Mental health is an issue that affects many people: latest estimates state that 1 in 6 adults experienced a ‘common mental disorder’ such as depression or anxiety in the past week and 1 in 6 children aged between 6 and 16 experienced a ‘common mental disorder’ in 2021. In 2020, the leading cause of death for people aged 5-34 was ‘intentional self-harm’.
In this QualityWatch update we look at a range of mental health service performance measures, and data on patient experience and outcomes, to give a view of how services have fared in the ongoing Covid-19 pandemic. Notably, the number of people being treated outside their area for acute mental health needs has been generally lower than before the pandemic. However, for other measures, such as eating disorder services for children and young people and the Improving Access to Psychological Therapies programme, demand has risen since the start of the pandemic. Further, the latest data on patient experience suggests that people are less satisfied with community mental health services than in previous years.
Below is a summary of our mental health indicators, with links to 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 fell to 1,025,210 in 2020/21 during the Covid-19 pandemic. The number of people starting treatment must increase considerably if the target of 1.88 million people starting treatment by 2023/24 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 34%. In September 2021 there were 152,957 referrals to IAPT (15% higher than in September 2020 and 9% higher than in September 2019) and 102,252 referrals started treatment (5% higher than in September 2020 and 10% higher than in September 2019).
- The number of people successfully finishing a course of treatment almost doubled between 2012/13 and 2021/22. In Q2 2021/22 (July to September 2021), 170,201 people successfully finished a course of treatment.
- The recovery rate (proportion of people who are no longer a clinical case at the end of IAPT treatment) improved gradually between Q1 2012/13 and Q4 2018/19, from 46% to 53%. Since then, it has decreased to 50% in Q2 2021/22.
Children and young people with an eating disorder waiting times
- The access and waiting time standard for children and young people with an eating disorder states that 95% of those referred should begin urgent treatment within one week and routine treatment within four weeks.
- Between Q1 2016/17 and Q1 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 88%, but decreased again to 63% in Q2 2021/22.
- The percentage of routine cases starting treatment within four weeks of referral increased from 65% in Q1 2016/17 to 90% in Q2 2020/21, and decreased back to 65% in Q2 2021/22.
- Since Q1 2020/21, alongside the worsening waiting times there has been a 71% increase in the number of children and young people starting treatment and a quadrupling in those still waiting to start.
- The number of children and young people with an eating disorder waiting over 12 weeks to start urgent treatment is at a record high, with 64 patients waiting over 12 weeks in Q2 2021/22.
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 2019/20, the rate for females increased from 508 per 100,000 population to 695 per 100,000 population. Over the same time period, the rate for males fluctuated around 200 admissions per 100,000 population.
- In 2019/20, the South West had the highest rate of admissions at 660 per 100,000 population. The rate was lowest in London at 192 per 100,000 population.
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 51% in Q4 2020/21. 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.
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. They are deemed ‘inappropriate’ if the reason is non-availability of a local bed.
- In April 2020, inappropriate out of area placements reached a low of 210, which may reflect changes in mental health inpatient care at the start of the Covid-19 pandemic. Since April, the number peaked in October 2020 at 630, but has since fallen to 430 in September 2021.
- In September 2021, there were 50 inappropriate out of area placements that required patients to travel a distance of 300km or greater. There were 190 inappropriate out of area placements that required patients to travel more than 200km but less than 300km.
Patients’ experience of mental health services
Respect and dignity
- Between 2014 and 2021, 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 9% over the same time period.
Do patients feel involved in decisions about their care?
- Between 2014 and 2021, the proportion of Community Mental Health Survey respondents who were ‘definitely’ involved as much as they wanted to be in agreeing what care they receive decreased from 56% to 52%. The proportion of respondents who were not as involved as much as they ‘wanted to be’ increased from 6% to 8%.
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 2021, 10% of service users rated their overall experience as poor or very poor (0, 1 and 2) and 48% rated their experience as good or very good (8, 9 and 10). In comparison to other NHS and social care services, mental health services perform the worst on overall experience.
- 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 56% in 2021.
- In 2021, 74% of Community Mental Health Survey respondents said they would know 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 2021 just under half (49%) of respondents said that they ‘definitely’ got the help they needed when they tried to make contact. 20% of respondents did not get the help they needed and 3% were not able to make contact.
Suicide monitoring and prevention
Follow-up care for adults with mental health problems
- In order to prevent suicides, in 2019/20 a new operating standard was introduced stating that at least 80% of patients should be followed up within 72 hours of discharge from psychiatric inpatient care. Since the earliest published data in June 2020, this standard has not been met nationally. In August 2021, 76% of adults leaving psychiatric inpatient care were followed up within 72 hours.
Suicides in mental health service users
- In 2018, there were 1,306 suicides in England by people who had been in contact with mental health services in the previous 12 months. In Scotland there were 222 patient suicides and in Wales there were 73.
- Between 2006 and 2018, the number of suicides by people in contact with mental health services in the previous 12 months increased by 10% in England. The rate of patient suicide, considering the rising number of people receiving mental health care, decreased from 98 to 49 suicides per 100,000 mental health service users over the same time period.
- The rate of inpatient suicide in all comparator countries (Belgium, Canada, Demark, Finland, Netherlands, New Zealand, Portugal and Spain) 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.