The state of health care and adult social care in England 2025/26

Key points

• Pressure on mental health services across the care pathway has continued to rise in 2025/26. The number of people in contact with community mental health services has increased by 34% over the last 3 years. This pressure is being compounded by more people with severe mental illness accessing care.
• As demand for care increases, we continue to see that people who live in the most deprived areas and people in ethnic minority groups have greater levels of need and contact with mental health services. But not everyone is able to access the care they need when they need it. Long waiting times remain a concern and we are particularly concerned about children and young people.
• The way community mental health services are commissioned and delivered is changing. Positively, providers have told us about working more closely with the voluntary, community, faith and social enterprise sector to deliver care in the community, but a lack of national standards and guidance is leading to a patchwork of different service models.
• People in crisis still struggle to access appropriate care and support when they need it, with only 25% of very urgent referrals receiving care within 4 hours. Those seeking help from urgent and emergency care services also face long waits for assessment by psychiatric liaison services, though this has improved over the last 2 years.
• For people admitted to hospital, we remain concerned about the risks created by the physical environment of mental health wards, and impact of challenges with staffing levels and capacity. However, we have seen examples of providers listening and responding to feedback to improve environments.
• A lack of community placements, incomplete information sharing, or poor representation from social care at planning meetings are creating challenges with discharging patients from secondary mental health services into the community. When systems don't work together to support people to access community care, they remain an inpatient for longer, increasing the risk of relapse or readmission.
• After being discharged, we are concerned that people with complex needs who present with high risks are being lost in the system and not receiving appropriate support, including specific groups who are more likely to disengage with services or those whose voices are seldom heard.
• We continue to be concerned about the use of restrictive practice, particularly for autistic people and people with a learning disability. Findings from our Independent Care (Education) and Treatment Reviews highlight the importance of person-centred, trauma-informed care, and how skills and knowledge of staff can have a direct impact on the quality of care.