There are around 8 million people in England that are denied access to mental health services because they do not have severe enough symptoms to get put onto a waiting list, according to NHS leaders.
As the official waiting list stands at around 1.6 million people, this means there are now almost 10 million people in England struggling without adequate help and support from mental health services.
The 8 million figure is based on the known prevalence of mental health conditions and the thresholds dictating who gets access to treatment; NHS England considers it an accurate figure for the number of people who are missing out on care because services are not adequate.
These 8 million are also unlikely to receive help any time soon unless the upcoming funding settlement for the NHS is adequate. Indeed, NHS Providers, which represents the NHS trusts, warns that any progress that has been made in improving mental health services over the past few months to help those who actually reached the waiting lists will also be lost without an adequate increase in funding. Saffron Corderoy, Deputy Director of NHS Providers, noted that the review:
“must make good on commitments to date which, despite years of underinvestment and the enduring care deficit, had started to improve services and experiences for mental health patients. Critically the settlement for mental health must also recognise that mental health trusts are treating more patients than ever before and that COVID-19 has added a significant challenge into the mix in terms of increasing the numbers seeking help and the complexity of the help needed.”
Funding calls
The consensus from healthcare leaders from NHS Providers, representing NHS trusts and the NHS Confederation, which brings together all providers of care in the NHS, is that the NHS needs £10 billion more per year to address the backlog and increase in demand due to the pandemic, but on Monday the Chancellor Rishi Sunak confirmed an extra £5 billion, amid strong calls for a more realistic funding settlement from across the NHS.
In 2020 when it became obvious what a devastating effect the pandemic was having on the nation’s mental health, there were calls for extra funding. In the November 2020 spending review, the Chancellor gave an extra £670 million,
but Head of Policy and Campaigns at the mental health charity Mind, summed up the view coming from many similar organisations:
“ [the funding] is some way short of estimates that due to increased demand mental health services will require more than £1bn a year for the next three years, to deal with the long term fall out of the pandemic.”
Pandemic effect
Services for under-18s in particular have seen a dramatic increase in demand since the pandemic began. The recent NHS Confederation report – Reaching the tipping point: children and young people’s mental health – notes that as many as 1.5 million children and young people may need new or additional mental health support as a result of the pandemic, but this is likely to be an underestimate. The official waiting list contains just 374,000 under-18s.
The area of eating disorders has been singled out as one that has seen a particularly high increase in demand. In August a new analysis by the Royal College of Psychiatrists found that at the end of the first quarter (April, May and June) of 2021/22, 207 patients were waiting for urgent treatment, up from 56 at the same time last year. A further 1,832 patients were waiting for routine treatment, up from 441 at the same time last year. And 852 patients received urgent treatment, compared with 328 in the first quarter of 2020/21. However, in May 2021, an NHS Providers survey found 85% of trust leaders said they could not meet demand for children and young people’s eating disorder services.
Then there is the impact on the NHS as a whole – FirstCare, which monitors absences in the health service reported that there were 13,000 NHS staff off work because of mental health issues in May 2021 – a 55% increase on the previous year – and in June the increase was 42%.
Although the problems within mental health services have been exacerbated by the pandemic, a decade of underfunding by Conservative governments has resulted in bed cuts, falling staff numbers, an infrastructure that is no longer fit for purpose, and A&E being used as the first port of call for patients in crisis, due to a lack of any other option.
The Lowdown has been reporting on the crisis situation in England’s mental health services for some time now. Although extra money has been ploughed into services in recent months, the concern is that it will not be enough to address even pre-pandemic issues, let alone the increases in demand due to the pandemic. NHS Providers notes that demand now significantly outstrips supply despite the fact that services are treating more patients than ever before.
As a result many of the issues that needed to be addressed in pre-pandemic times have got worse – the long waits for care, bed occupancy above safe levels, inappropriate out-of-area placements, including for young people, where treatment is miles away from home, and when patients are eventually seen, more and more of them are at a crisis point.
What is needed?
The service needs more staff, more beds, and an infrastructure that can cope with the demand; much of the NHS’ mental health service estate needs updating and repair. NHS Providers notes that services need “critical capital investment to tackle the most immediate challenges facing the mental health estate” plus “significantly more funding” to “recruit enough staff with the right skills, expand community services to avoid inpatient admissions where possible, increase bed numbers to bring care closer to home and to tackle the ever growing backlog of care caused by the pandemic.”
A survey conducted by the British Medical Association (BMA) just before the pandemic began found 63% of mental health staff worked in a setting with rota gaps, and 69% of these said such gaps occurred either most or all of the time.
According to The Health Foundation the number of mental health nurses dropped by 8% in the 10 years to June 2020, and there was a 39% fall in learning disability nurses. The latest figures for staff vacancies released in August 2021 from NHS Digital show 93,806 vacancies, with 38,952 of them for registered nurses, with a major problem in the mental health sector.
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