenced in recent reports suggesting that almost four times as many people are waiting more than 12 hours in A&E before they can access mental health care compared to two years ago, and more than 16,000 adults and 20,000 children who should be in receipt of community NHS mental health services not able to access the help they need every month.
While mental health services have previously benefitted from additional funding which has helped enable innovation and progress against the NHS Long Term Plan this was set before the onset of the pandemic.
Leaders are concerned that their services, staff and patients are now being side-lined at the time when demand is at an all-time high and when they are facing such huge and unsustainable pressure, they are very close to breaking point.
Commenting on the precarity of mental health provision across the country Matthew Taylor, chief executive of the NHS Confederation said:
“Mental health leaders are now very concerned of the real and present danger that the services they run are under unsustainable pressure. With demand for mental health support outstripping supply and rising at a rapid rate, the government simply must do more.
“Estimates from Centre for Mental Health suggest that 10 million people will need extra help for their mental health as a direct result of the pandemic, and 1.5 million of those will be children. With many people only now coming forward for help, the explosion in demand set against current levels of investment and workforce capacity means the provision of adequate care is becoming quickly unsustainable.
“This is not something that might happen in some far-off dystopian future – it is something that is already happening on our watch.
“The pressure on mental health provision is also creating a domino effect on the wider NHS and, coupled with the impact the rising cost of living is likely to have on people’s mental health, services are getting closer than ever to breaking point.
“Mental health leaders are calling on the government to urgently help alleviate the skyrocketing pressure and to bring forward a comprehensive 10-year plan as soon as possible.
“They also want to see the comprehensive NHS workforce plan, teased in the Chancellor’s autumn statement, include provision for a fully costed mental health workforce for the immediate, medium and long term.
“Mental health leaders and their teams are pulling out all the stops in what are very constrained circumstances, but they cannot be expected to solve this crisis alone – a mental health crisis is a crisis for the whole healthcare system and the country.”
This urgent call for a shift in the direction of travel comes as the NHS Confederation publishes a new report in partnership with the Centre for Mental Health setting out a vision for the shape of mental health, autism and learning disability services in ten years’ time.
Ifti Majid, chair of the NHS Confederation’s Mental Health Network and chief executive of Nottinghamshire Healthcare NHS Foundation Trust added:
“There is no hiding from the fact that demand for mental health services is rising very rapidly and we are seeing a clear impact not just on mental health organisations and their staff but across the NHS and care system as a whole.
“We are now in the midst of a national crisis and to address this adequately we need to see a renewed focus from government accompanied by further investment – NHS mental health organisations cannot be left to tackle this alone.”
Andy Bell, deputy chief executive of Centre for Mental Health and co-author of the report said:
“NHS mental health, autism and learning disability services need to change. We have produced a ten-point vision of how they should look different in ten years’ time. We know this vision can become a reality, because every element of it is already happening somewhere in the country.
“But to make it a reality for everyone, we need sustained and sufficient investment and a genuine commitment to radical reform of what services offer and how they work.”
Mental health, autism and learning disability services need to change. In ten years’ time, our vision is that these services will look very different in the following ways:
1. Prevention. In 2032, greater effort will be made to protect and promote our mental health throughout every stage of life and to ensure autistic people and people with learning disabilities are properly supported to have fulfilling and independent lives. Locally and nationally, government and public services will take a systematic ‘population health’ approach to reducing the social and economic risk factors for poor mental health and boosting protective factors in individuals, families and communities.
2. Early intervention. In 2032, services will not wait until someone is in crisis to offer help. Instead, early intervention will be the norm, with support front-loaded at an early stage to prevent more serious difficulties developing later on. Services will meet people where they are at, including online, at school, and in community spaces where they feel comfortable.
3. Access to quality, compassionate care. In 2032, there will be no wrong door for anyone seeking support for mental health, autism and learning disability needs. People will be able to present at any point in the system – from pharmacies, advisory services and community groups to education, social services, the criminal justice system and primary care – and get the right support.
4. Seeing the bigger picture. In 2032, mental health, autism and learning disability services will see the big picture as they support people to live their lives. People will get support with what matters most to them and services will help people with money, work and housing – with a package of support that is not limited to ‘healthcare’ per se.
5. Whole-person care. In 2032, services will support people with their physical and mental health and social needs together. Services will treat people as a whole person, being mindful and respectful of their needs, assets, wishes and goals.
6. Equality focus. In 2032, mental health, autism and learning disability services will be proactive in addressing structural inequalities and injustices. They will understand and challenge the intersecting inequalities that underpin the unequal risks of poor wellbeing and the subsequent inequities in access to support, experiences of services, and outcomes achieved.
7. Co-production. By 2032, there will have been a shift in the power imbalance between people who use mental health, autism and learning disability services and the organisations that provide them. Coproduction as an equal partnership will be the norm in the design, development and delivery of services.
8. Autonomy, human rights and community support. In 2032, service users will be reaping the benefits of a major investment in community support. As changes to the Mental Health Act will have channelled investment away from institutional and inpatient services, comprehensive support in the community will have risen up to meet people’s needs.
9. A stronger workforce. In 2032, there is a thriving workforce of clinicians, mental health professionals, allied professions, multi-disciplinary teams and diverse experts. Resources have been put in place to buy enough of people’s time and recruit those with the requisite skill levels. Coherent workforce planning has secured this capacity for the long term.
10. Outcomes that matter. In 2032, services at all levels will be holding the outcomes that matter to service users as their lodestar. They will be able to measure these outcomes and be held to account for them. The system will no longer be driven by the outputs that matter to institutions, but by the outcomes that matter to people
We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.