Mental health policy and services in England
This briefing provides an overview of mental health policy in England.
Warning: This briefing includes discussion of suicide and self-harm, which some readers may find distressing.
This briefing covers mental health policy and services in England. Health is a devolved policy area. Brief summaries of mental health policies and relevant legislation in Scotland, Wales and Northern Ireland are provided in section 10 of this briefing.
Structure of adult mental health services in EnglandNHS adult mental health services are provided in a range of settings including:
- Primary care services, such as GPs and NHS talking therapies for anxiety and depression.
- Services for people in acute need, such as crisis teams and A&E psychiatric liaison.
- Community services, such as generic community mental health teams, and teams aimed at specific groups or disorders (for example, perinatal mental health teams and early intervention in psychosis teams).
- Mental health wards and units and longer-stay rehabilitation units.
- Specialised services such as forensic mental health services.
The exact configuration of services differs from area to area, as most services are commissioned locally. The NHS Long Term Plan (2019) committed to developing new, integrated community mental health services for adults with severe mental illnesses.
Access to mental health servicesThe number of people accessing mental health services in England has increased over time. The number of people in contact with NHS-funded secondary mental health, learning disability or autism services in England was 24% higher in 2022/24 than in 2019/20 (pre-pandemic).
Access and waiting time standards are in place for early intervention in psychosis services and NHS talking therapies for anxiety and depression. These standards are being met but there are concerns that people may face additional waits within services.
The Conservative government consulted on introducing new waiting time standards for community mental health services and crisis services. The new standards are not yet in force.
The mental health workforceMental health support is delivered by a range of professionals including psychiatrists, psychologists, mental health nurses, support staff and peer support workers. The health think tank The King’s Fund has said that whilst the mental health workforce has expanded overall, this has been insufficient to meet demand. It said this is impacting upon staff satisfaction and moral, as well as quality of care and patient safety.
The NHS Long Term Workforce Plan (June 2023) sets out an ambition to increase training places for mental health nursing by 93% to over 11,000 places be 2031/32. This would start with an increase in mental health nursing places of 38% by 2028/29.
Commissioning and funding mental health services in EnglandMost mental health services are commissioned locally by Integrated Care Boards but some specialist services are commissioned by NHS England. NHS England is in the process of delegating responsibility for commissioning specialised mental health, learning disability and autism services to NHS-Led Provider Collaboratives. These are groups of specialist providers, led by a lead provider, that work together to manage the budget and care pathway for their local population.
Most local mental health funding is not ring-fenced, meaning each Integrated Care Board determines its own mental health budget from its overall funding allocation. This means that neither the government nor NHS England determines how much funding goes to mental health services in local areas. However, local areas are expected to meet the ‘mental health investment standard’, which requires increases in local mental health spending to be at least as large proportionally as overall increases in local health funding. NHS England reports that it has met this standard nationally every year since 2015/16. Local areas met the standard in 2021/22 and 2023/24, but not in 2022/23 (see the NHS mental health dashboard).
The NHS Long Term Plan included a pledge to give mental health services a growing share of the NHS budget, worth at least £2.3 billion a year by 2023/24. The King’s Fund has said funding for mental health services is not keeping up with demand and is not evenly distributed across the sector.
Mental health policy in EnglandThe government has indicated it will not publish a standalone “mental ill health strategy”. However it has committed to publishing a new 10-year strategy for the NHS informed by Lord Darzi’s independent investigation of the NHS.
The government has also said it will recruit an additional 8,500 mental health staff “to reduce delays and provide faster treatment.”
Lord Darzi’s independent investigation of the NHSLord Darzi’s report highlighted the increased prevalence of mental health conditions in England and rising demand on services, and said long waits for mental health have become normalised. It said funding and resources need to be shifted to the community and the NHS needs to embrace multidisciplinary models of care that bring together primary, community and mental health services. Lord Darzi also said there has been a lack of capital investment in the NHS and described the poor conditions in some mental health units.
Lord Darzi also discussed inequalities in access to mental health services and mental health outcomes. In particular, he highlighted the impacts of poverty and homelessness on mental health, as well as the disproportionate use of the Mental Health Act to detain Black or Black British people.
NHS Long Term PlanThe previous government set out its commitments on mental health up to 2023/24 in the NHS Long Term Plan (2019). This included plans to expand NHS talking therapies, perinatal mental health support and 24/7 crisis services. The Health and Social Care Committee Expert Panel and the National Audit Office reviewed progress against the commitments and raised concerns that even if the commitments were met, a gap would remain between the number of people with mental health conditions and the number receiving treatment.
In September 2023, the government published a new Suicide prevention strategy for England: 2023 to 2028.
Quality and safety in mental health settingsIn January 2023, following high profile cases of abuse and deaths in mental health inpatient units, the government announced a rapid review into patient safety in mental health inpatient settings in England, focusing on what data related to safety is collected and how it is used. The review made 13 recommendations, including a programme of work to ensure data collection includes metrics on the environments that create or reduce risks.
In June 2023, the government announced that a national investigation of mental health inpatient services would commence in October 2023. An interim report on learning from deaths and near misses in inpatient and community mental health services was published in September 2024. It said that risk assessment tools continued to be used to stratify risk despite no longer being acceptable. It added that families feel they are not listened to when discussing their safety needs and own perceptions of risk.
NHS England is aiming to make improvements to mental health inpatient care through the Mental Health, Learning Disability and Autism Inpatient Quality Transformation Programme. In February 2024, NHS England launched a culture change improvement programme as part of this.
The regulator of mental health services, the Care Quality Commission (CQC), has said more action is needed to address the high level of unmet need in the community and to understand gaps in quality of care, patient safety, public safety, and staff experience in community mental health services. NHS England has asked all local areas in England to review their community mental health services to ensure they have policies in place for engagement with patients in the community with serious mental illness.
The Mental Health Units (Use of Force) Act 2018 provides for the oversight and management of use of force in relation to patients in mental health units and similar settings in England. Requirements on service providers introduced by the act include having a written policy on the use of force, recording incidents of the use of force and providing staff with training on the appropriate use of force.
The CQC reports annually on the use of the Mental Health Act 1983. The CQC’s 2022/23 report found workforce retention and staffing shortages are affecting the quality and safety of care. It also said longstanding inequalities in mental healthcare persist, particularly in the over-representation of Black people detained under the Mental Health Act and use of force against patients from Black and minority ethnic groups. In addition, it said “too many abusive and close cultures persist in mental health services”.
Reforming the Mental Health ActIn October 2017, the government commissioned an independent review of the Mental Health Act 1983 in response to rising rates of detention and the disproportionate use of the act among people from Black and minority ethnic groups. The government published the white paper, Reforming the Mental Health Act, in January 2021. Following a consultation period, the Government response was published in July 2021.
A draft Mental Health Bill was published in June 2022. It was subject to pre-legislative scrutiny by a Joint Committee from July to December 2022. The Committee published its report on 19 January 2023.
The King’s Speech 2024 included a commitment to legislate to modernise the Mental Health Act.
More information is available in the Library’s briefing on Reforming the Mental Health Act.
Further readingInformation on the prevalence of mental health conditions in England can be found in the Library briefing on Mental health statistics: prevalence, services and funding in England.
Information on children’s mental health policy and services can be found in the Library briefing on Support for children and young people’s mental health (England).