In England, approximately 1 in 6 adults experiences a common mental disorder (such as anxiety or depression) in any given week. Half of mental health problems are established by the age of 14, rising to 75% by age 24. And in the UK, suicide is the leading cause of death among young people aged 20-34 years.
Despite these statistics, mental health services have been underfunded for many years. People with mental health problems have been stigmatised and marginalised, although recently, public attitudes towards mental health have shifted. The latest NHS policies aim to address prevention and transform mental health services. However, the ambition to achieve parity of esteem between physical and mental health will be challenging.
Here at QualityWatch, we’ve been monitoring how the quality of NHS mental health care has been changing over time. While some measures show an improvement, such as access to psychological therapies, other measures, such as crisis care, show a decline in quality.
Please find below a summary of our mental health indicators, and click on the links in the headings for more content and analysis.
Follow-up care for adults with mental health problems
- The national threshold states that at least 95% of patients should be followed up within seven days of discharge from psychiatric inpatient care. This is to reduce the risk of suicide and social exclusion and improve continuity of care.
- The target has consistently been met since 2010. However, the proportion of patients that are followed up within seven days has fallen in recent quarters. In Q1 2018/19 (April – June), 96% of patients were followed up within seven days of discharge from psychiatric inpatient care.
Hospital admissions as a result of self-harm in children and young people
- Between 2011/12 and 2016/17, the rate of hospital admissions as a result of self-harm in children and young people increased from 347 per 100,000 population in 2011/12 to 405 per 100,000 population in 2016/17 - a 16% increase.
Out of area placements
- At the end of June 2018, there were 680 active out of area placements in mental health services of which 95% (645) were deemed ‘inappropriate’. Inappropriate out of area placements are where patients are sent out of area because no bed is available for them locally.
- It is estimated that inappropriate out of area placements make up around 4% of occupied mental health beds.
- Between February and June 2018, the number of inappropriate out of area placements that travelled a distance of 300km or greater increased from 35 to 50.
Improving Access to Psychological Therapies (IAPT) programme
- In 2011/12 there were 887,452 referrals to IAPT, and this increased to 1,434,000 referrals in 2017/18 (a 62% increase).
- The number of referrals starting treatment increased by 89%, from 533,550 in 2011/12 to 1,009,072 in 2017/18.
- If the 2020/21 target of 1.5 million people being able to access IAPT services each year is to be met, an extra 164,000 people must start treatment each year for the next three years.
- The number of people successfully finishing a course of treatment increased by 69% between Q1 2012/13 and Q2 2016/17, but since then improvement has stalled. In Q1 2018/19, 147,229 people finished a course of IAPT treatment, which is slightly less than it was two years ago.
- The proportion of people who were moved to recovery at the end of IAPT treatment has increased over time, from 46% in Q1 2012/13 to 52% in Q1 2018/19. The target recovery rate of 50% has been met since Q4 2016/17.
Children and young people with an eating disorder waiting times NEW
- Between Q1 2016-17 and Q1 2018-19, the percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% to 75%.
- The proportion of routine/non-urgent cases starting treatment within four weeks of referral also increased over time, from 65% in Q1 2016-17 to 81% in Q1 2018-19.
- Despite this improvement, progress has stalled in recent quarters and waiting times need to be reduced further if the 95% target is to be met in 2020.
Service users’ experience of community mental health services NEW
- In comparison with other national patient surveys, service users rated their overall experience of community mental health services the least favourably. The most recent survey data shows that 37% of Children and Young People's Survey respondents rated their child's experience as very good compared with only 20% of Community Mental Health Survey respondents.
- The proportion of Community Mental Health Survey respondents who ‘definitely’ felt they were given enough time to discuss their needs and treatment has decreased over time, from 73% in 2010 to 61% in 2017.
- Between 2014 and 2017, the proportion of respondents who tried to contact mental health services out of hours during a crisis and ‘definitely’ got the help they needed decreased from 45% to 39%. Meanwhile, the proportion who did not get the help they needed increased from 21% to 26%.
Respect and dignity
- Between 2014 and 2017, the proportion of Community Mental Health Survey respondents who felt they were 'definitely' treated with respect and dignity decreased by 2%, and the proportion who felt they were not treated with respect and dignity increased by 1%.
Do patients feel involved in decisions about their care?
- The proportion of Community Mental Health Survey respondents who were not involved as much as they wanted to be in agreeing what care they will receive increased from 6% in 2014 to 8% in 2017.
Supporting people in employment
- The rate of employment amongst adults of working age (16-64) with a mental illness markedly increased from 27% in Q4 2006/07 to 46% in Q4 2017/18. This may partly reflect a true improvement in employment rate, but it could also be due to reduced stigma of mental illness in recent years.