Ensuring adequate funding to enable high-quality mental health care
While there have been welcome increases in mental health funding over the last decade, it has not matched increases and changes in demand and acuity levels. Funding has also not been broad or long term enough given the scale of underinvestment historically in the mental health sector. Lord Darzi highlighted mental health accounts for more than 20% of the disease burden but less than 10% of NHS expenditure. This gap looks set to persist without national action: despite the pressures the sector faces and the opportunities to support better care for all, the mental health sector's share of NHS spend fell in 2024/25 and is set to fall even further in 2025/26.
The planned funding reduction for 2025/26 is likely to be much more damaging than it appears due to there being limited ringfenced mental health service development funding, which mental health trusts have been able to count on in previous years. This drop is all the more concerning given four in five trust leaders responding to our survey last May 2024 told us they did not believe they had been given enough funding to sustainably reduce care backlogs across mental health services last year. In addition, 58% did not think it would be possible to meet demand for mental health care, even if the current trend of investment in mental health services continued. Over a quarter of respondents from all trust types (27%) saw mental health service capacity as their greatest risk over winter 2024/25. Nearly a third (32%) wanted to see investment in mental health services as a top priority for the government when considering enablers for improving patient care over the next decade.
...realism [is needed from the government and national bodies] on the proportion of national budget necessary to improve mental health and community services. Basically fund the left shift.
combined mental health and community trust
To address this, the mental health investment standard (MHIS) must be viewed as a minimum, rather than as a maximum based on affordability, to avoid widening the gap between resources for mental health services and local need. Multiple mental health trusts have told us this year they will not receive the increase in funding the MHIS exists to deliver to them, with the sum instead being used to offset their system’s overall financial deficit. Other trust leaders have highlighted they are being asked to find greater, more than double in some cases, efficiency savings, despite their funding having grown significantly less, than other trusts within their system to enable their ICB to return a balanced budget for 2025/26. The current rules around system control totals should be reviewed to ensure mental health trusts are not facing a disproportionate financial burden in comparison to other trusts in their system in order for their ICB to deliver a balanced annual budget. Trust leaders and stakeholders have also stressed the importance of long-term, multiyear funding to deliver improvement programmes.
We will not receive the MHIS growth funding which has been diverted to the acute hospital in our System. This leaves us substantially underfunded for key delivery areas.
Mental health / learning disability trust
To realise the economic and societal benefits derived from high-quality, accessible mental health services, we need to:
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Ensure all mental health trusts receive the mental health investment standard as a minimum in practice annually to avoid widening the gap between resources for mental health services and local need.
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Review the current rules around system control totals to ensure mental health trusts are not facing a disproportionate financial burden in comparison to other trusts in their system in order for their ICB to deliver a balanced annual budget.
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Prioritise mental health services in future funding and policy decisions to ensure trusts can meet rising demand through new and future models of care, and in recognition of the economic and wider benefits derived from investing in the delivery of high-quality, accessible mental health services.