Addressing the care deficit

The NHS is under extreme pressure to deliver mental health services, and is struggling. The reasons for the increased demand are being laid at the government’s door, with a recent survey by NHS Providers finding that 92% of mental health trust bosses in England believe the squeeze on benefits is to blame. In the March 2019 NHS Providers report, Addressing the care deficit, the parlous state of our mental health care services is revealed

Mental health care is approaching breaking point. Recent NHS England figures on current level of demand show a 4.1% rise in the numbers receiving NHS-funded secondary mental health, learning disabilities and autism services. In total, 1,310,985 needed specialist help – an additional 51,496 people. The majority (78%) of these (1,310,985) were in contact with adult mental health services.

Mental health among children is also worsening. Specifically, the number of children and young people starting treatment for an eating disorder has increased by 4.9% when compared to the previous year.

More positively, there were 144,722 referrals to talking therapies and demand for IAPT services is increasing. New referrals increased by 3.9% from 2016/17 to 2017/18; meanwhile, referrals who entered treatment increased by 4.5% over the same period.

But demand is outstripping supply – and shows no signs of slowing. To help explain the reasons why the demand for mental health care is increasing, NHS Providers has created an informative infographic.

Bleak future 

The NHS Long Term Plan and Five year forward view for mental health both set out ambitious plans for mental health in the NHS, but their bold statements aren’t supported with budgets. In simple terms, funding for mental health will rise by just 0.5% and leaders are almost unanimous (95%) in their belief that this won’t be enough. There are also concerns that the increased investment won’t even reach the front line; instead, it is often caught up in internal bureaucracies.

It’s the front line which is experiencing the biggest impact, with over half (55%) of mental health leaders having taken the difficult decision to change or close services as a result of funding pressures, including withdrawing mental health primary care provision.

The sobering truth for most leaders is that an overwhelming majority (81%) of trust leaders feel that they are not able to meet current demand for community CAMHS and 58% said the same of adult community mental health services. A massive 85% of community providers feel there aren’t adequate mental health community services to meet local needs.

While there may not be enough money, the shift towards system working has positively changed the mental health landscape, says NHS Providers. Mental Health Trusts have mixed views on the impact of integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) on their role, but they believe that the roll out of a more integrated healthcare system is a ‘positive step which will help to both overcome the fragmentation of commissioning and service provision in mental health and drive greater value from the investment in services.’

In light of its findings, NHS Providers has developed four key priorities for improving mental health care:

1. Mental health trusts, with the support of the national bodies, will continue to focus on reducing the number of OAPs and address inpatient capacity problems, although national bodies need to recognise the sustained demand here.
2. Many providers are in need of capital investment so that urgent improvements can be made to estates.
3. Mental health trusts need the national bodies to continue to promote careers in mental health, and retain the current financial incentives to recruit mental health professionals.
4. Mental health trusts will be working hard to continue the progress already made on data collection and data quality to give a better understanding of mental health activity, access and outcomes which can then enable better commissioning.

You can read the full Addressing the care deficit report here.

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