Background to the report

Many people will experience mental health problems in their lives. Around one in six adults in England have a common mental health disorder, and around half of mental health problems start by the age of 14. The proportion of young people estimated to have a probable mental disorder rose between 2017 and 2022, following the COVID-19 pandemic: for example, among 17- to 19-year-olds, the proportion went up from 10% to 26%.

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In 2011, the government set out long-term ambitions to improve support and services for people with mental health problems and achieve ‘parity of esteem’ with physical health services. These seek to reduce the personal, social and economic costs of mental health problems, by addressing the causes of such problems, and identifying and treating them earlier. The government acknowledged a large ‘treatment gap’ for people with mental health conditions.

From 2016, the Department of Health & Social Care (DHSC) and NHS England (NHSE) made specific commitments to improve and expand NHS-funded mental health services. NHSE, working with DHSC and other national health bodies, set up and led a national improvement programme to deliver these commitments.

Scope of report

This report focuses on the implementation of NHS commitments as set out in:

  • the Five Year Forward View for Mental Health (FYFV, July 2016)
  • Stepping forward to 2020/21: The mental health workforce plan for England (Stepping Forward, July 2017)
  • the NHS Long Term Plan

We examined whether the government has achieved value for money in its efforts to date to expand and improve NHS-funded mental health services by evaluating whether DHSC, NHSE and other national bodies:

  • have a clear understanding of how much their work to date has reduced the gap between mental and physical health services (Part One)
  • met ambitions to increase access, capacity, workforce and funding for mental health services (Part Two and Part Three)
  • are well placed to overcome the risks and challenges, including the impact from COVID-19, to achieving future ambitions


Since 2016, the NHS has taken some important first steps towards closing the historical and acknowledged gap between mental and physical health services. DHSC and NHSE made a series of clear commitments and plans to expand and improve mental health services, but they have not defined what achieving full parity of esteem for mental health services would entail.

Consequently, it is unclear how far the current commitments take the NHS towards its end goal, and what else is needed to achieve it. While funding and the workforce for mental health services have increased and more people have been treated, many people still cannot access services or have lengthy waits for treatment. Staff shortages continue and data that would demonstrate the results of service developments are limited.

DHSC and NHSE acknowledge that it will now take longer to achieve some of the existing commitments following the COVID-19 pandemic, amid signs of a large rise in mental health conditions, particularly among young people. Over the next few years, demand for mental health services will continue to significantly outstrip provision, putting pressures on patients, staff and people trying to access services.

DHSC and NHSE have plans to pursue challenging new ambitions such as improving community mental health services, but they need to be in a position to apply the lessons learned from their efforts to date. They have further to go to ensure value for money in their expansion efforts and will need to demonstrate a firmer grip on the significant ongoing risks to their ambitions.

Survey questions and responses

To inform the study, the National Audit Office carried out two online surveys – one of integrated care board (ICB) mental health leads and one of mental health trusts. Survey questions covered views on:

  • the future role of ICBs in improving mental health services (ICB survey only)
  • national support and guidance
  • barriers and facilitators to service improvement, including workforce and funding
  • data quality and availability (ICBs)
  • how well established pathways were between services
  • actions taken to manage service and demand pressures (trusts)
  • and future national and local priorities.

The survey ran from September to October 2022. We received responses covering 29 out of 42 ICBs, including three partial responses, and 39 out of 53 trusts, including seven partial responses.

For survey questionnaires and data on responses, see Downloads below.


Publication details

Press release

View press release (9 Feb 2023)

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