Exploring the gaps in mental health provision in Bristol
We asked people about their experiences of mental health services through an online survey and 1:1 interviews. We also held a focus group for professionals.
What people told us
We took a sample from our survey and analysed the feedback from 43 people living in Bristol.
36 people had accessed mental health support in the last two years. We heard that:
- 10 people waited over 12 months for support
- Eight people waited over one month
- 15 people did not receive the support they were expecting
- Seven people were told they did not meet the criteria for support
What are the barriers people face in accessing mental health support?
- Long waiting times (22 people said this was a barrier)
- No one calling back (13 people)
- Lack of trust in services (11 people)
- Mental health symptoms making it difficult to access treatment (16 people).
Six people felt that the care they received was trauma informed, but 15 people reported that it was not.
Six people felt their care reflected and respected their identity, culture and personal background. Eight people did not. Their reasons included language barriers and cultural differences.
When asked about positive aspects of their experience with mental health services, nine people reported there was nothing positive about their experiences.
Patient A is a 25-49-year-old mixed ethnicity (Black Caribbean and White) woman living in Bristol, who has a long-term health condition. Her GP diagnosed her with a mood disorder and anxiety and immediately prescribed her antidepressants.
She told us she tried four different anti-depressants, but with 'no actual support'. She self-referred to talking therapy, for which she waited over 12 months. She reports nothing positive about her experience with mental health services, since there is no help until you reach crisis point' and long waiting times make it difficult to access care.
Patient A is also the parent of a child who has psychosis. She said the 'system is broken' - intervention teams do not act early enough to prevent crises and have left her daughter unsupported during manic episodes, which have then developed into psychosis.
The patient suggested that accessible care within the community needs to improve, to stop people from hitting crisis point.
Feedback from VCSE organisations
20 organisations from statutory, public and charitable sectors were invited to take part in a focus group. Five organisations took part: Mind Bristol, Womankind, Rethink, St Mungo’s and Changes Bristol. Here's what they told us.
- Gaps in mental health provision. The available mental health resources across Bristol are struggling to meet demand. Waiting lists are long, and even when people access services, the level of support does not always match their needs.
- Impact on minoritised groups. Gaps in provision disproportionately affect minoritised communities. Language barriers, cultural differences, and a lack of services that are skilled in trauma-informed care and working with people with protected characteristics mean that many people cannot or do not access the help they need.
- Stop-gap services. Services that do not require a referral act as indefinite holding spaces for people who don’t meet thresholds for professional support on the NHS, or are not well enough for low-intensity support.
- Lack of early intervention. There has been a shift away from preventative care and support to reactive responses to people who are in mental health crisis.
- Engagement and accessibility. Many people who could benefit from support lack the trust or the means to access it.
- Commissioning challenges. Changes to the Community Mental Health Programme has made it almost impossible for people to receive long-term, meaningful intervention. Commissioning changes are frequent, making it hard to build continuity or care. It has left organisations that support people who are struggling with their mental health feeling disempowered.
Patient B is a 25-59-year-old White British woman diagnosed with complex PTSD from severe childhood trauma. Her GP supported her, prescribing medication and referring her to the mental health team.
Her engagement with the mental health team involved one telephone assessment, but she was told that her complex PTSD is beyond the remit of the team, so she should seek private counselling or therapy. Whilst Patient B acknowledged that she understands the service is stretched, she feels it 'has to do better, you can’t assess someone’s mental health over one telephone call'.
She also reported that her telephone assessor was 'not supportive' and referred to a decline in access to support – in the past, it was possible to access therapy, but now there is nothing unless you pay for it.
What happens next?
- People are being told that their needs do not fit within a particular service. This leads to a lack of continuity of care, and not knowing where to turn. We are working with Well Aware to develop a dedicated mental health page that offers information and will list organisations that can offer support with an explanation of referral pathways.
- We will develop an awareness campaign to promote Well Aware. The goal will be to help GPs and healthcare professionals know where they can refer people to, and help the public understand the support that is available and the pathways to receiving support.
- Local Mental Health and Wellbeing Integrated Network Teams (MINTs) will be inviting organisations to discuss bridging the gaps in provision that we have identified.
Patient C is a 50–64-year-old woman of mixed/multiple ethnicity. She has had mental health issues all her adult life and feels there has always been stigma around this. She feels she is labelled being an older person with mental health issues and feels judged. She attempted suicide last year, something she has done multiple times. She did not access any support as she felt ashamed and has a deep-rooted fear of any health workers.
Her experience when she has accessed services is that no one reads her records, meaning she must retell her story each time. This is the case with GP’s (even though the GP has put a note at the top of her records to state she must speak to the same GP every time she asks to due to her mental health).
She is currently with North Bristol Recovery Team and has a good psychiatrist who is supportive and advocates for her.
She self-referred to Vita Health and had been on the waiting list for 2.5 years for an EMDR as she has had this before and it really helped. She had an assessment with them in December, and they took her off the list and stated that due to her trauma being from childhood and historical they are not able to help her. Her psychiatrist is trying to get a new assessment for her.
She has not been able to work for 10 years and is a single guardian to a grandchild. She has been told in the past: 'I don’t know where you fit'. Social prescribing is always offered by GPs and other professionals but that is not suitable for everyone.
Background information
- 20% of Bristol residents reported having poor mental wellbeing in 2024/25. This rose to 24.4% in the most deprived areas.
- Bristol has the second highest 'low life satisfaction score' of all English core cities.
- 5,611 Bristol residents reported having a mental health condition in 2023/24. This is in line with the national average.
- 20.5% of people in inner Bristol reported having a long-term mental health condition.
- 621 people in inner Bristol have severe mental health issues and a comprehensive care plan.
