NHS bosses warn of mental health crisis with long waits for treatment
Posted on 7/07/2017 by
Report finds 80% fear they cannot provide timely, high-quality care to the growing numbers seeking help
More than half of trust bosses said they were unable to meet demand from troubled children and young people. Photograph: Mads Perch/Getty Images
Mental health services are so overwhelmed by soaring demand that patients are facing long delays to access care, a powerful group of NHS mental health trust bosses have warned.
Widespread shortages of specialist nurses and psychiatrists mean Theresa May’s pledge to tackle the “burning injustice of mental illness” is at risk according to chief executives and chairs from 37 of England’s 53 specialist mental health trusts.
Their concerns are contained in a new report by NHS Providers, which represents almost all of England’s 240 NHS hospital, mental health and ambulance trusts. The report concludes that children, older people and people in a mental health crisis too often receive inadequate care for conditions such as anxiety, depression and eating disorders.
“These concerns point to a growing gap between the government’s welcome ambition for the care of people with mental health needs and the reality of services they are receiving on the frontline,” said Saffron Cordery, NHS Providers’ director of policy and strategy.
“In some cases core mental health service provision by mental health trusts is actually getting worse,” she added.
Eighty per cent of bosses of NHS trusts in England it surveyed fear they will have too little money this year to provide timely, high-quality care to the growing numbers of people seeking mental health support. Many do not believe that the more than £1bn of extra funding pledged by ministers is reaching its intended destination.
The report paints a stark picture of mental health services struggling to keep up with a growing need for care. That trend is driven by factors including benefit cuts, more children and young people becoming distressed and even suicidal, and more older people developing dementia.
“The impact of rapidly rising demand, workforce shortages and the failure of funding to get through to the frontline means core mental health services are being overwhelmed,” the report added.
Two-thirds of respondents, who also included 115 chairs and chief executives of acute hospital trusts, have seen a rise in the number of patients seeking help, including those who turn up at A&E. Seven out of ten expect demand to increase or increase substantially for all forms of mental health support, including talking therapies and inpatient care.
Asked to identify why demand is rising, one respondent said: “More people of all ages are becoming ill as a result of the pressures of modern life.” Another said cuts to community-based mental health support had forced more people in distress to seek attention at A&E units.
Mental health organisations voiced deep concern at NHS Providers’ finding that large numbers of people with various forms of mental illness are not getting the help they need. In the survey, 57% of trust bosses said they were unable to meet demand from troubled children and young people, raising fears that under-18s will become even more ill as they confront up to 12-month delays to receive care.
Over half (53%) admit they are letting down those who seek urgent care at a hospital’s emergency department, while 33% say they are not providing timely help to older people. Almost as many (30%) admit they are failing mothers and mothers-to-be suffering who have mental health conditions associated with pregnancy and childbirth, such as postnatal depression.
Ministers and NHS national leaders have set out ambitious plans to expand access to mental health care. But only 10% of bosses told NHS Providers that they feel they are both managing current demand and planning to meet unmet need.
Severe staff shortages are limiting trusts’ ability to improve services. Bosses report particular problems recruiting and retaining enough mental health nurses and psychiatrists. “Mental health trust leaders are struggling to find sufficient staff to deliver their current services, let alone find new staff to extend, transform or innovate services,” said Cordery.
John Lawlor – chief executive of the Northumberland, Tyne and Wear mental health trust – said his organisation had recently begun trying to recruit more staff in India as it had a significant shortage of consultants to deal with the growing number of older people becoming unwell.
“We’ve seen demand grow by 5% to 10% over the last three to four years, but among children and young people it’s risen by 30% to 40%. Young people feel more pressurised now than a generation ago due to the expectations of their family, their peer group, society and at school. There is also pressure from social media,” he added.
The findings will disappoint Simon Stevens, the chief executive of NHS England, who has made overhauling mental health care one of his main priorities.
It declined to respond to many of the report’s key findings, saying only that: “Overall mental health funding is demonstrably and indisputably up by £1.4bn in real terms compared to three years ago. And last year alone, CCG [clinical commissioning group] spending on mental health rose by over 7%, which was far faster than overall NHS funding growth, meaning mental health services also grew as a proportion of overall NHS funding.”
A Department of Health spokesperson said: “We’re committed to seeing mental health services improve on the ground and we expect NHS England to ensure the record amount of funding we’re giving to mental health reaches the frontline, with an extra £1bn a year by 2021.
“We will continue to push forward change as we reform outdated mental health laws and have created targets to improve standards of care, including ending out-of-area placements by 2020.”
Alice Victor, 24, from London, was told that she would have to wait a year to be treated for her eating disorder on the NHS. She eventually ended up getting help privately. She shares her story.
“I was really sick of being unwell when I went to my GP aged 22. I had a big problem and I wanted someone to say – ‘OK we can help you.’ The doctor I saw was lovely and very empathetic but she remorsefully told me that I would have to wait a year to get help on the NHS. As I had private health insurance she suggested I pay to get outpatient help.
“To hear I wouldn’t get help for ages was horrible and I was worried about the financial cost of going private as insurance doesn’t cover everything. It takes a lot of courage to get to the point where you finally reach out and ask for treatment. I felt like it had to start immediately. I worried that if this didn’t happen I would get worse and spiral out of control.
“My eating disorder sneaked in over time and I had lost weight. Being at my lowest ebb was a very lonely, tearful and sad time. I spent more time on my own and I am a very social person. I really did retreat into myself and that is so unhelpful. It means you are reduced to being in a place that is unhealthy and one where no one challenges what you are saying to yourself.
“Seeing the GP at 22 was the only time I felt like I had been listened to because they said I needed to be referred. I had been to the doctor about my eating disorder a few times before but no one really engaged with me. I first became unwell at around 17-years-old. I went to the GP but they told me ‘It’s just stress and exams – it will pass.’
“But this time my weight was much lower. Eventually I got outpatient treatment privately for about six months and then when that ended I had a break and got NHS treatment, although not for long. Now I see a private psychologist and I have recently been diagnosed with anxiety and therapy for that is going well.
“I feel incredibly lucky that I was able to get private treatment as it meant I was seen within a month or two. An eating disorder turns you in on yourself and makes you restrained and feel guilt for everything. Taking that step and asking for help is so important and health services should be able to respond to that.
“Eating disorder patients are people who are crying out for help and in an ideal world we should be helping everyone going to their GP about a mental illness.”