Firefighting won’t reverse the mental health crisis

Mental health services have been chronically underfunded for years and are struggling to meet rising demand without the resources they need.

Effective treatments for severe mental illnesses are available, but when services are chronically overstretched it's harder to provide the very best of care.

Almost 1.4 million people with suspected mental illness in England are still waiting to start treatment. Change is needed both in terms of investment and in the way we deliver mental health services. Above all, we must end the cycle of people reaching crisis point before they receive specialist mental health treatment.

The Government was elected with a mandate to address what it calls an ‘epidemic’ of mental health problems in the UK. Every child will be given access to mental health support in schools and have the option of attending hubs near to where they live.

8,500 additional mental health staff have been promised, with a particular focus on those at risk of suicide – although we still don't know where they will fit in the multidisciplinary team.

While the new Government's promises are very welcome, the College's priority is to ensure that specialist mental health services are restored and enhanced, to meet rapidly growing demand. We must address the treatment gap.

Vicious cycle of crisis

Evidence suggests that people with severe mental illness who receive continuous care from the same psychiatrist and mental health team – both in hospital and in their local community – engage better with services, and therefore have better outcomes and are less likely to relapse. Continuity of care can also help reduce risk when people become very unwell.

Yet many mental health trusts are constantly over capacity. Adult acute bed occupancy in urgent and emergency care has not fallen below 95% in England since May 2022, and in too many areas, bed occupancy exceeds 100%. In June 2023, there were 39,137 emergency and urgent referrals to crisis care teams, an increase of 53% compared with June 2022.

The longer somebody waits for treatment, the more likely they are to experience a crisis, and require more specialist care and that takes time to deliver. Delays in accessing community care drive up demand in crisis services, in Emergency Departments and in hospital. It is a vicious circle that needs to be broken for the health system to work effectively for patients.

Many patients who arrive in the Emergency Department (ED) in mental health crisis have been known to mental health teams, however, they will likely face long waits to be reassessed.

Patients who are unwell enough to be in hospital may also be experiencing complex social problems as a result of their mental illness, which need to be addressed before they leave. In turn, this creates a discharge backlog that results in people who need admission waiting days, or even weeks in ED.

Lurching from crisis to crisis is bad for patients, and it is bad for staff. This is a form of firefighting. It doesn't put out the flames, it only kindles more fires elsewhere.

Morale is suffering

Psychiatry is an extremely rewarding career, that provides us with the opportunity to provide high-quality and holistic treatment to some of society's most marginalised people. However, sometimes psychiatrists are driven away as they feel too stretched to deliver the relational care we are expertly trained for.

Despite 99–100% recruitment into psychiatry, the growth rate of the psychiatric workforce is also significantly lower than growth rates for many other specialties. In England, the number of full-time equivalent (FTE) consultant psychiatrists working for NHS organisations only increased by 6.1% from 4,186.0 in June 2013, to 4,440 in June 2023.

Yet vacancy rates at consultant level have increased in recent years from 9.8% in 2021 to 15.8% in 2023, with addictions, eating disorders and child and adolescent psychiatry seeing the greatest shortages. There is also considerable regional variation. The locum psychiatric consultant workforce in England is also at its highest reported level and consultant retirements have increased.

In some areas, there's not enough office or clinic space for community mental health teams to see many of their patients in person. Many of us work in facilities that are no longer fit for purpose. The high risk maintenance backlog across mental health and learning disability sites has almost doubled from £16.2m in 2019/20 to £28.8m in 2022/23. We need immediate investment to reduce and eventually eliminate the current backlog of repairs in the mental health estate.

Renewed focus

A lack of investment in mental health services and staff, has undermined our ability to deliver the continuity of care that reduces crisis referrals, and admissions. The way NHS mental health trusts deliver care needs to be more effective.

The solutions to this crisis are well known. Intelligent commissioning of services, including of beds, helps ensure areas with persistently high bed occupancy are fully resourced. And NHSE agree with us.

We also need to access waiting time standards for all the elective care we do in community mental health services. It seems an anomaly that there is no standard for how long a person has to wait before they are seen by a community mental health team. This is a parity of esteem issue.

From Government, we expect to see more details on funding for the whole of the NHS, including mental health, in the Autumn Statement. We are at the Party Conferences where we have been heavily influencing decision makers to focus on both primary and secondary prevention to improve mental health outcomes. This is a year like no other for mental health care. We are raising the profile of psychiatry and it can be seen from the 173 mentions in the recently published Darzi review, that those we need to influence are listening.