Mental health services: the NHS trust perspective

• More individuals are accessing mental health care and treatment than ever before thanks to new services and higher levels of investment. However, there remains significant unmet need. Trusts continue to work hard to expand services and enable access to high quality care within significant staff and resources constraints. 
• Shifting resources towards prevention and early intervention will enable trusts to deliver a more proactive and co-ordinated community-based model of mental health care. It will also help prevent individuals becoming unwell and enable early access to support for those that do. At the same time, we need to ensure there is an appropriate bed base and safe therapeutic inpatient environments.
• The government must support mental health services in future NHS funding decisions to ensure trusts can meet rising demand through new and future models of care, and in recognition of the economic benefit derived from investing in the delivery of high quality, accessible mental health services. There needs to be a firm focus on the enablers of expansion and transformation – data and digital, workforce and capital funding – and a long-term approach to investment.
• There needs to be particular focus in national policy development and service provision on some of the most vulnerable and under-served groups in our society. This includes children and young people, people from Black, Asian and ethnic minority communities and people with a learning disability and autistic people, who face significant inequalities in their access to, and experience and outcomes of mental health care. 

Welcome strides have been made over the last decade to challenge the stigma of mental ill health, increase awareness of the need to improve care, and begin to tackle the lack of equity in terms of treatment and access to mental health services. More individuals are accessing mental health care and treatment thanks to new services and higher levels of investment. Latest annual NHS England data show 3.8 million people were in contact with mental health, learning disabilities and autism services during 2023-24, which is up almost two fifths compared to before the pandemic. This includes over one million children.

While trusts are doing all they can to expand services and provide the best possible care with the staff and resources available, demand for mental health care has significantly increased and outpaced welcome increases in capacity. Data from October 2024 shows that 1.68 million adults and 521,533 children are on the mental health waiting list – which is up 27.1% and 98.8% respectively compared to the same period before the pandemic. There are also 353,179 children and young people and 229,084 adults waiting for treatment from community mental health services. In our November 2024 survey, more than 9 out of 10 mental health trust leaders were worried about whether their trust had the capacity to meet demand for services over the next 12 months.

Trust leaders have also reported a growing increase in the severity and complexity of cases in recent years. During 2023-24, there were over 30 million contacts delivered by secondary mental health, learning disabilities and autism services in England, which is up 14.4% compared to before the pandemic, and detentions under the Mental Health Act have also increased by over 1,500 over the same period. 

How trusts are improving support for mental health Trusts are working hard to develop their services and meet the needs of their local populations, for example:

• setting up day services to provide an alternative to admission to hospital;
• using digital solutions to expand access to care where appropriate;
• working with schools, GPs, local authorities and the voluntary sector to better meet the needs who people have reached a crisis point, or at an earlier stage to help avoid individuals reaching a crisis point;
• working with other trusts and the independent sector to expand the availability of inpatient beds to help deliver care closer to home and have fewer people wait in general hospital beds or in the community;
• providing more intensive holistic support earlier to individuals to help better meet growing demand for adult community mental health services. 

Mental health trusts also work to support prevention of mental ill health. Examples include:

• a system-wide programme in Bradford focused on prevention, early intervention and integration;
• ‘South London Listens’ and South London and Maudsley NHS Foundation Trust’s work focused on the organisation as a community asset; and plans to create a mental health centre in South London looking at root causes of mental health issues and long-term solutions. 

The previous development of national fully-costed programmes for mental health service delivery have seen substantial, welcome steps forward to help begin tackling the lack of equity in terms of treatment of, and access to, mental health services.

To meet rising demand, address care backlogs and consistently deliver high quality mental health care it is vital to: build an appropriate bed base and a safe, therapeutic environment; increase community-based provision; and invest in the mental health workforce. Mental health needs to be consistently and adequately prioritised, with long-term approaches taken to enabling prevention and early intervention.

The concern to prioritise mental health care is shared across trusts, with over a quarter (27%) seeing mental health service capacity as their greatest risk this winter and nearly a third (32%) of trusts told us they would like to see investment in mental health services as a top priority for the new government when considering enablers for improving patient care over the next decade.

Meeting the needs of vulnerable and under-served groups

People with a learning disability and autistic people have faced longstanding, structural inequities, with many not receiving the care and support they need and should expect from the health and care system. Black, Asian and minority ethnic communities experience significant inequalities in access, experience and outcomes from mental health services; black individuals continue to be more likely to be detained under the Mental Health Act and receive more restrictive care in the community than other groups.

Trust leaders are also clear that support for children and young people must be a priority to meet needs now and prevent a mental health epidemic in future years. Nearly all respondents (90%) to our 2024 children and young people’s survey said that the health and wellbeing of children is not considered enough in national policy and only 33% were satisfied that local plans adequately prioritise these services.

Long-term capital funding

Mental health services are being delivered in some of the oldest parts of the NHS estate and, in many instances, the sector has lacked investment in modernisation and development despite best practice for mental health care having progressed significantly in recent years. Mental health trust leaders have highlighted how poor physical environments affects the rehabilitation and recovery of people using mental health services, emphasising that people are often accessing services at their most vulnerable and typically stay for longer than patients in other types of services. Having a high-quality physical environment is also important for staff morale and patient safety: large wards create a cramped and noisy environment and impact on staff’s ability to support patients safely.

It is essential that the government takes action to ensure all trusts have access to sufficient capital funding to halt the deterioration of their estate, eradicate the maintenance backlog, and provide high-quality care in environments fit for the 21st century. 

Workforce development

Despite growth in the mental health workforce in recent years, there remain significant shortfalls in both the number and skill mix of staff. The number of mental health nurses has only recently (2023/24) returned to 2009-10 levels. Over half of all trust leaders (54%) are worried or very worried about whether their trust has the right numbers, quality and mix of staff to deliver high quality health care. Effective mental health services depend on multi-disciplinary teams with the right levels of expertise, skills and experience to meet individuals’ care and treatment needs. Focus is also needed on retention and making the NHS a great place to work, alongside ensuring compassionate, courageous and inclusive leadership at all levels. 

Data and digital capability

There is a need for better data collection and data quality to ensure a clear understanding of mental health activity, access and outcomes, to in turn enable better commissioning of services. The scale of unmet need for mental health services is still not fully understood; prevalence data for mental ill health among adults in England is from 2014. Investment in the skills required to analyse and act on population-based trends is also needed. The digital fundamentals also need to be in place for trusts, for example, strong digital infrastructure (e.g. reliable wi-fi) and effective electronic patient record systems and shared care records to help staff deliver safer care, improve patient and staff experience and enable data-driven decision making. 

The role of wider public services

Increased support for wider public services, in particular public health and social care, is crucial given the contribution they make in helping to both prevent mental ill health and avoid deterioration. Trusts and their partners add the most value when working collaboratively with an appropriately funded public health service, with accompanying government focus on addressing the wider determinants of health.

Over eight in 10 leaders from combined mental health and community trusts (83%) were very worried (39%) or worried (44%) about having sufficient investment is being made in public health and prevention in their local area. The impact on physical and mental health should be properly considered in the development and implementation of all government policies. In social care, there remains a need for a clear vision of reform, and tangible, fully funded measures to improve access and quality for all ages.