"A decade of change crammed into just two years". That's how the secretary of state for health and social care recently described the seismic impact of the COVID-19 pandemic at the Global Mental Health Summit earlier this week. The impact of the pandemic on our nation's mental health has been stark. One in five adults in Britain experienced a form of depression at the beginning of this year, with nearly half of adults reporting their wellbeing has been affected by the pandemic.
The NHS in England has made significant strides in improving access to mental health services thanks to the welcome focus, investment and effort nationally and locally over recent years. Trust leaders' commitment to delivering the aims of the NHS long term plan, to improve and expand access to mental health care similarly remains steadfast. But those who run mental health services, and those who need them, know this isn't enough. As a healthcare system, we still have an undeniable 'care deficit' where it is accepted that not everyone who needs help and treatment for mental health conditions will be able to access it.
The impact of the pandemic has brought this inequity in how we view, support and deliver mental health services into sharper focus, with growing unmet need across multiple fronts in health and care. That comes with a terrible human cost.
The current approach to recovering care backlogs
This year's World Mental Health Day falls a month after the government committed to additional revenue funding for the NHS and social care over the next three years. This investment, which comes at a time of tightened public purse strings, will support the NHS' efforts to bear down on the backlog for planned 'physical health' operations. Yet we are not clear how much, if any, of this extra funding will be directed at mental health services to tackle the care backlogs they too face. The mental health waiting list currently stands at 1.6 million people, with data suggesting many millions more would benefit from mental health care.
This backlog weighs heavy on the shoulders of trust leaders. In our recent survey, these leaders told us backlogs in mental health services – specifically children and young people's and eating disorder services were one of the care backlogs they were most concerned about. Almost all mental health trust leaders told us demand for mental health care and the complexity and severity of people's needs are growing.
Tackling the care backlog in mental health
Most mental health trust leaders expect it will take two years or more to tackle their care backlogs and return to pre-pandemic waiting times. That's two years of, often the most, vulnerable and disadvantaged patients in society having to wait to get the care and support they desperately need. But a number told us they could tackle their care backlogs faster if they were given the right support.
So, what does the mental health sector need? Mental health services were given an additional £500m to address waiting times and invest in staff this year. But trust leaders are keenly aware that we are only seeing the tip of the iceberg in terms of the ongoing and increasing mental health care needs arising from the pandemic. Sustained investment will be critical to avoid a widening care deficit.
We can't forget either that more investment is also needed to address the day-to-day impact of COVID-19 on trusts: business as usual is more difficult and costs more. Simply put, investment beyond this year isn't keeping up with the growth – both in terms of numbers and complexity – of mental health demand and what trusts need to do to meet it. It is vital not only to ensure that the mental health investment standard is maintained but to reaffirm our commitment to parity of esteem as well.
Trust leaders will be hoping for important announcements for the mental health estate, which needs focused investment to ensure we have enough beds and a safe therapeutic environment for patients.
Interim Chief Executive
All eyes are now on the comprehensive spending review in just over two weeks' time, where crucial decisions about capital and workforce settlements in the NHS will be made. Trust leaders will be hoping for important announcements for the mental health estate, which needs focused investment to ensure we have enough beds and a safe therapeutic environment for patients.
The sector also needs at least £2bn to deal with the most urgent capital demands for safety critical repairs, upgrading units and building new facilities. Some progress has been made in growing the mental health workforce in recent years, but this still falls short of the growth needed by now and even more staff are needed to deliver longer term ambitions for the sector. Shortfalls in the number and skill-mix of staff in the mental health sector pose the most pressing challenge to the sustainability, accessibility and quality of services. There are limited quick fixes here, given the amount of time it takes to train staff.
This makes the need for a fully costed and funded national workforce plan for the longer term for the NHS, including the number of staff and skills mental health services all the more important. An ambitious programme of training and development must sit alongside this. There must also be ongoing funding to maintain a strong focus on creating more inclusive and compassionate cultures within the NHS, prioritising staff health and wellbeing, and making the NHS a great place to work.
The role of wider public services in mental health should not be forgotten either and in particular, public health and social care. These services have an important part to play both in preventing mental ill health and avoiding deterioration. Trust leaders have told us that a lack of suitable social care provision is one of the key reasons why demand for children and young people's mental health services is not being met as the right care cannot be given in the right place at the right time.
We can, and must, take the opportunity provided by this month's spending review to show that meeting the care deficit in mental health is part and parcel of our recovery from the pandemic.
Interim Chief Executive
Sajid Javid also said recently that "bolstering the efforts in mental health across the board is an indispensable part of levelling up in health – and the key to a safer, fairer and more supportive society". He added that we need to "tackle our social backlog – in mental health and public health – with the same spirit and sense of urgency with which we all tackled the pandemic".
We welcome this recognition that the mental health sector is operating in an unequal world and we need a fresh sense of urgency in tackling the mental health care backlog. We can, and must, take the opportunity provided by this month's spending review to show that meeting the care deficit in mental health is part and parcel of our recovery from the pandemic. Too many individuals, their families and wider society need, and deserve, nothing less.
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