The Government must urgently address that demand for mental health services is outpacing the resources afforded to them.
This page provides analysis on the pressures placed on mental health services, including access to services, workforce, and funding and is updated monthly and quarterly with new data.
Last updated 15 November 2023
Due to a cyber incident affecting some mental health service providers, some indicators between August 2022 and March 2023 use estimated data provided by NHS England.
As the analysis below clearly shows, mental health services are not being resourced at a fast enough rate to respond to the level of demand. As a result, patients are suffering. The BMA is calling on the Westminster Government and NHS England to support mental health services in the following ways.
Mental health workforce
- Ambitious and measurable commitments to expanding the mental health workforce must be made. This must include robust and frequent workforce data collection by NHS Digital, an action plan to attract more clinicians to work in mental health, meaningful action to retain existing staff, progress reporting against commitment timelines, and increased exposure to psychiatric specialities during training (particularly to those specialities with higher vacancy rates).
Mental health funding
- Funding for mental health services must be protected against inflation. The £2.3bn per year by 2023/24 promised in 2019 would need to be £2.6bn per year based on current forecasts.
- If the government genuinely wants to meet mental health needs, it must step up its commitments further still. While the £2.3bn promised for mental health services in 2019 was intended to provide 2 million appointments by 2023/24, this is insufficient to fully meet demand. In 2021, the NHS estimated that around 8 million people were not in contact with NHS services.
- This must be alongside increased investment in primary care, public mental health, mental health research, and the mental health estate.
Mental health beds
- The number of inpatient mental health beds in England must be expanded so that NHS England can finally meet the missed government target to eliminate inappropriate out of area mental health placements.
- The BMA supports the Royal College of Psychiatrists recommendation that all new Integrated Care Partnerships must conduct service capacity assessments and target investment towards services driving inappropriate out of area placements locally.
Demand for mental health services is rising
Before the COVID-19 pandemic, rates of mental illness in England had been slowly and steadily rising. The estimation of the prevalence of common mental disorders (for example, anxiety or depression) amongst adults aged 16-64, for example, had risen from 17.5% in 2000 to 18.9% in 2014. The next publication of the Adult Psychiatric Morbidity Survey (APMS) is due out in 2023/4, so we will have a clearer idea of the trend when that is released.
For children and young people, the latest evidence suggests that rates of mental illness may be growing at a faster rate than amongst adults. Between 2017 and 2022, rates of probable mental disorder increased from around 1 in 8 young people aged 7-16 to more than 1 in 6. For those aged 17-19, rates increased from 1 in 10 to 1 in 4.
The number of people seeking treatment, meanwhile, has grown at a much faster rate than the number of people estimated to have a mental illness. The percentage of adults aged 16-74 with a common mental disorder, who were accessing mental health treatment has risen from 23.1% in 2000 to 39.4% in 2014. This represents an increase of over two thirds (71%).
COVID-19 has only accelerated this trend, driving an increase in the number of people who are in contact with secondary mental health services. Mental health services in England received a record 4.6 million referrals during 2022 (up 22% from 2019), with the number of people in contact with mental health services steadily rising. As demand goes up pressure will be felt not only on mental health services but on general practice, at a time when GPs continue to face the wide-ranging impacts of the pandemic.
From the graph below we can see that for both adult and children and adolescent mental health (CAMHS) services, more people are asking for help than ever before. However, for CAMHS, the increase is most stark. There are over three times as many children and young people in contact with mental health services as there were seven years ago.
We can also see from the below graph strong evidence that those in areas of higher deprivation are more likely to be in contact with mental health services. This must be impetus for government action to improve economic security for the population.
It is to be welcomed that more people are accessing mental health services, and this is in no small part because of a reduction in stigma attached to doing so. However, services are not currently resourced to meet the increased demand, resulting in long waits and high thresholds for treatment; latest estimates put the mental health waiting list at 1.2 million people (2023). Mental health services need to be properly resourced to ensure people who need help are receiving it.
The mental health workforce is not big enough
The mental health workforce is not rising at the rate needed to meet either current demand or the expected increase in demand on services (due to such factors as population growth and the impact of the pandemic).
Psychiatry has been an underfilled speciality for too long and despite recent gains in the trainee psychiatric workforce, there are still not enough doctors in mental health services. There are also gaps in the wider mental health workforce that need to be urgently addressed.
