Mental healthcare recovery plan

Mental healthcare recovery plan urgently needed to tackle ‘second pandemic’

Mental health leaders warn that a generation of children and young people will face longer waits for treatment unless there is a comprehensive plan.

A generation of children and young people will face longer waits for their treatment and will see their mental health deteriorate unless there is a comprehensive plan from the Government to respond to the growing demand for mental healthcare in England.

This is the somber warning from health leaders running mental health services across the country who continue to see more people, especially children and teenagers, coming forward for support and treatment for their mental health, while the NHS contends with a staffing and estates ‘crisis’.

1.6 million people are currently on the waiting list for specialized mental health treatment – that is around one in 35 people, or roughly the populations of Leeds, Bradford and Wakefield combined.

On top of that, there are an additional eight million people who could benefit from this sort of treatment, including talking therapies and medication following comprehensive assessments.

The call follows the publication of the long-awaited NHS Elective Recovery Plan, which set out how the backlog of people needing planned surgical procedures will be addressed.

£44 billion of additional funding was allocated for the NHS in the government’s Spending Review last year, including £5.9 billion to tackle the elective care backlog, but none of this was specifically identified for mental health.

This is despite the government having committed to increase the proportion of planned spending on mental health services every year. Estimates have shown that mental health services would need an extra £1 billion in 2022/23 alone to keep up with the rising patient demand.

Also, of the 48 new ‘hospitals’ that the government has promised to build by 2030, 40 projects have been announced so far and of these, only two are for mental healthcare.

This is leading mental health leaders, such as NHS trust chief executives and medical directors, to raise concerns that their services, workforce and patients are being sidelined when they face high demand and pressure, just like the rest of the NHS.

The NHS Confederation’s Mental Health Network is calling for the same level of attention to be given nationally to address the backlog facing mental health services, referred by many in the sector as the ‘second pandemic’.

A key element of this recovery plan should include a sharp focus on providing early support for children and young people who have, or are at risk of having, mental health issues, as this is an area that has seen a significant increase during the pandemic.

For example, there has been a 72 per cent increase in children and teenagers being referred for urgent support for eating disorders over a recent 12-month period. Around three in five (59 per cent  of children and young people who need support for an eating disorder are seen within one week but with demand increasing, NHS teams in the community are struggling to keep up.

Elsewhere, there has been a 52 per cent rise in emergency referrals for under-18s to mental health crisis care over the last two years. This is against a backdrop of a 20 per cent cut in dedicated beds for children and young people with mental health problems over the last five years, meaning hospitals can become overwhelmed very quickly.

One way of identifying and supporting children and young people early on would be to make sure every pupil in England is covered by mental health support teams, which are based within schools and other education settings. Currently, around 15 per cent of pupils are covered, with the government only planning to expand this to 35 per cent (400) by 2023.

Other elements of the recovery plan for mental healthcare should include:

• Providing additional support for the mental health workers as many feel close to burnout and setting out how vacancies will be filled. While recruitment is ongoing, it is not at the rate needed, particularly for mental health nurses and consultant psychiatrists. Around one in ten consultant psychiatrist posts are currently unfilled.
• An expansion of estates for specialist mental healthcare, including modernizing dated buildings and equipment, as backed by the Royal College of Psychiatrists recently.
• Greater support for primary care services which are seeing more of their patients needing help for their mental health but who are not ill enough for secondary care treatment. This should include offering more flexibility to how community-based mental health practitioners are recruited across primary care, community and specialist mental health services, and involve the voluntary sector.
• Expanding access to digital platforms, such as apps, remote consultations and therapy sessions, while appreciating that this will not be appropriate for everyone.
• Identifying targeted ways to encourage people to come forward and access support for their mental health locally, in recognition of known health inequalities. A recent report from the NHS Race and Health Observatory, which is hosted by the NHS Confederation, found that minority ethnic patients were less likely to be referred to Improving Access to Psychological Therapies (IAPT) than white British patients by their GPs and also, they are less likely to be referred for cognitive behavioural therapy (CBT).
• Appointing a prominent national leader from within the NHS to steer the recovery plan, in the same way Sir Jim Mackey has done to address the elective care backlog.

Alongside this recovery plan, the NHS Confederation is calling for more attention to be given to tackling the broad social and economic determinants of good mental health, such as poverty, employment, education and housing, and for these to be reflected in both national and local strategies.

Matthew Taylor, chief executive of the NHS Confederation, said: “We are moving towards a new phase of needing to ‘live with’ coronavirus but for a worrying number of people, the virus is leaving a growing legacy of poor mental health that services are not equipped to deal with adequately at present.

“With projections showing that 10 million people in England, including 1.5 million children and teenagers, will need new or additional support for their mental health over the next three to five years it is no wonder that health leaders have dubbed this the second pandemic. A national crisis of this scale deserves targeted and sustained attention from the Government in the same way we have seen with the elective care backlog.

“Also, this calls for a radically different approach to how we support and promote good mental health at both national and local levels, rather than simply leaving it to the NHS to respond to overwhelming levels of illness.

“It is encouraging that the Secretary of State has confirmed there will be a renewed focus on mental health as part of the updated Long Term Plan but if we don’t respond now and look at new prevention strategies, a generation of people risk being let down by the institutions that should be there to protect and support them.”

Dr Adrian James, President of the Royal College of Psychiatrists, said: “We urgently need a fully-funded mental health recovery plan, backed by a long-term workforce plan, to ensure everyone with a mental illness can get the help they need when they need it. Millions of children, young people and adults are seeking help from mental health services that are over-stretched and under-resourced. The situation is critical. The Government cannot afford to neglect mental health recovery any longer.”

Olly Parker, Head of External Affairs at YoungMinds, said: “The impact of the pandemic on young people’s mental health cannot be overstated and it is critical not only that there is a proper recovery plan for mental health, but that young people are at the heart of it.

“The latest NHS performance figures demonstrate that the goalposts have drastically shifted since the NHS Long Term Plan was published. There can be no clearer evidence that a range of mental health support for young people must be available, including options for them to get help early on, close to home, when they first experience poor mental health.

“We must also see as much time and attention given to making sure mental health services are equipped to deal with current and forecast demand as to dealing with the elective backlog, particularly as physical and mental health go hand in hand. It is also vitally important that the Government’s upcoming mental health plan helps the NHS to do this, has a dedicated focus on young people and sets clear cross-government goals for improving young people’s mental health.”

Dr Phil Moore, a GP and chair of the NHS Confederation’s mental health, learning disability and autism system group, said: “Covid and societal pressures are leading to mental health services becoming overstretched despite everything hardworking teams are doing.

“Intervening early is effective, yet waiting lists are growing, particularly across eating disorder services, children’s mental healthcare and early intervention for psychosis, where backlogs can often result in people’s individual circumstances deteriorating to the point of crisis. No clinician wants to see this happen to their patients.

“This was a problem before Covid but things are a lot worse now and so, it is time for a proper review of how the NHS, wider public services and the Government should respond to the significant mental health crisis facing our population.”