The BMA has carried out in-depth interviews with doctors across the mental health system, including those working in psychiatry, general practice, emergency medicine, and public health. We wanted to explore their experiences of providing mental healthcare, including what helps and hinders them in providing good care to patients, how things have changed in the time they have worked in the NHS, and their thoughts on how the challenges identified are impacting on patient care and experience. Interviews with doctors were supplemented by discussions with key stakeholders, including patients and charities.

The interviewees characterised the state of the failing healthcare system that we hear about daily from our wider membership. Doctors told us that mental healthcare is under huge pressure and they are unable to provide the care that patients need and that they want to provide.

Good mental health is essential to a functioning society. Mental illness carries a huge cost to individuals, society, and the health and social care system. Without the appropriate treatment or support, mental illness can lead to lost productivity and the need for informal care; mental ill health has been estimated to cost around £118 billion annually to the UK economy, and nearly £101 billion in England alone, equivalent to roughly 5% of the UK's GDP. Mental health problems and poor mental health can also influence all aspects of a person’s life and relationships, often causing huge anguish to individuals, families, and communities.

The BMA is calling for urgent action to address five key problems.

Based on the interviews, and desk research, the BMA has identified five key problems in mental healthcare that need urgent attention by the UK Government, NHS England, the Department of Health and Social Care, and NHS employers.

1.  Funding is insufficient and not always used in a way that allows doctors to provide the care they want for patients.

All the doctors we interviewed spoke of the mental health system as a system under extreme pressure. They highlighted how resource constraints are resulting in a system at or beyond its limit.

Funding for mental health services has increased over the last few years, but the number of people trying to access services has increased by far more. Operating in an environment of scarcity means doctors do not have the resources they need, and a lack of funding has wide-ranging impacts including insufficient workforce and inadequate estates.

2.  There are not enough trained staff in the health and social care system to treat and support people with mental illness. 

Doctors spoke of their frustrations that their job is made harder, and their patients’ care’ made worse, by a lack of staff who can provide good quality mental healthcare.

It is, primarily, a case of insufficient numbers, with vacancies and rates of turnover too high, and levels of recruitment and retention too low. The problem is made worse by not having the right mix of staff to provide strong multidisciplinary care.

3.  The different parts of the health and social care system that provide treatment and support to people with mental illness find it difficult to work together to support patients.

For doctors to provide the most effective care for patients, all parts of the system need to be able to work together. Unfortunately, because so many parts of the system work under extreme pressure, this is often impossible.

Doctors told us of siloed services, and the challenge services face when working together. General practice, community mental health, and urgent and emergency care are overstretched, and there is often tension between different parts of the system.

4.  Our society is not set up to support people’s mental health and to prevent the onset of mental illness.

The extent to which medical care can address rising rates of demand for mental healthcare is limited. Mental health, like all other aspects of health, is significantly influenced by social determinants (the conditions in which people live, grow, work and age.) If someone’s mental illness is caused or exacerbated by the social determinants of health, a doctor’s ability to provide care is compromised.

There is a limit to what a doctor can do when someone’s mental health is so affected by living in poor housing, unemployment, or difficult family lives. It was clear from many of our interviews that doctors feel they are working with patients for whom the odds are stacked against them.

5.  All these pressures on the system are damaging patient care and particularly affecting certain groups, such as children or people with neurodevelopmental disorders.

The consequences of a mental healthcare system under pressure, and a failure to improve the social determinants of health, mean many patients are receiving inadequate care, and some groups are falling through the gaps and not receiving any care at all.

Doctors in specialist mental health services, which are mostly located in secondary care, are increasingly unable to see as many patients as need their help, or they are not able to see patients as often as they were able to in the past. Children and young people, people with neurodevelopmental disorders, and people with a substance misuse problem are some groups most at risk of falling through the gaps.

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