More than 1,000 autistic people left in mental health hospitals for over two years

Progress towards shifting mental health, autism and learning disability care from hospitals into community settings is falling short of ambitions, with a lack of suitable housing and support contributing to prolonged hospital stays, a new report has warned.

No wrong door? A review, published by Centre for Mental Health, assesses progress towards a ten-year vision for services in England, first set out in 2022 following consultation with people who use, work in and support mental health, autism and learning disability services.

The review identifies significant gaps between the vision and the current reality. It argues that community services, supported housing and social care must be strengthened if people are to receive the right support closer to home, rather than remaining in hospital because suitable alternatives are unavailable.

In June 2026, 2,150 autistic people and people with a learning disability were in mental health hospitals in England. Of these, 1,025 had been in hospital for more than two years and 320 for more than a decade.

The report identifies a lack of suitable accommodation as a major reason for delayed hospital discharges. It says investment in safe, supported housing and community services is essential to enable people to leave hospital and live in the community, while ensuring inpatient care remains available when it is needed.

The proposed shift from hospital to home, set out in the NHS 10-year plan, will require more than changes to hospital provision. The review stresses that local services need the capacity to provide sustained support, including social care, housing and joined-up help for people with complex or overlapping needs.

Without this, people may continue to experience prolonged admissions, while others risk homelessness or destitution when mental health support is not connected to housing advice, welfare assistance and other services.

The review also highlights the pressures facing community services more broadly. Although investment in adult community mental health services over the past five years has enabled services to reach record numbers of people, demand has risen rapidly. Centre for Mental Health says more evidence is needed to establish how far services have been transformed and how this has affected people’s experiences of support.

The Government’s plans to expand community mental health centres are identified as a potential step towards improving access. Six centres were operating at the time of the review, with capital funding intended to support expansion to around 100 centres in England over the following three years. However, the report raises questions about how the centres will be staffed and operated, noting that the availability of revenue funding remains unclear.

The report warns that the wider workforce also needs long-term investment. The NHS mental health and learning disability workforce in England grew from 111,791 full-time equivalent clinical and support staff in September 2019 to 138,479 in March 2023. More recently, growth has slowed. While the Government has met its target of adding 8,500 staff during the current Parliament, the review says there is no clear plan to expand the workforce further.

Without a long-term workforce plan and greater ambition to increase capacity, services risk continuing to struggle to meet demand. The report also raises concerns about the health and wellbeing of staff working across mental health, learning disability and neurodivergence services, including those employed by charities and private providers, where support for staff wellbeing depends on the resources and priorities of individual employers.

The review identifies other barriers to timely support, including long waits for autism and ADHD assessments or treatment. Some children are waiting more than two years for an essential service, while too many people continue to miss out on help until they reach crisis point.

Although the report recognises progress in early intervention, including the expansion of mental health support teams in schools, it warns that improvements remain uneven. It argues that prevention must become a greater priority across government, rather than being left to mental health services working under pressure.

Andy Bell, chief executive of Centre for Mental Health, said the people involved in developing the original vision had been clear that services needed to change.

“The people who spoke to us in the creation of No wrong door were clear that mental health, autism and learning disability services needed to change. They helped us compile a compelling vision of what support could be like in 2032. It’s time to return to that vision to equip mental health services with the right resources to fulfil their potential in the years to come.”

The report calls for the forthcoming cross-government mental health strategy to put prevention at the heart of government policy and adopt a ‘mental health in all policies’ approach, recognising the impact of issues such as poverty, housing, employment and education on people’s mental health.

It also argues that the shift towards community-based support must be matched by better accountability and a clearer focus on outcomes that matter to people using services. Without reliable, transparent outcome data, it says, it is difficult to assess whether reforms are improving people’s lives or to hold providers and commissioners to account.

Bell said the new strategy could help set a more ambitious direction for services.

“Just last week, the independent prevalence review demonstrated beyond doubt that there is a need for more action to prevent mental distress and to improve support for neurodivergence and mental ill health. The government’s new strategy can set a direction of travel that builds on the good practice that exists today, that invests in a workforce fit for the future, and is ambitious about the support that’s available to people where and when they need it.”