Millions of adults and children in England face longer waits for mental health care as NHS trusts prepare another round of service closures and job cuts. Ministers talk about expanding access, but the workers, funding and services needed to provide that care are being stripped away.
A March survey by the NHS Alliance found that 68 percent of responding mental health trusts expected to reduce or close services during 2026-27. More than half, 57 percent, anticipated cutting clinical staff, while 59 percent expected to freeze vacant posts.
The threatened services include child and adolescent mental health care, talking therapies, addiction support, crisis treatment and community programmes. Services aimed at low-income and ethnic minority communities are also in danger.
These aren’t harmless “efficiency savings”. They mean exhausted workers carrying larger caseloads, patients deteriorating while they wait and families being left to manage serious illness without proper support. Care that should be provided collectively is pushed back into the home, where the burden falls heavily on working-class women.
East London foundation trust is reportedly planning to close a £25m financial gap by cutting hundreds of jobs and reducing a wide range of services. NHS workers say the same process is under way elsewhere.
An NHS consultant psychiatrist said: “This is not an isolated example in east London. Many mental health trusts are in a similar, if not worse, situation and are responding in similar ways through cutting jobs and compromising service delivery.”
A manager at another trust reported that mental health providers had already faced declining funding and repeated cost-reduction targets.
Capitalist politicians present these decisions as technical accounting exercises. Trusts have “holes” in their finances. Managers must make “difficult choices”. Budgets must be “balanced”. This language hides the class decision being made: the books will be balanced by taking care away from workers and by making NHS staff labour harder for less.
The working class produces society’s wealth, yet the services it needs are always treated as burdens. Money can be found to protect banks, subsidise corporations and landlords, and maintain the military power required to defend Britain’s imperial interests. When working people need counsellors, addiction workers, psychiatric nurses or safe crisis care, however, the ruling class suddenly discovers the virtues of restraint.
Capitalism doesn’t cause every mental health condition, but it creates and intensifies many of the pressures that make people ill. Low wages, insecure work, unemployment, racism, debt, overcrowded housing and the constant fear of poverty grind people down. The same system then rations the care they need to recover.
This is one reason mental health provision remains especially vulnerable. Much of its funding pays for skilled staff rather than machinery or buildings. When governments demand cuts, labour becomes the main target. Vacancies go unfilled, permanent posts disappear and the remaining workforce is subjected to speed-ups and impossible workloads.
The damage spreads far beyond mental health trusts. Someone denied early support may later need emergency treatment or hospital admission. They may lose work, housing or income. Their relatives may have to reduce their own paid employment to provide care. What capitalist accounting records as a “saving” reappears as greater suffering and higher costs elsewhere.
Prime minister Andy Burnham has announced plans for nearly 200 community mental health centres and mental health A&Es by 2029. He said: “These services will make it much easier for people to get the right support, at the right time, in the right place.”
New facilities may be useful, but buildings don’t treat patients. Workers do. Capital funding for centres can’t compensate for cuts to the revenue budgets that pay nurses, psychiatrists, therapists, administrators and support staff. A clinic without enough workers is an empty promise dressed up for a press release.
The Department of Health and Social Care says £16.1bn is being invested in mental health services this year, more than 8,500 additional mental health workers have been recruited and 159 new facilities will receive £343m. But the share of total NHS spending devoted to mental health is still expected to fall for the third year running. Headline figures mean little if funding fails to match rising demand, inflation and the real cost of providing safe care.
The contradiction is plain. Ministers promise shorter waits while trusts prepare to employ fewer clinicians. They promise community care while providers report no investment in community teams. They announce facilities while existing services face closure. These aren’t simply mistakes. They reflect a system in which public provision is subordinated to capitalist priorities.
Underfunding also accelerates the growth of two-tier health care. People with money can turn to private therapy or treatment. Those without it must wait, go without or reach crisis point. Public deterioration becomes a business opportunity for private health companies, while the NHS is blamed for a crisis created by political decisions.
Mental health charities are right to say meaningful improvement will be impossible while staff and services are being cut. But appeals to ministerial goodwill won’t be enough. The capitalist state isn’t a neutral referee standing above society. Its priorities reflect the balance of class forces, and lasting concessions have always had to be forced from it through organised struggle.
Unite general secretary Sharon Graham said: “We cannot balance the books on the backs of the most vulnerable in society and by underfunding mental health provision you simply kick the can down the road and it costs more in the long term.
“Our members at health trusts across the country are outraged at attempts to cut jobs and services and will be fighting back with the full support of their union.”
That fight deserves the support of the whole labour movement. The immediate demands should be clear: no closures, no job cuts and no compulsory redundancies. Mental health trusts need sustained funding for permanent, properly paid staff, not another round of temporary schemes. The unions must fight for these demands independently of ministers and trust executives, linking the defence of mental health services to the struggle against austerity, privatisation and imperialist spending.
Giving workers and patients a “voice” inside the present system won’t alter which class holds power. Trust boards, government departments and Parliament remain parts of a capitalist state. Workers can force concessions from that state through struggle, but those gains will remain insecure for as long as the banks, monopolies and capitalist class control society’s resources.
Lasting health care organised entirely around human need requires socialism. The working class, led by its communist party, must take state power, expropriate the vital sectors of the economy and organise production through socialist planning. Only a workers’ state — the dictatorship of the proletariat — can break the power of capital and direct society’s wealth towards comprehensive, freely available care.
Every service defended and every job saved strengthens the working class for that larger struggle. The fight for mental health provision must become part of the fight for socialism: for the overthrow of a system that sacrifices human life to profit and imperial power, and for working-class rule.
