Leading voices across the mental health sector gave last week’s ‘back to work’ Budget a ‘requires improvement’ rating, highlighting how government failure to address fundamental capacity and workforce issues risks undermining the new support announced by the chancellor.

Among the various ‘shifting the dial’ support initiatives announced in the Budget were an expansion of the existing individual placement and support (IPS) scheme – which supports people with severe mental health difficulties into employment.

Also announced were access to digital resources, a ‘WorkWell’ pilot scheme to combine employment and health support, support for individuals returning to and remaining in work, and new consultations on widening access to occupational schemes offered by employers, all forming part of a £400m package for those unable to work due to mental health problems, but what impact will they have?


One of the first groups to react to the Budget statement was the Royal College of Psychiatrists whose president, Dr Adrian James, said, “Unfortunately, these interventions will have a limited impact if people cannot get the mental health support they need when they need it. Last year, mental health referrals reached record levels of 4.6 million [but] there are just simply not enough psychiatrists to deal with this surge in demand. If the government is serious about improving productivity, it needs to publish the workforce plan – backed by adequate investment – as a matter of urgency.” 

James’ stance is amply backed up by recent NHS workforce statistics also showing a shortage of mental health nurses, with more than 1000 fewer employed in hospitals, community and mental health services in England than there were in 2010. And that’s hardly ‘stop the press’ news – almost a year ago a review by Health Education England identified about 11,300 nursing vacancies at mental health trusts in England, leading review chair Baroness Watkins of Tavistock to warn that, if steps were not taken immediately, “There is a risk that this profession will be lost.”

Mark Winstanley, chief executive of charity Rethink Mental Illness, welcomed the move to expand the IPS scheme, but echoed James’ wider concerns, adding, “Until the long-awaited workforce plan for the NHS is published, it is unclear how an over-stretched NHS will be staffed to meet demand or provide the workforce required for implementation of [the] long-awaited Mental Health Act reform. Overall, there was no indication in this Budget of how services will be shored up to help meet the rising tide of need and record demand for support.”

Both Winstanley and the Centre for Mental Health’s interim chief executive Andy Bell also focused on a more immediate issue, highlighting the unwelcome suggestion in the Budget (and in the accompanying Health and Disability Paper) that the use of benefit sanctions might be increased, despite their potential impact on patients’ mental health.

Mind picked up on the same concern, noting in its press release that, “Stopping or threatening to stop someone’s benefits when they’re too unwell to work is cruel, inappropriate, and ineffective at helping them back into employment.” The charity also questioned the value of the funding on offer for work-based occupational health schemes – and of the value of online support, telling the BBC that, “Online support isn’t right or accessible for everyone… It’s also important to remember that with the ongoing underfunding of NHS mental health services… the majority of people in need of mental health support will struggle to benefit from this.”

And like the Centre for Mental Health and Rethink Mental Illness, Mind again stressed the urgent need for a fully costed, long-term workforce strategy. It summed up its reaction to the Budget in a press release headline that simply read, “Chancellor’s ‘back to work’ Budget is anything but.”

New analysis

Two pieces of research, published in the same week as the chancellor delivered his Budget speech in the House of Commons, offer a stark picture of the reality for many patients wanting to access mental health services – a reality which measures outlined in the Budget do little to address.

Analysing data compiled by NHS Benchmarking, news website HSJ found that the four-week waiting times ‘standard’ in mental health, proposed two years ago by NHS England, is yet to be introduced, and there is no timeline set for implementation – unsurprising, perhaps, since nearly 75 per cent of adult patients are currently waiting longer than that for treatment to start.

And more worryingly, a recent report commissioned by Look Ahead Care Support and Housing warned that young people are unlikely to be admitted to mental health in-patient care unless they have “attempted suicide multiple times”.

What’s the strategy?

Jeremy Hunt’s statement to the Commons came just weeks after the DHSC trumpeted a switch to a ‘major conditions strategy’, effectively abandoning a previously stated ambition to develop a ten-year standalone plan for mental health. This earlier announcement admittedly came in the same week as a government press release promoting a £150m investment for “150 new facilities to support mental health urgent and emergency care services”, but that amount was not new money, having been promised in the 2021 Spending Review.

The message from the mental health sector seems clear – insufficient capacity within the NHS, driven by the lack of a long-term workforce strategy, continues to impede the mental health sector, and undermines the limited support packages. These long standing calls for action also raise questions about the government commitment to building new NHS services, especially when viewed alongside government appeals to companies to boost their occupational health schemes by taking out insurance to cover counselling, as mentioned in a recent Times article, which seem to steer away from public provision.

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