More investment needed to close the growing mental health treatment gap, says Centre for Mental Health

9 February 2023

New figures show there is an urgent need to invest in preventing mental ill health and further improve treatment, especially for children and young people too often forced to wait and travel long distances for care. The National Audit Office’s Progress in improving mental health services in England report confirms a welcome increase in the NHS mental health workforce, up 22% since 2016/17, and a boost to mental health service budgets to £12 billion, or 9% of the whole NHS budget. The number of people getting mental health support has risen since 2016/17 from 3.6 million to 4.5 million.

However, the same report shows that even this substantial increase in mental health service staffing and budgets cannot keep pace with rising demand. Referrals to NHS mental health services are up 44%, from 4.4 million people in 2016/17 to 6.4 million in 2021/22. As a result of this growing gap between service provision and demand there are now 1.8 million people on NHS mental health waiting lists and an estimated further eight million people with a mental health condition not getting any support.

This gap is especially bad for children and young people with the National Audit Office estimating that the proportion of 17-19 year olds with a probable mental health disorder increased to 22% in 2022 from 10% in 2017, partly as a result of the Covid-19 pandemic. Whilst the National Audit Office recognises that waiting time and investment standards had been helpful where they are applied to services such as early intervention in psychosis, these standards are too limited to specific services. As a result, too often waits for these services are too long, and provision is inadequate or too far away.

The National Audit Office also points out that despite promises to end the practice of out of area placements, an average of 600 people a month are being sent far from their homes for inpatient care – a problem that is especially acute for children and young people. It is also worrying that nearly half of mental health trusts surveyed by NAO (15 out of 33) have had to raise thresholds for some of their services in recent years.

The National Audit Office also found that children and young people, people from racialised and LGBTQ+ communities, and those with complex needs report poorer access and patient experience. It is especially worrying that just two out of 29 integrated care boards have enough data to know how well they are tackling mental health inequalities in their areas.

This gap between demand and provision has grown as poverty, which drives mental illness, has increased and as public health and other council services, which prevent ill health, have had their budgets cut by about a quarter. These cuts have fallen most heavily in areas of high deprivation, meaning that people are getting poorer, more ill and with less preventative services to support them. Combined with the effects of the Covid-19 pandemic, this is causing and worsening population mental health and driving demand for mental health services that is not being met.

Andy Bell, interim chief executive of Centre for Mental Health, said: ‘While we welcome the increase in staff, funding and use of waiting time standards for some mental health services, it is clear that these improvements cannot keep pace with rapidly increasing demand. The Government must commit to putting in place new access and waiting time standards for the full range of mental health services. We also need a longer term plan to sustain the progress the NHS has made in expanding mental health services since 2016, and to build a workforce that’s fit for the future. As well as an urgent need to address the disturbing gaps in service and quality, especially for children and young people and for marginalised groups, we need an equally urgent focus on tackling the causes of mental ill health like poverty, poor housing, racism and discrimination.’

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