Nursing staff raise alarm over mental health care inequality

Just one in 10 nursing staff across the UK think governments are achieving equality between mental and physical health care, it has been revealed.

To mark World Mental Health Day, the Royal College of Nursing (RCN) has published results from a survey of 4,424 nursing staff about the challenges that remain in achieving parity between mental and physical health.

The RCN has called on governments across the UK to support mental health care by increasing funding, improving access to services and ensuring there are safe levels of staffing.

In 2013, the NHS Constitution in England changed with the aim of ensuring physical and mental health care would be treated equally, after legislation on the issue.

"Governments across the UK are failing to provide the funding and resources that mental health care services need"

- Nicola Ranger

Yet a decade later, nursing staff have told the RCN that disparities remain between mental health and physical health care.

The RCN conducted its last survey on this topic in 2018, and has now expanded its remit to include all health and care settings where RCN members work.

In the latest survey, published today, 95% of nursing staff said they believe there is inequality between mental and physical health care in the UK.

In addition, half of respondents (50%) said that efforts to achieve mental health equality had got worse since the pandemic, compared to 15% who said it had got better.

Respondents noted that having enough funding, patient access to services and safe staffing were the greatest areas where inequalities existed between the two.

Notably, these were exactly the same areas identified in the 2018 survey, which the RCN said reflected “little shift in thinking around where priorities should lie”.

The survey revealed that over two thirds of respondents (68%) thought that their country of work had been unsuccessful in ensuring mental health gets equal attention to physical health.

Just one in ten (10%) reported that they thought their country had been successful in achieving this.

Similarly, 60% of respondents said that their local NHS service had been unsuccessful in ensuring that mental health gets equal attention to physical health, while 12% said their local NHS service had been successful.

In its report of the findings, the RCN said that nursing staff thought mental health services were “often reactive and short term instead of proactive and long term”.

In addition, respondents said staffing was a major barrier to equality, “with many feeling that there are insufficient resources to provide adequate care”.

One respondent said: “There is a will to give mental health an equal footing but not the budget to allow the investment to match that aspiration.”

Another said: “I think local NHS services are trying their best with what they have got but long-term poor planning has impacted services.”

For those working in a predominantly physical health setting, almost half (49%) said it was ill-equipped to support the mental health needs of patients, while 26% said their setting was equipped to deal with it.

There was a common feeling among respondents that mental and physical health services were often treated as separate entities, leading to a lack of consistency in the level of support provided for mental health needs.

One respondent said: “Despite working in a hospital that has a mental health unit on the same site, referrals are difficult to make.”

Another said: “I work in an A&E department. Physical and mental health are still very much treated as separate conditions.”

Meanwhile, for those working in a predominantly mental health setting, over 40% of respondents said it was equipped to deal with the physical health needs of patients, while 34% said it was ill-equipped.

Respondents cited efforts to deliver “robust physical health care skills” for those receiving care in mental health settings, however responses showed an “inconsistent and patchy picture across services”.

“Unfortunately, many areas do not have fully functioning equipment for monitoring physical health,” said one respondent.

However, another said: “On our mental health wards, we have physical health nurses attached to each ward.

“We also have physical health nurse contacts for community mental health settings.”

Nursing staff working across mental health and physical health settings agreed that further training and the ability to work with other local services would help to achieve equality in the delivery of care.

Commenting on the survey, the RCN’s chief nurse, Professor Nicola Ranger, said: “Despite many years of promises and commitments for equal treatment of physical and mental health care, nursing staff are seeing things heading in the wrong direction.

"Governments across the UK are failing to provide the funding and resources that mental health care services need, with serious care consequences for patients and service users.

“People are waiting far too long, traveling huge distances, or even feeling forced to pay privately to get treatment.

“This World Mental Health Day, we’re reminding governments why parity matters and to provide the funding, resources and joined-up care between mental and physical health care that people desperately need.”

- Nicola Ranger

Responding to the survey, the deputy chief executive of NHS Providers, Saffron Cordery, said: "It appears that achieving equity for mental health services is no longer a priority.

"Mental health care needs more long-term investment, including for staff, for capital to transform dated facilities and for early intervention and prevention, to give patients the high-quality, 21st century treatment they need."

When asked to comment, the Department of Health and Social Care directed Nursing Times to a blog on how the government is supporting mental health services in England.

The blog noted that funding for mental health was “expected to increase to 8.92% of NHS funding in this financial year”.

In addition, it highlighted that the government was investing at least £2.3bn of additional funding a year by March 2024 “to expand and transform mental NHS health services, so an extra two million people can get mental health support”.

Meanwhile, a Welsh Government spokesperson said: “We recognise the important role mental health nurses play, which is why we've increased training places by 29.2% in the last year.

"We are also investing £6m in the Mental Health Workforce Plan for Wales.

“Later this year we [will] also be consulting on our successor strategy to Together for Mental Health.

“Ensuring people can access effective mental health support is a priority.”

Also responding, a Scottish Government spokesperson said: “Mental health spending by NHS Boards has doubled in cash terms - from £651 million in 2006-07 to £1.3bn in 2021-22 - and we have record numbers of staff providing support to a larger number of people than ever before.”

They added that, in the coming weeks, the government will be publishing a strategy delivery plan and accompanying mental health and wellbeing workforce action plan.

The spokesperson said: “As part of this work, we will commission a Scottish mental health nursing review.

“This will provide a specific focus on the unique challenges faced in mental health nursing and allow us to consider what more needs to be done to attract, grow, support, and develop the mental health nursing workforce and leadership.”

The Department of Health in Northern Ireland was contacted for comment.