Before the onset of the coronavirus (Covid-19) pandemic, an estimated one in six adults in England experienced a common mental health condition each week. Inequalities in mental health persisted, with some groups facing poorer mental health and barriers to accessing services. And in England and Wales, suicide was the leading cause of death for people aged 20 to 34 years.
As with all parts of the health system, the pandemic has had a significant impact on mental health services. The number of referrals fell and trusts have reported an increase in the number of people presenting in crisis. Symptoms of common mental health conditions, such as depression and anxiety, have increased. This raises concerns about a future surge in demand for support from services which were already under strain.
Here at QualityWatch, we’ve been monitoring how the quality of mental health care has changed over time. While some measures, such as waiting times for children and young people with an eating disorder, show an improvement, other measures, such as follow-up care for adults discharged from psychiatric inpatient care, have not improved. A summary of our mental health indicators is shown below. 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 increased from 533,550 in 2011/12 to 1,165,747 in 2019/20. But the number of people starting treatment must still increase considerably if the 2023/24 target of 1.88 million people is to be reached.
- Between February and April 2020, following the onset of the Covid-19 pandemic, the number of referrals to IAPT more than halved and the number of referrals starting treatment fell by 24%. In August 2020 there were 116,102 referrals to IAPT (11% lower than in August 2019) and 79,281 referrals started treatment (12% lower than in August 2019).
- 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 2020/21, 167,655 people successfully finished a course of treatment.
- The recovery rate increased gradually between Q1 2012/13 and Q4 2018/19, from 46% to 53%. Since then, it has decreased to 50% in Q1 2020/21. The target recovery rate of 50% was first achieved in Q4 2016/17, but has not been met for the past two quarters.
Children and young people with an eating disorder waiting times
- Between Q1 2016/17 and Q2 2020/21, the percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% to 85%.
- The percentage of routine/non-urgent cases starting treatment within four weeks of referral increased from 65% in Q1 2016/17 to 90% in Q2 2020/21.
- Between Q1 2016/17 and Q1 2020/21, the number of children and young people starting treatment each quarter following an urgent referral fluctuated at around 300. In Q2 2020/21 (July to September 2020), the number of urgent referrals starting treatment increased to 625.
Hospital admissions as a result of self-harm in children and young people
- Rates of hospital admission as a result of self-harm in children and young people (aged 10-24) are considerably higher for females than males. Between 2012/13 and 2018/19, the rate for females increased from 508 per 100,000 population to 690 per population. Over the same time period, the rate for males fluctuated around 200 admissions per 100,000 population.
- In 2018/19, the South West had the highest rate of admissions at 679 per 100,000 population. The rate was lowest in London at 196 per 100,000 population.
Out of area placements
- An out of area placement occurs when a person with acute mental health needs who requires inpatient care is admitted to a unit that does not form part of their usual network of services.
- Between September 2017 and February 2020, the number of inappropriate out of area placements started each month increased from 586 to 665. In March 2020, the number started began to fall reaching a low of 210 in April. This may reflect changes in mental health inpatient care use due to the Covid-19 pandemic. Since April, the number started each month has increased and in August, 575 inappropriate out of area placements were started.
- In August 2020, there were 50 inappropriate out of area placements that required patients to travel a distance of 300km or greater. There were 140 inappropriate out of area placements that required patients to travel more than 200km but less than 300km.
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 target was consistently met until Q2 2019/20, when performance dropped to 94.5%. In Q3 2019/20, the proportion followed up within seven days increased slightly to 95.5%.
Suicide in mental health service users
- In 2017, there were 1,216 suicides in England by people who had been in contact with mental health services in the previous 12 months. In Scotland there were 223 patient suicides and in Wales there were 78.
- Between 2006 and 2017, the number of suicides by people in contact with mental health services in the previous 12 months increased by 8% in England. The rate of patient suicide, taking into account the rising number of people receiving mental health care, decreased from 98 to 48 suicides per 100,000 mental health service users over the same time period.
International comparisons of mental health outcomes
- The rate of inpatient suicide in all comparator countries is less than 2 per 1,000 patients. The UK has consistently had one of the lowest rates of inpatient suicide, although internationally comparable data on the quality of mental health care is limited.
- The UK’s suicide rate within 30 days of discharge from hospital among patients diagnosed with a mental disorder is consistently the lowest of the comparator countries for which there is available data.
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 2020, 19% 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 2020, 59% of respondents felt they were ‘definitely’ given enough time. *
- In 2020, 72% of Community Mental Health Survey respondents said they knew who to contact out of hours within the NHS if they had a crisis. *
- Of those who knew who to contact out of hours and had tried in the previous 12 months, in 2020 over half (52%) of respondents said that they ‘definitely’ got the help they needed when they tried to make contact. 17% of respondents did not get the help they needed and 2% were not able to make contact. *
Respect and dignity
- Between 2014 and 2019, the percentage of Community Mental Health Survey respondents who said 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 slightly from 7% to 8% over the same time period.
- In 2020, 73% of respondents felt that they were ‘always’ treated with respect and dignity and 8% felt that they were not. *
Do patients feel involved in decisions about their care?
- The Community Mental Health Survey asks respondents if they were involved as much as they wanted to be in agreeing what care they receive. Between 2014 and 2019, the proportion of respondents who were ‘definitely’ involved as much as they wanted to be decreased from 56% to 52%.
- In 2020, 53% of respondents said they were ‘definitely’ involved as much as they wanted to be and 8% said they were not involved, but wanted to be. *
* Fieldwork for the 2020 Community Mental Health Survey was carried out between February and June. Analysis found that the scale of changes made by services due to the Covid-19 pandemic varied between trusts. Some trusts received the majority of their survey responses before the pandemic, while others received all responses during the lockdown. Therefore, results are not considered comparable to previous years.
Are patients told about medication side effects?
- In 2020, less than half (43%) of Community Mental Health Survey respondents said that they were ‘definitely’ told about possible medication side effects. This compares to 44% of Urgent and Emergency Care Survey respondents and only 37% of Adult Inpatient Survey respondents.
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 52% in Q4 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.
- Between 2017-18 and 2018-19, the proportion of adults in contact with secondary mental health services who are recorded as being employed increased slightly from 7% to 8%.
For more information and analysis on mental health, see these Nuffield Trust blogs: