NCPS | The King's Fund: Mental health 360 review

The King's Fund has published a '360 degree' review of mental health care.

There is, regrettably, no mention in this report of counselling/psychotherapy, or the role that those practitioners play in supporting the nation's mental health, or indeed the huge workforce of upwards of 60,000 practitioners on Accredited Registers across the UK.

By better integrating counsellors/psychotherapists into the public health system, we would see a reduction in waiting times, and greater diversity in the types of therapeutic intervention offered.

Key messages

  • Since 1999, prevalence of mental illness among children and young people has increased. The availability of timely data on prevalence is inadequate to support appropriate planning and delivery of services.
  • National policy on mental health has prioritised access, resulting in more services and more people receiving support. However, measures of access across services are limited and there are variations in levels of access depending on the type of service, use of national targets, and local commissioning decisions.
  • There has been an increase in the number of children and young people accessing mental health support. However, the NHS is unlikely to meet its current commitments to expand access for children and young people, leaving many unable to access timely support.
  • NHS staff satisfaction and patient experience have declined in recent years. Systemic factors, including lack of workforce capacity and poor physical environment, impact negatively on quality of care. However, efforts to improve quality are compounded by poor processes for identifying and responding to issues, and a lack of outcome measures to identify good practice.
  • There are an increasing number of adults and older people in hospital, fewer beds, and increases in length of stay, all of which place pressure on inpatient care. Nationally, there has been limited progress on reducing the number of people admitted inappropriately to hospitals outside their local area.
  • The mental health workforce has expanded overall, with increases in the number of nurses and psychiatrists. However, expansion has been insufficient to meet demand, and the number of vacancies among NHS mental health providers is higher than for other sectors of the NHS.
  • Spending on mental health services has increased and is in line with current policy commitments. However, funding is not keeping pace with demand. Targeted national funding has meant that some areas of care have benefited, while others remain underinvested. Lack of capital investment is a major challenge to improving safety and quality of care.
  • There are stark and longstanding inequalities in who is likely to develop a mental illness, as well as in access to care and experiences of care. People with mental health problems are also more likely to experience wider health and social inequalities.
  • There is a great deal of data on mental illness and mental health services. However, issues with coverage and quality of data limit its value for being able to plan services and understand what is going on. This directly impacts on the quality and safety of care, and efforts to improve care.

In their 'Workforce' deep-dive, the overview is as follows:

  • Since 2017, the mental health workforce has seen a year-on-year expansion in numbers overall.
  • Despite this, the rate of workforce growth and retention has been insufficient to meet current demand and planned expansion of services.
  • Vacancy rates for NHS mental health staff are higher than for other parts of the NHS.
  • Increases in newly qualified staff, vacancies among clinical staff, and new unregistered roles are leading to a change in skill mix and experience of the mental health workforce.
  • Insufficient numbers of appropriately trained staff is having a direct impact on staff morale and patient care.

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