Plans to transform mental health services set to fail if psychiatric roles aren’t filled, RCPsych survey suggests

03 October 2019
  • One in 10 consultant psychiatric roles are unfilled, UK-wide RCPsych workforce census finds
  • Vacancy rate has doubled in the last six years. Rates particularly high in children’s mental health and eating disorder services, putting plans to improve those services at risk. Eating disorders are the deadliest mental disorders
  • College calls on more junior doctors to Choose Psychiatry – and for the Government to address workforce issues including the pensions crisis


THE rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years, a survey by the Royal College of Psychiatrists shows.

One in 10 posts are vacant – 568 posts out of a total of 5,730 (9.9%) – up from one in 20 in 2013 (5.2%).

Vacancy rates are particularly high in areas of mental health care prioritised by the Government for improvement, prompting fears that plans to transform services over the next 10 years under a major investment programme will fail.

Rates across the UK vary: in Scotland that figure is 9.7%, in Northern Ireland 7.5% and in Wales 12.7%. Across the UK that rate is 9.6%.

Download the pre-report summary

The “alarming” findings come at a time of soaring demand for mental health care, with a shortage of psychiatrists contributing to the lengthy waits for treatment many patients face. The impact on patients’ lives can be devastating, including divorce, debt and job losses.

The Government’s ambitious long-term plan to transform NHS mental health care by 2029 is welcome, but will fail unless this shortage is addressed, the College says.

Although access to children’s mental health services in England is improving, currently only 35% of those with mental illness get treatment. Earlier this year, a report published by the College found that people with eating disorders can wait up to 41 months for treatment, with adults waiting on average 30% longer than under-18s.

Similarly, many patients are still being sent away from their local area for treatment. Official data shows between April and June there was a 21% rise in the number of inappropriate out-of-area bed days in England, compared to the same time last year.

Professor Wendy Burn, the College’s President, said:

“These findings are very alarming.

“The Government’s plans will fail unless more junior doctors choose psychiatry.

“We know exactly what is needed and action must be taken now to implement practical solutions which will make the NHS a better place to work.

“We must urgently address some of the burning issues around the NHS workforce, such as the pensions crisis and unacceptable levels of work-related stress.”

The census, to be published in the coming weeks, also showed huge regional variations in psychiatric staffing levels, confirming patients also face a postcode lottery of care.

In eating disorders, the vacancy rate for consultant psychiatric posts is 11% in the East Midlands (Trent), but soars to 17% in the South East and South West and 33% in the East of England.

Eating disorders are the deadliest form of mental illness and long waits for treatment can mean the difference between life and death.

Student Sarah Lechmere, 20, from Norwich, who has anorexia and a history of self-harm, said that by the time she was admitted to hospital in February 2014, four months after seeing her GP, she was at death’s door.

“In the end I got seen because I had lost so much weight I was on the verge of death.

“I got admitted to Norfolk and Norwich general hospital in February 2014 because I was very, very physically ill.

“When I saw the mental health nurse she told my mum she hadn’t expected me to live through the weekend because I was eating maybe a couple of hundred calories a day and I had lost a lot of weight. My BMI was very low.”

It was only in hospital that she saw a mental health specialist for the first time.

She added: “When I can get good psychiatric input it can be really helpful. That is why we need more psychiatrists.”

The census’s findings for children’s mental health services are equally concerning – the vacancy rate in the North West is 15% and in both the East and West Midlands 17%, compared with an average for England of 12%.

There is a huge gulf between the mental and physical health workforce – between June 2012 and June 2019 the number of NHS consultant psychiatrists increased by just 4.7% compared to a 28.7% rise for all other medical specialties.

Today the College is launching the latest phase of its Choose Psychiatry recruitment campaign, which aims to encourage junior doctors to decide to train in psychiatry.

The College’s dean, Dr Kate Lovett, said:

“Psychiatry is a fantastic career, which requires a unique skillset of scientific understanding, sophisticated communication and the ability to be alongside people during their most difficult times.”

She added that as well as its Choose Psychiatry campaign, the College has launched a number of workforce initiatives such as its perinatal bursary training scheme.

This has helped train general adult consultant psychiatrists to work in Mother and Baby Units and community perinatal services, Dr Lovett said.

The College has also introduced a Child and Adolescent Mental Health Services ‘run-through’, which allows junior doctors to commit to specialising in child psychiatry at the start of their training and to do that training close to home, where previously they could not.

In the short-term the College is calling on the Government to put in place practical measures which would make the lives of junior doctors easier. This includes making sure they have hot food to eat when on call at night; that car parking spaces are available out of hours so night-time working is safe (and providing security where possible); and ensuring there is no delay in getting paid if they move from one hospital to another (which anecdotally the College understands is not uncommon).

In the long-term, as well as encouraging more junior doctors to choose psychiatry, it wants the Government to double the number of medical schools places in England to 15,000 by 2029.

The College first launched its Choose Psychiatry campaign in 2017. Since then the number of junior doctors deciding to train in psychiatry has risen by a third in Great Britain.

It takes 13 years to train a consultant psychiatrist, including five years of medical school.

In 2016, the Government unveiled ambitious plans – backed by the College – to transform mental health care in England.

This focussed on areas like perinatal, children’s (including community eating disorders) and liaison psychiatry services.

Huge investment has gone into those areas with tangible benefits, such as more Mother and Baby Units for women who fall ill around the time of childbirth, but many mental health services – such as adult eating disorder services – remain woefully inadequate.

Sarah said her health deteriorated dramatically after she was transferred to her local adult community eating disorders service on her eighteenth birthday.

She started losing weight despite doing therapy and her self-harming “sky-rocketed”. Sitting her A-Levels added to the pressure.

“I started self-harming really badly – I was cutting myself 100 times a day,” she said.

For her, like many others, paying for private care has been the only solution. She has now got her life back on track and is studying at university while working part-time.