There should be no winners and losers when it comes to access to healthcare.
Yet for years national support and resources for mental health services have lagged far behind what is given to physical health services. A broader set of mental health waiting time and access standards comparable to those we have had for decades for physical health services have not yet been fully introduced despite having been consulted on and agreed to years ago – in part due to a lack of resources to deliver them in practice.
The House of Lords resumed its consideration of the Mental Health Bill at the start of this week. More resources are key to successful implementation of the bill, which aims to improve how and where people access high quality mental health services. A proposed amendment to the bill, which would have guaranteed mental health funding doesn't fall as a share of overall NHS funding beyond 2025/26, brought welcome renewed attention to the issue of funding for the sector.
Lord Darzi concluded in his recent diagnosis of the state of the NHS that 'there is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20% of the disease burden but less than 10% of NHS expenditure'.
We need big changes.
For instance, far too many people still need to be sent as a last resort many miles from home to receive mental health care because of severe bed shortages. Services such as those for children and young people with eating disorders are still unable to meet key national targets despite their best efforts.
Latest official figures highlight the enormous challenges mental health trusts face. Services are experiencing huge increases in demand, particularly for services like children and young people's ADHD and autism assessment services. Demand is considerably higher than before Covid-19, as the last count referrals are 39% higher. The number of people in contact with mental health services reached a record high of 2m in December 2024.
Also, many NHS mental health services are in desperate need of capital investment to modernise outdated buildings and facilities in order to provide a safer and more therapeutic environment for patients as well as a better place for staff to work. More capital funding will also enable mental health trusts to further support the government's aim to deliver more high-quality, integrated care in community settings. Frustratingly, some trusts have the money but arcane treasury rules prohibit them from spending it.
A recent survey by NHS Providers found four in five trust leaders do not believe they have been given enough funding to reduce sustainably care backlogs across mental health services. Only 8% of respondents were confident in their system's ability to meet recovery targets for mental health services compared to physical health. 9 in 10 mental health trust leaders in our most recent annual survey also told us they were worried about their capacity to meet demand over the next 12 months.
The mental health investment standard has been a critical safety net which has ensured a growing share of NHS spending on mental health services, supporting significant expansion and transformation of services. However, despite this safeguard, there remains significant unmet need and we remain concerned about whether overall levels of funding are enough and whether mental health services are being appropriately prioritised locally or nationally.
While aspirations have grown, the healthcare system is still operating in the context of a 'mental healthcare deficit' where we accept that not all those that need help and treatment will seek or be able to access timely support. It means also that mental health services are not prioritised across the whole of the NHS. Increases in mental health funding to date, while welcome, have also not matched increases and changes in demand and acuity levels, and not been broad and long term enough.
The government must prioritise mental health services in forthcoming NHS funding decisions, in recognition of the economic and wider benefits derived from investing in high-quality, accessible mental health care. Poor mental health is the leading driver of ill-health related economic inactivity. Investing in high quality, accessible mental health services can also reduce healthcare costs, improve productivity and lead to better health outcomes for patients.
The government's promised 10-year health plan is an opportunity to ensure that the mental health sector can keep improving how and where safe, high-quality mental health services are accessed and rise to the challenge we face of better, and more equitably meeting the needs, of patients.
It's time to give mental health the priority it deserves.
This article was first published in Healthcare Management.
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