Mental healthcare in England has become “a national emergency”, with “overwhelmed” services unable to cope with a big post-Covid surge in people needing help, NHS bosses say.
Care is so stretched that thousands of people undergoing a mental health crisis are having to be admitted every year to acute hospitals, even though they are not set up to deal with them.
Hospital bosses claim mental health in England has been “forgotten” by ministers who are giving priority to tackling the record 7.7m-strong care backlog, access to GPs and ongoing NHS strikes.
“Mental health has slipped down the government’s set of priorities and patients and services are being forgotten. This is a national emergency which is now having serious consequences across the board, not least for those patients in crisis,” said Matthew Taylor, the chief executive of the NHS Confederation.
Evidence the confederation has collected from NHS trusts in England shows that some mental health patients are in such poor health that they have to be admitted to acute hospitals because there are no beds free in specialist psychiatric facilities for them or other help available.
“People are coming to A&E and having to wait very long periods of time either to be admitted or found the right package of care for those needs in the community”, added Taylor.
“NHS leaders say that this is now leading to thousands of patients being admitted to acute care beds when this may not be the right clinical setting for them and risks their mental health deteriorating further as a result”.
A historic lack of investment in community mental health facilities and places in supported housing facilities means that “there is simply nowhere else for people to be referred on to quickly enough, at which point the only viable option is an admission to acute bed,” Taylor added.
People in the midst of a mental health crisis are spending up to 50 hours stuck in A&E because NHS support for them outside hospitals is so limited, the confederation said.
However, acute hospital bosses voiced concern that their doctors, nurses and other staff are not well-placed to respond to all the needs of people suffering from severe episodes of conditions like depression or psychosis, because their expertise is primarily in managing physical illness.
One acute boss said: “We often reach a point where the whole [health] system agrees that the acute hospital is not the right place for the patient, but finding a better place is hugely challenging.
“The impact this has on the patient themselves, the staff caring for them and the other patients in the ward cannot be underestimated.
“The patient is being physically cared for but their mental health condition is often not improving and may be deteriorating in the noisy environment of an acute hospital ward.”
The confederation’s intervention comes after NHS England’s national mental health director admitted that services were severely under-staffed and that psychiatric hospitals were very close to full all the time as a result of an unprecedented demand for care.
“A lot of services are still struggling with staffing”, Claire Murdoch told the Health Service Journal. One in five mental health nursing posts are lying vacant. In addition, mental health trusts rely more heavily than any other area of NHS care on locum doctors, according to evidence collected by Manchester University and shared with the HSJ.
Murdoch, who worked as a mental health nurse and runs a major London mental health trust, also said the long delays patients faced accessing care meant that “the treatment gap is still too considerable”.
NHS England has delayed for two years the introduction of new waiting time targets in mental health care amid apprehension that staff shortages means they cannot be delivered.
A Department of Health and Social Care spokesperson said: “We’re transforming our country’s mental health services and investing an additional £2.3bn annually to expand services so an extra 2 million people can get support.” The £2.3bn of funding was announced in 2019, before the pandemic added extra pressure to mental health services.
“Our workforce plan sets out the ambition to grow the mental health workforce by 73% and in December 2022 there were 9,000 more mental health staff than the previous year,” they said.
