Pressures in mental health: How are people being affected?

Blog - 10 October 2023

On this World Mental Health Day, we're looking at people's recent experiences of mental health services. With GPs often acting as the front door for mental health support, we've also analysed our evidence about getting a GP referral for mental health. Read about what people told us and what this means for healthcare leaders.
Teenage girl sitting on armchair and talking about her problems to psychologist during consultation at office

Mental health is a broad area of health and care with complex individual cases involved. One in four people will experience a mental health problem of some kind each year in England.  

NHS Digital Mental Health Services Monthly Statistics suggests that demand for mental health services is growing fast. Mental health services in England received a record 4.6 million referrals in 2022 (up 22% from 2019).  

However, for children and adolescent mental health services (known as CAMHS), the increase is most stark. There are over three and a half times as many children and young people in contact with mental health services as seven years ago.  

And while more people need support from mental health services, help is patchy. For instance, waiting times for NHS Talking Therapies (formerly IAPT) vary geographically: "…average waiting times for first treatment varied substantially across England, from lows of four days in Castle Point and Rochford (Essex) to highs of 229 days in South Sefton (Merseyside)."  

Last year, our analysis of people's experiences of mental health services highlighted the need for:   

  • easier access  

  • greater understanding and support  

  • and longer-term treatment plans.  

Key issues people told us about 

Our new analysis of 931 pieces of feedback about mental health services shared with us in September identified the following issues:  

  • delays to care 
  • impacts on wider family 
  • limited choice of support. 

Delays to care   

We know from recent insight that care delays can worsen people's health. People have told us they spend long searching for adequate support to meet their mental health needs. In the meantime, their mental health deteriorates, and they struggle to live an everyday life:  

“Waited 10 months for my daughter to get to the top of the waiting list for talking therapy. By this point her mental health has deteriorated. She’s had several unsuccessful attempts at therapy before and feels trying again is pointless, her last therapist agrees her issues will not be solved by 6 weeks of counselling. GP referred to CAMHS again who said just try more counselling. If that doesn’t work GP can re-refer to consider medication but the wait is likely to be a year. In the meantime she isn’t well enough to attend college or get a job.” Story shared with Healthwatch England 

Accessing care in a timely way is key to preventing worsening mental health issues. Delays to care and support can mean people develop multiple health needs. 

Impacts on wider family  

We heard that challenges in getting the right care and treatment could significantly impact the wider family.  

"[...] my husband is having a mental breakdown and I have no care plan or crisis plan for him and I’ve had to call an ambulance twice within a week because I’ve been so terrified he’s going to commit suicide. 

Last week we saw […] my husband’s psychiatrist who doesn’t want to section my husband even though my husband keeps asking to be sectioned… 

I’m terrified that I’m going to lose my husband and our daughter will lose her father because the level of care just isn’t there […] I want him moved to a different CMHRS." Story shared by Healthwatch Surrey  

In most cases, mental health conditions do not require hospitalisation. As a result, family members often step in and offer day-to-day support. However, caring for a person with a mental illness can be emotionally and physically daunting.  

Ideally, there would be acknowledgement and support for the wider family when someone needs mental health care. 

Limited support  

Cognitive behaviour therapy (CBT) is one mental health treatment that has become more used in recent years. We received several examples of people's experiences with CBT this month. 

Unfortunately, in most cases, people thought the sessions were not long enough. Another issue was that this treatment was not right for their condition, but they were not offered an alternative. 

“I work for our local IAPT Wellbeing service and I had a traumatic car accident while working earlier this year.  I asked my employer for some therapy to help me overcome the trauma as it was affecting my ability to drive for work. I was offered CBT which I've had before … and it didn't help. Was told that was all there was. I asked for EMDR (Eye Movement Desensitisation and Reprocessing) at that point but was told it wasn't available to me even though I know my service offers it. 

The CBT made things worse and I asked to stop treatment and try something else. I was told it was CBT or nothing and discharged even though I was a member of staff and the trauma was affecting my ability to work. I am now having to pay for private EMDR therapy which has so far been massively helpful.” Story shared with Healthwatch England 

We also heard of instances where people’s specific needs were not taken into account. Someone with complex post-traumatic stress disorder struggled to speak to male staff but was not offered a female doctor as per their request. As a result, they didn’t feel able to engage with the medical professional and were subsequently discharged from care.

GP referrals to mental health services   

There are everyday things people can do to lift their mood or ease anxiety, but in many instances, people need a referral from a GP to hospital team for more specialist care.  

Our recent reports on the referral process found that waiting times for getting a GP referral can vary considerably, with some people waiting months for support on ‘hidden waiting lists’ while others enter a ‘referrals black hole’ and bounce back to their GP team.  

We've looked at the experiences of 296 people trying to get a mental health referral from general practice to community or hospital teams.  

Key Findings  

 

  • Three-quarters (74%) of respondents needed two or more appointments for a mental health referral, compared with 62% for all referrals combined.   
  • People wanting referrals to mental health support were less likely to be happy with the referral process. Just over half, 55%, thought they were referred when necessary, and only 49% thought they were referred to the most appropriate setting (compared with 65% and 63%, respectively, for all referrals).  
  • People wanting mental health referrals were more likely to experience further impacts on their mental health as a result of the referral process:  
    • Over a third, 37%, of those wanting mental health referrals experienced more stress getting appointments than 28% for all respondents.  
    • Half of the respondents seeking a mental health referral experienced a negative impact on their mental health from not getting a referral, compared with 28% for all other respondents.
    • Nearly half, 41%, of those seeking a mental health referral experienced a negative impact on their mental health due to referral delays, compared with 26% for all other respondents.  

Trying to get an appointment to see a GP has become a lottery. Being refused is bad enough but to be told to turn up at 7.30 am to queue for when the receptionists opens up and depending on the number of appointment times are available, and you might be lucky. This has had a dramatic impact on my mental health to the point I have considered not being here anymore. 

Man, aged 65-79, Nottingham

We also analysed results from a small sample, which indicated that experiences of mental health referrals were worse for neurodiverse people, with one in five having to chase delays, compared with just five per cent for all respondents. 

Our recommendations  

  • Commissioners and providers should take all opportunities to provide early or ongoing support through additional staff roles, including mental health practitioners, peer support workers, and school-based teams.   

  • The government should publish a parity of esteem definition as soon as possible to put mental and physical health services on equal footing.  

  • The Major Conditions Strategy should set out a roadmap for:  

  1. Reducing mental health waiting times for assessments, treatment, and crisis support.  
  2. Improving transitions from child to adult mental health services based on need, not just age.  

  • The Draft Mental Health Bill should be amended and pushed through without delay to ensure that patients get more say over their treatment, improved access to advocates, and that a new duty is placed on doctors to consider patients’ wishes before deciding on compulsory treatment. We also support the proposed legislation aim to reduce the disproportionate number of Black people who are sectioned.  

  • NHS staff should be better equipped to understand the needs of young people who are autistic or have a learning disability through bespoke training. 

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