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Overview

  • There are an increasing number of people in contact with mental health services.  

  • Where there are waiting time targets, access to care has improved over time and most targets are currently being met.  

  • The use of national waiting time targets is currently limited to three services. Evidence indicates that access varies across different types of service.  

  • People may face additional waits within services, particularly between assessment and receipt of treatment. These waits are poorly captured by current measures.  

  • Reasons for poor access are varied but have a negative impact on people in need of care, such as increased risk of self-harm and suicide, and poor treatment outcomes. 

Demand for mental health care is increasing 

There are an increasing number of people in contact with NHS-funded mental health, learning disability and autism services. Since April 2016, the number of people in contact with secondary mental health services has increased by 59%, and the number of referrals to NHS Talking Therapies has increased by 44%.  

The number of people in contact with secondary mental health services has increased

Most access and waiting time standards are being met 

National access and waiting time standards apply to two NHS mental health services (see table), and one service for children and young people (see section on Children and young people’s mental health).  

NHS Talking Therapies (formerly Improving Access to Psychological Therapies, or IAPT)  

  • 75% of people referred to the service should start treatment within six weeks of referral, and 95% within 18 weeks of referral. 

  • Access to the services in 2021 should be 25% of the proportion of predicted prevalence of anxiety and depression in the local population.  

Early Intervention in Psychosis  

  • 60% of people experiencing a first episode of psychosis should have access to a NICE-approved care package within two weeks of referral. 

The waiting time standards for NHS Talking Therapies and Early Intervention in Psychosis services, established in 2016, have consistently been met in recent years. However, fewer people than expected are accessing NHS Talking Therapies. The expected access rate if 25% of the population in 2021/22 had been referred would be 1.6 million people per year, but the actual figure was 1.2 million – 22% lower. This means there are a substantial number of people likely to benefit from this support who are currently not accessing it.  

Waiting time targets are consistently being met

The use of access and waiting time standards is generally accepted to have improved access to care and treatment. However, the standards are not without issues; in particular, they may not fully reflect people’s experience and may underestimate the amount of time people have to wait. A National Audit Office analysis of waiting times in NHS Talking Therapies services identified notable gaps in the data for people who drop out or are discharged before attending at least two appointments. This has led to a significant underestimation of the number of referrals and a lack of visibility around delays in treatment, including for people who have been on the waiting list for more than 18 weeks.  

There have been proposals to further expand access and waiting time standards to community-based mental health crisis services, mental health needs in an emergency department, and non-urgent community mental health care. NHS England has undertaken wider consultation on a set of new standards that are currently being piloted, including national data collection, but a timeframe for setting the standard is yet to be announced. Published data on non-urgent access to adult community mental health services shows that the current average (median) waiting time from referral to the second contact (when treatment is deemed to have started) is 47 days. However, 10% of people have waited at least 238 days. The recommended target is four weeks.  

Access in other areas of mental health care is variable 

There is no common standard for access to mental health services. Both the NHS Five year Forward View for Mental Health and the NHS Long Term Plan established targets around expected access rates to types of care and treatment (ie, how many people should receive that care) and around the coverage and standard of services to be achieved by 2023/24 (see table).

NHS Long Term Plan targets (to be met by 2023/24)

1.9 million adults and older adults to have access to NHS Talking Therapies for common mental illnesses

370,000 adults and older adults with severe mental illness to access integrated primary and community mental health care

  • 2021/22 interim target met? N/A

  • Current figures: 573,065 (November 2023) 

At least 66,000 women with moderate-to-severe perinatal mental health problems should have access to specialist community services

  • 2021/22 interim target met? No

  • Current figures: 54,227 (November 2023)

55,000 people with severe mental illness will have access to Individual Placement and Support services to help them stay in or move back into employment

  • 2021/22 interim target met? No

  • Current figures: 13,100 (Q1 2023/24) 

390,000 people with severe mental illness will receive an annual physical health check

  • 2021/22 interim target met? No

  • Current figures: 279,900 (Q2 2023/24) 

Nationwide coverage of age-appropriate 24/7 mental health crisis lines

  • 2021/22 interim target met? Yes

  • Current figures: 100% (2021/22) 

All general hospitals to have mental health liaison services that reach the ‘Core 24’ standard

  • 2021/22 interim target met? Yes

  • Current figures: 61% (Q1 2023/24) 

Despite these efforts, there are consistent reports of poor access to mental health services, for reasons that include the following factors:  

  • Increases in demand for services that exceeds planned or commissioned capacity. For example, there has been a large increase in referrals for assessment to services for people with attention deficit hyperactivity disorder (ADHD).  

  • Gaps in access to support and treatment between primary and secondary care. This includes:  

    • people whose needs are deemed too complex for NHS Talking Therapies services but do not meet the thresholds for access to specialist mental health services  

    • people with long-term mental health conditions who have been discharged from secondary care but still require support and monitoring of care. 

  • Identification of unmet need. One of the early findings of trusts involved in a programme to transform community services was a high level of unmet need, which falls outside the programme’s focus on people with severe mental illness.  

In part, these issues reflect the fact that services are often still being developed and expanded to meet population needs. Current plans, including the Community Mental Health Transformation programme, aim to address some but not all of these areas.  

Even after having been assessed as requiring care, some people may face considerable waits. This may be due to insufficient capacity for staff to manage or co-ordinate an individual’s care, or availability of treatments and interventions, including those not routinely provided by NHS Talking Therapies services (such as psychological therapies for people with severe mental illness). Most of these access issues are not transparent, because data on the service and the care provided is not routinely collected or published.  

Our analysis of Care Quality Commission (CQC) inspection reports as part of this work found that an insufficient understanding of demand and insufficient staffing (including staff vacancies) were among the key issues contributing to poor access. Challenges in meeting demand were felt directly by staff: 

'The frustration for some of the staff came from their struggles to meet demand... In response [to concerns raised by staff], the service had completed a capacity and demand review. Following this they requested four whole-time equivalent band six staff and one whole-time equivalent band seven nurse.'
CQC inspection report 

Impact of poor access 

Delays in access to services can exacerbate the negative impacts of mental ill health, such as on personal relationships and work. People’s conditions may deteriorate, or the lack of care may result in them accessing care via emergency or crisis services. Lack of access to community-based mental health services is being attributed to current pressures on inpatient mental health care, as people are unable to receive support at an early enough stage to prevent deterioration, leading to the need for hospital admission. Delays in access can also increase the risk of adverse consequences, including self-harm, suicide and risk to others. As a result, people experiencing a mental health crisis may also be more likely to come into contact with police. Even when people access services, evidence shows that waits for treatment in some areas of care can have a negative impact on outcomes. 

Mental health 360: workforce

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