Consultant psychiatrists are being pushed to ‘breaking point’ by unmanageable workloads, according to the Royal College of Psychiatrists, whose latest census reveals one in seven consultant posts are vacant in England (748 out of 5,193 consultants). The 14% of unfilled posts represents an increase from 10% in 2021 and 6% in 2015.
The whole picture is even worse: more than a quarter (27%, 1,417) of psychiatrist posts were unfilled or covered by locums as services are increasingly forced to rely on temporary staff.
These workforce shortages mean there is only one consultant psychiatrist for every 2,540 people expected to experience a mental illness each year, leaving many without the support they need, or facing long delays accessing care.
The highest consultant vacancy rates among specific areas of psychiatry were 20% for eating disorder posts, 17% for general adult posts and 16% for child and adolescent posts. Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said:
“We have seen new referrals to mental health services rise from 4.4 million to 5.5 million a year since 2021, yet workforce growth has slowed in the last couple of years. It is clearly not sustainable to have one in seven consultant psychiatrist posts vacant if we want to deliver the care and treatment these patients so desperately need. It is particularly concerning to see that eating disorder and children and young people’s services are so understaffed as three quarters of mental illness occurs by the age of 24.”
To make matters worse the mental health nursing workforce has also lagged behind the growth in demand, meaning fewer nurses per patient as patient numbers increase. In the ten years to 2023/24 the number of registered mental health nurses in the NHS in England only grew by 12% (from a monthly average of 36,758 to 41,100), and the number of community mental health nurses grew by 39% (from a monthly average of 14,994 to 20,829): but according to the RCN demand for mental health services more than doubled (up 106%) over the same period.
Long delays in A&E
The result of the staff shortages is increasing long delays in accessing treatment for the patients with most serious needs. It mirrors the pattern of delays to the most serious Type 1 A&E patients, in which over 30% of emergency admissions have been kept waiting for 12 hours or more from arrival at hospital.
Last November the Health Service Journal used internal figures to show that one in 10 mental health patients who attended A&E in England last month stayed for more than 24 hours – and this figure rose to more than one in three in some Emergency Departments.
More than two thirds (68%) of the 173 acute hospital sites with a major type 1 or specialist type 2 A&E recorded stays of 24 hours for mental health patients, with a staggering 4,008 24-hour stays nationally in October alone.
At 19 hospitals, 24-hour delays affected more than one in five (20 per cent) mental health patients, and at three trusts (Royal Blackburn Hospital, Epsom and St Helier Hospital and Royal Sussex County Hospital) around one in three mental health patients at A&Es stayed there for more than 24 hours.
Mental health charity Thinking Ahead commented:
“Mental health patients may be a small proportion of attendances, but they often face longer waits than patients with physical health needs, many with co-occurring physical issues, making their care complex. Rising demand, limited specialist beds, and stretched inpatient services mean A&E teams are left managing pressures that reflect wider system failings.”
The statement also argued for the need to include mental health social workers in the teams responding to serious mental health problems:
“… mental health support must be organised to better meet people’s needs in the community. Housing, finances, relationships, and social connections all play a huge role in wellbeing. We need a workforce that understands these influences and can offer both clinical care and social support, working through neighbourhood-based services to prevent crises before they reach emergency care.”
Not a priority
However Claire Murdoch, CEO of Central and North West London Foundation Trust (who was NHS England’s mental health and learning disabilities lead until she resigned in September) has again complained that the attention of government and NHS England is not focused on mental health at all, but on “electives, A&E and money.”
As a result they are holding back plans to improve mental health services. The sector feels “abandoned”, she argues, with no long-term plan and its “share of spend falling like a stone”.
This last statement may be a slight exaggeration, but Wes Streeting has admitted in Parliament that funding for mental health has fallen as a proportion of NHS spending in England by 3.2%, even though there has been a token real terms increase of £140m.
Even as the spending share falls, statistics now show more than one in five (22.6%) of people aged 16-64 in England (rising to one in four among young people) now have a common mental health condition, a 20% increase since 2014. Mental health problems are the leading health condition among of young people out of work.
Mark Rowland, Chief Executive at the Mental Health Foundation, said: “Poor mental health is at record highs, including millions of children and young people on waiting lists for treatment or out of work with mental health problems without adequate support to return to the workforce. This is a human and economic catastrophe, costing the UK at least £118 billion a year. In the midst of a national mental health crisis, a cut to the share of spend for mental health raises real concerns about the government’s commitment to mental health.
“We wouldn’t accept rising cancer rates and falling share of spend and we shouldn’t for mental health. Without an effective, co-ordinated ‘invest to save approach’, the mental health crisis will only get worse. It will continue to cost the UK billions of pounds, and millions of people will continue to suffer the consequences of preventable mental health problems.”
Worse still, even after waits that are often several days for patients in mental health crisis in mainstream EDs, the care they receive is too often inadequate. The HSJ has reported on multiple cases of poor care in acute hospitals for people with complex mental health needs.
Mental health emergency departments
One of the policies to tackle acute mental health issues that was flagged up in the government’s 2025 10-Year Plan ‘Fit for the Future’ was to invest “up to £120m” in the next five years to create a network of around 85 new ‘Mental Health Emergency Departments.’ The viability of this plan is already being questioned.
