Further significant, specific challenges facing mental health provision and NHS mental health trusts that need to be addressed to fully deliver the three shifts the government wants to make to health and care, and provide sustainable high-quality mental health services over the next decade include:
- National mental health strategy: while the sector has benefited from the Five Year Forward View for Mental Health and the NHS Long Term Plan, focus and investment has not been long term or broad enough to turn the tide on the scale of historical and structural disadvantage the sector has faced compared to physical health provision.
- Prioritisation and funding of mental health services: despite the pressures faced, and the opportunities to support better care for all, the government has recently confirmed the mental health sector's share of NHS spend fell in 2024/25 and is set to fall even further in 2025/26. This is the first time the sector's share of spend has fallen since it started being annually reported on and reinforces existing concerns about overall levels of funding for mental health services and whether they are being appropriately prioritised locally and nationally.
- Long term capital investment: mental health trusts are operating in some of the oldest parts of the NHS estate. These outdated buildings often do not provide suitable therapeutic environments for patients. Frustratingly, some trusts have the money, but arcane Treasury rules prohibit them from spending it.
- Workforce development: demand for services continues to outpace workforce supply and there remain high vacancy rates and shortfalls in both the number and skill mix of staff, particularly in nursing. Dilapidated physical working environments, industrial relationships that are still in recovery, add to the challenging workforce context.
- Data and digital capacity: there are significant challenges around data collection and data quality which hamper understanding of mental health activity, access, outcomes and inequalities which would enable better commissioning of services. Digital capacity and the skills required to analyse and act on population-based trends are further gaps that need addressing.
- Commissioning: the commissioning of mental health care by local and national commissioners has been fractured following the Health and Care Act 2012, impacting on the efficiency of service delivery and continuity of care, as well as decreasing investment in the wider services supporting mental health patients and service users.
- Integration with wider public sector services: wider socioeconomic factors significantly influence mental health, including poverty, homelessness, and public health concerns including substance misuse. Wider public services, and in particular social care and public health, are therefore critical to improving access and care, but remain significantly underfunded and resourced.