A new report, ‘It’s broken’ (Doctors’ experiences on the frontline of a failing mental healthcare system), reveals a worrying picture of mental health services in England.
The current economic cost of mental ill health has been estimated to be over £100 billion in England alone, but this report demonstrates that across the NHS, doctors are in an ongoing struggle to give patients the care they need because the funding is just not enough, there are insufficient staff, and the infrastructure and systems are not fit for purpose.
Based on first-hand accounts of doctors working across the NHS, the report makes plain that without a concerted effort from central Government to resource mental healthcare based on demand (which continues to grow beyond what the NHS can respond to) as well as changes in society to promote good mental health, the future looks bleak.
There are particular concerns around the lack of sufficient beds, with the daily average of available beds decreasing from around 23,500 in September 2010 to just over 18,000 in June 2023. That’s a 23% drop at a time when the population of England has continued to grow, meaning the decline in number of beds relative to the population is even greater. The report acknowledges that in part this is due to an effort by NHS England to prioritise community mental health services, but points out that this cannot be at the expense of provision for people for whom inpatient care is necessary.
One Consultant Psychiatrist, working in A&E, who was interviewed in the report says: “There have been patients who’ve waited up to five days for a bed … in the ED, which doesn’t go down very well and it’s quite difficult because if they become really, really agitated … on occasion, they have been admitted to things like places of safety because there have been no beds anywhere. So there’s always this massive bed juggling issue that goes on, and that impacts on them, because they can’t start their treatment or their assessment properly.”
The report finds that safe occupancy rates for mental health beds are routinely breached. It also finds that several Trusts are due to miss the Government-set target to replace dormitory-style accommodation with single, en-suite accommodation by 2025, citing “challenging economic conditions” as the reason.
Other infrastructure causes of concern include the age and condition of buildings, which in many cases pre-dates the formation of the NHS and is not resourced to provide a therapeutic environment for mental health patients.
The BMA recommends that ringfenced funding should be provided for mental health infrastructure, to ensure the estate is fit for purpose. It believes ringfencing is necessary to ensure capital is not allocated elsewhere in the NHS estate, or used to “plug other gaps in the system.” This should be based on an assessment of need, considering the current state of infrastructure, what is needed to make it fit for purpose, and how many beds are needed and where.
It further recommends that funding targets should be set based on a full assessment of unmet need, rather than an increase compared to historical rates.
The report concludes that mental healthcare has not been provided with the funding or staff necessary to achieve the level of improvement needed for patients and the doctors who work within it. It also makes plain that trying to pinpoint just how much extra funding and staff are required is difficult due to a lack of consistent data on the prevalence of mental illness in England.
