Long waits and inequality leaving mental health patients more unwell, CQC warns

People are waiting too long for mental health care and becoming more unwell while they wait, according to the Care Quality Commission’s (CQC) latest annual report on the use of the Mental Health Act.

The regulator’s Monitoring the Mental Health Act 2024/25 report, published on 29 January, draws on interviews with more than 3,000 patients and over 700 family members and carers. It warns that rising demand, staff shortages and higher thresholds for admission are contributing to long delays, inconsistent experiences and increasing use of restrictive and inappropriate care.

While the report recognises the commitment and compassion of frontline staff, it highlights persistent system-wide pressures. Out-of-area placements are rising, despite a national commitment to end the practice by March 2021, and a lack of available beds is forcing some people into unsuitable environments. This includes children being placed on adult wards and people being cared for far from home, limiting contact with family and support networks.

Inequalities remain stark. People living in the most deprived areas are 3.6 times more likely to be detained under the Mental Health Act than those in the least deprived areas, while Black people continue to be detained at four times the rate of white people. Despite this, more than half of services visited had not provided staff with training on racial inequalities, and three-quarters of services were unfamiliar with the Patient and Carer Race Equality Framework, which is mandatory for NHS mental health providers.

The report also raises concerns about workforce capacity. Nearly one in ten roles in NHS mental health trusts were vacant as of March 2025, with heavy reliance on agency staff. This, the CQC says, can undermine continuity of care, make it harder to build therapeutic relationships and limit staff’s ability to de-escalate distress. Patients reported feeling unsafe on wards due to low staffing levels, while staff described increasing levels of burnout.

Some patients also said staff lacked the skills to support autistic people or those with a learning disability, leaving them feeling misunderstood or treated without dignity.

The human impact of these pressures is illustrated by the experience of Emily, a former patient detained under the Act, who said she felt “almost like a criminal” and was not informed of her rights during the early weeks of her stay. Although she later received therapy and support, she believes earlier community-based care might have prevented her detention.

Chris Dzikiti, interim chief inspector of mental health at the CQC, said it was “deeply disappointing to again be highlighting the same issues”, adding that many people detained under the Act had already “exhausted all other avenues of care” before facing long waits and inappropriate placements. He stressed the need for “a bigger, more robust workforce” and enough beds to meet demand, while thanking staff who continue to provide compassionate care in challenging conditions.

The regulator is calling for a system-wide approach to improve access to timely, personalised mental health support, reduce inequalities and prevent people spending months or years in hospital when they could be supported safely in the community.