One in three child and adolescent consultant psychiatrist posts in England are vacant, according to a “shocking” analysis laying bare the workforce crisis that experts say is fuelling “unacceptable” long waits for NHS care.
The number of children and young people requiring mental healthcare has soared in recent years, but many face lengthy delays before they can access treatment. Some are deteriorating to a dangerously severe state of mental ill-health while they wait.
At the same time, persistent underfunding of the health service over the last decade has devastated its ability to recruit and retain enough psychiatrists to cope with the huge rise in demand for care.
A workforce census published by the Royal College of Psychiatrists shows child and adolescent mental health services now have the highest consultant vacancy rates of any psychiatric specialism.
Of 842 child and adolescent consultant psychiatrist posts in England, one in five (19.2% or 162 posts) were vacant, according to the census. When combined with posts being covered by locums, the total vacancy rate was more than one in three (36.8% or 310 posts), the report said.
In an interview with the Guardian, Dr Lade Smith, the president of the Royal College of Psychiatrists, called for immediate action from the government to resolve the workforce crisis.
“Chronic underfunding for over 15 years alongside pressures on mental health services has had a detrimental impact on the ability to recruit and retain enough psychiatrists,” she said.
“As the workforce ages and pressures on staff grow, consultants are leaving without enough new recruits to replace them. The result is high staff vacancy rates, with children at their most vulnerable experiencing delays in accessing what we know are effective treatments that will keep them healthy and well.”
Smith said the solution was simple. “The government must fully implement the updated NHS long-term workforce plan. It must also fund the expansion of the mental health workforce and additional services that can help meet this demand while investing in children’s mental health as a matter of priority.”
The rise in waiting times for children and young people to see mental health services was “unacceptable”, she added. Too many children experience a deterioration in their mental health while on waiting lists, she said.
The Guardian revealed earlier this year that the number of children referred to emergency mental healthcare in England had soared by more than 50% in three years, reflecting the impact of lengthy waiting lists for regular NHS treatment.
There were 32,521 emergency and urgent referrals to child and adolescent mental health services crisis teams in 2022-23. In 2019-20, the year before the Covid pandemic, the figure was 21,242.
The increase means that more than 600 mentally ill children a week are deteriorating to such a state that they have reached crisis point, according to a review of NHS figures by the Guardian.
“We know that many children and young people can recover if treated early,” said Smith. “The evidence shows us that children who receive early support are less likely to develop long-term conditions that can affect their education, social development, employment prospects, overall productivity and, of course, their health in later life.
“The government needs to prioritise dealing with the crisis in children’s mental health. Anything else will be shortsighted and even more costly, as it creates further pressure and demand for services as their mental health problems continue into adulthood.”
Smith said a lot of medical students want to choose child and adolescent psychiatry.
“Our members tell us that working with children and seeing them thrive after treatment motivates them and gives them high levels of job satisfaction. But there just aren’t enough training places and this ultimately results in not enough psychiatrists to meet the overwhelming need.
“This is solvable. It just needs the government to prioritise our children.”
Responding to the workforce census, Olly Parker, the head of external affairs at YoungMinds, a children’s mental health charity, said: “It is shocking that so many posts remain vacant.”
Workforce shortages are “a huge obstacle” to increasing the numbers of young people receiving support, he said. “It takes years to become a psychiatrist – the government needs both long- and short-term solutions to fill the gaps.
“Insufficient staffing has very real impacts on young people, who are often already facing huge waiting lists. Over a million under-18s are referred each year to services, and systemic change is needed to both support the larger numbers of people needing support and to stop young people falling into crisis.
“The government need to urgently roll out open access early support hubs to ease the pressure on the NHS and provide further detail about how they are going to fill the staffing gaps that are putting extra strain on an already overburdened mental health system.”
A government spokesperson said: “Too many children and young people are not getting the mental health care they need and we are going to change that.
“We will recruit an additional 8,500 mental health workers across children and adult services to reduce delays, ensure there is access to a specialist mental health professional in every school in England, and a Young Futures hub in every community.”
