Every year, the NHS Benchmarking Network presents data to mental health services across the four UK nations, including the services they provide, the resources that go into them, and some of the issues they face on a daily basis countrywide.
The results for 2023 present a picture of services that are working at a relentless pace to keep up with growing demand for mental health support. While the Benchmarking Network’s data provide raw numbers, they tell an important part of a story that is as yet unfinished, of how mental health services in the UK are changing and responding to unprecedented levels of need.
Last year, referrals to adult community mental health services rose by some 11% on the previous year – with 625,000 people referred to ‘generic’ community mental health teams (CMHTs) alone. A further 213,000 children and young people were on waiting lists for Children and Young People’s Mental Health Services (where referrals rose by 7% last year).
Waiting times for adult CMHTs remained similar to the year before, at about eight weeks from referral to a second appointment, with a similar picture for children and young people: where 38% went from ‘referral to treatment’ within four weeks, but 27% waited over 18 weeks. And 78% of children who were referred to mental health services were accepted – a similar proportion to the year before.
That’s been made possible by a rapid growth in the NHS mental health care workforce. The children’s mental health workforce, for example, expanded from 88 whole time equivalent staff per 100,000 population in 2019/20 to 121 last year. That is a big change in a short space of time.
While services are expanding, keeping pace with rising levels of need is more of a challenge. The last few years have seen record numbers of people seeking mental health support, most notably in the wake of the pandemic. In children’s mental health services, for example, school Mental Health Support Teams are now in place in many areas across the country, but they accounted for just 6% of referrals in 2022/23 (a proportion that should grow as they expand further).
The Benchmarking Network’s data shows, once again, that the pressures are greatest in inpatient services. Admissions to adult acute mental health beds rose last year, and more than half of them were compulsory (via the Mental Health Act). Lengths of stay in hospital also rose, to an average of 39 days, and bed occupancy rates remained at 94% – far in excess of the recommended ‘safe’ level of 85%, despite the fact that the number of beds per 100,000 population actually rose (to 22, from 20) last year. Inpatient services have higher staff sickness absence rates than community mental health services, higher vacancy and turnover rates, and a much more limited range of professionals working within them. This is particularly the case in older adult wards, where 95% of staff are either nursing or support workers, lengths of stay are far longer (at 88 days) and more than one in ten patients in hospital is experiencing a delayed discharge. Lengths of stay in children’s inpatient services were also longer than for adults, at an average of 89 days. And it is in children’s wards where the greatest frequency of restraint incidents took place – more than seven times as often as in adult wards.
Demographic data from the Network provides important insights into dramatic differences, by both gender and ethnicity, in the provision of mental health services. Women accounted for 57% of people using community mental health services and 48% of hospital inpatients, within which they comprised 87% of those in eating disorder beds but just 10% in medium secure. For children and young people, 50% of those using community services were female, compared with 72% of those in inpatient beds (where 2% were non-binary or other – reinforcing the importance of safe and effective provision for this group of young people).
Ethnicity data continues to show stark disparities and inequities, most notably for Black people in both adult and children’s mental health services. While significant gaps in recording are also notable here – making the following figures a likely underestimate – they show that Black people comprise 4% of the adult population, and the same among the community mental health services caseload, but 7% of those in inpatient beds, 10% of those who were admitted compulsorily, and 16% of those in medium secure services. By contrast Black people comprised less than 1% of those in eating disorder beds and in older adult wards. Similar disparities were found in children’s mental health services, where just 3% of those on community caseloads were Black compared with 6% of inpatients and 8% of those admitted via the Mental Health Act. The Patient and Carer Race Equality Framework cannot come a moment too soon to address these ongoing inequities across our mental health system.
The Benchmarking Network’s data reinforces what we have heard from other sources about the continued challenges facing NHS mental health services as they grow, but in a very challenging context. This new year marks a pivotal moment for mental health services in England in particular. The five years of the Mental Health Implementation Plan, characterised by significantly increased funding and central direction towards nationally set targets, are coming to an end. We don’t yet know what that means for mental health services, but it brings significant risks if progress made since 2019 is not sustained across the country. Future funding decisions are yet to be made, both nationally and locally. And with a general election less than a year away, decisions made by the political parties at Westminster will determine what further progress will be made, with both investment and reform, in England.
It’s clear that mental health services in the UK need to continue to grow and to change. If they don’t, there’s a real danger that access, quality and equity will all get worse rather than better, and the progress that’s been made in the most challenging of times will be lost.