We can see from the graph below that, for CAMHS services, since 2016 the number of children and young people in contact with these services has expanded at over 3 and a half times the pace of the psychiatry workforce.
The average vacancy rate across England for doctors working in NHS mental health services is high with around one in seven planned FTE roles currently vacant. While all parts of the country urgently need more medical professionals working in mental health, there is considerable variation across the country, with the East of England having the lowest vacancy rate, and the North West the highest. The overall average vacancy rate is now higher than it was when the COVID-19 pandemic began.
Within NHS mental health nursing, the vacancy rate is even higher – standing at 21% on average across England (June 2023). This is also higher than it was when the pandemic first arrived in the UK in 2020.
For all parts of the mental health workforce, true vacancy rates are likely much higher as NHS Digital figures underestimate vacancies. This is because hospitals often cannot afford to fill posts, and so vacancies are not advertised.
Mental health funding is not keeping up with demand
There has been a welcome increase in UK government commitments to mental health services in England in recent years, which has translated into an overall higher level of funding. However, whilst spend is increasing, it is not increasing at a fast enough rate; spending on mental health has increased at a slower rate than overall NHS expenditure, and the proportion of the NHS England budget spent on mental health has fallen since 2016/17.
In 2022/23, the NHS plans to spend £12.8 bn on mental health services, which is 8.1% of the total NHS budget. Between 2016/17 and 2022/23, there has been a cash terms increase in total NHS spend on mental health of 28%, which in real terms represents a smaller 8% increase (2023/24 prices). In addition to that, the NHS Long Term Plan for Mental Health (2019) included a commitment to create a new ringfenced local investment fund worth at least £2.3 billion a year in real terms by 2023/24 – which is £2.6 billion in current prices. Looking at recent trends, the NHS is on track to meet that commitment.
However, the fact that some targets set by the UK Government’s own mental health strategies are still being missed, and that many people with mental illness are not receiving appropriate support, suggests this increased funding is not enough.
As well as NHSE having missed the target to eliminate inappropriate out of area placements by the end of March 2021 (examined in more detail later), there are other targets that continue to be missed. The target that 95% of children and young people (up to the age of 19) who are referred for assessment or treatment for an eating disorder should receive NICE-approved treatment from a designated healthcare professional within one week for urgent cases, and four weeks for every other case by 2020/21 is an example of this. This is being missed, at last count (August 2023) by some considerable margin. For both urgent and routine cases, fewer than 74% of children and young people are receiving treatment within one week or four weeks respectively.
In light of the scale of unmet need before the pandemic, the COVID-19 backlog, and increased demand as a result of the pandemic, we do not believe these funding promises have gone far enough. Without the necessary spend attached to mental health services, demand will continue to outpace the supply of services.
There are not enough mental health beds in England
There are not enough mental health beds in England and patients are being sent far from home for treatment as a result. The extent to which overnight bed numbers have fallen varies across different settings. Learning disability and mental illness beds have seen the largest reduction of 69% and 24% respectively since 2010/11. This reflects policies to move care for these patient groups out of hospitals and into the community.
The high number of inappropriate out of area mental health placements is one indicator of this problem. Workforce shortages remain a barrier for safe staffing if there is to be greater inpatient capacity. Both elements therefore need attention if treatment is to be given when people need it, close to their homes and support systems.
Sending patients out of area for inpatient mental health care is both worse for health outcomes and costly for the NHS. Ease of access for family and friends is an important part of a patient’s recovery, and, especially for someone experiencing mental distress, being removed from their support system can hinder recovery. This, in turn, can lead to delayed discharge, and reduced capacity for others also requiring help. Unfortunately, this type of placement is sometimes the last option for doctors and patients for whom a local bed cannot be found (the criteria in place which defines this type of placement as ‘inappropriate’).
The target that the Government set in 2016 to eliminate these placements by April 2021 remains unmet and at times the number of inappropriate out of area placements has increased since the target was set. While the Covid-19 pandemic has not helped, the Government was not on course to meet the target even prior to the beginning of the pandemic in early 2020.
It is important to note that the number of new placements started in a three-month period has decreased over time. However, in recent months we have seen worrying signs of steadily increasing numbers once again. Moreover, the number of inappropriate placements active at the end of the three-month period has remained stubbornly high since January 2017.