Across England, Integrated Care Boards are grappling with an escalating cost that few outside the health and care system notice, but which carries major implications for the sustainability of mental health services. New NHS England data shows that the bill for post-discharge care for patients detained under the Mental Health Act has reached £909 million in the 2024-25 financial year. That is a 42 per cent increase in just two years, up from £643 million in 2022-23, and 14 per cent higher than last year alone.
This is section 117 aftercare. It is a statutory requirement under the Mental Health Act, ensuring that patients who have been detained receive funded care for as long as they need it after discharge. The intention is clear and commendable: to give people the best chance of recovery, stability, and reintegration into the community. But the scale of the cost increase raises pressing questions about how these services are delivered and funded.
Funding responsibilities are split between Integrated Care Boards and local authorities, depending on the nature of the support. ICBs typically cover community mental health services, therapies, and clinical input, while local authorities often fund accommodation or social care. Many patients require complex, specialist placements. These can be essential for recovery but also carry high costs, particularly where accommodation and 24-hour support are needed.
The latest figures also reveal stark variation in spending. When adjusted for mental health need, some ICBs are spending more than double the national average. Coventry and Warwickshire, and Hampshire and the Isle of Wight, are among the highest spenders. Others, such as Northamptonshire, Shropshire, Telford and Wrekin, Kent and Medway, and Norfolk and Waveney, are at the lower end. While some variation will reflect genuine differences in local need, others have pointed to coding issues and differences in how cases are recorded and managed.
Several ICBs have voiced concerns about the financial pressure these rising costs bring. In an NHS already stretched by workforce shortages, rising demand, and growing waiting lists, a rapid increase in one area inevitably affects what is available elsewhere. Policymakers must recognise that statutory obligations like section 117 aftercare cannot be diluted without risking harm to vulnerable people; but that does not mean the system cannot be improved.
NHS England has not directly addressed the section 117 cost pressures in its public statements, but it has pointed to work aimed at preventing mental health crises before inpatient care becomes necessary. This includes expanding 24/7 crisis support, trialling neighbourhood health centres, and widening access to local crisis hubs. These measures are welcome, but prevention is a long-term strategy, and the immediate financial pressures remain.
There is a danger that rising costs in this area could drive short-term fixes that undermine patient care. Cutting placements or reducing specialist support risks setting back recovery and increasing the likelihood of relapse, which in turn could mean further detention under the Mental Health Act, adding more pressure to the very budgets policymakers are trying to protect.
A more constructive approach would focus on three things: improving the quality and consistency of coding and data, ensuring that care packages are both clinically appropriate and cost-effective, and investing in community-based recovery services that reduce the need for high-cost placements over time. Better data would allow ICBs to understand what drives variation and to share good practice between regions. Stronger community support could shorten the length of specialist placements, enabling patients to move back into more independent living sooner.
Section 117 aftercare is a vital part of the mental health care system. It supports some of the most vulnerable people in the country at a point where the right intervention can make the difference between sustained recovery and repeated crisis. But with costs rising sharply and unevenly across England, it also highlights the need for smarter commissioning, clearer oversight, and a long-term plan that matches clinical priorities with financial reality.
Without action, the upward trend in costs will continue, straining the ability of Integrated Care Boards to fund other essential services. This is not just a budgeting issue. It is a question of how we deliver on the promise of high-quality mental health care in a way that can endure.
