Mental health services continue to be under-resourced, leading to long waits and poor care. This week, MPs called for urgent national reform of the NHS’s eating disorder services if they are to address the UK’s escalating eating disorder crisis.
In the report The Right to Life: People with Eating Disorders Being Failed – the All Party Parliamentary Group (APPG) on eating disorders highlighted the widespread neglect within eating disorder services across the UK and alarming practices, including the discharge of patients with life-threateningly low BMIs.
With NHS admissions for eating disorders surpassing 30,000 for the first time in 2023/24 (in comparison to 19,000 before the pandemic), the report shows that the current system is struggling to keep up.
Responding to the report, Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said:
“The APPG’s report lays bare the significant mismatch between rising demand for eating disorder services and their availability. People are being left on waiting lists for far too long and action is needed to address this.
“People with eating disorders can often make a full recovery and those who receive timely and effective care are far less likely to develop a more complex illness. It’s also important that those who are less responsive to treatment continue to be provided with care that increases their chances of getting better regardless of the length of their illness.
“Services are struggling to manage demand partially due to chronic staff shortages, historic underfunding and a lack of resources. They must be provided with additional funding so that they can meet the needs of patients and carers both now and in the future.
Report assesses mental health services
Sadly the state of all mental health services across the country is in just as bad a situation, as highlighted by the CQC’s annual State of Care report, with escalating demand, long waits, poor care and specialist staff shortages all against a backdrop of a mental health estate that is aging and often not fit for purpose. Since the CQC’s report, more evidence has emerged of the terrible state of mental health services, in particular for children and young people.
Children waiting and rejected
Journalists at the HSJ recently obtained data on waiting times for community health services, which showed a massive increase in the number of children waiting two years (104 weeks) or more for a community health service; the number more than tripled between February and October, to 7,946. Of this number, 80% (7,053) were waiting for the “community paediatric service”, which primarily deals with diagnosis and treatment for neurological issues, predominantly ADHD or autism, and potential mental health problems.
The STADIA trial, recently published in the Journal of Child Psychology and Psychiatry, highlighted that children with high-level mental health needs are being left without specialist care as almost half of referrals (44%) in the trial were rejected by NHS child and adolescent mental health services (CAMHS). Then, 35% required a re-referral to CAMHS, which delayed them receiving help.
The study across eight trusts in England involved 1,225 children and young people with emotional difficulties who had been referred to CAMHS for help and followed them up over 18 months to see how they got on.
The children and young people in this group were found to have high levels of mental health needs, with 67% scoring very high for at least one emotional disorder, most commonly depression or an anxiety disorder. Despite this level, the authors were shocked to discover that only 44% of children and young people had their referral to CAMHS accepted.
Professor Kapil Sayal, from the School of Medicine and the STADIA Chief Investigator, noted:
“We are very concerned that many children and young people with high levels of mental health needs, particularly conditions such as depression and anxiety disorders, for which NICE-recommended evidence-based interventions are available, are struggling to access help and have their difficulties appropriately recognised. One year is a very long time in a child’s life – delays in accessing the right care mean that their difficulties and distress, and the associated impact on their day-to-day lives and activities, are being unnecessarily prolonged.”
Although the STADIA trial lasted from 2019 to 2021, GPs commenting in Pulse said that although health services experienced difficulties during this time, things have not changed.
“Dr Richard Cook, a GP in West Sussex told Pulse that the referral rejection figure matched his experience. ‘CAMHS do not offer a useful service and the waiting list is huge. A major overhaul is needed.’
And Dr Selvaseelan Selvarajah, a GP in London, told Pulse: ‘The results do reflect our experience of CAMHS services. Children’s mental health services, like many other parts of the NHS, are underfunded. There are also shortages of child psychiatrists and mental health practitioners. The referrals are likely to be going up as well. As a result, children and parents do find it challenging to access the service in a timely manner.”
A lack of timely treatment is likely to be behind the increase in urgent referrals. A recent analysis of NHS data by the charity YoungMinds found 34,793 emergency, very urgent or urgent referrals to CAMHS crisis teams between April and October 2024, up 10% on the same six-month period in 2023.
Many of these children requiring emergency care are very likely to have been stuck on NHS waiting lists for months or even several years.
The chief executive of YoungMinds, Laura Bunt, said:
“Early support would help prevent many young people from becoming more unwell, but instead their mental health is deteriorating, pushing them into crisis and in some instances putting young people’s lives at risk.”
Staffing shortages
However, timely care will only be possible if staffing levels are addressed. Recent data published in The British Journal of Mental Health Nursing show that while mental health staffing has risen over the past decade, the rise was at half the rate of the overall NHS clinical staff. While numbers have grown since 2019, they have only just passed 2009 levels, not enough to keep up with demand.
For years, those who suffer from mental health conditions have been promised parity of care with physical disorders, yet the data on waiting times tells another story. The government’s most recently announced plan for the NHS focused on yet again reducing the wait for elective surgery.
The waiting list is high, which is undisputable, but funding boosts and recovery targets have already pushed the number of two-year waits for surgery down steeply since 2022 to just 151 in November 2024. In contrast, the number of children and young people waiting two years or more for community services, primarily mental health, is over 50 times the number of people waiting over two years for elective hospital care.
Concern that the government is not prioritising mental health and might abolish the “mental health investment standard”, led to Lord Simon Stevens tabling an amendment to the Mental Health Bill in December 2024, which would guarantee mental health spending “must not fall as a share of their [NHS England and Integrated Care Boards’] expenditure.”
Wes Streeting, the health and social care secretary, has since told the Commons health and social care committee that he is “committed” to the mental health investment standard.
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