The recent RCPsych survey offers a powerful and sobering insight into the daily realities faced by psychiatrists across the country, particularly those working in general adult services. As Chair of the Royal College of Psychiatrists’ Faculty of General Adult Psychiatry, I feel a strong responsibility to highlight what these findings mean, not just for our profession, but for our services and our patients.
The data makes for difficult reading. Almost half of respondents practising general adult psychiatry reported facing daily delays in timely admissions due to lack of local or specialist capacity. Three quarters acknowledged having to make decisions on admission or discharge based on factors other than clinical need. A similar proportion believed that such decisions compromised patient care and safety. Perhaps most concerning of all, 84% report witnessing or experiencing signs of moral injury, a deeply damaging consequence of being unable to deliver the care they know is needed.
We are operating within a wider system under immense strain. There has been a marked deprioritisation of mental health in national policy in England over the past year. The absence of mental health from the Elective Recovery Plan, the dilution of commitments made under the NHS Long Term Plan, the threats to the Mental Health Investment Standard, and the void in strategic workforce planning all create a perfect storm. Local funding cuts via ICB allocations and increasing demand pressures due to social care fragility further exacerbate the strain on services and challenge our ability to deliver care that is timely, person-centred, and sustainable.
This survey reinforces the urgency of continued advocacy and action at every level. While much of the system context, such as funding constraints and national workforce policy, sits beyond our direct control, there is still much we can do. Across health care settings, we must continue to prioritise investment in our environments, strengthen multidisciplinary teams, and protect clinical decision-making from being overridden by operational pressures. We should also ensure that our staff feel heard and supported, especially when faced with ethically challenging decisions. This includes supporting peer networks, clinical leadership pathways, and wellbeing initiatives.
Crucially, we must also use our voice to influence system-wide reform and make an unrelenting case for greater prioritisation of mental illness and severe mental illness across government and health strategies. The call from the College to restore parity of esteem for mental health, invest in local inpatient and step-down capacity, and rebuild community services aligns closely with what we see on the ground. We must contribute to shaping policy, not just adapting to it, as the cost of neglect is both human and economic, with untreated mental illness leading to worse outcomes across physical health, education, employment and criminal justice.
Health care providers all have a responsibility to model what good mental health care can look like, even in a stretched system. That means being patient-focused, and solutions-oriented. It also means acknowledging the moral distress our clinicians may feel, and actively working to mitigate it through support, empowerment, and a shared vision for better services.
We must articulate clearly that psychiatrists and mental health teams have the expertise and the will to deliver therapeutic and safe services, but cannot do so within a system that is stretched beyond safe limits. The themes arising from the survey – pressure from bed managers, system flow targets overtaking clinical judgement, inappropriate discharges and inadequate community provision – reflect a system that risks undermining the very foundations of compassionate, relational care. We must argue for realistic workforce planning, a protected infrastructure for community and inpatient services, and sufficient capital investment to maintain and expand therapeutic environments.
The survey also provides rich material for solution-focused advocacy. The call for improved local inpatient capacity, step-down accommodation, strengthened community services, and a rebalancing of decision-making power back towards clinical teams is unmistakable.
This moment, while challenging, is also an opportunity. An opportunity to speak with clarity about what needs to change. An opportunity to support our teams more effectively. And an opportunity to reaffirm our commitment to providing safe, compassionate, and clinically-led mental health care.