Mental Health Staff at 'Breaking Point' Over Workforce Shortages

Peter Russell

January 10, 2020

Government commitments to expand and improve the mental health workforce in England are not on track and have affected clinicians' workload, wellbeing, and morale, according to a report.

The British Medical Association (BMA), which produced the report, warned that staff shortages, combined with rising demand, had left mental health staff at "breaking point" and threatened patient care.

The Department of Health and Social Care (DHSC) said it was taking action to fill staff vacancies.

The report cites a survey of 1036 mental healthcare professionals conducted by the BMA in collaboration with the Royal College of Nursing (RCN) and the Association of Clinical Psychologists, which found that 63% said they worked in a healthcare setting with rota gaps across the team, while 52% reported being too busy to provide the care they would like on their last shift worked.

The report Measuring progress: Commitments to support and expand the mental health workforce in England , found little growth in the mental health workforce in England over the last 10 years.

Rising Demand for Mental Health Services

Many of the key staff groups had either remained at a similar level since 2009 or had declined, the report said. There has been a loss of 7000 nurses, health visitors and midwives, and 6000 clinical support staff since 2009, although the number of doctors remained steady at around 9000.

Meanwhile, demand for mental health services increased by around 21% between 2016 and 2019.

"We know that the workforce shortages are particularly widespread, and this has really helped highlight that mental health services are continuing to be the 'Cinderella' of the NHS," Catherine Gamble, public health spokesperson for the RCN told Medscape News UK.

According to the report:

  • Around 12% of all medical vacancies are in mental health services

  • Around 12% of all nursing vacancies are in mental health, with a similar figure for clinical psychologist vacancies

  • Many sub-specialties in psychiatry are facing under-recruitment year on year

Previous government commitments to expand the mental health workforce set out in the NHS Mental Health Implementation Plan and NHS England's Long Term Plan were at risk of being unachievable, according to the report.

These included an increase of around 600 psychiatrists, 4000 nurses, 8000 psychologists, psychotherapists and psychological professionals, 5000 support workers, and 600 social workers.

Workforce 'Near to Breaking Point'

Responding to the report, Dr Andrew Molodynski, mental health policy lead at the BMA, said: "This study highlights the very serious problems facing the mental health sector with a workforce near to breaking point.

"There are desperate shortages of care staff of all types across mental health, with doctors and nurses on the frontline overworked and demoralised."

Catherine Gamble added: "We've lost over 300 nurses in the last 4 or 5 years to suicide, and it's particularly worrying that this is on the increase."

She said that expansion of the mental healthcare workforce was unlikely to succeed without efforts to retain staff. "What they're not doing is articulating how they're looking after the existing workforce, because the existing workforce are going to be sending out messages of demoralisation, of exhaustion, of traumatising experiences and drop out, and therefore we'll be consistently in this situation over a longer period of time," she warned.

Improving funding and access to workforce training and development was crucial to staff retention, according to Catherine Gamble. "At the moment over half of mental health nurses have told us that their access to training had worsened over the last 2 years," she said.

Professor Mike Wang, chair of the Association of Clinical Psychologists UK, said: "This survey vividly illustrates the dire shortage of mental health professionals and gross underfunding of mental health services at a time of overwhelmingly increasing demand, resulting in serious compromise to the quality and adequacy of care for the public.

"In particular, severe and longstanding deficits in the numbers of qualified clinical psychologist posts throughout all sectors of the NHS are highlighted by the survey."

A DHSC spokesperson said: "Expanding the mental health workforce is a key priority for this Government so we meet rising demand on services and ensure patients receive the best treatment.

"From September this year, we're giving all nursing and midwifery students at least £5000 a year, and we're taking immediate action to fill vacancies and secure the staff we need – including increasing university clinical placements by over 5000 more and bolstering the workforce through greater international recruitment."

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