Workforce

Most specialisms in psychiatry have consistently declined in number since 2009, and Wales is now below the OECD average number of psychiatrists per head. A crude calculation would suggest that Wales has 15.3 per 100,000 people compared to the UK average of 18 per 100,000.*

Training figures are promising, and Wales achieved a 100% fill rate into core training last year, but round 1 recruitment was still lower in Wales than the UK average. In the wake of COVID-19 and a no-deal Brexit, the Welsh Government need to ensure that the Welsh NHS has increased posts in specialist services and that those posts can be filled. 

*Analysis of:

Stats Wales. 2020. Medical and Dental Staff by Specialty and Year.

OECD Stat. 2020. Health Care Resources: Physicians by Categories.  

In Wales, there isn't currently a programme to grow the number of physician's associates working in mental health. In England, physicians associates are now supporting mental health services to attend to patients' physical needs, freeing up the time of consultants to focus on their specialism - mental illness.

The RCPsych supports the employing of physicians associates in mental health services. The Welsh Government need to ensure that there is an attractive pathway into mental health services for physicians associates in Wales, so no only do physicians associates choose to work in mental health, but they choose to work in Wales. 

That children and adults accessing mental health services should not have access to the same minimum level of nurse staffing as those in wards for physical health conditions is an obstacle to parity of esteem. Not having a safe level of nurse staffing results in lower quality of care, excessive use of restrictive practices and seclusion, and lower patient and family satisfaction. Anecdotally we have been told that having too few nurses restricts the freedoms of patients who are detained under the mental health act; patients may be granted section 17 leave but may not be able to take it if there are not enough nurses to escort them. 

Psychiatrists bring specialist expertise in areas of mental health to their teams to help them understand and treat complex mental health problems. They conduct complex assessments, interventions and prescribing as well as give clinical leadership and advice. However, increasingly we're being told by members that they're doing more administrative tasks and that is restricting the amount of time they can spend with their patients. In the face of such small numbers of psychiatrists in Wales, we do not feel this is an example of prudent health care. 

Referrals for medical psychotherapy have increased significantly compared to other mental health services. From around 11 per year in 2012 to over 200 per year in 2019. That represents a sustained growth of 2000% across 7 years. Stats Wales reports that no psychiatrists are employed as medical psychotherapists in Wales. A higher training programme would support to increase the capacity of the Welsh NHS to deliver medical psychotherapy, and make Wales a more attractive place for psychiatric trainees to train.

The mental health inequalities faced by people from minoritised ethnic backgrounds is by now well documented, and these vary across ethnic backgrounds. Services need to develop bespoke responses to reflect the diversity of communities they serve in order to help alleviate health inequalities experienced by these groups. We're grateful that the First Ministers Black, Asian and minority ethnic advisory group recommended that the framework be immediately rolled out. The next Welsh Government should ensure this work continues to be resourced.