Mental health: prevention and resilience

Natasha Mutebi; Sonja Stiebahl

Overview

Health and social care in the UK is a devolved policy area but all nations of the UK are undergoing legislative reform to mental health care provision and are producing long-term mental health strategies.

There has been an increased commitment to expanding mental health services in England since 2019.[1] While this has led to more funding, spending on mental health has increased at a slower rate than overall NHS expenditure, decreasing from around 9% of the NHS budget in 2018/19 to 8% in 2022/23.[2][3] While mental health services are expanding, stakeholders state they are struggling to keep pace with increasing demand. The number of NHS mental health staff has increased by 19% between 2016/17 and 2022/23. The number of people using mental health services has increased by 36% in the same period.[4][5]

The Centre for Mental Health estimates that in 2022, mental ill health cost the UK economy approximately £300 billion (2022).[7] Due to increased demand for mental health services and the associated societal and financial costs, stakeholders have stressed the importance of the prevention of mental ill health.

Academics argue that decreased investment in social security and job instability can impact health due to increased financial hardship and chronic stress. This can result in increased incidence of mental ill health and lead to increased risk of burnout, sick leave, and higher staff turnover.[6][7]

The Lord Darzi report highlighted that prevention has been hampered by a lack of funding, and that this had a greater impact on individuals and communities in the most deprived areas.[8]

Challenges and opportunities

There is widespread recognition that statutory services are not meeting the rising demand for mental health care in the UK.[9] This unmet need is especially evident in marginalised, minoritised ethnic, young, disabled, and socioeconomically deprived groups (PN671 PN685,PN722). Global studies have identified stigma, service quality, barriers to accessibility, lack of understanding of identity-related issues, and lack of availability as reasons access to mental health care is more difficult for disabled people[10] as well as people in LGBTQI+ communities, particularly in younger demographics.[11][12]

Mental health services in England received a record 5 million referrals in 2023, representing a 33% increase from 2019 and an 11% increase from 2022.[13] Increasing demand has led to systemic pressures impacting mental health services, workforce and also general practice, at a time when GPs are treating the wide-ranging impacts of the Covid-19 pandemic (HS47,PN737).

This increase in demand has led to longer wait times. Time spent on waiting lists, in turn, is associated with negative psychological and behavioural consequences, including exacerbated existing physical and psychological health issues.[14][15][16][17] In England, a 54% increase in referrals to mental health services from 2016 to 2022 was accompanied by a 10.9% increase in service funding.[3]

Hospital beds for individuals with learning disability and mental ill heath have shown the largest reduction, with a decrease of 69% and 24% respectively since 2010/11.[8] The reduction in hospital beds allocated to patients experiencing mental ill health reflects policies to move care out of hospitals and into the community.[8] However, when community mental health services are unable to meet demand, this leads to more ‘out of area’ mental health placements. In December 2023, almost 3 in 5 mental health in-patients were treated in areas more than 60 miles from where they lived.[18] Out-of-area inpatient mental health care can worsen health outcomes and increase costs for the NHS (PN722).

Ease of access for family and friend visitation can be important in a patient’s recovery, particularly for individuals experiencing mental distress; being removed from support systems can hinder recovery.[8] Delayed recovery can lead to delayed discharge and limited mental healthcare capacity.[19] In March 2024, NHS mental health units in England recorded 49,677 days of delayed discharges—the highest since at least January 2016.[20] This was also partly due to a lack of availability of appropriate post-discharge community treatment options and social care provision.[21]

Data indicates that those in areas of higher deprivation are more likely to use mental health services. As of March 2024, over twice as many people in the highest deprivation decile were in contact with mental health services than those in the lowest decile (275,681 compared to 131,677, respectively).[5] Stakeholders argue this should be an incentive for government action to reduce deprivation and improve mental health services for vulnerable communities.[5]

While mental health services and access are an area of focus, preventative public health measures have also been identified by academics and other stakeholders as requiring attention. Research suggests that next to individual factors such as genetics and behaviours, it is equally important to consider the core social and environmental determinants of health, like socio-economic status, employment and housing.[22] Considering these determinants of health is key to improving population mental health. For example, research investigating impacts of austerity including the Marmot Review, has shown links with deterioration in health outcomes and increased health inequalities.[23] Individuals with a low income and low levels of education appear to be at higher risk of mental ill health and suicide than their higher-income counterparts (HS45).[24]

Academics suggest that to improve public mental health, interventions must be expanded beyond the boundaries of clinical care settings and be implemented in other policy sectors such as housing, education and transport (particularly within rural areas).[25] Connecting policy areas enables whole-systems approaches to individual support, which consider the socio-economic, political and environmental context that enable people to thrive.[26]

Research also highlights emerging opportunities in using digital interventions and support tools, for example, AI tools are currently being trialled across various health trusts and services, for example precision psychiatry (PN637, PN737, PN738).

Experts highlight the need to consider interactions between physical and mental health.[27] The life expectancy of people living with severe mental illness is over 20 years shorter than that of their healthy counterparts.[28] This gap is partly attributable to an inability to maintain a healthy lifestyle,[29] as well as delays in treatment for physical health problems.[30][31]

Enabling people to live healthier lives, especially encouraging exercise and time spent in green spaces, can improve symptoms of psychological distress.[32][33] Stakeholders note that interventions that go beyond encouragement and awareness campaigns and facilitate socioeconomic conditions for people to be able to incorporate time in green spaces, exercise, and healthy diets into their lifestyles can significantly improve health outcomes.[34][35]

Uncertainties and unknowns

Robust and longitudinal research evidence is needed to understand and investigate the complex socioeconomic, political, and environmental factors that contribute to mental health outcomes and resilience in England.[36] [37]

There continue to be uncertainties around identifying the most effective investigations and analysis of an individual’s interactions leading up to mental health diagnosis and treatment. Additionally, experts have emphasised the need for a better understanding of the relevance and effectiveness of current treatment options, as well as investments in researching new and innovative treatment interventions.[38]

Key questions for Parliament

What approaches can create conditions for people to live healthy lives and prevent mental ill health?
What additional research is needed to understand the impact of demographic, socio-demographic, economic, and other environmental factors on people’s wellbeing?
How can sustainable academic funding best enable longitudinal research?
How can access to mental health services become more equitable?
What is needed to meet the increasing demand on NHS mental health services?
What are the most effective and feasible interventions currently available to service users and how can we use these to build up resilience?