This week marks the 22nd annual mental health awareness week. Raising awareness helps to reduce the stigma of mental ill health and can help more people come forward to seek the support they need. It also helps to highlight the scale of mental ill health and unmet need, and strengthen the case for continued support and investment to improve and expand mental health services.
Raising awareness feels more important than ever this year amid widespread concern about a host of issues both at home and abroad and the impact of these on people's mental health, as well as their impact on the level of focus and priority we give to mental health at a national level.
The theme for this year's awareness week is loneliness, and mental health trust leaders have long been concerned about its impact: our pre-pandemic survey found 97% of trust leaders who responded identified loneliness and isolation as having an impact on increasing demand for services.
Not only is loneliness a driver of demand – with chronic feelings of loneliness associated with increased risk of depression, anxiety, psychological distress and substance misuse – but longstanding and widespread challenges in accessing services can also bring on or exacerbate loneliness among people with mental health needs. It can be incredibly lonely to wait – for months and, too often, years – for a diagnosis and the right care and treatment, or to be sent far from home for care due to lack of capacity in local services.
As we consider the impact of the pandemic and look towards shaping mental health services in response and to make them fit for the future, it's helpful to take a look at how mental health services are currently performing, where the particular pressure points are and what is needed to address these.
What has happened to demand and how have trusts been responding?
Demand for mental health services has been steadily rising over the years, with the past two years putting particular pressure on people's mental health and mental health services. There were an average of 362,634 referrals a month in 2021 – 14.8% more than in 2019. Trust leaders are telling us demand has not only increased, but they are also seeing more complex and severe cases than before the pandemic.
Mental health trusts and their staff have been working hard, helped by welcome increased focus and investment, to meet as much of the demand for their services as possible: the number of people in contact with services has reached record highs with 1.5 million people in contact in January 2022 – 10% more than before the pandemic.
Throughout the pandemic, mental health trusts have sought to find new ways to maintain services and continue to make inroads on longer term plans to expand and improve the way they deliver care. For example, setting up mental health A&Es and 24/7 emergency service access lines, establishing enhanced crisis care and delivering some home-treatment models and clinical services online, as well as working to set up new models of community-based mental health care.
Access to Improving Access to Psychological Therapies services to support depression and anxiety is one area that has notably kept on track despite the challenges facing the sector over the last two years: latest data shows 90% of referrals were seen within six weeks, which means the national access standard is currently being met.
Challenges in meeting demand
However, we know that it is a significant challenge for trusts to meet demand for a range of other services. For example, despite trusts' best efforts, the target of 95% of children and young people referred for assessment or treatment for an eating disorder receiving treatment (within one week for urgent cases and four weeks for other cases) continues to be missed. In the last quarter, only around six in 10 individuals were being seen quickly enough.
Recent data shows there were 1.3 million adult 'open referrals' and 411,000 open referrals for children and young people.
And, while it is important to recognise the NHS is delivering mental health care to more people than ever before, we know the NHS is only beginning to scratch the surface in terms of meeting demand for everyone in need of help. Recent data shows there were 1.3 million adult 'open referrals' and 411,000 open referrals for children and young people, which means 1.7 million individuals have reached the referral threshold for secondary care but have not yet been seen. The number of children and young people waiting to be seen is three times higher than when records began.
Trust leaders are also concerned that beyond these known cases, there remains substantial, longstanding unmet need in the community and that is continuing to rise. Latest prevalence data from 2021 showed one in six children and young people now have a probable mental disorder, up from one in nine in 2017.
The significant mismatch between the need for mental health care and the capacity of mental health services is a key reason why we see people placed out of area to receive the care that they need: too many people are too far away from home – and their family and wider support network – for too long. Before the pandemic, progress was being made to reduce the number of people affected. However, increasing pressure on services means there are now 770 people receiving treatment away from home inappropriately – 13% more than the same month two years ago.
So what do we need to address these concerns?
Addressing the significant increase in demand for mental health services, how long people are waiting and how far away from home some individuals are accessing care is a complex and significant challenge. It will be key to secure sustainable levels of support and funding for mental health trusts and their wider partners, particularly social care and third sector organisations, to intervene earlier and which reflects the impact of the last two years.
Tackling loneliness in and of itself more broadly is ultimately a cross society endeavour. We need transparency on the extent of need and a robust response with proper support throughout the system, as part of a post-pandemic recovery approach. Trusts and their local partners have an important role to play and can add the most value when operating in partnership with appropriately funded public health services and a government focused on addressing the wider determinants of health.
This blog was first published by BMJ.