New BMA report highlights ‘broken’ mental health system

By Integrated Care Journal

Persistent lack of funds and trained staff, combined with soaring demand, are placing unprecedented strain on NHS mental health services, new report finds.

A new BMA report, based on first-hand accounts from doctors working across the NHS, reveals the state of England’s ‘broken’ mental health services.

The current annual economic cost of poor mental health has been conservatively estimated at more than £100 billion in England alone, and £117.9 billion across the whole UK. The report from the BMA, “It’s broken.” Doctors’ experiences on the frontline of a failing mental healthcare system, identifies that a compound of funding, staffing, infrastructure and systemic challenges have led to the “dysfunctional” and “shocking” deterioration of NHS mental health services.

Without concerted efforts from central government to resource mental healthcare according to demand, which continues to outstrip NHS capacity, as well as societal change, the report argues that the future is bleak for those suffering from poor mental health, especially children and those with neurodevelopmental disorders.

Despite there being a greater focus on mental health from successive recent governments, the report finds that words have rarely translated into action, and that there has been no overall improvement to services in the last decade.

This is partly attributed to a lack of adequate resources within the system, but also to the impact of wider social determinants, such as housing, unemployment or financial concerns. It accuses the government of failing to grasp “the significance of the issue and how failing to tackle these wider societal issues is increasing demand for NHS mental healthcare.

Among its recommendations, the BMA report calls on the Department for Health and Social Care to “plan for and incentivise the expansion of the professionally trained workforce, including within psychiatry and general practice,” as well as to “embed mental health social care within the NHS, for example through in-house social workers.”

It also makes argues that attempting to quantify how much extra funding and staff levels are needed is incredibly difficult due to a lack of consistent data on the prevalence of mental illness, and echoes recommendations from Healthwatch that NHS England collect and publish national data on referrals and waiting times.

The BMA carried out in-depth interviews with doctors across the mental health system, including those working in psychiatry, general practice, emergency medicine, and public health. “[Support for people with mental health conditions] is shocking,” said a practicing psychiatrist quoted in the report. “We would not accept this in any other area of medicine.”

Quotes in the report:

“Mental healthcare in this country is dysfunctional. It’s broken.” – GP, Nottingham

“Patients always know that they can come into the emergency department…between spring this year and spring 2022 there was a doubling of Mental Health Act assessments in the emergency department. Which I think is fairly indicative of more systemic issues and obviously it impacts on our workload.” – Consultant psychiatrist working in A&E, Oxford

“Everybody wants to do the right thing. Everybody’s trying really hard, but we’re just not putting our money where our mouth is when it comes to saying we need to invest in prevention and early intervention.” – Public health consultant, West Yorkshire

Dr Andrew Molodynski, a consultant psychiatrist in Oxfordshire and the mental health lead at the British Medical Association, said: “As doctors struggling to provide mental health care, we know only too well that the system has crumbled. Some of our patients wait as long as four years for treatment, meaning too many people – including children – continue to fall through the gaps, and all the while funding remains insufficient. We’re having to make hard prioritisation choices that leave many patients without care and support that they urgently need.

“The demand for mental health services has changed dramatically, but funding has not kept pace. Mental healthcare funding must be based on what people need today, instead of being based on what we spent yesterday, which was inadequate even then.

“We need these changes to the system to be able provide good quality care and tackle the huge cost of mental health to people’s lives, the NHS, and the economy.”

Number of nurses experiencing suicidal thoughts up 98%, RCN finds

By Gabriel Blaazer

The findings have been described as a “frightening wake-up call”, with mental health support for nursing staff declining amid increased pressures.

The number of nurses experiencing suicidal thoughts has risen by 98 per cent compared to the same period last year, according to new data released by the Royal College of Nursing (RCN).

Calls to the RCN’s Advice Line in October found that an equivalent of one person each working day was reporting suffering from suicidal ideation in their initial call, compared to just one per week in October 2021. In response to its findings, the college has commissioned research to understand in greater detail the reasons behind poor wellbeing among members, and to discern whether or not marginalised groups are being impacted disproportionately.

The RCN has previously highlighted the “failure of [the] UK government’s promise to recruit 50,000 nurses”, and points to a 12 per cent fall in the number of people expected to take up nursing courses in England this year as evidence that the nursing workforce is facing “dangerous staff shortages”, which are proving harmful to staff morale and patient care.

The RCN is renewing its call on the government to invest in dedicated mental health support for nurses who are suffering from “persistent understaffing, intolerable pressures at work and financial insecurity at home”. Despite these pressures, one third of the 41 mental health hubs established by NHS England have closed, including seven specialist hubs established during the Covid-19 pandemic. A further seven reported in May 2023 that they had less than a year’s funding to stay open.

The RCN’s Interim Head of Nursing Practice, Stephen Jones, has described the findings as a “frightening wake-up call”, adding: “Nursing staff contribute so much to our society, but working in an inherently stressful job can come at an enormous personal cost. Yet we see support services cut when we should be seeing greater investment in looking after those who care for us.

