Urgent adult referrals to mental health crisis teams in England more than doubled between 2023 and 2024, according to a healthcare watchdog, which said people were becoming more unwell while waiting for help from overstretched services.
The report, from the Care Quality Commission (CQC), found there were not enough beds or staff, and ward managers felt pressed to discharge the “least unwell” patients.
Very urgent adult referrals to crisis teams increased to 3,063 in March 2024, from 1,400 the previous April.
The report, published on Thursday, also raised concerns about the over-representation of black people detained under the Mental Health Act, finding they were 3.5 times more likely to be held than white people.
Dr Sarah Hughes, CEO of Mind, said the statistics were “a source of national shame”.
“Black people, particularly black men, have been consistently overrepresented in mental health crisis care data for years,” she said. “They are also seven times more likely to be placed on a community treatment order, which are intrusive and don’t serve their intended purpose of stopping people repeatedly going back to hospital.”
She added that the CQC report showed England’s mental health system was “light years away from delivering not just effective, but compassionate care”.
The report, which draws on visits to 870 wards and interviews with more than 4,500 mental health patients, also found people from the most deprived areas of England attended A&E for their mental health 3.5 times more than those from the least deprived areas did.
Many services told the CQC that on admission, detained patients seemed to be more unwell than in the past – but that the increased demand for inpatient beds meant they were being discharged too soon.
In nearly half of cases where a child or young person was detained under the act, they had to be admitted again within a year.
Jenny Wilkes, the interim director of mental health at the CQC, said the report showed a “damaging cycle” of ineffective treatment. “Without timely access to necessary mental health support, people may find themselves being bounced from service to service without ever receiving the level of care that they need,” she said.
She said that, while the forthcoming mental health bill aimed to reduce detentions and improve mental health care, “this can’t be addressed by legislation alone as there simply aren’t the resources to fix these issues”.
The new laws, if passed, would give patients more power over their care, ensure relatives are included in discussions and introduce shorter limits to the length of time people with learning difficulties or autism can be detained.
The CQC report also found inappropriate out-of-area placements, where patients were admitted to services far from home for treatment, increased by 25% on the previous year, up to 5,500.
The report found the ward environment was often of poor quality, with not enough beds available. In some cases, bed shortages meant patients were placed in seclusion rooms, sparse rooms with limited furnishings not designed for long-term use.
In another service, 16 patients were allocated to a 12-bed ward, meaning that four – who were either being treated voluntarily or were on overnight leave – did not have a bed to return to.
Marjorie Wallace, the chief executive of the mental health charity Sane, said sectioned people were “still being shunted around the country like unwanted parcels”.
“Callers to our helpline, SANEline, report they are told there are no beds available locally and crisis and intervention teams are full to capacity,” she said.
Hughes said: “Fundamental problems with the very basics of safe care, like adequate staffing levels, bed capacity and run-down hospitals, are severely impacting people’s ability to properly recover.
“Isolating people and holding them in crumbling, outdated facilities is the very opposite of dignified, humane care. In some cases, people with mental health problems can’t even get outside to a monitored courtyard for fresh air due to such low staffing levels.”
Brian Dow, the deputy chief executive of the charity Rethink Mental Illness, said the report provided “yet more evidence that our mental health system is at breaking point”.
“Given today’s news that the NHS will now come under direct political control, we’re calling for a clear plan on how it will ensure mental health services have the funding and staff to deliver timely support,” he said.
A Department of Health and Social Care spokesperson said: “Through our mental health bill, we are making this legislation fit for the 21st century, giving patients greater choice and autonomy, as well as ensuring everyone is treated with dignity and respect to improve patient outcomes and recovery.
“To address staff shortages, we are recruiting 8,500 more mental health workers, and we will update the NHS long term workforce plan to ensure the health service has the right people, with the right skills, to deliver the care that patients need.”
• In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978
