Progress towards the vision for mental health, autism and learning disability services in 2032
Andy Bell
In 2022, we were commissioned by the NHS Confederation (now NHS Alliance) to identify a vision for mental health, autism and learning disability services in England. We did this through research and consultation with a wide range of stakeholders, reading and hearing about people’s hopes and beliefs about what these vital services should be like in 2032.
This briefing, No Wrong Door: A review, assesses progress towards this vision almost five years on. It finds some signs of progress, but also worrying signs that without the necessary investment, it will remain a vision rather than a reality.
Whilst there has been a shift towards earlier intervention, progress has been slow and there are worrying signs that many services are shifting in the other direction.
Access to care in a mental health crisis continues to be a major concern. Mental health emergency departments are being rolled out but are untested and it is unclear how far they will address the weaknesses in urgent mental health care.
On prevention, mental health service providers are more aware of structural inequalities and their impacts, but there is less evidence of a proactive approach being taken to dismantle them at the necessary scale. Interventions to address poverty, housing and welfare needs are often very low cost compared with the consequences of these needs being neglected, but are not being addressing meaningfully.
The mental health workforce has grown, but there are no current plans to expand it further and, without this, there is a significant risk that services will continue to struggle to meet demand. The health and wellbeing of the mental health, learning disability and neurodivergence services workforce also remains a major concern. The report calls for a long-term plan for the mental health workforce and renewed ambition to expand capacity beyond the current level to meet rising demand.