“The increasing burden on nursing staff, as they try to help clear the excessive backlog in care, has created intolerable working conditions on every shift. Coupled with nursing pay not keeping up with the cost-of-living, we’re alarmed by this growing mental health crisis among nursing staff.
“The UK government must understand that cuts to mental health support for nursing staff can’t continue – when you invest in the health of nursing staff you also invest in the health of patients.”

Saffron Cordery, Deputy Chief Executive at NHS Providers, said that: “The RCN is right to highlight the impact of escalating pressure on nurses’ mental health due to increased demand and staff shortages. We need urgent action to tackle this situation, which has led to an alarming rise in suicidal thoughts among nursing staff.

“Nurses play a vital role in our society but cannot be expected to meet such high demand without proper national support for, and investment in, frontline services.”

More than 1 in 10 NHS mental health jobs currently vacant despite sharp rise in demand

By Integrated Care Journal

An additional 450,000 people a month are contacting mental health services in 2023 compared to 2020, while antidepressant prescriptions rise by millions in just a few years.

New analysis of the latest NHS statistics by Clerkenwell Health show that more than 1 in 10 mental health professional jobs in the NHS are currently unfilled. The analysis also reveals significant regional disparity with the North West and Midlands faring worse than average, with 17.5 per cent and 14.9 per cent respectively of mental health jobs vacant. This compares to an overall NHS medical vacancy rate of 5.8 per cent.

The figures come alongside a sharp increase in the number of people seeking contact with NHS mental health services every month – rising consistently from 1.3 million people a month in June 2020 to 1.75 million people a month by March 2023. Meanwhile an extra 3,000 people every month are also occupying a bed in a mental health hospital, when compared to January 2021.

The latest NHS data also shows a sharp rise in the number of antidepressants prescribed. Between October to December 2022 (the latest figures available), 22 million antidepressants were prescribed to an estimated 6.6 million identified patients. This compares to 15 million prescriptions in Q1 of 2015 and 19.6 million in October to December 2020.

The new analysis comes from Clerkenwell Health, the first commercial organisation in Europe to design and deliver clinical trials for a range of drug developers to find novel treatments for complex mental health conditions. They are working with drug manufacturers to explore innovative treatments for conditions with which the NHS is struggling to cope including treatment-resistant depression, anxiety, PTSD and alcohol use disorder, as well as conditions affecting the central nervous system.

Clerkenwell Health is developing trials to test the use of psychedelics such as psilocybin to treat a range of mental health conditions and are actively recruiting participants.

Tom McDonald, Chief Executive Officer at Clerkenwell Health, said: “With a sharp rise in people contacting mental health services and antidepressant prescriptions rocketing in just a few short years – all amidst a major mental staff shortage – it’s clear the need for innovative mental health treatments has never been more acute.

“There is no silver bullet, but a growing body of research suggests that psychedelic drugs could be ground-breaking for the treatment of complex mental health conditions. The Government must help accelerate the number of clinical trials being delivered in the UK to help new treatments reach patients more quickly and stem this growing problem.”

Mental Health, News February 15, 2023

Millions waiting to access mental health services, says NAO report

By Integrated Care Journal and Gabriel Blaazer

Despite increases in funding and staffing levels, millions of people are waiting to access mental health services in England, according to a new report from the National Audit Office (NAO).

The NHS saw a 44 per cent increase in referrals to mental health services between 2016-17 and 2021-22 and although capacity has increased, services are failing to keep pace with demand, according to a new report from the National Audit Office (NAO). The report, Progress in improving mental health services in England, has found that the number of people accessing NHS mental health services rose from 3.6 million in 2016-17 to 4.5 million in 2021-22, and while the mental health service capacity expanded during this time, it has failed to keep pace with demand.

Published on 9 February 2023, the report focuses on the implementation and progress of NHS commitments around mental health service provision, as set out in the Five Year Forward View for Mental Health (2016), Stepping forward to 2020/21: The mental health workforce plan for England (2017) and the NHS Long Term Plan (2019).

It finds that trusts are increasingly seeking alternative means of managing surging demand for mental health services and in many cases, are reducing the levels of support they offer. According to the report, from 2021-22, six out of 33 mental health trusts reduced provision of some services in order to cope with demand, while nearly half (15) raised treatment thresholds and 32 of 33 increased their use of temporary and bank staff, implying the presence of significant and system-wide pressures.

Workforce constraints “a major challenge”

The report also notes that the NHS mental health workforce increased by 22 per cent between 2021-22 (to 133,000 full-time equivalent staff) but describes the ability to retain staff as “a major constraint [and an] increasing challenge”. According to the report, 17,000 of the mental health workforce (13 per cent of the total) left the NHS during 2021-22 alone.

The NAO’s own survey of NHS mental health trusts has previously highlighted concerns over shortages of medical and nursing staff and psychologists, with the reasons behind these shortages including “difficulties recruiting and retaining staff, high turnover between service areas, and competition from health and non-health sectors”.

The NAO finds that NHS mental health services achieved new waiting time standards for talking therapy services as well as early intervention in psychosis services, whereas waiting times for eating disorder services for children and young people rose. Waiting times for eating disorder services for children and young people were falling until 2019-20, until surges in demand during the pandemic disrupted performance. Just 68 per cent of young people who were urgently referred to these services were seen within a week from April-June 2022, significantly below the target of 95 per cent.

