HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector. Mental Health Matters is now written by HSJ’s new mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at firstname.lastname@example.org or by sending a direct message on Twitter.
Various data-heavy publications put mental health services under the spotlight last week, including the much-awaited prevalence survey of mental health illness in children and young people, NHS Digital’s annual report, and the Care Quality Commission’s survey of community mental health teams.
The last time the prevalence survey was published was 2004 and the whole sector has been preparing itself for the new statistics to paint a worsening picture. There was no real surprise in the headline figure; 12 per cent of children and young people were recorded as having a mental health illness compared to 9 per cent in 2004.
Since prime minister Theresa May labelled the care of children and young people one of the “burning injustices” of our time, the issue has been high on the national agenda.
Given that platform, it will be very surprising if children and adolescent mental health services were not already on top of the long-term plan bidding pile before the prevalence survey figures were published.
That being said, the data could still provide extra impetus for NHS England to ring-fence spending on this area in mental health.
Even commissioners are calling for this. As they explained to the health and social care select committee, while the mental health investment standard is useful, it doesn’t guarantee any funding for children and young people’s services.
The data also provides some evidence for those lobbying for investment within education and social care. For example, the most common “service” contacted by children with mental health illnesses were teachers, and there was a striking correlation between household income and the proportion of children and young people with mental health illness.
Both of these areas are difficult for the NHS to control, but demonstrate the need for more cross-government working and the impact education budgets will have on health services.
The headline figures in NHS Digital’s annual report suggested mental health services were performing well and exceeding national targets for waiting times and recovery rates. For instance, 51 per cent of those who finished a course of treatment entered recovery (were deemed to be effectively treated).
This is against a national target for 50 per cent of “eligible referrals” to move to recovery. Slightly different measurements, but overall the figures are positive.
However, there is a cohort of patients who slip through gaps in the data. For example, we don’t know what happens to those patients who don’t finish a course of treatment or the reasons why patients who are referred to the services don’t start treatment at all. The so-called dropouts.
Why are these patients dropping out and do they end up presenting somewhere else in the health services? Having this level of information would enable a more meaningful look at where improvements can be made.
What was also interesting was that just 7 per cent of those who finished their treatment were over 65, compared to 48 per cent of 36 to 64-year-olds, and 43 per cent of 18 to 35-year-olds.
The Royal College of Psychiatrists suggests that talking therapies can be very effective for the elderly, so why are the numbers of over 65s being treated by IAPT so low?
Could this be because of how Improving Access to Psychological Therapies services are set up? If treatment is dependent on a patient travelling to a GP practice or health centre, for instance, how might a frail elderly person be able to consistently make it to the sessions?
This is something those writing the long-term plan should pay attention to.
The CQC’s patient survey of community based mental health services showed patients’ experience of community mental health services is in slow decline.
As with the prevalence survey, the findings won’t come as any great surprise to those in the sector, but do provide some insight into which areas of community mental health need the most attention – for example, the low proportion of respondents who received advice or support for their physical health needs, which was also identified as a key area by Simon Stevens a few weeks ago.