Millions of people with mental ill health in England are still unable to access support, with some facing lengthy waits for treatment, and the situation is unlikely to improve into next year, a report by the government’s spending watchdog has concluded.
The National Audit Office (NAO) report adds to the evidence of a growing crisis in NHS mental health provision, including a report last autumn by the Royal College of Psychiatrists suggesting nearly a quarter of mental health patients (23%) wait more than 12 weeks to start treatment.
Despite funding and staffing levels for mental health services having increased, and more patients being treated, there still remain sizeable gaps in care provision, the NAO pointed out.
The report, Progress in improving mental health services 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 standards for talking therapy services and early intervention in psychosis services, but not for eating disorder services for children and young people, the NAO argued.
The NHS made “good” progress against these standards until 2019-20, when the pandemic 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 NAO highlighted.
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The NHS had “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 were reporting poor experiences.
“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),” it added.
The NHS mental health workforce had increased by more than a fifth (22%) between 2016-17 and 2021-22, but staff shortages and the speed of expanding the existing workforce remain major constraints.
Retaining staff was also becoming increasingly difficult. During 2021-22, 17,000 staff (13%) left the NHS mental health workforce, the NAO pointed out.
“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,” it warned.
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What’s more, sizeable gaps in provision and long waits are likely to continue through 2023 and into 2024, the NAO forecast. “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,” it added.
