Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4

This chapter describes mental health treatment and service use in England, among people with a common mental health condition (CMHC) as measured by the Clinical Interview Schedule-Revised (CIS-R). The proportion of people with other conditions in receipt of treatment is covered in the relevant chapters.  

Current receipt of psychotropic medication and psychological therapy are examined, as well as use of health care services for a mental health reason (GP, inpatient and outpatient) and day and community care services in the past year. Prevalence estimates presented are based on participant self-reports, not health records.

• Overall, one in six adults (15.7%) reported being in receipt of mental health treatment (psychotropic medication, psychological therapy or both) at the time of interview. Use of medication (12.5%) was more commonly reported than psychological therapies (5.1%). 
• Treatment receipt was strongly associated with severity of symptoms; ranging from 6.1% of those with few or no CMHC symptoms (CIS-R 0-5), to 55.7% of those with severe symptoms (CIS-R 18+). 
• The proportion in receipt of treatment increased since 2007. Among 16 to 74 year olds with CMHC symptoms (CIS-R 12+), receipt of either psychotropic medication or psychological therapies was stable between 2000 (23.1%) and 2007 (24.4%), increasing to 39.4% in 2014 and 47.7% in 2023/4. The proportion reporting psychological therapies rose from 10.4% in 2007 to 17.9% in 2023/4; and the proportion using medication rose from 19.6% in 2007 to 38.4% in 2023/4. 
• Likelihood of treatment receipt varied between groups and was lower among people who were older (aged 75 and over) or in Asian/Asian British and Black/Black British ethnic groups. Among people with CMHC symptoms, men and women had a similar likelihood of receiving mental health treatment.  

A central aim of the Adult Psychiatric Morbidity Surveys (APMS) since 1993 has been to describe patterns in the use of treatment and services by people with symptoms of CMHC (McManus et al. 2020). The APMS questionnaire covered a range of treatment types, delivered in primary, secondary, specialist and community care settings, as well as by private providers. While the data can be used to compare what people report receiving with what National Institute for Health and Care Excellence (NICE) recommends people receive, the data cannot determine whether individual participants’ treatment plans were appropriate or not. The APMS series is, however, uniquely well-placed for describing:  

• trends in mental health treatment and service use among adults with and without symptoms,  
• potential levels of unmet need in the population, and  
• whether some groups with need are more likely to receive treatments and services than others. 

Developments in mental health treatment in England 

Over the past thirty years, there have been shifts in how mental health treatment and services are delivered in England. 

Psychological therapies: NHS Talking Therapies (formerly Improving Access to Psychological Therapies, or IAPT) is a service to which adults aged 18 or over can self-refer or be referred to by a GP. It was launched in 2008 to improve access to evidence-based therapies for conditions such as mild to moderate anxiety and depression (Clark 2012). Referrals to the service have increased over time and in 2023/4 1.83 million people were referred to the service and it was accessed by 1.26 million (NHS England 2024). Psychological therapies in England may be delivered in a range of settings, including by community, perinatal and acute mental health services (NHS 2019) as well as from charities, via workplaces and educational institutions, or private practitioners (Mind 2025). 

Psychotropic medication: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are among the most widely prescribed medications in England (NICE 2020). The average amount of time people use an antidepressant for is about a year (Sehmi et al. 2019). The number of antidepressant prescriptions issued tripled between 1998 and 2018 (Bogowicz et al. 2021), and an estimated 8.75 million people were prescribed at least one antidepressant medication in 2023/4 (NHS Business Services Authority 2024). Some antidepressants are also used to treat anxiety. Other medications sometimes prescribed for anxiety symptoms include benzodiazepines and beta-blockers. Although less widely used, the use of anxiety medications as a whole are also increasing: from 24.9/1000 person-years-at-risk in 2003 to 43.6/1000 in 2018 (Archer et al. 2022).    

Lord Darzi noted in his investigation of the NHS in England that ‘general practice, mental health and community services will need to expand and adapt to the needs of those with long-term conditions whose prevalence is growing rapidly as the population age’ (Darzi 2024). The NHS Long Term Plan, published in 2019, outlined goals to expand mental health treatment and service provision, including in community services and crisis care (NHS 2019). However, workforce shortages, increased demand, waiting times and regional disparities have been highlighted as challenges in meeting these goals (Royal College of Psychiatrists 2024; Darzi 2024). Shifts in how mental health treatment and services were provided also occurred during the COVID-19 pandemic, with some changes, such as increased use of remote contact, remaining (Taxiarchi et al. 2023). 

