Workforce implications of proposed reforms to the Mental Health Act

While we broadly welcome the proposed reforms to the Mental Health Act, we are concerned about the impact on the psychiatric workforce. Find out what the College is doing to campaign for the required resource to make the reforms a success. 

In January 2021, the Government published the Mental Health Act White Paper, which set out proposed changes to reform the Act.

The College broadly welcomes the proposed reforms. They provide an opportunity to modernise mental health law, tackle racial disparities, and improve support for people in a mental health crisis.

However, the proposed reforms will result in significant changes to the way psychiatrists work and will place more demands on their time.

Key changes include:

  • Reducing the time intervals between Mental Health Tribunal hearings    
  • Statutory Care and Treatment Plans and Advance Choice Documents
  • Earlier involvement of Second Opinion Appointed Doctors
  • The introduction of the Nominated Person role
  • Expanding the role of Independent Mental Health Advocates
  • Increasing the evidence required to justify the use of Community Treatment Orders

Due to workforce shortages and slower than needed increases in particular parts of the psychiatric workforce, we have told the Government that changes to the Mental Health Act cannot be absorbed within the existing workforce.

In light of these concerns, and to support policy makers prepare for successful implementation of the reforms, the College commissioned The Strategy Unit to provide an independent assessment of the impact of the proposed changes on the psychiatric workforce.

This was with the aim of better understanding how many additional psychiatrists would be required to deliver the reforms in the proposed year of implementation, and 10 years later.

The research found:

  • By 2023/24, an additional 333 Full-Time Equivalent psychiatrists will be needed, costing £40m per year by 2023/24.
  • By 2033/34, a further 161 Full-Time Equivalent psychiatrists will be needed, costing £60m per year by 2033/34, at current prices (including £40m cited to 2023/24). 

These numbers relate only to the impact of the proposed reforms. 

It is imperative that the numbers are interpreted as being in addition to those required to deliver NHS Long Term Plan commitments, meet increased demand for mental health services, fill existing vacancies within services, and replace those leaving the profession. 

The College has made the following recommendations to the Government:  

1. At the 2021 Spending Review, invest a cumulative £82m (at current prices) by 2024/25 in the psychiatric workforce required to deliver the proposed reforms to the Mental Health Act  

Assuming that implementation of the reforms will begin in 2023/24, we recommend that the Government invest a cumulative £82m over the Spending Review period to cover the 349 psychiatrists that are required. 

Following 2024/25, the Government should also commit to further annual investment in the psychiatric workforce to reach £60m by 2033/34, to ensure continued implementation of the reforms is successful. 

Investment should be accompanied by a workforce plan to ensure the required workforce is in place at the time of implementation. 

Without requisite investment, we would recommend that the timeframes for implementation be revised. 

2. Amend the Health and Care Bill to require the Secretary of State for Health and Social Care to, at least once every two years, report current and future workforce projections

Alongside several other organisations, we are calling for the Health and Care Bill to be amended so the Secretary of State for Health and Social Care has to report independently verified assessments of current and future workforce numbers at least once every two years. 

This would ensure future alignment between service planning and workforce planning, leading to service plans that are grounded in the realities of workforce capacity. 

It would help avoid a situation where identified improvements to patient care are not deliverable due to workforce constraints. 

3. Publish a long-term workforce plan to enable the delivery of key NHS commitments and meet increased demand for mental health care 

Alongside a specific workforce plan to deliver the Mental Health Act reforms, the College recommend the publication of a comprehensive NHS workforce strategy, following publication of HEE’s new strategic framework.

This strategy should be accompanied by a multi-year settlement for workforce training and education to allow for the growth in the mental health workforce, including via new roles, necessary to deliver the NHS Long Term Plan and proposed standards from the Clinically-led Review of NHS Standards, as well as meet increased demand for mental health care.