CQC warns that long waits, inappropriate accommodation, and lack of local support mean children and young people are being failed by mental health services

Published: 21 March 2024 Page last updated: 21 March 2024

Short staffing and underfunding mean children and young people with mental health needs face long waits for essential treatment while racial inequalities in care persist, a report by the Care Quality Commission (CQC) revealed today.

The Monitoring the Mental Health Act in 2022/2023 report highlights that a record high of nearly half a million children and young people were waiting to access or undergoing mental health treatment in November 2023. According to the latest statistics from NHS England, this number increased by almost 20,000 by January of this year. These children are having to wait an average of 40 days from referral to treatment. Many children who are receiving care have been placed in the wrong settings, such as adult wards or general children’s wards, adding to their distress.

Additionally, the longstanding inequalities in mental health care raised in last year’s report persist. People from ethnic minority communities in the UK are more likely to experience mental illness but are less likely to receive the mental health care support they need.

Black or Black British people are over 3 and a half times more likely to be detained under the mental health act than White people. This is a slight improvement on the previous year when Black or Black British people were over 4 times more likely to be detained, however much more progress needs to be made and rapidly. Black or Black British people are also 8 times more likely to be placed on community treatment orders (CTOs), where supervised treatment is given in the local community, than White people.

The annual report looks at how healthcare providers use the Mental Health Act (MHA) in the treatment of people with mental health needs. Produced following conversations with 4,515 patients and 1,200 carers, as well as people with experience of being detained, the report found that there are insufficient staff and beds to treat people with mental health needs, leading to isolation, poorer quality of care, and reduced access to activities and therapy. Lack of staff is also increasing the risk of inappropriate restraint, as well as abuse and violence to both patients and staff.

The lack of suitable accommodation within the community has led to people, particularly autistic people and people with a learning disability, being unnecessarily detained in hospital, while a significant number of patients are being placed far from home, some for years at a time.

At the end of 2023, CQC published its updated policy position on restrictive practices and an updated human rights approach. Both highlighted that more needs to be done to reduce the use of restrictive practices such as physical restraint or restricting a person’s movements and that restrictive practices should only be used as a last resort. Working with the British Institute of Learning Disabilities and the Restraint Reduction Network, CQC has also developed training for inspectors to help improve their reporting of restrictive practices.

The draft Mental Health Bill included important amendments to the Mental Health Act 1983, which aimed to increase the safeguards for people who are detained. However, despite this recognition of the need for change, the bill was not mentioned in the King’s speech as a priority, meaning that people continue to be denied improved safeguards.

With 1 in 5 mental health nursing posts vacant, patients and staff are struggling. The report welcomes the increase of 50,000 nurses since 2019 but most of these posts are not specifically in mental healthcare, and therefore don’t address this devastating staffing gap.

NHS workforce plan are necessary to ensure people with mental health needs get the care they urgently need.

Chris Dzikiti, Director of Mental Health at the Care Quality Commission, said:

People with lived experience of being detained and mental health staff will be all too familiar with the issues laid out in this report.

Half a million children are receiving or waiting for mental health care and are having to wait on average 40 days to access care, but often much longer – with many reporting a deterioration in their mental health while waiting and some attempting to take their own life.

Without access to good, timely care, children with mental health needs are at increased risk of harm and in some cases suicide. This issue is a ticking time bomb, and we will face the consequences if it’s not resolved.

Black people are still far more likely to be detained under the Mental Health Act. This is a longstanding inequality which everyone involved in the delivery and oversight of mental health services must put measures in place to address, starting with implementing the Patient and Carer Race Equality Framework (PCREF). Without this commitment, there will be no change and Black people will continue to be over-represented among those being detained.

We welcome the NHS workforce plan which is a positive start, however this plan must be put into action to gain and retain enough staff to meet current and future needs.

CQC will continue to monitor, raise, and work to mitigate issues of unequal and inappropriate treatment. As part of our new assessment framework, we will be analysing whether providers are offering care which respects the rights of the individual for example, are people included in decisions around their care, are there any barriers to receiving equal care and are these being addressed?

While staff are working hard, staffing shortages can make it extremely challenging to deliver personalised high-quality care. A larger, permanent workforce is needed to reduce pressures on overburdened healthcare workers, supported by improved community support and consistent funding to help struggling providers. Without these measures, people won’t get the mental health support they need – and the consequences, particularly for children and young people, could be devastating.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.