Levels of unmet need  

The relationship between people and services can be understood by the concepts of demand, need, and utilisation (Brewin et al. 1987). Demand is the subjective perception of the amount of services and treatments required as viewed by clients or carers and is based on personal experience and lay knowledge of disorder and treatment. Need has been defined as the amount of services and treatments required as identified from the professional perspective. It presupposes the identification of problems for which there are potentially effective interventions (Brewin et al. 1987; Bebbington 1990). Finally, utilisation is the actual take-up of services and adherence to treatments. It is shaped by the availability of services, the attitude of people to their health, and their perception of the accessibility and utility of services on offer. Inadequate treatment may therefore arise because clients and service providers do not recognise needs, and/or because of inadequate provision of treatment resources. Over-treatment is also possible, defined as utilisation without need. 

In APMS, need was not assessed directly. However, it is possible to estimate this by assuming that people with a particular level of mental health symptoms are likely to benefit from treatment. The level of ‘unmet need’ in the population is then the proportion of people with symptoms who do not receive treatment. Unmet need will be greater if the provision of treatments is insufficient, inappropriate, inaccessible, or where service uptake is poor. 

There are limitations to this approach to estimating unmet need. The APMS definition of CMHC is broad: it thus conflates milder, potentially self-limiting conditions (i.e. those that will remit in the absence of treatment) with conditions that are more likely to persist and need treatment, including some that are severe and enduring. The interventions defined as treatment include a range of psychological therapies and medications, but exclude general support, for example, from a GP or community organisations. APMS findings are also based on cross-sectional data and therefore include only those individuals with symptoms present at the time of the interview. Some of those classified as not receiving treatment may have had this in the past or may have sought help shortly after taking part in the survey. Likewise, some of those found to have mild, moderate or no symptoms may be recovering from a condition which has responded to recent treatment. Thus, it cannot be assumed that such circumstances represent over-treatment. Since psychological therapies tend to be of shorter duration than pharmacological treatments, this approach may underestimate provision and uptake of the former in particular. APMS data, which are cross-sectional, cannot be used to evaluate the effectiveness of treatment or recovery trajectories. However, outcome data on almost all people who have a course of psychological therapy in the NHS Talking Therapies programme (NHS England 2024) is published and informs the evidence base on efficacy. 

Despite limitations, a population-based survey like APMS provides unique insight into likely levels of unmet need in England. APMS measures symptoms of mental disorder in people with and without diagnosed conditions, independent of any help-seeking or treatment. The surveys collect information from people in contact with services, but also from those who are not (some may not be registered with a GP). 

Inequalities in receipt of treatment and services  

APMS data is also ideal for identifying whether some groups are less likely to receive treatment after controlling for differences in levels of symptoms (Cooper et al. 2013; McManus and Brugha 2025). Previous analyses have shown that people of working age were more likely than older people to get appropriate treatment, especially psychological therapy (Cooper et al. 2010). The survey also provided evidence that treatment receipt was lower for all minoritised ethnic groups compared with the White British group, and lowest among Black people, for whom inequalities appeared to have widened between the 2007 and 2014 surveys (Ahmad et al. 2022). APMS data can also be used to identify area-level variations: while people living in less urban areas were half as likely to receive psychological therapies as those living in urban areas, no association between urbanicity and antidepressant receipt was found (Hiepko et al. 2024). Bogdanova and colleagues used APMS 2014 data to look at variation in whether people with symptoms of mental health conditions had these recognised by professionals. They found that White people were the ethnic group most likely, and those over 75 the age group least likely, to get diagnosed by a health professional - an important step towards receiving treatment (Bogdanova et al. 2022).  

Measuring mental health treatment

Participants were asked about any treatments they were receiving for a mental or emotional problem around the time of the interview. These included different types of psychotropic medication, and counselling and other psychological therapies.

Measuring psychotropic medications

There have been changes between the surveys in how medication data have been collected. In 2000, interviewers asked about and coded all prescribed drugs, including non-psychotropic medications. In 2007, a show card listing brand names and generic names of psychotropic medications was used instead. People were also asked to show interviewers the packaging for each psychotropic medication reported, so that the interviewer could check it was correctly coded. The 2000 and 2007 surveys found similar rates of psychotropic medication use, suggesting that the change in methodology did not affect comparability. A show card approach was also used in 2014. However, rather than listing drug brand names first, followed by the generic name (the approach taken in 2007), the generic name was listed first on the show card prompt. See the APMS 2014 report for more information.  

