The next government must tackle our mental healthcare deficit

Julian Hartley profile picture

03 July 2024

Julian Hartley
Chief Executive

Demand for mental health services has never been higher. Over 2 million people – 1.5 million adults and over half a million children and young people – are on the waiting list for mental health care in England. Referrals have nearly doubled since the pandemic. These numbers – representing people in pain, anguish and distress – have been growing at an alarming rate and are expected to rise further still.

Over 90% of mental health trust leaders have told us they're worried about whether their trust can meet this rising demand.

Years of underinvestment in mental health services has led to a significant mismatch between demand and capacity. Where extra funding has been given in recent years, this has been hugely welcome, but it has been short term and narrowly focused. The impact has also been hampered by cuts to wider public services that are crucial to prevention, early intervention and support for people with mental health needs more broadly.

The general election is a critical opportunity for politicians to commit to placing mental health high on the agenda of the next government – addressing the wider determinants of mental ill health, prioritising early intervention, and enabling the delivery of the right care in the right place at the right time.

Politicians have a pivotal role to play in shaping the future of mental health care in England.

Julian Hartley    Chief Executive

Early delivery of the long-overdue reform of the Mental Health Act is essential. Now over 40 years old, this piece of legislation no longer reflects how we understand and deliver mental health care. Updating the act would help trusts improve access to, and the quality of, mental health services.  

Under this current law, people from ethnic minority backgrounds are 3.5 times more likely to be detained compared to their white counterparts. Reform is urgently needed to address this clear iniquity so that everyone gets the same high-quality care and protections. A draft bill based on widely supported recommendations to reform the act was published two years ago but has not progressed. This election must be the catalyst we need for change.

Failure to reform the Mental Health Act is just one instance of the repeated sidelining of mental health and waning political will to address the systemic challenges facing the sector. This includes the ongoing lack of equity between the approaches taken to mental and physical health services. Mental health patients are often disproportionately waiting more than 12 hours – sometimes days – in A&E. Waiting time standards for community and urgent mental health services comparable to those for physical health conditions are key to making progress but are also yet to be fully introduced.

Capital investment in mental health services also remains disproportionately low. This is despite the fact that around a fifth of mental health services are delivered in outdated buildings and inpatient stays for mental health conditions often last weeks – unlike the shorter stays typically seen for other health issues. 

Politicians have a pivotal role to play in shaping the future of mental health care in England. To shift the dial, we need a cross-government mental health strategy that supports the delivery of a more proactive and holistic model of mental health care and places it on an equal footing with physical healthcare provision.

The first signal of meaningful change we'll look for will be reforming the Mental Health Act.

Julian Hartley    Chief Executive

Ensuring adequate capital investment in mental health services must be a key element of that strategy. This would support the delivery of high-quality care and help trusts meet more people's needs in the right place at the right time. 

Implementing the NHS Long Term Workforce Plan's mental health workforce ambitions, including efforts to improve equality, diversity, and inclusion within the mental health and wider NHS staff body, is also critical to delivering high-quality care that better meets patient and community needs.

Adequate levels of funding are also needed for community and inpatient services, as well as public health and social care, to tackle the underlying drivers of demand for, and pressure on, stretched mental health services.  

The first signal of meaningful change we'll look for will be reforming the Mental Health Act and committing to prioritising mental health services more widely. By doing this, the next government can help build the next generation NHS – one that delivers equitable care for all, supporting a healthier and more productive society. 

This opinion piece was first published by BMJ.

About the author

Julian Hartley profile picture

Julian Hartley
Chief Executive

Sir Julian Hartley joined as chief executive in February 2023, having been chief executive of Leeds Teaching Hospitals since 2013, where he led a major programme of culture change and staff engagement to deliver improved quality, operational and financial performance.

Julian’s career in the NHS began as a general management trainee and he worked in a number of posts before progressing to a board director appointment at North Tees and Hartlepool NHS Trust.

In 2019 Julian was asked to be the executive lead for the interim NHS People Plan, having previously worked as managing director of NHS Improving Quality, and in 2022 he was awarded Knight Bachelor for services to healthcare in the Queen’s Birthday Honours. Read more

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