The NHS mental health workforce decreased significantly during austerity, with notable disparity in staffing levels across the country, according to a new review.

The uneven growth in the mental health workforce over recent years is highlighted in the new analysis by the University of East Anglia. While, overall, the evidence is that the mental health workforce in 2023 is bigger than the mental health workforce in 2009, there appear to be notable differences in the way the workforce has grown between regions.

The figures show that in 2009, there was a 39% difference between the best served (North East and Yorkshire) and least served (East of England) regions.

In 2023, there is now a 54% difference between the best served (London) and least served (East of England) regions. In addition, the growth in the mental health workforce appears about half that of the growth in the wider clinical workforce, suggesting that ambitions to create a ‘parity of esteem’ between mental and physical health conditions are not reflected in the workforce.

The new analysis is based on existing data but because it is adjusted for population, it makes it much easier to see changes in the workforce and make comparisons between regions. “Mental health workforce in England: regional trends and disparities” is published in the British Journal of Mental Health Nursing.

Author Dr. Peter Beazley, from Norwich Medical School at UEA, said he conducted the analysis because he could see the NHS was publishing wholetime equivalent (WTE) headcount data but providing no adjustment for population growth.

He said, “Adjusting for population provides a fairer comparison, not least because the growth in population over recent years has been quite unevenly distributed over the country. Here at UEA we train a number of mental health professionals, and I felt motivated to conduct this analysis after hearing of issues about un-met need first hand from our trainees and supervisors working in the region

“It’s a rather simple analysis, but without this sort of data, we can’t plan effectively for future needs or ensure equitable distribution of resources between regions.

“Plans to develop the mental health workforce further should account for the regional differences observed, but should also consider anticipated population growth. This sort of long-term planning isn’t necessarily very exciting, but it is particularly important for institutions like ours which are involved in training the mental health workforce of the future.”

Key findings from the report highlight:

• Differences between the Mental Health Workforce and wider clinical workforce—The mental health workforce, overall, grew a little less than 10% between 2009 and 2023. On the other hand, the wider clinical workforce across the NHS grew by almost 20%. Such a difference is surprising in the context of the wider social concern and demand for mental health services.
• Reductions in the Mental Health Workforce during the years of austerity—The analysis shows that the mental health workforce was hit particularly hard during the austerity years, with some regions being more severely affected than others. This reduction in size of the mental health workforce was greater than the overall clinical workforce in the NHS.
• Post-COVID Workforce Growth—Although the mental health workforce has seen significant growth, particularly since the COVID-19 pandemic, it has only relatively recently surpassed 2009 levels. While there are no figures showing the workforce at different clinical levels of qualification, Dr. Beazley said the rapid increase in staffing was likely driven by hiring less qualified personnel. highlighting concerns about the quality and sustainability of this growth.
• Regional Disparities—While the data suggests national improvements over recent years, the East of England and South East regions appear particularly under-served in terms of the proportion of the mental health workforce to regional population. However, limitations in the way that data is recorded means that these findings must be treated with caution, since services provided in one region may be delivered by a provider based in another.

Dr. Beazley said that the analysis does not account for the fact that people living on the edges of particular geographic regions may receive NHS services from a bordering geographic region; for example, a hospital in London could be serving people in the South East.

Furthermore, some NHS services are highly specialized and are therefore provided in a centralized location with funding from other regions. This may explain to some extent a need for additional provision within London.

However, Dr. Beazley said, “There are some factors which do impact on quite how generalizable the data is, but even so I think it’s hard to argue with some of the findings. The increasing gap between the mental health workforce and the wider clinical workforce appears to reflect “poorly on wider ambitions to achieve a ‘parity of esteem’ of mental health.”