In APMS 2023/4, a show card was not used and instead participants who reported taking medication for a mental health reason were asked to provide the name of the medication and the medication packet if possible. Interviewers recorded the medication by typing the medication name into the Computer Assisted Personal Interviewing (CAPI) software and selecting the correct name and dosage from a look-up file of medications. This method was used to improve the quality of the data collected, improve accessibility and reduce interview length. 

The medications were coded into the following categories: 

Drugs used primarily to treat… 

• Depression 
• Anxiety 
• Bipolar disorder 
• Psychosis 
• Sleep problems 
• Attention deficit hyperactivity disorder (ADHD).

Groupings relate to the main reasons that medications are commonly prescribed, but they may have been prescribed to individuals for different reasons. Several medications were listed in more than one group. 

In addition, in 2023/4 participants were asked about substance dependence medication. Substance dependence medications are reported on separately and not included in the 'any psychotropic medication' measure. 

A list of the specific medications (generic and brand name) included in each category is in the APMS 2023/4 Methods documentation. 

Measuring psychological therapies

Psychological therapies were asked about in broadly comparable ways in each survey. Although there were some minor changes across the years, the key estimate used to measure change in overall psychological therapy use over time is based on an initial stem question, which has remained consistent across the surveys:  

‘Are you currently having any counselling or therapy listed on this card for a mental, nervous or emotional problem?’ 

Follow-up questions established the type of therapy received. The list of therapy types has changed slightly over survey years, reflecting the nature of current provision and terminology. Below is the list of therapy types asked about in APMS 2023/4:   

• Psychotherapy or psychoanalysis  
• Cognitive behavioural therapy (CBT) 
• Art, music or drama therapy   
• Social skills training  
• Couple or family therapy  
• Sex therapy  
• Mindfulness therapy  
• Alcohol or drug counselling 
• Counselling (including bereavement) 
• Another type of therapy.

Survey development work found that participants in pilots were generally unable to state reliably which services provided treatments such as psychological therapies. Therefore, APMS data has not been used to describe shifts, for example between primary and specialist services, in the provision of such treatments. 

Measuring health service use for a mental health reason

Health service contact records were not examined in the survey. Health service use for a mental health reason related to certain types of primary or secondary health service use. This was recorded if a survey participant reported any of the following: 

• Having spoken with a GP about being anxious, depressed, or about a mental, nervous or emotional problem in the past two weeks or the past year, respectively 
• Being an inpatient for a mental, nervous or emotional reason in the past three months 
• Being an outpatient or day patient for a mental, nervous or emotional reason in the past three months.

Although the reference periods varied between different types of health service, this approach was consistent with that used in previous years of the survey and so was retained to allow for trend analysis. 

Measuring community and day care service use

Participants were also asked questions on their use of community and day-care services in the past year, excluding treatment and service use they had already reported. Community care services included use of the following in the past year: a psychiatrist, psychologist, community psychiatric nurse, community learning disability nurse, other nursing services, social worker, self-help/support group, home help/homecare worker or outreach worker. Day care service use included use of a community mental health centre, day activity centre, sheltered workshop and other nursing services in the past year. To ensure comparability with previous surveys in the series, changes to items and terminology were minimal.  

The different types asked about are listed in the APMS 2023/4 Methods documentation. 

Measuring unmet treatment requests

Participants were asked: ‘In the past 12 months, have you asked for any type of counselling or mental health related medication, but not received it?’ 

If the participant answered yes, follow-up questions were asked about what type of treatment had been requested and whether or not the participant was on a waiting list for it at the time of the interview. 

Measuring treatment need

The CIS-R has been used in every APMS to measure CMHC symptoms and to identify people meeting CMHC diagnostic criteria. This chapter focuses on differences in treatment rate by symptoms and types of CMHC. Treatment and service use among people with other types of mental health conditions are addressed in the condition-specific chapters. 

CMHC symptoms

The CIS-R score provides an indication of overall non-psychotic symptom severity, and is used in the analyses in this chapter to indicate the type of mental health service intervention required. 

• CIS-R score of 12 or more (CIS-R 12+): is used to indicate the presence of clinically significant symptoms of CMHC, and identifies people with ‘symptoms of CMHC’ sufficient to warrant recognition. 
• CIS-R score of 18 or more (CIS-R 18+): is used to indicate the presence of ‘severe symptoms of CMHC’, sufficient to warrant intervention. 

