Is it time for a mental health waiting target?

A young boy with his hands on his head (his face cannot be seen) Image copyright Science Photo Library

Waiting time targets have become synonymous with the NHS in England. They apply to everything from A&E units and ambulance calls outs to routine surgery and cancer treatment.

But it's not just an English phenomenon. Other countries in the UK have introduced their own.

The exception is mental health. It should come as no surprise - mental health care is often said to be the poor cousin of the NHS family. Figures show that the condition gets 11% of the budget, but accounts for 28% of the disease burden.

The result is that many people go without help. An estimated three quarters of people with a mental illness receive no treatment. For physical disorders, the rate is nearer a quarter.

Research released this week by We Need to Talk, a coalition of mental health charities and royal colleges, shows this can have devastating consequences.

The group carried out a survey of 2,000 patients who had spent time waiting for psychological therapies. It found of those that faced long waits or went without care, four in 10 had harmed themselves and one in six attempted suicide.

Targets in the NHS in England
Service Target
Routine surgery 18 weeks from GP referral to treatment starting
A&E Four hours to be admitted, transferred or discharged
Ambulances Eight minutes for most serious life threatening cases
Cancer Host of targets, including two-week wait to be seen after urgent referral

The coalition has called for waiting time targets to be introduced for psychological therapies, suggesting 28 days from referral to treatment. Currently one in three patients wait longer than this - despite evidence showing symptoms get worse after this point.

The call has received some support in the corridors of power. England's chief medical officer Dame Sally Davies has suggested targets may help address some of the disparity she believes exists between physical and mental health conditions, while Care Services Minister Norman Lamb has championed the issue.

NHS England is now looking at how "access standards" could be introduced from 2015. It's not yet clear how far these would go. But if a mandatory target was to be introduced, would it make a difference?

Andy Bell, deputy chief executive of the Centre for Mental Health, thinks so, saying it could "correct the balance".

"It would send a clear message about what is expected and in turn that would force issues of investment and resources to be addressed. But there would need to be clear entitlements to treatment too. It's no good setting waiting times if people can't then get referred."

It is easy to understand why there is such a desire. While at times maligned, targets have made a huge difference to the patient experience. Before waiting time targets were introduced for routine surgery waits of two years were seen, while delays of 12 hours in A&E units were not unheard of before the four-hour target was installed a decade ago.

But it also needs carefully considering. Mental health services cover a wide range of treatments. While there is evidence that those waiting for psychological therapies should wait no more than 28 days, those needing help from crisis teams or young people experiencing psychosis need immediate attention. It may not be just one target mental health services need, it could be several.