NHS England’s spending has been protected in recent years and yet health services face unprecedented financial and operational pressures. This is due to a growing demand for care, especially for hospital services and inpatient care. Overall hospital activity has steeply increased by 22% in the last 10 years and emergency hospital admissions continue to rise by 4% each year. Poor mental health is the single largest cause of disability in England with one in four individuals experiencing a mental health disorder at some point during their lives. Concerningly, national surveys indicate that the prevalence of mental health disorders in the general population is on the rise. However, it remains unclear how these increases are translating to the hospital setting. In this colloquium we examine national trends in psychiatric hospital activity over the last 20 years and ask whether a growing need for psychiatric inpatient care is contributing to the unprecedented burden on the NHS.