In an independent review of the NHS, Lord Darzi, a respected surgeon and former health minister lays bare the current performance of the health service, but insists it can be fixed.
The report, which took just 9 weeks to complete, highlights the results of austerity, the pandemic, systemic issues and a decline in the nation's health overall. We highlight the main insights into mental health services.
Demand has grown rapidly
The report states "the need for mental health services has been growing rapidly. In 2016, around 2.6 million people were in contact with mental health services; by 2024, this had increased to 3.6 million people."
This is in line with physical health trends too which have declined overall, putting more demand on health services. This has been a steady trend, as life expectancy grows but the number of people living in poor health for extended period's of time also rises. This has further been compounded by austerity cuts, lack of social care, poor housing and the pandemic.
Demand for assessments has also soared, and referrals for ADHD and Autism assessments are now at a level that has overwhelmed the system.
Waiting times
This rise in demand naturally has affected waiting times, to the extend that Lord Darzi said long waits have come to be expected as the norm.
By April 2024, about 1 million people were waiting for mental health services.
345,000 referrals where people are waiting more than a year for first contact with mental health services—more than the entire population of Leicester.
“As of June 2024, more than 1 million people were waiting for community services, including more than 50,000 people who had been waiting for over a year".
80 per cent of those on the waiting list are children and young people.109,000 of those has been waiting for a year. “For any person, a year wait is far too long. But for young people who are going through profound life changes, this is particularly concerning.”
50,000 adults waiting at least 13 weeks for an assessment for Autism, and the backlog of patients waiting for ADHD assessments would at the present rate, take 8 years to clear. Some trusts would take decades at their current performance.
"Since 2019, the number of children waiting at least 13 weeks for an assessment for Autism has increased at a rate of 65 per cent a year, while for adults the increase has been 77 per cent a year."
A&E
Accident and Emergency departments are inappropriate for those experiencing mental health problems, due to being 'bright, busy and noisy', and yet those patients waited approximately 25 per cent longer than those presenting with physical health problems.
In 2023-2024 more than 80,000 people waited more than 12 hours and more than 26,000 waited for more than 24 hours. "One patient with complex mental health needs spent more than 18 days in an A&E department in August 2024". The report explains two reasons for this are management problems and a lack of availability of beds for mental health patients.
The lack of sufficient good quality facilities contributes to mental health inpatients being accommodated far from their family, friends and loved ones. Inappropriate out-of-area placements of mental health service users have decreased at a rate of 8 per cent a year since 2018 but while they fell from their 2019 peak through to 2022, they began to rise again in 2023 and stood at nearly 6,000 in that year. Being far from a support network hinders recovery and makes it harder for people to get back to daily life.
Follow up and risk management
"At the same time, there are also concerns about the rigor with which patients who have serious mental illnesses are followed up in the community and how effectively risk is managed. There are a number of cases, high profile and not, where people with serious mental illness have not had appropriate risk assessments or sufficiently assertive follow up. There is significant scope for improvement in the quality, safety and consistency of care."
Poor facilities
The report discussed poor facilities; "The NHS has a special responsibility to those that it treats while they are detained under the Mental Health Act. During visits as part of this investigation I saw some high-quality, modern facilities that are world-leading. But I was appalled to uncover that mental health patients continue to be accommodated in rooms that were constructed for a Victorian asylum. In one ward that I visited, patients’ rooms were 7’ x 8’6” with a fixed bunk that measured 6’6” by 3’, occupying more than a third of the room".
"Patients told me how nearly 20 men were expected to share just two showers, how the laundry facilities often broke down, and how they struggled to maintain their personal hygiene and dignity. They spoke of infestations of mice and cockroaches.
Deprivation
Despite the rise in demand for services, there is also an issue reaching those with unmet healthcare needs. A survey by the JRF found that among the lowest 20% of earners, , only 33 per cent had accessed mental health services, and 39 per cent physical health services.
"Analysis by the JRF and The King’s Fund described the impact of deprivation on mental health: in the poorest communities, the depression rate was twice as high, double the number of people were in contact with mental health services, and nearly four times as many were sectioned under the mental health act as in the least deprived".
"A study of homeless hospital inpatients found that 64 per cent had three or more physical health co-morbidities, while a survey of people experiencing homelessness found that 82 per cent had a mental health diagnosis. Poor health can precipitate homelessness and homelessness creates poor health".
Minorities
"Patients from minority ethnic groups experienced worse outcomes; waited longer for assessment; and were less likely to receive a course of treatment following assessment in the NHS Talking Therapies Programme.
There is a substantial evidence base that shows that people from minority backgrounds are more likely to be sectioned under the Mental Health Act. The standardised rate of detention under the Mental Health Act for Black or Black British people was more than 3.5 times higher than the rate for White people. As Mind described in their submission to the Investigation, black people are more than ten times as likely as white people to be subject to a community treatment order, where they can be recalled to hospital if they do not comply with treatment protocols."
Disparity between physical and mental health care
Despite costing the economy £300 billion a year and accounting for 20% of healthcare needs, mental health care gets 10% of the NHS budget. This is despite the quantifyable impact mental health has on physical health;people with severe mental illnesses die nearly two decades earlier than others in society and the gap is widening.
"There is no question that rebalancing healthcare resources is complex and challenging. But the “right drift” is not an accidental outcome. It is the result of financial flows that have funded hospitals for their activity and much of the rest of the NHS for their efforts. It was the choice of successive governments to exclude primary care, mental health and community services waiting times from NHS constitutional standards, which are instead focus on hospital care. This has been reinforced by the failure to invest in the measurement of primary, community and mental health services, which has obscured the real consequences of cuts to block budgets."
Reduction in mental health staff
There has been an overall decline in the mental health workforce, by 9.4 per cent between 2010-11 and 2016-17.
"The number of mental health nurses dropped by 13 per cent between 2009-10 and 2016-17. The workforce then expanded by 26.5 per cent between the start of 2017-18 and the end of 2023-24. But the number of mental health nurses only returned to their 2009-10 level by 2023-24".
Overall, the report depicts a system under considerable strain, characterised by long waiting times and inconsistent quality of care. However, it also identifies areas of improvement and innovation. The findings underscore the necessity of investing in preventative measures, social care, community services, and ensuring quicker access to healthcare. These investments are crucial for enhancing the long-term prospects of the nation’s economy, health, and welfare.
