PAUCITY OF ESTEEM

and in clinics and, ultimately, burning out. He says the Government needs to ‘invest in the wellbeing of the workforce’ urgently.

Dr Smith describes the problem as ‘chronic’ – and says many trusts, with consultant vacancies at 50 per cent, are forced to turn to locum staffing at ‘far greater’ expense, which costs the NHS around £3bn a year.

‘If you’ve got a significant proportion of locums who come in, do the sessions and leave, then leave without helping build and develop the service quality, gradually the quality of the service is not going to improve,’ she says. ‘That’s really concerning.’

Staff in tears

The combination of surging demand and dwindling staff numbers is brutal for staff. One doctor says: ‘It’s impossible to not take it home. You just have this level of exasperation… “I really want to help you, but I can’t”.’

Dr Molodynski adds: ‘The sense of frustration and unhappiness is palpable. We’ve had members of our team in tears at times.’

Funding is a critical issue. While the Government has committed more spending to mental health – at least £2.3bn a year by 2023/24, it says – it is not likely to be anywhere near enough. In recent years, spending on mental health has increased at a slower rate than overall NHS expenditure and the proportion of the NHS England budget spent on mental health has fallen since 2016/17.

Professor Dave says ‘we’re still playing catch up’ with resource and highlights a lack of beds as an immediate effect of lack of resource.

Bed numbers have fallen significantly under successive governments. Learning disability and mental illness beds have seen the largest reduction, of 69 per cent and 23 per cent respectively, since 2010/11.

Professor Dave says: ‘I have been on call when there has been no bed available nationally. There are times when you realise that unless somebody is being detained there’s no hope of finding a bed.’

The effect on patients is brutal.

Dr Molodynski says: ‘The more demand there is for the same amount of services means the threshold for accessing services gets higher and higher every year. People who would have been able to access, for example, talking therapy, 15 years ago, in many parts of the country would get nowhere near it these days.’

Two-tier system

Behind every number and every target are thousands of real lives blighted by this crisis.

Saskia Homer, a civil servant from Wales, is familiar with the effect under-resourcing has on patients. Saskia lives with autism, depression and agoraphobia and has attempted to take their own life on ‘numerous’ occasions.

Their interactions with mental health services have been torturous – including a three-year waiting list for autism support, another lengthy waiting list for specialised sexual abuse support, a 111 call handler who described them as not sounding ‘very suicidal’ and a ‘frightening’ inpatient stay in a psychiatric hospital. They also told The Doctor they fear hospitalisation owing to the likelihood of being an inpatient miles away from home in Wales or their parents in Scotland.

‘There’s a disconnect between waiting lists and people’s actual lives.’ Saskia says. ‘The real issue is the waiting times.’

Saskia adds: ‘You don’t feel like you’re going to be helped… You feel like you’re going to be fobbed off from service to service… It makes you lose trust and faith in the mental health system.’

Doctors are also concerned about the creation of a ‘two-tier’ care system with increasing numbers of people turning to private care for assessment, diagnosis and treatment.

Father-of-two Simon, from the south east of England, felt he had no other alternative when one of his daughters, who was struggling with depression and attending school, was told the waiting list was likely to be years rather than days or weeks. Simon paid for counselling and an autism diagnosis, which then unlocked

The state of mental healthcare in England

4.3m 2021

BMA emergency department data: More than 350 per cent rise in number of mental health patients waiting 12 hours or more in emergency departments from 2016/17 to 2021/22

350% RISE

3.8m

2019

Resource:

General demand: Record 4.3 million mental health referrals in 2021. Up 13 per cent from 3.8 million in 2019.

The BMA has called for a doubling, plus accounting for inflation, of the extra £2.3bn announced for mental health in 2019

Workforce: One in seven planned FTE doctor positions in mental health are vacant

1 in 7 VACANCY RATE

One mental health patient waited 744 hours (31 days) in A&E at a London hospital in 2021/22

744 hrs WAIT IN A&E other avenues of support, but had to fork out thousands of pounds in savings.

Simon says: ‘It must be a dreadful situation to be in where you know that something may be helpful and possibly transformational, but you can’t access it purely because of the cost. I think services need to be far better resourced. People need access to staff like clinical psychiatrists much faster.’

Communities are littered with families such as Simon’s. Reflecting on these stories, the child psychiatrist in an inpatient tier 4 unit says the effects of these delays can be ‘lifelong’.

The BMA is calling on the Westminster Government and NHS England to support mental health services – demanding an expansion of the workforce, ‘robust and frequent’ collection of data, an action plan to attract more clinicians and increased exposure to psychiatric specialties during training.

Investment essential

The BMA is also urging ministers to protect mental health services against inflation and for a promised £2.3bn increased funding to be brought in line with inflation and then doubled to meet demand. This investment, it says, must come alongside support for primary care, public mental health, mental health research and estates.

Finally, the association is urging an expansion of inpatient mental health beds in England to eliminate inappropriate out-of-area mental health placements.

Appealing for urgent change, Dr Molodynski says: ‘People with mental health problems are enormously varied, but at heart, they have a shared characteristic in that they are in mental health crisis or have mental health problems.

‘If there was any other group of people who had a shared characteristic and we said to this group of people that we’re going to tolerate them having manifestly worse services than other people, tolerate them living on average 15 to 20 years less than the people they live next door to when other factors have been controlled for, we’re going to tolerate them having access rates to evidence-based and NICE guidance-approved services of as low as 20 to 30 per cent, it would be absolutely unthinkable. It would be very clearly a civil rights issue.

‘But for some reason, in this country, and in most countries, we’ve come to a position where we think that’s OK.’ for

It is abundantly clear, from his testimony and that of other doctors and patients, that it’s not OK.