Mental health staff facing ‘unmanageable’ workloads

Mental health staff are facing unmanageable workloads, depleted teams and poor access to training, a report by the British Medical Association (BMA) has found.

The reported included a survey of more than 1,000 doctors, psychologists and mental health nurses and highlighted failings across multiple measures of the workforce, including its treatment of staff, and employers’ commitment to their wellbeing.

The survey, which was conducted in partnership with the Royal College of Nursing and the Association of Clinical Psychologists UK, found that almost seven out of 10 staff members work in teams with vital members of staff missing most or all of the time. While nearly half (47 per cent) of doctors work shifts in which they are down at least one medical colleague.

Four in 10 respondents from all three professions said their workloads are ‘unmanageable’ or ‘mostly unmanageable’, while half said access to training had worsened or greatly worsened.

The survey also found that, while positive improvements were reported by most working with multidisciplinary teams, many lacked access to the support staff they needed to take part fully.

A consultant psychiatrist, who asked not to be named, said he recently decided to quit his job after the struggle of running an inpatient service for years, caring for people who are acutely unwell. He said:

‘Inpatient services are seen as the most expensive resource and the bottleneck in the service.

‘The level of bureaucracy and scrutiny is relentless whenever something doesn’t go well. It inevitably results in another layer of process added on.

‘It is difficult to get much sense of a break from work, certainly not enough of a consistent one. Nursing staff are probably hit more than doctors but nonetheless it does affect us as well.’

Unfillable vacancies

Royal College of Nursing professional lead for mental health Catherine Gamble said the survey shows staff are consistently held back by unfillable vacancies and the ‘e-rostering system’, which made agency work more attractive than full-time posts. She said:

‘The clear majority of nursing staff felt the absence of one of their own on their last shifts. This hammers home the reality of the chronic workforce shortages that have plagued our profession.

‘Unless there is urgent investment in growing the nursing workforce the pressures will continue to grow to the point where it will no longer be possible to attract nurses to work in the NHS, and parity of esteem for physical and mental health remains a goal yet to be realised.’

The BMA said the government has made a series of ‘bold pledge’ to recruit more mental health staff over the years, all of which have gone unmet. In their 2017 Manifesto,  Tory bosses promised 10,000 extra staff would be recruited by 2020. A figure that was then pushed up to 19,000 by 2021 as part of the government’s Stepping Forward plan.

In 2019 the government revealed its Long Term Plan, including the NHS England Mental Health Implementation Plan which envisioned a ‘multidisciplinary’ approach to mental health which would require a further  27,000 staff, a mix of psychologists, psychiatrists, nurses, social and peer and other support staff.

Worsening of care standards overall

However, BMA mental health policy lead and consultant psychiatrist, Andrew Molodynski, said such pledges, alongside parallel ones to improve services by funding the front line, are yet to make a significant mark. He said:

‘The opposite has happened, there are longer waiting lists, increasing out-of-area placements, slimmed-down services that cannot cope with demand, and most worryingly, a rising suicide rate for the first time in decades.

‘Why, in the fifth-richest country in the world, do we allow this situation to continue and indeed worsen?

‘Twenty years ago, there were similar calls for change, and these were answered – by a national service framework for mental health services and the necessary funding to enhance and transform services. It worked. We need something similar now.

‘The era of parity of esteem has seen a worsening of care standards overall. We at the BMA call loudly for real parity – parity of resources, access and outcomes.

‘If the government will commit to achieving that over the period of the 10-year plan then their promises may come good and there will be fewer lives shattered or ended by the current shameful underinvestment.

‘Fewer people languishing on waitlists for desperately needed therapy, fewer people being shipped around the country in the night for want of a bed, fewer children having their life chances ruined by waiting years (yes years) for treatment they need, fewer people taking the tragic final steps to end their lives because help and hope have gone.

‘Real parity, 25 per cent of NHS funding for mental health care across primary and secondary care, is not a choice – it’s a necessity.’

A Department of Health and Social Care spokesman said: ‘Expanding the mental health workforce is a key priority for this Government so we meet rising demand on services and ensure patients receive the best treatment.

‘From September this year, we’re giving all nursing and midwifery students at least £5,000 a year and we’re taking immediate action to fill vacancies and secure the staff we need – including increasing university clinical placements by over 5,000 more and bolstering the workforce through greater international recruitment.’

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