Running hot: the impact of the pandemic on mental health services
Key points
- The mental health sector has seen a surge in demand during the pandemic, with levels of need vastly increasing from 2020 to 2022. Approximately 1.6 million people in England, or one person in 35, are currently on the NHS waiting list for specialised treatment, and a further eight million people, or one person in seven, would benefit from support.
- Children and young people’s (CYP) services are reporting an increase in the severity of cases, especially for those with eating disorders, resulting in pressures on inpatient beds as they remain occupied for longer and with more complex cases.
- The mental health workforce has increased overall, but there is still a shortage of key staffing groups, such as mental health nurses and consultant psychiatrists. We need a national long-term, fully funded plan for expanding the mental health workforce.
- Despite the sector facing increasing challenges, of the £44 billion in additional funding for the NHS over the course of the Spending Review, there was no extra investment allocated to mental health services. Further investment is required to provide increased, and earlier, access to services for all who need them.
- It is not clear what the longer-term impact of the pandemic will be, and how economic issues such as the increase in inflation, fuel poverty and benefit changes, will impact on people’s mental health. Poverty and other social determinants of mental health need to be tackled as a priority to reduce the risk of services becoming overwhelmed.
- The case for ensuring access to early intervention support is both moral and economic. The return on investment is three times higher for preventative interventions than specialist services, yet in 2019/20 only 3 per cent of NHS mental health spend was on preventative interventions. Improving access to preventative services for children and young people is particularly important.
The pandemic has had a significant impact on people’s mental health, and the knock-on effect is putting services and partner organisations under considerable pressure. Our members report a steep post-pandemic increase in the severity of the mental health needs of the people presenting to their services, especially in children and young people. This briefing outlines the current context, the case for change in mental health support, and calls for actin from the government including a comprehensive plan to respond to the growing demand for mental healthcare in England.
Increased severity of mental health problems linked to the pandemic
Our members report a steep post-pandemic increase in the severity of the mental health needs of the people presenting to their services, especially in children and young people.
The number of young people completing an urgent pathway for eating disorders increased by 72 per cent between quarter four in 2019/20 and quarter three in 2021/22. Unsurprisingly, performance against access targets for these services have dramatically slipped, with some young people waiting over 12 weeks for urgent care, when the target is for 95 per cent of CYP to receive treatment within a week of referral.
We have also seen an increase in the number of people of all ages needing crisis care. In children and young people under 18 years of age, the number needing an emergency referral to the crisis care team increased by 52 per cent between December 2019 and November 2021, and the number needing urgent referrals during that period increased by 87 per cent. In people of all ages, urgent referrals to crisis care increased by around 12 per cent. 1
The wider social context
It is not clear what the longer-term impact of the pandemic will be, and how economic issues such as the increase in inflation, fuel poverty and benefit changes, will impact on people’s mental health. Poverty is a well-known risk factor for mental health problems, and with 1.8 million children now living in ‘deep poverty’ , it is important that this and other social determinants of mental health are tackled as a priority to reduce the risk of services becoming overwhelmed.
The case for change
Prevention and easy access to mental health support
The case for ensuring access to early intervention support is both moral and economic. The return on investment is three times higher for preventative interventions than specialist services. However, in 2019/20 only 3 per cent of NHS mental health spend was on preventative interventions.
Improving access to preventative services for children and young people is particularly important, as rates of mental illness have been rising in this group. Currently, 17.4 per cent, or 1 in 6 people aged between six and 16 years of age have a mental health disorder.
Mental health support teams (MHST) work in schools to provide easy access to mental health support, and 15 per cent of pupils have access to a MHST currently. Funding has been confirmed to increase this to 35 per cent by 2023, however there was no additional funding in the 2021 Spending Review to support further expansion. A commitment from government that funding will be made available so all schools can have MHSTs in place will help reduce the risk of inequalities in service provision across the country.
Digital services have expanded considerably over the last few years, and they can enable quick and easy access to support. Digital providers such as Kooth, IESO and Healios are already commissioned to provide easy access support in a number of areas across the country and expansion would allow more people to access this type of service. However, digital services will not be right for everyone and a blended approach, which includes access to face-to-face services, will be required.
Funding
Progress has been made over the past few years to start to address the historic underfunding of mental health services, but this progress is at risk.
The government continues to confirm its commitment to funding services via the Mental Health Investment Standard (MHIS). However, despite £44 billion of additional funding for the NHS announced in the 2021 Spending Review, none of this has been specifically allocated to mental health services so far.
Workforce
Workforce capacity has been a long-term concern. While the mental health workforce has increased in line with targets set for 2021, the overall numbers are the same as they were ten years ago, and the number of key staffing groups such as mental health nurses and consultant psychiatrists has not increased in line with the targets, with only 38 per cent of the target numbers in post. 2
Viewpoint and recommendations
- It is clear that the pandemic has significantly impacted on people’s mental health, and the knock-on effect is putting services and partner organisations under considerable pressure.
- So far, there is no further funding beyond that calculated to meet pre-pandemic demand rates earmarked for mental health services, despite the issues outlined in this briefing, making it very clear that further investment is required to provide increased, and earlier, access to services for all who need them.
- Many of the determinants of good mental health are outside the control of the NHS. Education, employment, social security, housing and the criminal justice system all impact on the mental health of the population. The development of a cross-government strategy for mental health and a tool to assess the mental health impact of wider government policies are opportunities to create an environment that support people’s mental health and recovery and reduces demand on the NHS. Cross-government strategies need to be underpinned with resources and buy-in from the relevant departments, and we are concerned that the lack of additional funding and uncertain political leadership puts the effectiveness of this strategy at risk.
- We know how crucial it is that people experiencing mental ill-health are seen promptly, before their conditions worsen. There are early intervention models that already exist, such as the mental health support teams, but more must be done to ensure access to these services, including the accelerated roll-out of CYP interventions.
- We support the Health and Social Care Committee’s recommendation that mental health support teams should cover two thirds of schools by 2024/25, and 100 per cent by 2027/28.
- However, these recommendations cannot be implemented without the specialist workforce required to deliver real change. The recent expert panel on mental health stated that ‘workforce shortages represent the single biggest threat to national ambitions to improve mental healthcare.’ We must therefore stress the need for a national long-term, fully funded plan for expanding the mental health workforce that is aligned and integrated with ICS workforce plans.
- Strengthening the system’s legal duty around mental health funding to ensure that we continue to work towards parity, would send strong signals to the system that mental health funding must be a priority. We support amendments to the health and care bill that would enable this.
