A workforce crisis has left mental health staff at “breaking point.” Wendy Burn discusses what can be done to recruit more doctors into the specialty
A stitch in time saves nine. Prevention is better than cure. You’ve heard it before, but who can argue with this?
Sadly, many people seeking support for mental illness, like Jane, who told us that she needed to wait 12 weeks to see a psychiatrist, are not able to benefit from this wisdom. During this time, she became more and more unwell, and eventually was detained under the Mental Health Act to an inpatient ward.
Due to shortages of permanent staff, during one hospital stay, Jane ended up receiving care from three different locum psychiatrists. Frustratingly, each doctor changed the way that she was cared for and Jane’s depression continued to deteriorate.
Experiences like this are highlighted in the BMA’s mental health workforce report which finds 63% of mental health professionals surveyed have rota gaps across their team, and almost half of doctors said that there was a shortage of at least one medical staff member during their last shift.
These figures chime with the early findings of RCPsych’s latest census (published in December 2019) which found one in 10 consultant psychiatric roles are unfilled. I’m worried that there will be many more people like Jane across the country left waiting too long to get help, and that workforce shortages are affecting clinicians’ workload, wellbeing, and morale.
Progress has been made in recent years with an increase of more than a third in trainees taking up core training in psychiatry in England between 2017 and 2019 following the success of our #ChoosePsychiatry campaign, as recognised by the BMA.
Despite this our census finds that the vacancy rate for consultant psychiatrists has doubled in the last six years. In addition, between March 2017 and March 2019 only 120 consultant psychiatrists have been added to the NHS workforce which means 450 still need to be recruited to meet HEE’s mental health workforce targets by 2021. Upsettingly, areas prioritised for investment including eating disorders, child and adolescent mental health services, and perinatal services have particularly high vacancy rates.
There is clearly a long way to go to securing the mental health workforce needed. I fully support ambitious plans set out by NHS England last year to improve mental health care. They build upon significant investment already made, which is increasing access to many specialist services. But in the bluntest terms—without people in place to deliver improved and expanded services, the plans will fail.
I do not want the people who stand in line to be helped by these plans, to be let down.
Immediate action is needed to make practical changes like providing computers that are ready to use within a few minutes, places to sleep after night shifts and buildings that are safe for patients and that we are not ashamed of. The pension crisis is still not fully solved and yesterday I heard of another person leaving the workforce due to this. These things might seem basic, but I assure you they are essential to keep existing people in the NHS. Improving staff wellbeing and morale will also be key: at RCPsych we are developing standards for a wellbeing section to be included in psychiatrists’ job descriptions.
In terms of having the people to deliver services, looking closest to home is best. The BMA identifies the ongoing practice of sending patients out of area for treatment as a major challenge in mental health services. New figures out this week find that 675 patients at the end of October 2019 were receiving treatment far from home. This is a reduction from previous months which I am very pleased to see but there is further to go—out of area placement should be a Never Event. Not only is this extremely detrimental for patients, but it also adds extra strain on staff who are required to make what can seem like futile attempts to find their patient a bed. They may also be left with the terrible dilemma of a patient who is willing to accept a local bed but who refuses to go to a hospital miles from their home and who then might require detention under the Mental Health Act to keep them safe.
Independent research commissioned by RCPsych identified 13 areas experiencing significant struggles with sending patients out of area to receive care or with extremely high levels of bed occupancy and showed that more mental health beds are needed. RCPsych is calling for additional beds across these areas, aligned with workforce and service delivery plans so they are properly staffed and resourced.
Looking to the future, the road from applying to medical school to helping patients as a fully trained psychiatrist is long. To meet demands across the NHS and guarantee adequate supply of doctors to help people with mental illness, the government must double the number of medical school places in the next decade.
What is then important is that a good chunk of these medical students opt to pursue psychiatry. Without the stigma of previous generations, more and more young people are interested in helping others with their mental health. We must tap into this interest.
As the BMA recommends, it is crucial that all medical students get a better understanding of mental illness and psychiatry. RCPsych found that students’ experience at medical school has a huge impact on the specialisms they choose to work in, particularly the content of courses taught to students and the quality of their placements.
In order to achieve parity of esteem between mental and physical health, we need any new medical school places to be allocated to medical schools with concrete plans to raise students’ interests in shortage specialties, like psychiatry. RCPsych has developed guidance to help medical schools develop such plans. They should include giving students access to high quality placements in mental health services and revising curricula so that psychiatry is brought into courses consistently—led by psychiatrists and as early as possible—rather than as an obscure add-on.
I want people to choose psychiatry and choose to listen, to see possibility and to make a difference. To give an example from my own experience—can you imagine how it feels to watch your elderly patient start (and hold down) a job as a result of having finally received support for a psychotic illness which had left her unable to work for forty years?
It’s incredibly uplifting. Yet too many others are not half as lucky. This is exactly why a stitch in time is needed now, to secure the mental health workforce and to secure the mental health of future generations.
Wendy Burn, President of the Royal College of Psychiatrists and a consultant old age psychiatrist.
Competing interests: None declared