The new units are supposed to be located near “existing major hospital Emergency Departments” – but with only 85 planned many would inevitably be substantial distances away from other EDs. The HSJ has pointed out that none of the first 18 “open and planned” units will be in the South East or the South West, while the HSJ map also shows none will be in East Anglia and none in the North West north of Manchester.
The 10-Year Plan said the MHEDs would “[ensure] patients get fast, same-day access to specialist support in an appropriate setting”, because at present “many people experiencing a mental health crisis go to accident and emergency department because it is the most visible or accessible option”.
However, there is little evidence so far on the effectiveness of the new units that have been established, and even less about the overall roll-out of the plan for all 85 units. A Nuffield Trust report aiming to cover the first ten units could not find four or them.
Use of MHEDs is not evidence-led policy, and there are concerns that sidelining mental health patients to them may mean they cannot access treatment they need for urgent physical health symptoms. This is a problem because, as the Nuffield Trust says:
“While fewer than 1% of A&E attendees for non-mental health complaints had a mental health diagnosis flagged in their attendance, 42% of mental health attendees were flagged with a non-mental health diagnosis.”
The Nuffield Trust adds that the capacity for mental health A&Es to provide physical treatment is “often inconsistent and difficult to ascertain:” So while “it is plausible that mental health patients will experience shorter waits for treatment in an environment where staff better understand their needs,” the danger is that it would “exclude a substantial proportion of people requiring treatment that mental health A&Es cannot offer”.
“For example, the North London Foundation Trust’s service excludes patients with an ‘urgent medical need’, whereas the new service in Tooting includes ‘psychological difficulties in the context of physical illness’ but excludes patients with ‘serious medical conditions’.”
Royal College of Psychiatrists president Lade Smith told the HSJ MH A&Es were welcome but must be co-located with general A&Es, as the patients also have physical needs.
Financial pressures on the NHS also seem to be shaping decisions that undermine proven effective and efficient services to address the mental health crisis. This month three of London’s five ICBs have pulled out of the award-winning mental health crisis response car service that once spanned the capital, despite the cars’ success in avoiding A&E attendances: LAS figures show only 14 per cent of patients attended by the vehicles ended up in A&E. Another study showed the service treated and discharged twice as many people at the scene compared with the usual ambulance response – without taking any extra time to do so.
Waiting lists
Outside of the issues of delays in accessing emergency care for mental health patients in crisis, there are even more lengthy delays for mental health patients on waiting lists for treatment. A Rethink report last October, drawing on a survey of 450 patients, revealed how things are getting worse:
“The majority of respondents (83%) said their mental health had deteriorated while waiting for treatment, rising from 80% last year. …
“Around one in three (31%) attempted to take their own life, up from one in four (25%) last year, while 74% reported suicidal thoughts, rising from 64% last year.
The report also showed lengthy waits for treatment impact not just individuals and employers but also the health service, with nearly one in four (23%) phoning 999 or attending A&E as their mental health had deteriorated.
Even where patients do manage to access treatment, the pressure on resources seems to be a factor in patients suffering from eating disorders being discharged too early, while still dangerously thin and underweight.
The situation is also poor for child and adolescent mental health. A press release from the Centre for Mental Health (CMH) in January highlighted the scale of the problem:
“Around one in five young people aged 8–25 now report a diagnosable mental health problem such as anxiety or depression, with girls and young women facing particularly high rates, and the UK lags behind comparable nations on key wellbeing measures.
“Worsening youth mental health is being driven by stagnant living standards, rising child poverty, fewer opportunities, the lasting impact of the pandemic, increasing online harms, and the erosion of trusted relationships.”
CMH announced that a coalition of charities is calling for action to address the growing need for support for young people:
“We’re calling for decisive action to expand early intervention, strengthen specialist and crisis care, and develop safer, more accessible digital services. If we are serious about building a healthier, more confident, and more productive generation, transforming children and young people’s mental health must be central to that mission.”
Andy Bell, CMH chief executive, said:
“The mental health of children and young people is under unprecedented strain. It is disrupting education, limiting future employment, driving up public service costs, and threatening the UK’s long-term prosperity. Too little is done to prevent mental health problems in childhood. Too many children face long waits or are turned away from specialist care, while early support is often patchy or unavailable.”
Whether this or any of the other initiatives seeking to secure government action and resources to tackle the growing mental health crisis succeeds in persuading ministers or NHS England chiefs to change course is open to doubt.
Wes Streeting remains obsessed with reducing already minimal A&E delays for Type 3 patients with the most minor problems, shaving fractions of a per cent from the 7.3m elective waiting list, and pushing through large-scale job cuts at national and more local levels. As long as these remain the priorities, there is little hope that he or health chiefs will even attempt to confront the considerable obstacles to improving care for the most seriously ill patients.
Campaigns at the local level, exposing service delays and failures and access problems, and piling pressure on councillors and local MPs to demand change, may be the most effective way to shake Streeting out of his complacency and force ministers to take action.
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