Rise in mental health workers

A survey of employers reveals there has been a substantial rise in the children’s mental health workforce over the past five years.

Data collected by NHS Benchmarking Network on behalf of Health Education England (HEE) shows 20,626 whole-time equivalent (WTE) staff were employed across NHS, voluntary and local authority providers on 31 March 2021, 39 per cent higher than in 2019 and nearly two-thirds the level recorded in 2016 (see graphics).

The rise has been welcomed by mental health campaigners and service providers, who point to the importance of policy initiatives like the NHS Long Term Plan and children’s mental health green paper as instrumental in boosting the status and profile of the sector.

"The growth in the workforce could suggest that we are starting to see the results of these plans,” says Charlotte Rainer, lead at the Children and Young People’s Mental Health Coalition. "For example, the data highlights a significant rise in education practitioners, reflecting the expansion of mental health support teams in parts of the country."

However, their enthusiasm is tempered by the fact that the sector is starting from a low base due to severe cuts during austerity and that some parts of the workforce, such as child psychiatrists are reporting rising vacancy rates (see expert view).

In addition, the number of children with mental health problems is rising at an alarming rate due to the impact of the pandemic.

Figures from the NHS Confederation show that in February this year, there were 305,802 children and young people in contact with mental health services, compared with 237,088 in March 2020.

The HEE data shows that three quarters of children’s mental health staff work within the NHS, mainly in community services, while the number of people working in local authority services has fallen by more than a third since 2019. Rainer points to deep cuts to councils’ early help budgets as a key factor in this fall.

“It is perhaps no coincidence that the falling numbers of staff coincide with the recent cuts in funding we have seen to local authority budgets,” says Rainer.

Investment in council and voluntary sector services is vital if commitments in the NHS Long Term Plan and pandemic recovery are to be achieved, she adds.

EXPERT VIEW
RISING STAFF NUMBERS ARE WELCOME BUT PROGRESS IS SLOW AND NOT KEEPING PACE WITH INCREASING DEMAND

By Sean Duggan, chief executive, the NHS Confederation Mental Health Network

The demand for children and young people’s mental health support is increasing all the time so the fact the workforce is also expanding is to be welcomed.

However, it’s important to recognise that in terms of the numbers working in children’s mental health we are starting from a low base and are therefore still falling well short of what is needed to meet that rising demand. Although there has been a strategy to improve the mental health workforce and additional funding, unfortunately progress is very slow.

A recent review by the Care Quality Commission – Provider Collaboration Review: Mental Health Care of Children and Young People During the Covid-19 Pandemic – highlighted the lack of trained nurses and staff with the specialist skills to care for children and young people with mental health needs. The Royal College of Psychiatrists’ early data on consultant psychiatry posts in 2021 also highlights that the vacancy rate for child and adolescent psychiatrists is now more than 15 per cent.

The large increase in new roles such as education mental health practitioners, who form part of the mental health support teams working in schools, is good news. However, this will also mean more experienced staff will need to be on hand to provide clinical supervision, which in turn could be problematic as there are high vacancy rates in both child psychiatry, nursing and psychology.

The shortage of nursing staff is also a real concern, as they make up a quarter of the workforce in community services, and nearly a third in inpatient services.

As with any service, you need a good skill mix, but there has been an increase in services using unregistered staff or support workers, especially in inpatient services and this raises its own issues especially given the high vacancy rate of some of the traditional mental health roles.

Mental health support is not just provided by health services – the number of mental health workers in local authorities and the voluntary sector is, however, quite low.

Many local authorities do not provide dedicated children’s mental health services, so it is not a surprise that this sector reported low levels of staff. However, a low response rate means it is unclear what the true picture is for this sector. Given the vast number of voluntary sector organisations in the country that provide some level of mental health support, this would suggest that this is potentially an underreporting of relevant staff.