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 public attitudes towards mental health have shifted recently. 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 follow-up for patients discharged from psychiatric inpatient care, show a decline in quality. Find a summary of mental health indicators below, and click on the links for more detailed content and analysis.
Improving Access to Psychological Therapies (IAPT) programme
- The number of referrals to the IAPT programme starting treatment has more than doubled, from 533,550 in 2011/12 to 1,092,291 in 2018/19. But the number of people starting treatment must still increase considerably if the 2020/21 target of 1.5 million people is to be reached.
- The number of people successfully finishing a course of treatment increased between 2012/13 and 2016/17, but since then improvement has stalled. In Q1 2019/20, 148,775 people finished a course of IAPT treatment, which is only 3% more than it was three years ago.
- The recovery rate has increased gradually over time, from 46% in Q1 2012/13 to 52% in Q1 2019/20. The target recovery rate of 50% was first achieved in Q4 2016/17, and has been met consistently since then.
Children and young people with an eating disorder waiting times
- The percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% in Q1 2016/17 to 81% in Q2 2018/19, but has since decreased to 75% in Q2 2019/20.
- Between Q1 2016/17 and Q2 2019/20, the percentage of routine/non-urgent cases starting treatment within four weeks of referral increased from 65% to 86%.
- 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.
Hospital admissions as a result of self-harm in children and young people
- Between 2011/12 and 2017/18, the rate of hospital admissions as a result of self-harm in children and young people (aged 10 to 24 years) increased from 347 per 100,000 population to 421 per 100,000 population – a 21% increase.
Out of area placements
- At the end of August 2019, there were 755 active out of area placements in England, of which 710 (94%) 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 5% of occupied mental health beds.
- Between February 2018 and August 2019, the number of inappropriate OAPs that required patients to travel a distance of 300km or greater increased from 35 to 60.
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 was consistently met until the most recent quarter (July to September 2019), when performance dropped to 94.5%. Previously, the proportion of patients followed up within seven days had fluctuated at around 97%.
Suicide in mental health service users
- Suicides by people in contact with mental health services are arguably the most preventable. In the UK, there were 1,612 suicides by people who had been in contact with mental health services in the previous 12 months in 2016. This accounts for 27% of all suicides in the general population.
- Between 2006 and 2016, the number of suicides by people in contact with mental health services in the UK increased by 11%. However, this is overshadowed by a substantial decrease in the rate of patient suicide, when you take account of the rising number of people receiving mental health care.
Service users’ experience of community mental health services
- The Community Mental Health Survey asks service users to rate their overall experience from 0 (very poor) to 10 (very good). In 2019, 17% of service users rated their overall experience as very good and 3% rated their experience as very poor.
- 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 65% in 2014 to 57% in 2019.
- In 2019, 69% of Community Mental Health Survey respondents said they knew who to contact out of office hours within the NHS if they had a crisis.
Respect and dignity
- Between 2014 and 2019, the proportion of Community Mental Health Survey respondents who felt that they were ‘always’ treated with respect and dignity decreased from 74% to 71%. The proportion who felt that they were not treated with respect and dignity increased from 7% to 8%.
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 9% in 2019.
Supporting people in employment
- The rate of employment among adults of working age (16–64) with a mental illness increased markedly from 27% in Q1 2007/08 to 49% in Q1 2019/20. 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.