Types of CMHCs 

The CIS-R has been used on each APMS in the series to assess six types of CMHC:  

• Depression 
• Generalised anxiety disorder (GAD) 
• Phobias 
• Obsessive compulsive disorder (OCD) 
• Panic disorder 
• CMHC not otherwise specified (CMHC-NOS).

In this chapter those identified with ‘any CMHC’ are considered, as well as those identified with specific CMHCs. Everyone with a CIS-R score of 12 or more was classified with at least one type of CMHC. However, it was possible for individuals with specific CMHCs to be identified without having a CIS-R score of 12 or more. The CIS-R and the individual CMHCs are described in more detail in the APMS 2023/4 Methods documentation.

Mental health treatment, by CIS-R score

Overall, 15.7% of adults reported receiving mental health treatment (psychotropic medication and/or psychological therapy) provided by the NHS or other providers. The proportion in the overall population was likely to be between 14.5% and 17.0% (referred to as the 95% confidence interval (95% CI)). This equates to an estimated 7.3 million adults in England reporting receipt of some form of treatment for a mental health or emotional problem. 

Reported treatment use was strongly associated with severity of mental health symptoms, ranging from one in sixteen adults (6.1%) among those with few or no current symptoms (CIS-R 0-5), to one in three (34.8%) of those with a CIS-R score of 12-17, and over half (55.7%) of those with severe symptoms (CIS-R 18+). Treatment use among those without CMHC symptoms is not necessarily unwarranted, as it could indicate, for example, recovery, relapse prevention or an intermittent condition.  

Medication was the most common form of mental health treatment, reported by 12.5% of adults, while 5.1% reported receiving psychological therapy. Receipt of medication increased with severity of mental health symptoms, with 44.8% of those with severe CMHC symptoms receiving medication, compared with 4.7% among those with few or no CMHC symptoms. Similarly, 22.3% of those with severe symptoms were receiving psychological therapy, compared with 1.6% of those with few or no current symptoms.  

1.9% (CI 1.5, 2.3) of adults reported receiving both medication and psychological therapy. This proportion increased with severity of CMHC symptoms. Prevalence was highest among those with severe CMHC symptoms (11.7%), and lowest among those with few or no current symptoms (0.3%).  

For more information: Table 2.1 and Table A1 for confidence intervals

Mental health treatment, by type of CMHC

44.6% of adults meeting the diagnostic criteria for at least one CMHC were receiving treatment, compared with 15.7% of the population as a whole. 

Prevalence of treatment use varied by type of CMHC and was highest among those identified with phobias (65.6%), OCD (64.3%) and depression (62.2%). About half of those identified with GAD (55.3%) and panic disorder (52.7%) were in receipt of treatment, and treatment rates were lowest among people with CMHC-NOS (30.8%). The small base size for those with panic disorder (65 participants) means that analyses by this group should be treated with caution. It should also be noted that for conditions other than CMHC-NOS, it was possible for a person to be identified with more than one CMHC.  

Medication was the most commonly reported treatment for adults with each type of CMHC. Prevalence ranged from about half of those with phobias (56.1%), OCD (53.0%), depression (51.8%) and GAD (46.7%) to one in four with CMHC-NOS (23.4%). 

Rates of receiving psychological therapy were highest among those with phobias (30.4%), depression (27.3%) and OCD (25.3%) and lowest among those with CMHC-NOS (11.9%).  

For more information: Table 2.2

Psychotropic and substance dependence medication, by CIS-R score

One in eight adults (12.5%) reported currently taking psychotropic medication. The most commonly reported psychotropic medications were those used primarily to treat depression (11.7%) and anxiety (10.7%). Medications commonly used to treat bipolar disorder (1.1%), psychosis (1.0%), ADHD (0.4%) or sleep problems (0.2%) were each reported by about one in a hundred adults or less. Substance dependence medication was also asked about on the survey and was reported by 0.3% of adults.  

The prevalence of psychotropic medication use increased with severity of CMHC symptoms. 4.7% of those with few or no current symptoms (CIS-R 0-5) were taking psychotropic medication, compared with 44.8% of those with severe symptoms (CIS-R 18+).  

Use of substance dependence medication was also linked to severity of CMHC symptoms, with 1.3% of those with severe symptoms reporting taking them, compared with 0.1% of those with few or no current symptoms. 

