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Despite funding and staffing levels for mental health services increasing, and more patients being treated, millions of people with mental health needs are still not accessing services, with some facing lengthy waits for treatment, according to a new National Audit Office (NAO) report.
Progress in improving mental health in England found that the NHS has expanded mental health service provision. Between 2016-17 and 2021-22, the number of people in contact with NHS mental health services increased from 3.6 million to 4.5 million people. NHS mental health services achieved new waiting time standards1 for talking therapy services and early intervention in psychosis services, but not for eating disorder services for children and young people. The NHS made good progress against these standards until 2019-20 but the pandemic has disrupted performance. For young people’s eating disorder services, waiting times increased following surges in demand during the pandemic. During April-June 2022, just 68% of young people who were urgently referred were seen within a week, against a standard of 95%.
The NHS has taken some important first steps towards closing the gap between mental and physical health services, although services remain under pressure and many people using them are reporting poor experiences. NAO interviews with stakeholders highlighted that some groups had poorer experiences accessing or using services, including children and young people, those from minority ethnic groups, LGBT people, and those with more complex needs or more than one diagnosis. In an NAO survey of NHS mental health trusts, most reported that, in response to demand and service pressures, they had allowed waiting times and lists to increase, while a minority had raised treatment thresholds (15 out of 33) and reduced provision in some service areas (6 out of 33).
The NHS mental health workforce increased by 22% between 2016-17 and 2021-22, but staff shortages and the speed of expanding the existing workforce remain a major constraint. Retaining staff is also becoming an increasing challenge: during 2021-22, 17,000 staff (13%) left the NHS mental health workforce. The NAO’s survey of NHS mental health trusts highlighted specific concerns about shortages of medical and nursing staff, and psychologists. Reasons for shortages include difficulties recruiting and retaining staff, high turnover between service areas, and competition from health and non-health sectors.
The share of funding for mental health services has also increased slowly, reflecting the pace set by NHSE’s targets. Although the NHS is on track to meet commitments to increase health spending by £3.4 billion by 2023-24, between 2016-17 and 2020-21 the percentage of local funding spent on mental health services only went up from 11.0% to 11.4%.
Following the pandemic, demand for mental health services is higher than the 2019 NHS Long Term Plan anticipated, particularly among young people. For example, between 2017 and 2022, the proportion of young people with probable mental disorders increased by 50% for 7- to 16-year-olds and more than doubled for 17- to 19-year-olds. This is likely to mean it will take longer to reduce the gap between demand for mental health services and provision.
Despite a series of clear commitments, neither the Department for Health and Social Care nor NHS England has defined what achieving equality in service access and provision between mental and physical health services – known as ‘parity of esteem’ – entails2. The NAO therefore remains unclear how far the current initiatives take the NHS towards its long-held end goal, including what else is needed to achieve it.
Furthermore, the impact of initiatives to reduce inequalities in mental health is unclear. Less than 10% (2 out of 29) of Integrated Care Boards3 surveyed by the NAO said they had all or most of the data needed to assess variations in patients’ access, experiences, and outcomes.
While further service expansion is planned, the forecast rates under the current programme mean that, by 2023-24, there will still be sizeable treatment gaps. For example, the ambition for 1.9 million people to access talking therapy services by the end of next year represents just a quarter of those with a diagnosed need estimated before the pandemic. NHSE also estimates that the number of people with mental health needs not in contact with NHS mental health services, as of 2021, is 8 million.
The NAO report concludes that, while funding and workforce for mental health services have increased and more people have been treated, both DHSC and NHSE must learn the lessons from their efforts to date and demonstrate a firmer grip on the significant ongoing risks to their ambitions in order to ensure value for money in their expansion efforts. They must also set out what is required to achieve equality between mental and physical health services.
