A shortage of mental health nurses is contributing to “harmful gaps” in the treatment and care of people with mental health needs, the Care Quality Commission (CQC) has warned.
The CQC report Monitoring the Mental Health Act in 2023-24 found that a lack of staff, beds and training was having a damaging impact on the care of people who are detained under the provisions of the Mental Health Act 1983.
“With the right funding, a sustainable and well-trained workforce and enough beds to meet demand, we can break this damaging cycle”
Jenny Wilkes
During 2023-24, the CQC interviewed more than 4,500 people who were ‘sectioned’ under the Mental Health Act, covering 870 wards, as well as relatives and people who had previously been detained.
The CQC found that there were not enough staff to support all patients, and that services across the country were facing challenges in recruiting staff, including nurses.
This supports the findings of a previous report from the Health Services Safety Investigations Body (HSSIB) in October 2024 which found that mental health wards were haemorrhaging experienced nurses.
According to the CQC, on some wards, staff shortages have meant that patients were being left without a named nurse, who should be there to promote the patient’s wellbeing and safety.
At one clinic a patient’s named nurse had left and not been replaced while in another hospital patients claimed that they did not know who their named nurses were.
The CQC also found that demand for mental health treatment was continuing to outstrip capacity. Because there are not enough beds available for people detained under the act, many people were being placed far from home, family and friends.
This echoes the findings of another HSSIB report published in November last year which found that inappropriate out-of-area mental health placements were increasing despite the risk of serious harm to patients.
Young people, those from areas of deprivation and people from minority ethnic groups face the biggest barriers to accessing care and are detained at a higher rate than the rest of the population, the CQC found.
Black people were 3.5 times more likely to be detained under the Mental Health Act than White people, the CQC reported.
The CQC report also said that people were being caught in a “damaging cycle” of re-admittance to mental health services because of a lack of appropriate care in a community setting.
“We see other problems gathering, for example, with universities announcing the closure of nursing courses”
Dave Munday
Despite a legal entitlement to aftercare, people often did not receive the support that they required to transition back into the community, thanks to stretched community mental health and general practice services, the CQC reported.
It found that in nearly half of cases where a child or young person had been detained under the Mental Health Act, the patient was re-admitted within a year.
The regulator is calling for national action to tackle system-wide issues in community mental health.
Interim director of mental health at the CQC, Jenny Wilkes, said: “These issues will be all too familiar to people in mental health crisis, and their loved ones.
“We urgently need more community support and a better understanding of people’s needs to reduce the number of people being detained.
“And we know the situation is even starker for people from deprived areas, people from ethnic minority groups, autistic people and people with a learning disability.”
She said that the Mental Health Bill introduced in the House of Lords in November last year would not be enough to address the problems identified by the CQC in this latest report.
“While the Mental Health Bill aims to address inappropriate detentions and improve mental health care, this can’t be addressed by legislation alone as there simply aren’t the resources to fix these issues,” Ms Wilkes said.
She added: “With the right funding, a sustainable and well-trained workforce and enough beds to meet demand, we can break this damaging cycle.”
Dave Munday, lead professional officer for mental health at the union Unite, which runs the Mental Health Nurses Association, urged health and social care secretary Wes Streeting to look at the CQC’s report with “great attention”.
He further told Nursing Times: “Whilst the work to amend the outdated [Mental Health] Act should address some of the issues highlighted, we know it will fall short if changes don’t happen to better support those working in mental health services, including the biggest group, mental health nurses.
“And whilst frontline staff need that support, we see other problems gathering, for example, with universities announcing the closure of nursing courses, the plans to cut 50% posts at NHS England and the rush to cut benefits from people with disabilities, which will place further pressure on the services designed to help.”
