Mental Health Services · MHSDS · Monthly Publication

Mental health caseloads are up 31% in three years. NHS trusts are not where the growth is.

Three years of NHS England’s mental health services data tell a story the headlines have missed: 2.4 million people were in contact with NHS-funded mental health, learning disability and autism services in July 2026, 576,000 more than in September 2023 — yet the caseload held by NHS trusts has barely moved. The growth sits almost entirely with independent assessment providers, while one appointment in six is still missed and community waiting times are improving from a very low base.

By Dr Yogasakaran Arjuna · 20 September 2026 · NHS England MHSDS monthly statistics, September 2023 to July 2026 · 106 sub-ICBs · 36 ICBs · 416 providers

01A caseload that grows every month

People with an open referral to any NHS-funded mental health, learning disability or autism service at the month end — the caseload — has risen in 24 of the last 34 months.

From 1.83 million in September 2023 to 2.41 million in July 2026: a rise of 31%, or from 29 to 38 people per 1,000 registered patients. Open referrals (one person can hold several) rose from 2.27 million to 2.94 million. Referrals into services are running at 5.87 million a year, 6% up on the year before, and July 2026 was the busiest single month in the series with 529,226 new referrals. Adult open referrals grew fastest of all, by 43%, from 1.19 million to 1.71 million.

None of this is a mystery to anyone answering a practice telephone. What the provider split shows is where those extra people have actually gone.

02The NHS line is flat

Split the same caseload by the organisation holding it and the growth almost vanishes from NHS trusts.

NHS trusts held 1.74 million people in September 2023 and 1.88 million in July 2026, a rise of 8% over three years. Everyone else held 159,000 and now holds 680,000: four times as many, and 27% of all provider caseload where it was 8%. The step changes in the orange line are individual organisations appearing in the data for the first time. The five largest independent providers in July 2026, none of which had a published caseload two years earlier, together account for 361,000 people:

Psych-UK alone now holds a larger caseload than any NHS mental health trust in England. These organisations advertise one thing above all: ADHD and autism assessment, mostly commissioned through the patient’s right to choose. The MHSDS file does not label referrals by condition, so the data cannot prove that every one of those 680,000 people is on a neurodevelopmental pathway. But the names, the timing and the arithmetic point the same way: the national rise in “people in contact with mental health services” is, to a large degree, the assessment queue for ADHD and autism moving onto the books of new providers. It is worth keeping in mind the next time a headline uses the national caseload as a measure of mental illness.

03Meanwhile, inside the NHS services

The service lines GPs refer into most have moved far less than the headline, and not all in the same direction.

Adult community teams for severe mental illness, the core of secondary care, carry 4% more open referrals than three years ago. Memory service referrals have fallen 8%, which is consistent with the dementia diagnosis rate stalling rather than with demand easing. Crisis and home-treatment caseloads are unchanged. Children’s services are up 18%. Set against a 31% rise in the total, the picture is of NHS core services running close to flat while the periphery expands.

The 12-month access measures NHS England reports against its own ambitions have all grown by around a fifth: 893,219 children and young people supported in the year to July 2026 (up 21% on the year to September 2023), 697,331 adults with two or more community contacts (up 22%), 66,176 women in specialist perinatal care (up 23%) and 172,068 children supported by school-based mental health support teams, a measure that only began in 2025.

04One in six appointments is missed

Every month, between 370,000 and 500,000 mental health contacts are recorded as not attended.

England’s rate has sat between 14.7% and 17.4% throughout the series and was 15.4% in July 2026: 470,900 missed contacts against 2.58 million attended. The spread between systems is enormous. Humber and North Yorkshire loses 7.3% of contacts; Coventry and Warwickshire loses 33.4%, one appointment in three, and its main trust records 38.6%. Deprivation, transport and the way “did not attend” is coded all play a part, and a high rate is not automatically a verdict on the service. But the four-and-a-half-fold range is real, has persisted for three years in the same places, and represents capacity that exists on paper and not in practice.

05Waiting: better, from a low base

The community mental health waiting-time measure counts the clock as stopped only when someone has been assessed and started meaningful help. Four weeks is the aim.

When the measure started in April 2024, 10.5% of adult community referral-spells and 17.6% of children’s reached a full clock stop within four weeks. By July 2026 the figures were 21.6% and 26.7%. That is a doubling for adults, and it is still fewer than one in four. Among adults still waiting, 113,881 had been waiting more than a year in July 2026, a third of everyone in the queue, down from 134,389 and 37% two years earlier.

For children the older measure, the 90th-percentile wait from referral to a first contact, has not moved: 225 days in September 2023, 239 days in July 2026, never below 205 in between. One child in ten waits eight months to be seen at all. The range between ICBs runs from 66 days in Birmingham and Solihull to 1,144 days in Lincolnshire, seventeen-fold, with Kent and Medway (977), Nottingham and Nottinghamshire (889) and Thames Valley (802) also past the two-year mark. Early intervention in psychosis, the one standard with a long track record, was met: 71.6% of people started treatment within two weeks against a 60% target.

06The 72-hour follow-up

The days after discharge from a mental health bed carry the highest suicide risk. The standard is that 80% of people are contacted within 72 hours.

England reached 78.3% in July 2026, up from 71.3% in September 2023 and its best in the series, but still short of the standard on 4,806 of 6,140 discharges. Nineteen of the 36 ICBs met it in July. The rest ranged from 79% down to Coventry and Warwickshire at 16.7%, a figure so far from the rest that it is more likely a recording failure than a clinical one, and either way worth a question. Inpatient beds themselves are quietly emptying: 22,855 people were in a mental health bed at the end of July, 6% fewer than three years ago.

07Thirty-six ICBs, two-and-a-half-fold

Caseload per 1,000 registered patients ranges from 20 in Essex to 51 in North East and North Cumbria. Colour shows the missed-contact rate.

A high caseload is not a bad thing in itself: it can mean a system that finds and keeps people, or one where independent assessment providers have registered a large queue. North East and North Cumbria (51 per 1,000) also has the highest rate of children supported (19.2 per 1,000) and a 72-hour follow-up of 83%. Essex (20 per 1,000) has the lowest adult community access in England at 5.8 per 1,000. The full table, with year-on-year movement in caseload, is below; every column can be explored by sub-ICB on the dashboard.

For local readers: North Central London (sub-ICB 93C, within West and North London ICB) had 66,005 people in contact in July 2026, 37.0 per 1,000 against England’s 38.2 and up 6% on the year; a missed-contact rate of 22.4%, well above England; 72-hour follow-up of 74.3%; and a children’s 90th-percentile wait of 217 days, down from 409 a year earlier. Its adult four-week clock-stop rate fell from 28.9% to 15.3% over the same year, one of the few local measures moving the wrong way.