Mental health trusts have less money to spend on patient care in
real terms than they did in 2012, official figures analysed by the
Royal College of Psychiatrists show.
The College is calling for mental health trusts to be given more
money and for better ways of tracking where mental health money is
being spent. It fears some of that money is failing to reach the
Mental health trusts’ income is lower in
England now than it was in 2011-12 once inflation is taken into
account, according to the latest available figures.
This is despite the Government’s assertion
that mental health spending is at “record” levels.
It comes as demand for services soars, with
some trusts saying a lack of funds has forced them to cut
The picture across the UK is similar, with
mental health spending in Wales, Scotland and Northern Ireland all
lower now than it was in recent years.
Professor Wendy Burn, the College’s president,
said: “It is totally unacceptable that when more and more people
are coming forward with mental health problems, trusts are
receiving less investment than they did, in some cases, seven years
“Patients with mental illness continue to bear
the brunt of an underfunded sector experiencing unprecedented
demand with limited supply.
“Prioritisation of mental health is about
getting the right care, at the right time, in the right place. This
can’t happen when trusts continue to receive inadequate
For England, the College looked at the trusts’
annual reports and data on their spending published by regulators.
For Scotland, it looked at data published by the health arm of the
Scottish government; for Wales, Welsh government data; and for
Northern Ireland, data provided by its department of health. All
the data was adjusted for inflation.
- 62% of mental health trusts (34 out of 55) at the end of
2016-17 reported lower income than the amount for 2011-12
- Only one trust saw their income rise all five financial
- Nine mental health trusts saw their income fall all five
years, including three in Yorkshire and Humber
Rest of the UK:
- In Scotland, there was less money spent by health boards on
mental health in 2016-17 compared to 2009-10 in real
- In Northern Ireland, mental health investment by the Health
and Social Care Commissioning Board in real terms is down on where
it was two years ago
- In Wales, mental health investment in real terms is lower
than it was in 2010-11
The situation is at odds with recent claims by
both the Prime Minister Theresa May and Health and Social Care
Secretary Jeremy Hunt that mental health funding is at “record”
Similarly, Mr Hunt has referred publicly to
the extra £575 million spent by commissioners (Clinical
Commissioning Groups) in 2016-17 compared with the previous
But it is up to the CCGs to pass this money on
to mental health trusts and other providers and the College’s
figures reveal that mental health trusts’ income is still lower
than it was in 2012.
Part of the reason why the funding situation
is so opaque is because the 2012 Health and Social Care Act changed
the way mental health services are funded.
Mental health trusts are now only part of the
picture – mental health funding is also distributed through GPs,
local councils, private providers and the voluntary sector.
The picture is further confused by the fact
some mental health trusts also provide community health services
such as district nursing and sexual health. As the King’s Fund
think-tank has pointed out, given the key role mental health trusts
have in providing mental health services their income provides an
important marker of their ability to deliver that care.
For example, as of September last year 89.5%
of all NHS psychiatrists are employed by a mental health trust,
according to NHS Digital.
While spending by commissioners in monitored
by NHS England’s mental health statistics ‘Dashboard’, there is no
regular publication of high-quality data for those other
The College is calling for comprehensive
spending data to be published regularly by all providers of
publicly-funded mental health services.
The total amount of income that mental health
trusts received in 2016-17 was £11.829 billion, £105 million lower
than in 2011-12 at today’s prices.
Of those trusts, only one trust (Tavistock and
Portland NHS Foundation Trust) saw its income rise in each of those
five financial years (2012-13, 2013-14, 2014-15, 2015-16 and
Nine trusts – Black Country Partnership NHS
Foundation Trust, Coventry and Warwickshire Partnership NHS Trust,
Leeds and York Partnership NHS Foundation Trust, Norfolk and
Suffolk NHS Foundation Trust, North West Boroughs Partnership NHS
Foundation Trust, Rotherham, Doncaster and South Humber NHS
Foundation Trust, Solent NHS Trust, South West Yorkshire
Partnership NHS Foundation Trust and Worcestershire Health and Care
NHS Trust – all saw their income fall for five years in a row over
For example, Black Country Partnership saw
their income fall from £118,429,000 in 2011-12 to £101,400,000 in
2016-17, a fall of 14.38%.
In 2016-17, health boards spent £936,606,000
on mental health compared with £996,732,000 in 2009-10 in real
terms, a fall of 6%. (These figures are for net spend).
According to Welsh government programme budget
data, the amount spent on mental health care fell from £699,830,000
in 2010-11 to £697,940,000 in 2015-16 at today’s prices, a fall of
According to figures supplied by NI’s
department of health, mental health spending fell from £262,330,000
in 2014-15 to £259,000,000 in 2016-17 at today’s prices, a fall of
England case studies
Cornwall Partnership NHS Foundation Trust had
three years of real-term income cuts in a row (in 2013-14, 2014-15
and 2015-16). A new contract for community services won in 2016-17
saw them move into the black overall for the period the College
analysed, but medical director Dr Ellen Wilkinson said she had seen
first-hand the damaging effects of underfunding.
She said her trust had made savings each year
but that as it got harder to make the savings required it would be
forced to take money out of funding doctors, nurses and crucial
Historic underfunding has set many services up
for failure, she said. In one instance, money was given to
commissioners for children and young people’s mental health
services, but then subsumed into paying off overall debt, she
“There is no doubt that demand on mental
health services is going up, and there is a real danger that
because of well-known pressures people are reluctant to come
forward when they need it the most,” she said.
“We’re also finding that smaller support
services which help supplement and complement mainstream NHS
services are being cut. Services like domestic violence support,
befriending or services to help families with problems just aren’t
getting the same funding in the current climate.”
The medical director from a Midlands mental
health trust, which also had its income squeezed, painted an
equally bleak picture.
The medical director, who wanted to remain
anonymous, said doctors’ case-loads had gone up at the same time as
public expectation about the services had risen and the trust was
having to cut services.
Five years ago, they had a liaison-psychiatry
service seven days a week and now cuts have brought that down to
“Our doctors are seeing more patients and yet
resources are more scarce. How are we supposed to cope with this
mental health crisis in that kind of environment?” the medical