Half of community mental health nurses say patients are frequently coming to harm because of overwhelming caseloads, as new analysis shows demand for services has grown more than twice as fast as the nursing workforce.
The findings are released after the Royal College of Nursing (RCN) carried out a survey of community mental health nurses working in healthcare settings across the UK.
Community mental health nurses provide specialised care and treatment to patients with mental ill health outside of hospitals. They are crucial in improving patients’ quality of life by helping them to keep healthy, access work and remain in education.
In the survey, half (51%) said they believed mental health patients frequently come to harm because caseloads are too high, while one in four (24%) say time pressures negatively impact patient wellbeing every single day, such as avoidable deterioration, relapse or self-harm. Nurses say excessive admin and a "tick-box" culture divert valuable time away from delivering proper care.
The survey findings come as new analysis from the College also reveals the large and growing gap between patient demand and community mental health nurse staffing levels. In England alone, between October 2022 and 2025, the number of people accessing community mental health services increased by 38% from 499,730 to 689,769, growing more than twice as fast as the nursing workforce, which increased by 15% from just 20,171 to 23,280. The rise in patients amounts to an extra five patients per community mental health nurse at any one time.
Nearly two-thirds (61%) of survey respondents said their caseloads – the number of patients they care for – had risen “a lot” over the last three years. Just one in five (19%) said they found their caseloads manageable.
RCN General Secretary and Chief Executive, Professor Nicola Ranger, describes the situation as “a perfect storm”, with nurses unable to cope with rising demand, under-staffing and overwhelming levels of administrative work, and patient outcomes worsening after missing out on crucial interventions.
One nurse said that vulnerable patients who reach out for help from her trust often have to wait “weeks” before receiving a response and sometimes wouldn’t be contacted “at all”.
“Every single day my nurses finish late. Every single day tasks are not completed. It is unmanageable and unsafe,” said another nurse.
“It is incredibly dangerous and I await the day I am called to a coroner’s court,” said one nurse, a sentiment echoed by multiple survey respondents.
Another respondent described how some people with mental health problems are so frustrated by long waits they take themselves to known suicide locations in a desperate attempt to alert services of their need.
Pressures are also leaving nurses struggling to maintain their own wellbeing. One nurse said she often doesn’t have time to “urinate or have a drink of water” because of the sheer number of patients on her caseload.
Another respondent said she is so overworked she routinely does her “notes after hours when the kids are asleep”.
“I do my best every day but it always feels inadequate. I am always working over to keep up,” she said.
In the survey, just one in ten (12%) believe they have enough time to care for patients, with many community mental health nurses attributing excessive admin and a “constant pressure” to hit targets as major factors in reducing their time with patients.
“It feels like a sales job to see how many patients we can churn out,” one nurse said.
“We are being asked to do the bare minimum, when we used to have time to review each patient properly,” said another.
“I spend far too many hours in front of the computer. Twenty-five years ago I saw more patients and had a fraction of the administrative duties,” another nurse said.
“Main worry if an incident occurs is ‘have I completed the paperwork?’, not ‘how is the person?’,” said another respondent.
When asked to rank solutions to the crisis in community mental health nursing in order of preference, respondents said new investment in the community mental health workforce and services, better pay, enforceable limits on caseloads and less time spent on admin should be the government’s top priorities.
The RCN is calling for significant, up-front investment in community services and the community mental health nursing workforce, to fund ambitions to transform care and tackle dangerous levels of under-staffing. The College is also calling for rapid improvements to digital infrastructure to reduce the need to duplicate records across different digital platforms, minimise repetitive data entry and ultimately free up nursing staff to deliver crucial interventions for patients.
The Westminster government is due to publish its ten-year workforce plan in the coming weeks.
The survey’s findings add to the overwhelming evidence that show community mental health services are failing to provide adequate care to patients. A recent report by the Care Quality Commission (31 March) found that one in three people are waiting three or more months for an appointment, while another third said they did not get the help they needed when contacting a crisis team.
RCN General Secretary and Chief Executive, Professor Nicola Ranger, said:
“With too few staff, overwhelming caseloads and excessive admin, community mental health nursing teams are caught in a perfect storm. It means that despite working exceptionally hard, they just cannot meet rising demand. The result is vulnerable people with mental ill health going without care and nursing staff feeling deeply distressed as patients deteriorate.
"It’s shocking that such poor workforce planning has allowed community mental health nurse numbers to fall so far behind demand for services. These highly skilled professionals are essential to improving people’s quality of life and helping them access things like work and education. They also save the NHS money in the long run by bringing down waiting lists and preventing unnecessary hospitalisations.
“Growing this crucial workforce must be a priority for a government wanting to move from treatment to prevention and from hospital to community. We now need to see sustained and significant investment in community mental health nursing and digital infrastructure to enable them to focus on patient care and improve outcomes for our most vulnerable.”
Ends
Notes to editors:
The survey of registered community mental health nurses across the UK was issued in November 2025, closed in December 2025 and received 399 responses in the month it was open.
RCN analysis shows that the community mental health nursing workforce has not risen nearly enough to meet the overwhelming demand on services. The numbers of people accessing community mental health services increased by 38% (499,730 to 689,769) between October 2022 and October 2025, while the community mental health nurse workforce only increased by 15% (20,171 to 23,280) in the same period. The difference since 2022 is an average of five additional patients per nurse at any one time – obtained by dividing the number of patients at each timepoint by its respective workforce figure.
An RCN policy briefing paper is available on request.
Coroner’s courts are so-called in England, Wales and Northern Ireland. In Scotland, the Procurator Fiscal would decide if a Fatal Accident Inquiry is required.
