Millions with mental health needs not seeking NHS help, watchdog says

Millions of people in England with mental ill-health are not seeking NHS help, and many who get it face long delays and a “poor experience”, a report says.

Long waits for care will persist for years because soaring demand, exacerbated by Covid, will continue to outstrip the ability of severely understaffed mental health services to provide speedy treatment, the National Audit Office (NAO) found.

Whitehall’s spending watchdog praised NHS England for expanding the amount of care that patients with psychological conditions can access since 2016, as part of a government plan to give mental illness “parity of esteem” alongside physical conditions. It has expanded the workforce, introduced new services, treated growing numbers of people and brought in new waiting time targets.

However, despite these moves, the report found that “NHS mental health services are under continued and increasing pressure and many people using services are reporting poor experiences”. Under-18s, the LGBT+ community, minority ethnic groups and people with more complex needs are most likely to find the system inadequate.

“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,” the NAO said.

It found:

• An estimated 8 million people with mental health needs are not in contact with NHS services.

• There are 1.2 million people waiting for help from community-based mental health services.

• While the mental health workforce grew by 22% between 2016-17 and 2021-22, the NHS recorded a 44% increase in referrals over the same period.

• In 2021-22, 13% of mental health staff – 17,000 people – quit.

The NHS has met new targets intended to ensure that more people access talking therapy and receive help when they have a first episode of psychosis.

However, too many children and young people referred to an eating disorders service are waiting too long for help, the report says. The NHS is meant to ensure that 95% of under-18s with a suspected eating disorder are seen within a week. But in April-June 2022 just 68% did so.

An NAO survey of 33 of England’s 54 specialist mental health trusts found that, in response to severe pressure, “most” trusts had allowed waiting times and lists to increase; 15 had raised the threshold for how ill people had to be before they got care; and six had cut back the services they offered.

Meg Hillier, who chairs the Commons public accounts committee, said failure to treat patients quickly could have damaging lifelong consequences.

“I am concerned that children and other vulnerable groups are more likely to have a poor experience of treatment, if they manage to obtain treatment at all,” she said.

She urged NHS England and the Department of Health and Social Care (DHSC) to increase mental health provision in order to help staff who were having to “firefight on all fronts”. She said: “The cost to individuals and wider society will be significant if they fail to do so.”

Rosena Allin-Khan, the shadow mental health minister, said the NHS’s findings were a “sorry indictment of the state of mental health services after 13 years of Conservative governance”.

She added: “Waiting lists for mental health treatment are soaring, and health inequalities are growing. The government is haemorrhaging experienced NHS staff in the mental health workforce – it’s a mess of the government’s own making. Patients are being failed.”

The DHSC said: “This report rightly acknowledges some of the extreme challenges faced by the NHS during the pandemic, and the impacts on patients, services and staff. It also recognises the progress made. Spending and workforce have increased, more patients are being treated, and good progress was made towards meeting targets before the pandemic.

“We are increasing investment in mental health services by over £2bn a year by 2024, and delivering 27,000 more mental health professionals, so 2 million more people will be able to get the mental health support they need.”