21 October 2019
Andy Bell reviews the latest data on NHS mental health services and what resources they have to meet people’s needs
The NHS Benchmarking Network produces annual data on adult mental health services across the UK, including every NHS provider in England, Wales and Northern Ireland and much of Scotland. It gives us the clearest picture available of what NHS mental health services are in place and what resources they have to meet people’s needs. Having collected data since 2011/12, it also gives us important insights into changes over time.
The Network’s data demonstrates that there is a wide variety of types of inpatient service: a fact often hidden in political debates about whether we have ‘enough’ mental health care beds. The most common type, ‘adult acute’ care for people of working age, represents 37% of beds, while older adult services comprise 19%, secure beds 22% and rehabilitation 11%; the rest including a mix of specialised provision such as mother and baby units and eating disorder services.
there is a wide variety of types of inpatient service: a fact often hidden in political debates about whether we have ‘enough’ mental health care beds.
In total, there are now just over 18,000 inpatient beds for adults in England, a reduction of more than 2,000 over the last decade. During the same period, the number of admissions has also fallen steadily year on year (by 19% since 2011/12) but average lengths of stay have not. On average, people spend 33 days in acute adult beds in England, considerably longer than in Wales (24 days). Some of this difference may be explained by lower rates of Mental Health Act admissions in Wales (at 20%, compared with 40% in England).
Bed occupancy, meanwhile, remains at a very high rate of 95% on average, considerably higher than the recommended rate of 85%. But the more positive news is that the numbers of incidents of violence and restraint have been falling since 2016, with some NHS trusts now reporting zero incidents of prone restraint.
The Network also found no relationship between the number of beds in a local area and its rates of compulsory admissions – adding to the evidence from the independent Mental Health Act Review that reductions in inpatient beds are not, as is often claimed, the reason why compulsory admissions have been rising over the last decade.
Looking at community mental health services, the Network’s data reveals that some 800,000 people in the UK are receiving support from a wide range of teams. Just under half (45%) are seeing ‘generic’ community mental health teams (CMHTs) while 30% are in contact with older adult CMHTs or memory services. Three per cent are in contact with early intervention in psychosis services (which have grown since 2016 thanks to the Five Year Forward View for Mental Health) while the numbers using assertive outreach are now sadly negligible as these have been long neglected in national policy.
the more positive news is that the numbers of incidents of violence and restraint have been falling since 2016, with some NHS trusts now reporting zero incidents of prone restraint.
The average waiting time for community mental health services is around seven weeks, with 88% of people being seen within 18 weeks: so while most people are seen in a timely manner, a substantial minority have to wait a lot longer. For early intervention in psychosis services (which have a two-week waiting time target) the average is 1.9 weeks, indicating the continued power of access and waiting time standards in the NHS. And for people who are on community team caseloads, an average of 78% had been seen within the previous three months: a figure which varies widely both locally and between different types of service (from 87% of people in early intervention in psychosis teams to just 52% in ‘assessment and brief intervention’ services).
Finally, the data reveals some interesting comparisons between inpatient and community services. They calculate that just 1% of people in contact with mental health services (including psychological therapy services, which now see over a million people each year) are in inpatient beds at any one time (and about five per cent during the course of the year). Yet staffing and finance levels are broadly similar, with inpatient services accounting for more than 40% of mental health spending. Overall, they note, the cost of one inpatient bed for a year (about £145,000) is the same as the cost of supporting 44 people through a CMHT over a year.
The average waiting time for community mental health services is around seven weeks, with 88% of people being seen within 18 weeks: so while most people are seen in a timely manner, a substantial minority have to wait a lot longer.
What the Benchmarking Network data cannot tell us is how far and how well mental health services are meeting people’s needs and with what impact. These questions require different types of data, including measures of ‘outcomes’ and experience, and much needed attention to equality in the provision of mental health support. Nor can it capture the important and often overlooked roles of local authorities and voluntary and community sector organisations in mental health care.
This year’s Benchmarking Network data does, however, provide an important starting point for the next five years, as the NHS Long Term Plan begins to take effect. It will, of course, take some time before we begin to see the impact of the planned expansion of community mental health care during the next five years in the data they collect. But there should (and must) over time be significant and sustained growth so that more people are getting the help they need, where and when they need it.