While lauding the “important first steps” taken by the NHS to improve mental health service provision, the report describes services as “under pressure”, and NAO interviews with stakeholders have highlighted poor experiences accessing and using these services. This is particularly true for children and young people, people from minority ethnic groups, LGBTQ+ people, and those with complex needs.

Among the lingering effects of the Covid pandemic is a sharp rise in mental health conditions among young people. The report estimates that between 2017 and 2022, the proportion of young people with probable mental disorders increased by 50 per cent for 7-to-16-year-olds and more than doubled for 17-to-19-year-olds, higher than was estimated in the NHS Long Term Plan. This will likely increase the length of time it takes to reduce the gap between mental health service provision and demand.

The share of the total NHS budget dedicated to mental health services rose slightly, reflecting the government’s 2014 commitment to ‘parity of esteem’ for mental health provision. The report notes, however, that neither DHSC nor NHS England have defined exactly what achieving ‘parity of esteem’ in service access and provision will entail. As such, the NAO is unable to quantify the degree of progress to date and what else is needed to achieve ‘parity of esteem’.

“It is vital that DHSC and NHSE define what is required.”

Gareth Davies, Comptroller & Auditor General of the NAO, said: “The Department for Health and Social Care and NHS England have made a series of clear commitments and plans to improve mental health services, but they have not defined what achieving full parity of esteem for mental health services will entail. It is therefore unclear how far the current commitments take the NHS towards its end goal, and what else is needed to achieve it and match the increasing public awareness and need.

“While funding and the workforce for mental health services have increased and more people have been treated, many people still cannot access services or have lengthy waits for treatment. With demand for mental health services having increased since the pandemic and being expected to increase further in the coming years, it is vital that DHSC and NHSE define what is required to meet the growing demand.”

Meg Hillier MP, Chair of the Committee of Public Accounts, said: “The many individuals affected by mental health problems rely on the right treatment at the right time, so they can lead fulfilling lives.

“Today’s NAO report shows that DHSC and NHSE have made some progress on expanding vital mental health services. However, their plans fall short of demand and the quality of provision is uneven. I am concerned that children and other vulnerable groups are more likely to have a poor experience of treatment, if they manage to receive treatment at all.

“My committee has previously highlighted the immense challenges across the health and social care landscape; addressing fundamental workforce issues are central to fixing the crises. The challenge facing the nation’s mental health has grown enormously since Covid-19. DHSC and NHSE must ensure that mental health provision is given due attention as they firefight on all fronts. The cost to individuals and wider society will be significant if they fail to do so.”

The full report can be accessed here.

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Mental Health Act reform to tackle detention disparities

By Niamh Macdonald

The Queen’s Speech yesterday outlined government plans to change the Mental Health Act 1983, empowering the individual to have more control over their care.

The announcement included plans to introduce a draft bill which will change the criteria for detaining so that it is only used when necessary: if the person is a genuine risk to their safety or others and there is therapeutic benefit.

The definition of a mental disorder will also be amended in the draft to ensure no one can be detained solely for having a learning disability or being autistic.

Plans to reform the Mental Health Act 1983 follow the government-commissioned Independent Review, published in December 2018 and the follow-up white paper produced in January 2021.

The government set out a goal to ‘deliver a modern mental health service that respects the patient’s voice and empowers individuals to shape their own care and treatment.’ It also made recommendations on how to address disparities in how the act affects people from black, Asian and people from ethnic minority backgrounds.

The next steps will likely be that the draft bill is considered by a parliamentary committee to inform full legislation to reform the act. It is not currently clear when the draft legislation will be published but the proposals will be considered over the next year.

Responding to the proposed new measures, director of policy and strategy at NHS Providers Miriam Deakin said: “A new Mental Health Act on its own won’t be enough to guarantee high-quality mental health services or transform the way we deliver them for years to come. Mental health services are under severe strain from huge demand and limited resources.

“Covid-19 has left a significant legacy on the nation’s mental health, particularly for children and young people, and the effects of poor mental health are expected to last longer than in some other areas of care.

“Coming hard on the heels of the biggest health service reforms for more than 10 years under the new Health and Care Act, we look forward to seeing detailed government proposals to reform the Mental Health Act as soon as possible.”

Vicki Nash, Head of Policy, Campaigns and Public Affairs for Mind, said: “Over 53,000 people were detained under the existing Mental Health Act in England in 2020/21 – an increase of four per cent on the year before. As these numbers continue to rise, we urgently need to see the UK government implement the long—overdue legislative changes needed to give people greater choice and control over their treatment

“In most cases, people are detained under the Mental Health Act against their will because they didn’t get the right help when they needed it. Black people are hardest hit, with higher rates of detention and practices that restrict their liberty, including face-down restraint, which can be fatal.

We need the new Mental Health Bill to change this and we must see more investment in early intervention to reduce the number of people becoming unwell in the first place. Mental health problems become more difficult to treat if left unchecked, as well as more costly to the NHS.”