Stretched mental health services leaving psychiatrists ‘in emotional and ethical distress’

24 June 2025, 00:05

Pressure on mental health services has led to professionals making “life and death decisions” based on financial factors rather than clinical concerns, said the president of the Royal College of Psychiatrists.

Speaking to delegates at the college’s international congress this week, Dr Lade Smith will warn that “psychiatrists across the UK are experiencing growing emotional and ethical distress as they are forced to navigate a mental health system stretched beyond its limits”.

It comes as a survey of RCPsych members found almost three-quarters felt they had made decisions to admit or discharge people based on factors other than what is in the patient’s best interests.

According to Dr Smith, “long-term underinvestment and a failure to follow an evidence-based approach has led to an erosion of standards in the mental health system”.

She will add: “Despite this, mental health staff across the NHS continue to provide outstanding care in the face of unprecedented demand and workforce pressures.“Psychiatrists are committed to providing expert and timely treatment that prevents people entering mental health crisis.“

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"But the reality is that current targets are not based on patient outcomes. Pressures that override clinical judgment, combined with inadequate inpatient and community provision, are damaging the very foundations of compassionate, therapeutic and holistic care.“

"Repeated failure to attend to the pressures facing mental health services mean that provisions are now so threadbare that psychiatrists are having to make life and death decisions based on financial rather than clinical concerns.“

"At worst, these systemic pressures prevent clinicians from delivering the care they know is needed, risking people becoming more unwell, resulting in greater risk of mental health crisis and increased risk of suicide. This is causing deep distress and moral injury among psychiatrists.”

Of the 860 RCPsych members who completed the survey in England, 73% felt they had made decisions to admit or discharge patients based on factors outside clinical need.

Meanwhile, more than eight in 10 (81%) said they had experienced feelings of guilt, shame, burnout and frustration over these decisions.

Members said a lack of investment in community mental health services lead to more patients going into crisis, while a lack of affordable housing is causing delayed discharges.

Almost half (47%) of those who responded to the survey said they are facing delays in admitting or treating people because of a lack of local capacity.

Dr Smith will add: “These findings paint a stark picture of longstanding systemic issues in the way mental health services are currently commissioned and delivered.”

She said the upcoming 10 Year Health Plan “presents the perfect opportunity” for the Government to outline a “clear ambition for the prevention and treatment of serious mental illness”.“

"Alongside this, we need to see an updated long-term workforce plan with a recommitment to double medical school places as well as bolder promises to retain the workforce and increase specialty training places,” Dr Smith will tell delegates.

An NHS spokesperson, said: “The pandemic has had a huge impact on the nation’s mental health with NHS staff treating a million more people now than we did in 2019, which is why we’ve drastically expanded access and boosted our mental health workforce by over 40,000 staff.“

"We know more needs to be done to increase access to inpatient services, which is why we are working with the Government on the upcoming NHS 10 year-plan to create a service that is better for patients and is fit for the future.”