The mental health workforce: challenges facing the NHS

The pandemic has put a huge psychological strain on many people across the UK, and it is likely that there will be a surge in those seeking mental health support. Even before Covid-19, 1.5 million people in England in the year to March 2019 were referred to Improving Access to Psychological Therapy (IAPT) services. This is the largest programme of talking therapies offered by the NHS, and ambitions are set out in the NHS Long Term Plan to increase the number of people accessing these services by around a quarter by 2023/24.

But to increase access to these services (and other mental health therapies), a sufficient pool of NHS staff must be available to deliver mental health support to those who need it. While not explicit, various workforce plans seem to suggest an ambition to expand the staffing pool by over 38,000 by 2023/24 (from 89,000 to 127,000).

On the face of it, the recent trend in the number of staff providing or supporting the provision of mental health services seems encouraging – having grown by over 12,000 since the release of Health Education England’s mental health workforce strategy in 2017. University applications to study mental health nursing rose by 30% in a year (to 31,455 for the 2020 intake). However, these apparent green shoots are only some of the story, with a number of our reports on various aspects of mental health careers flagging areas of concern and for further exploration.

The workforce as it stands

As mentioned, there has been an increase in the number of mental health staff working in the NHS, although looking at the picture over a nine-year period, staff numbers have increased (on average) by only about 1% a year. The trend is particularly stark for mental health nurses, whose numbers have declined by 3% over the same period. This is contrasted by the rising demand for mental health services, with an 89% increase in IAPT referrals from 2011/12 up to 2019/20. It is also important to note that referrals made to IAPT in the last year (2020/21) have likely been suppressed as a result of people staying away from the NHS during the pandemic.

While recent funding boosts intend to increase access to mental health services, there is still a concern of pent-up demand. And, given that the latest sickness absence data shows mental health and learning disability trusts have the second-highest rates of sickness absence out of all trust types, pressure on existing staff is likely to be felt.

Making mental health careers accessible and attractive

The recent uptick in university applications to mental health nursing should only be seen as a first step. Our research on mental health nursing noted that local areas will need to be agile in ensuring that enough capacity is available to meet demand for the various education routes – from apprenticeships to postgraduate courses. Moreover, our work suggested there was scope to better promote the unique and varied aspects of the mental health nursing profession and provide access to positive personal experiences of and exposure to mental health services.

Our earlier work on mental health careers also highlighted that attitudes towards such roles appear to be affected by either a lack of awareness or stereotypes. This has partly been attributed to inaccurate media representations, which indicates that improving perceptions will take a societal, multi-organisational shift. Perceptions around the low pay offered for some non-medical professions, and the costs and requirements of training are cited as  reasons for people finding a potential clinical career less attractive. However, these barriers are not unique to mental health careers.

The opportunities to make mental health careers a more attractive and accessible option are particularly apparent when looking at psychology students. We found that the vast majority of psychology undergraduates wanted a career in mental health at the start of their degree. However, the proportion of students not considering a career in psychology or mental health in their final year more than doubled from 9% to 21%. It is likely that they recognised the lack of opportunities to progress a career in clinical psychology, despite there being a shortage of psychologists.

However, increases in numbers entering mental health professions will only be welcome if a broad range of demographic groups are sufficiently represented. We found that while the mental health support workforce had twice the level of black representation compared to the NHS as a whole, there are apparent inequalities. For example, those of black or Asian ethnicity were much less likely to work in senior positions in psychological professions, and were less likely to be accepted for clinical psychology doctorates. Our forthcoming study on the mental health clinical support workforce also asks whether we are offering this group sufficient flexibility, training and progression opportunities.

What next?

There are clear challenges when it comes to increasing the number of mental health staff working in the NHS, and an increasing pressure to do so given the rising demand for such care. Steps must be taken to make mental health careers accessible and attractive. Awareness campaigns at schools, as well as stronger links between NHS Health Careers and careers services at universities can play a part in this.

Issues around equality, and offering flexible working patterns and development opportunities to all employees must be addressed. The mental health clinical support workforce has encouraging levels of diversity, and widening participation from disadvantaged and underrepresented groups has been an area of attention in developing the support workforce. But this is one of the lowest paid staff groups in the NHS. Disappointingly, broad representation cannot be said for mental health roles at higher pay bands. Marginalised groups must be represented at senior and all other levels of the mental health workforce, and this should be a key consideration for future mental health workforce planning.