Nearly 48,000 adults in Croydon are estimated to be living with persistent anxiety or depression. Mind in Croydon supported over 15,000 people last year. And the NHS trust that delivers all of Croydon's mental health care has just been downgraded by the regulator.
Last week, the Care Quality Commission published its inspection findings on South London and Maudsley NHS Foundation Trust, the organisation responsible for most of Croydon's NHS mental health services. The headline rating, "requires improvement" for how well-led the trust is, is a downgrade from the "good" rating SLaM received at its last inspection in 2021.
That gap, five years between inspections, is worth noting before anything else.
The CQC inspected four services between June and October 2025, including the trust's acute inpatient wards, community mental health teams, crisis services, and forensic wards. It also conducted a trust-level well-led review, with an on-site visit in October 2025, 19 staff focus groups, and observations of board and committee meetings over several months. The findings were published on 13 February 2026.
SLaM serves around 1.3 million people across Croydon, Lambeth, Lewisham and Southwark, with more than 40,000 people in the community and 712 beds across 48 inpatient wards.
What the CQC actually found
The trust-level rating now focuses solely on leadership and culture, so this is, officially, a judgment about how SLaM is run, not a rating of individual clinical services. But the underlying service inspections tell a more specific story.
Of the four services inspected: forensic wards at Bethlem Royal Hospital remained rated as good overall; acute wards for adults of working age and psychiatric intensive care units dropped from good to requires improvement; mental health crisis services and health-based places of safety dropped from good to requires improvement; and community-based mental health services for adults of working age remained at requires improvement.
That last one is worth sitting with. Community mental health services were already rated "requires improvement" before this round of inspections. They have not improved.
Community mental health
The findings from community mental health are the ones that concern me most, because they describe a system failing people who are waiting, often urgently, with no safety net in place while they do.
At the time of the inspection, 596 people remained on waiting lists, including 160 urgent referrals, with no formal process in place to monitor or review their clinical needs while waiting.
That is not a minor administrative gap. That is 160 people flagged as urgent, sitting in a queue, with nobody formally checking whether they are still okay. In a community mental health context, "still okay" can mean a great deal.
Staff hadn't completed up-to-date risk assessments in 10 of 20 care records inspectors reviewed. The service didn't manage caseloads in line with national guidance: in the Lewisham early intervention in psychosis team, practitioners carried an average of 26 to 27 cases, significantly above the NHS England recommended maximum of 15.
The Lewisham figure is for a different borough, but SLaM runs Croydon's equivalent teams on the same model. There is no reason to assume Croydon's caseload picture is materially better.
Inspectors also found that leaders didn't consistently act on learning from incidents and deaths, and that recurring themes from mortality reviews, including poor documentation and gaps in basic life support training, remained unaddressed.
Crisis services
Staff in home treatment teams didn't all have access to working alarms to obtain support in an emergency. The home treatment team in Croydon is one of four HTTs the CQC visited during this inspection. The report does not name Croydon as the specific site for this finding, but the finding applies to the service as a whole.
The service kept most people in the health-based place of safety for more than 24 hours, which was not in line with the Mental Health Act code of practice. Approximately 40% of people were from outside of the trust's geographical boundary, which contributed to assessment delays.
Access remains a concern, with high numbers waiting over 12 hours in emergency departments compared to other London trusts, and excessive delays for Mental Health Act assessments in crisis services.
Leadership and culture
Many staff described a disconnect between front line staff and senior leaders, saying they didn't feel their experiences were heard or that their work was always appreciated. Staff told inspectors that they no longer felt that they wanted to provide feedback through the staff survey or other means as they didn't believe this would make a difference. This was reflected in the low completion rate of 39% for the 2024 NHS staff survey.
A 39% completion rate is not a data quality issue. It is a signal that a large proportion of staff have concluded that nothing changes when they speak. That is a serious institutional problem. It also means the 61% of staff who didn't return the survey are not counted in whatever results the trust uses to assess its own culture.
Leaders didn't always have effective working relationships with staff networks. Work was needed to ensure all networks feel valued and that issues of race, racism and disability are understood and appropriately addressed.
The Section 31 point that hasn't received much attention
One detail in the report has not been widely covered. The CQC informed the trust that it was considering whether to use its powers pursuant to the urgent procedure under Section 31 of the Health and Social Care Act 2008, due to concerns identified during visits to the health-based place of safety and to the community-based mental health services for adults of working age at Lambeth Single Point of Access. The trust submitted a detailed action plan, averting further measures, with themes followed up in the well-led review.
Section 31 powers allow the CQC to suspend a provider or impose conditions of registration at short notice, without the usual notice period. The regulator considered using them here. That the trust's action plan was enough to avert this is a reasonable outcome. But it tells you something about the severity of what inspectors found that the option was on the table at all.
What SLaM said
Jane Bailey, the Trust Chair, and Ade Odunlade, the Trust's Interim Chief Executive since December 2025, acknowledged that the inspection feedback would guide the organisation on its improvement journey. The trust would focus on areas where it can do better while building on things it was doing well.
The statement references a "2026 Roadmap, Five Foundations" as the framework for their action plans. No public summary of this document is readily available. What it contains, and how it addresses the specific failures identified in the CQC report, is not clear from what SLaM has published.
SLaM is in Segment 3 of the NHS National Oversight Framework, which means it is subject to mandated regional support and oversight. This predates the CQC report. The trust was already flagged, at a national level, before these findings landed.
What's not in the report
The CQC report covers acute inpatient, community, crisis and forensic services. It does not provide a specific breakdown of findings by borough. Croydon is named throughout as one of the four areas, but the most granular criticism in this round is directed at Lambeth services: it was the Lambeth Single Point of Access that triggered the Section 31 consideration, and several of the caseload and waiting list examples come from Lewisham and Lambeth teams.
That does not mean Croydon services are performing well. It means the report does not tell us one way or the other. Croydon's community mental health services for adults of working age have been rated "requires improvement" across multiple inspection cycles. The home treatment team in Croydon was visited during this inspection. No position on Croydon-specific performance has been published beyond the trust-wide findings.
That absence matters. Croydon is the largest of SLaM's four boroughs by population. What is happening in the Croydon teams specifically should be publicly accountable, and it is not.
What this means if you're currently using SLaM services in Croydon
The honest answer is that it depends on the service, and on the team. The CQC's own report notes that carers gave largely positive feedback about community services, with 88% rating their experience as good or very good in the family and friends survey. Frontline staff are praised throughout the report for their compassion and commitment. The forensic wards at Bethlem are rated good.
The problems the CQC has identified are largely structural: insufficient oversight of waiting lists, caseloads above safe levels, incomplete risk documentation, poor escalation of concerns, a leadership culture where staff don't feel heard. These are not failures of individual clinicians. They are failures of the system those clinicians work within.
If you are on a waiting list with SLaM, or supporting someone who is, you can contact the Patient Advice and Liaison Service (PALS) on 020 3228 2302 if you have concerns about how your care is being managed while you wait. If there has been a significant change in your situation or someone else's, it is worth contacting your GP to flag this, as GPs can request urgent reviews.
For mental health crisis support, call 111 and press 2 to reach the local crisis team, available 24 hours a day for Croydon residents. Crisis support does not require a referral.
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