For more information: Table 2.3 

Psychotropic and substance dependence medication, by CMHC

Among adults with a CMHC, about one in three (36.0%) reported current psychotropic medication use, and one in a hundred (1.1%) reported use of substance dependence medication. The use of psychotropic medication was highest among those with phobias (56.1%) and lowest among those with CMHC-NOS (23.4%). 

For more information: Table 2.4

Psychological therapy, by CIS-R score

One in twenty adults (5.1%) reported currently receiving psychological therapy. The use of psychological therapy was associated with severity of CMHC symptoms, with 22.3% of adults with severe CMHC symptoms (CIS-R 18+) in receipt of psychological therapy, compared with 1.6% of those with few or no symptoms (CIS-R 0-5).  

The most common types of psychological therapy received by those with severe symptoms were counselling (including bereavement counselling) (8.0%), cognitive behavioural therapy (CBT) (6.0%), psychotherapy or psychoanalysis (5.5%) and mindfulness therapy (5.3%).  

For more information: Table 2.5

Psychological therapy, by type of CMHC

Among adults with a CMHC, 16.2% reported currently being in receipt of psychological therapy. Prevalence of receiving psychological therapy was highest among those with phobias (30.4%), depression (27.3%) and OCD (25.3%). It was lowest among those with CMHC-NOS (11.9%).  

For more information: Table 2.6  

Health care service use, by CIS-R score

The use of health services for a mental or emotional problem included attending hospital in the last quarter, either as an inpatient or outpatient, for a mental health reason or speaking with a GP about a mental health problem (in the past year or past two weeks).

13.5% of adults reported using any health service for a mental health reason. This mostly involved speaking with a GP about a mental or emotional problem in the past year (13.2%). 

The likelihood of using health services was associated with severity of symptoms. About half of adults (52.9%) with severe CMHC symptoms (CIS-R 18+) had used health services for a mental health reason, compared with 5.0% of those with few or no current symptoms (CIS-R 0-5).  

All types of health service use for a mental health reason were most common among those with severe CMHC symptoms (CIS-R 18+), compared with those with fewer or no symptoms. One in nine (11.2%) adults with severe symptoms had spoken with a GP in the past two weeks, 3.5% had attended hospital as an outpatient and 1.0% had attended as an inpatient in the past quarter for a mental health reason.           

For more information: Table 2.7 

Health care service use, by type of CMHC

Four in ten (40.0%) adults with a CMHC reported using health care services for a mental health reason. Use of health care services for a mental health reason was highest among those with depression (58.9%), phobias (58.7%), and OCD (58.2%). Those with panic disorder (33.0%) and CMHC-NOS (32.8%) were less likely to have used health care services for a mental health reason. 

Among those with a CMHC, 39.2% reported having spoken with their GP in the past year about a mental health problem, and 7.1% had done so in the past two weeks. 2.3% attended hospital as an outpatient and 0.5% as an inpatient for a mental health reason in the past quarter.   

For more information: Table 2.8

Community and day care services use, by CIS-R score

One in twelve adults (8.1%) reported having used a community or day care service in the past year. The use of community and day care services was most common among those with more severe CMHC symptoms (CIS-R 18+), with more than a quarter (28.7%) having used such services, compared with 3.6% of those with few or no symptoms (CIS-R 0-5). 

Among those with a CIS-R score of 18 or more, the most common types of services used were self-help or being part of a support group (8.4%), contact with a psychiatrist (6.7%), contact with a social worker (5.5%) and contact with a psychologist (5.3%).  

For more information: Table 2.9

Community and day care services use, by type of CMHC 

Contact with community or day care services in the past year was reported by 22.4% of adults with a CMHC. The proportion was highest among those with phobias (36.8%), depression (33.8%) and OCD (33.6%) and lowest among those with CMHC-NOS (18.7%). Contact with a psychiatrist was highest among those with phobias (11.7%), while 6.8% of those with phobias reported contact with other nursing services (excluding community psychiatric and learning disability nurses).  

For more information: Table 2.10

Mental health treatment in adults with CMHC symptoms, 2000, 2007, 2014 and 2023/4 

Mental health treatment use was defined as being in receipt of psychotropic medication or psychological therapy around the time of interview. The method for collecting medication data changed across survey years. For further information see Section 2.2 Definitions and assessments and the APMS 2023/4 Methods documentation.  

