Only one in three people with mental health problems receive treatment. The NHS Long Term Plan, a ten-year plan for the health service published in 2019, made it a central ambition to change this fact. It committed to providing mental health care to two million more people by 2024.
But just one year into that plan, the coronavirus pandemic began. It has derailed those ambitions. Social isolation, bereavement and disruptions to employment and education are fertile soil for mental health problems.
The rise in mental health issues has been staggering. And it has been felt most severely by young women and children. England’s Mental Health of Children and Young People Survey found the proportion of children with a probable mental illness increased from 10.8 per cent to 16 per cent between 2017 and 2020. Only a fraction of these children will receive specialist help.
Published this week, the State of Health and Care report from the Institute for Public Policy Research (IPPR) has surveyed the impacts of the pandemic on NHS services over the past year. Among a range of new analysis, it finds that referrals for childhood eating disorders have doubled, with waiting times for treatment pushed to a five-year high.
It is estimated the pandemic will lead to 1.8 million new mental health service referrals by 2024. This almost exactly cancels out plans to increase access, as outlined in the NHS Long Term Plan.
Allowing demand for mental health services to grow faster than they can be provided pushes the threshold for specialist care higher and higher. Even before the pandemic, this threshold was very high, particularly for children. Now many more will be told they are simply not unwell enough to see a specialist mental health practitioner.
That should not be acceptable. Successive governments have made it a goal to prioritise mental health – most recently, this government reiterated its commitments in the 2019 Conservative manifesto. It must not now duck the responsibility because the challenge has grown.
The costs of not intervening are high. They extend far beyond health and would be felt for years to come. For individuals and families, mental health is the single greatest factor that determines whether people are satisfied with their life. For society and the economy, mental health problems are the leading cause of working-age disability. Any rise in population mental illness is matched by a loss in economic output. It will undercut the economic recovery that begins as lockdowns lift.
With the right ambition, the solutions are in reach. We need not simply accept a decade of mental health disruption.
Last year, the government committed an extra £500m for mental health services. That is welcome. But it is not commensurate with the scale of the problem. New IPPR polling of senior NHS and local government officials across the country finds the rise in mental illness, as well as staff burnout, is perceived as the greatest post-pandemic challenge they face as healthcare leaders.
The IPPR is calling for a five-year funding agreement to lift the NHS’s core budget by £2.2bn a year to recapture the NHS Long Term Plan’s trajectory on mental health care. It is part of a bigger £12bn blueprint the think tank is putting forward to sustain health and care in the long term.
But more funding is of little use without enough staff to provide the care. It is a statement of the obvious, but all too often NHS service planning ignores the fact that expanding services relies on a bigger workforce.
A survey conducted by the British Medical Association just before the pandemic began found 63 per cent of mental health staff worked in settings with rota gaps, and 69 per cent of these said such gaps occurred either most or all of the time.
Better alignment between contribution and reward is at the heart of addressing the recruitment and retention problems in the NHS, which are particularly severe in mental health services. Better pay is the main driver of that alignment. A 5 per cent pay rise for all NHS staff (excluding consultants and senior managers) would cost £1.4bn, the IPPR has found. This is not just affordable in the current macro-economic climate, it is a good fiscal stimulus that would contribute to a strong and fair economic recovery.
But the focus cannot just be on increasing mental health service capacity to keep up with growing demand.
Preventing mental health problems relies on action outside of the NHS. Employment, education and housing conditions are the leading determinants. Social and economic policymaking in the post-pandemic recovery must be mindful of that. For example, more generous welfare support for children and families would make a big difference to the prevalence of mental health problems.
The government wants to “build back better”. To do that, it will need to finally make good on promises to put mental health on a par with physical health. There is still a long way to go.
Dr Parth Patel is an IPPR research fellow, and co-author of the State of Health and Care report.
To see the most recent Spotlight report on mental health click here.