The Care Quality Commission’s (CQC) review of patient survey results helps with the assessment of NHS performance and forms a key part of its core purpose; to monitor, inspect and regulate health and adult social care services.
The Community Mental Health Survey is therefore one of several informing CQC’s understanding of the risks and quality of local and national services, supporting their targeted assessment activities.1 The results are also used by the Department of Health and Social Care (DHSC) and providers to improve services, and by government, to support accountability.
The 2024 results, from 14,619 patients, (a response rate of 20%) are stark.2 Growing demand for community mental health care is more often than not met with long waits and insufficient support.3 This is little changed from the 2023 survey results and, concerningly, will continue into the medium term. The National Audit Office (NAO) has reported that ‘over the next few years, demand for mental health services will continue to significantly outstrip provision.’4
Key points from the survey
Whilst people did report slightly more positively about a few areas, too many continued to report poor experiences. Key findings about adults’ experiences were:
- More than a quarter of patients (27%) did not get the help they needed in a mental health crisis, and 22% did not know who to contact
- When not in crisis, almost a quarter did not get the help they needed from their mental health team
- Whilst waiting for their first appointment for treatment by the mental health team, after an earlier assessment 42% felt their mental health deteriorated and 40% received no support for their mental health
- Care plans were not in place for more than a third of patients (38%)
- Almost half (43%) had not had a review meeting to discuss their care
- Support with physical health needs was not offered to 39% of respondents
- Almost half to almost three quarters of respondents received no help to access other areas of life support known to impact on mental health, such as joining groups or activities (44%), advice on finding work (69%) and support with financial advice or benefits (67%)
- Children’s and adolescents’ experiences were worse ‘across multiple areas of care’3
- A third (33%) did not know who to contact in a crisis
- Almost half (45%) waited at least 3 months for their first appointment for treatment
- Whilst waiting, more than half (53%) received no support for their mental health. This had improved a little from 60% in 2023
- Care plans were not in place for almost half of respondents (43%)
- About the same high proportion as adults (44%) had not had a review meeting in the last 12 months.
Younger, disabled and autistic people reported worse than average experiences, as well as people accessing services over the phone.
Older people reported more positive experiences. They felt they were:
- Treated with care and compassion (82%)
- Involved in agreeing their care plan (79%)
- Listened to by the mental health team (73%).
A handful of small improvements were noted since 2023, though mostly to the tune of just 2-3%:
- More people were told what would happen if they stopped taking medication (an improvement from 39% to 41%)
- More people were asked if they needed support to access care and treatment (from 41% to 44%)
- Of those taking up that support to access, more said it met their needs (from 29% to 32%)
Almost three quarters of respondents (74%) felt they had sufficient privacy to talk comfortably during therapy. The overall situation was summarised by Jenny Wilkes, the Interim Director of Mental Health at the Care Quality Commission:
‘This report lays bare the devastating reality that people are still not getting the mental health support they need, when they need it. This is particularly stark when looking at young people – we know that early intervention is critical in making sure people get the support they need and too often this is not happening.’5
Trust outliers
In benchmarking and categorising each NHS trust’s performance,6 the CQC identified four which performed better than expected across the survey as a whole, and one which was worse:
Better than expected:
- NAVIGO Health and Social Care CIC (community interest company)
- Gloucestershire Health and Care NHS Foundation Trust
- Rotherham Doncaster and South Humber NHS Foundation Trust
- Camden and Islington NHS Foundation Trust.
Worse than expected:
- Livewell Southwest.
NAVIGO respondents felt more positive than other trusts about 19 of the 35 survey questions, and about the same as others for the remaining 16. They reported no areas as being worse than other trusts.7 The trust was ‘much better than expected’ in providing support for patients’ mental health while they were waiting for their first appointment for treatment. Clearly, they have practices here which can be shared with other trusts.
It also performed well in relation to patients’ care reviews; crisis care support for patients and families; and support with physical health needs. Patients’ experiences regarding 27 questions about Livewell Southwest’s service were about the same as for other trusts, but worse for 8.2 These related to patients’ care planning and care reviews, support for mental health while waiting, crisis care support for patients and families, support with physical health needs and with financial advice or benefits.
Data on waiting times
The Statistical Analysis report of the survey notes that ‘A third of respondents (33%) reported waiting 3 months or more for their first appointment for treatment.’8
Interestingly, access and waiting times for only three mental health pathways are currently measured by NHS England:
- NHS Talking Therapies, for anxiety and depression
- Children and Young People (CYP) with an eating disorder (ED)
- Early Intervention in Psychosis (EIP).
- NHS England states that plans are in place to publish other waiting times in the future including all age community mental health (CMH) services.9
Action taken and next steps
In relation to the annual survey, individual Trusts are asked to set out improvements they intend to make. This applies equally to those with the most positive responses overall, as responses to individual questions varied.
With regard to the state of mental health services overall, plans are afoot. Ambitions set out by the NHS in 2011 to improve support for people needing mental health care were subsequently bolstered by specific commitments made by DHSC and NHS England to improve and expand these services.4
However, the NAO reports that, while funding and the relevant workforce has increased, and more people have been treated, there is further to go. There is still a shortage of staff, and data to demonstrate progress are limited. Government ambitions remain but are acknowledged to take longer to achieve than first thought.
These plans also likely need expansion, given the nation’s worsening mental health, particularly since the COVID-19 pandemic following which, the estimated proportion of young people with a likely mental disorder rose from 10 to 26%. Given these factors, the known incidence levels of mental illness and the lack of support available, the survey results strongly indicate that urgent escalation is needed. Particularly the introduction of routine and accurate measurement of how long people are waiting for community mental health care.
Amanda Halliwell
Independent care coach
https://claritascarecoach.co.uk/
amandaatclaritas@gmail.com
References
1. Care Quality Commission. Surveys. https://www.cqc.org.uk/publications/surveys (accessed 23 April 2025).
2. Care Quality Commission. NR5_Livewell Southwest Benchmark Report. https://nhssurveys.org/all-files/05-community-mental-health/05-benchmarks-reports/2024/ (accessed 23 April 2025).
3. Care Quality Commission. Community Mental Health Survey 2024. https://www.cqc.org.uk/publications/surveys/community-mental-health-survey (accessed 23 April 2025).
4 National Audit Office. Progress in improving mental health services in England.
https://nhsproviders.org/resources/briefings/next-day-briefing-nao-improving-mental-health-services-progress-report (accessed 23 April 2025).
5 Care Quality Commission. Press release: High demand, long waits, and insufficient support, mean people with mental health issues still not getting the support they need. https://cqc-newsroom.prgloo.com/news/high-demand-long-waits-and-insufficient-support-mean-people-with-mental-health-issues-still-not-getting-the-support-they-need (accessed 23 April 2025).
6. Care Quality Commission. Community mental health survey 2024: Trust outliers. https://www.cqc.org.uk/publications/surveys/community-mental-health-survey (accessed 23 April 2025)
7 Care Quality Commission. NQL_NAVIGO Health and Social Care CIC. Benchmark Report. https://nhssurveys.org/all-files/05-community-mental-health/05-benchmarks-reports/2024/ (accessed 23 April 2025).
8 Care Quality Commission. Community mental health survey 2024: Statistical release. https://www.cqc.org.uk/publications/surveys/community-mental-health-survey (accessed 23 April 2025)
9. NHS England. Mental Health Access and Waiting time standards. https://www.england.nhs.uk/mental-health/resources/access-waiting-time/ (accessed 23 April 2025)