Comparisons of 2023/4 with previous survey years (2000, 2007 and 2014) are based on adults aged 16 to 74, as the 2000 survey did not include those aged 75 and over, and are analysed by sex (male and female) rather than gender (men and women). See How to interpret the findings for information on how changes over time were assessed. 

Among those with CMHC symptoms (CIS-R 12+), the proportion receiving treatment was about one in four in 2000 (23.1%, 95% CI 20.6, 25.7) and 2007 (24.4%, CI 21.9, 27.2), before increasing to 39.4% (CI 36.5, 42.4) in 2014 and 47.7% (CI 43.8, 51.6) in 2023/4. The pattern was similar for males and females. 

Similar upward trajectories were evident among adults with severe CMHC symptoms (CIS-R 18+). There was a steady upward trend in the proportion receiving psychological therapies: 12.5% in 2000, 15.2% in 2007, 18.4% in 2014 and 23.2% in 2023/4. The proportion using medication for a mental or emotional problem was 28.5% in 2000 and 26.5% in 2007, before increasing to 42.6% in 2014 and 45.8% in 2023/4.  

For more information: Table 2.11 and Table B1 for confidence intervals 

Health service use in adults with CMHC symptoms, 2000, 2007, 2014 and 2023/4

Among adults aged 16 to 74 with CMHC symptoms (CIS-R 12+), the proportion using health care services for a mental health reason increased between 2000 (39.1%, 95% CI 36.1, 42.2) and 2014 (47.0%, CI 43.8, 50.2). The proportion reporting health care services use in 2023/4 was 43.5% (CI 40.4, 46.7), remaining fairly stable since 2014.  

For more information: Table 2.12 and Table B2 for confidence intervals 

Community and day care service use in adults with CMHC symptoms, 2000, 2007, 2014 and 2023/4 

In 2023/4, 22.9% (95% CI 19.9, 26.3) of adults aged 16 to 74 with CMHC symptoms (CIS-R 12+) used a community or day service. This was an increase from 17.2% (CI 15.1, 19.6) in 2000.  

For more information: Table 2.13 and Table B3 for confidence intervals

Mental health treatment in adults with CMHC symptoms, by gender and age 

Gender 

Among those with CMHC symptoms (CIS-R 12+), the proportion of men (43.3%) and women (46.7%) receiving mental health treatment was similar. This was the case for both use of psychotropic medication (36.3% of men, 36.2% of women) and psychological therapy (17.5% of men, 17.3% of women). 

Age 

Among those with CMHC symptoms, the proportion receiving treatment varied by age. Treatment use was highest in 16 to 24 (49.9%), 25 to 34 (53.5%), 45 to 54 (52.3%), and 55 to 64 (47.8%) year olds, and lowest in the older age groups (33.2% of those aged 65 to 74 and 21.9% of those aged 75 and over).  

Use of psychotropic medication among those with CMHC symptoms was highest in those aged 25 to 34 (43.4%), 45 to 54 (40.9%) and 55 to 64 (40.1%), and lowest in those aged 75 and over (19.1%).  

Receipt of psychological therapies among those with CMHC symptoms was highest among those aged 25 to 34 (23.1%), 35 to 44 (21.8%), and 45 to 54 (20.6%), and lowest in the oldest age groups: 5.1% of 65 to 74 year olds and 2.8% of those aged 75 and over. 

For more information: Table 2.14 and Table 2.15 

Mental health treatment in adults with CMHC symptoms, by other characteristics

Ethnic group

The proportion in receipt of treatment for a mental or emotional problem varied between ethnic groups (age-standardised). However, due to the small number of participants in some ethnic groups, these comparisons are based on the whole sample and not restricted to those with CMHC symptoms. Variations in treatment use may therefore reflect different levels of need in the different groups. 

White British (18.4%, 95% CI 16.9, 20.0) adults and those from another White background (16.7%, CI 11.7, 23.4) were most likely to be receiving treatment. Adults in the Asian/Asian British (4.1%, CI 2.4, 7.0), Black/Black British (8.2%, CI 5.0, 13.3) and Mixed/multiple or other (9.5%, CI 5.8, 15.2) groups were less likely than their White British counterparts to be in receipt of mental health related treatment. 

15.2% of White British adults were taking medication for a mental or emotional problem, compared with 3.1% of Asian/Asian British adults and 4.3% of Black/Black British adults. 

Receipt of psychological therapy was highest among adults from another White background (6.4%) and lowest among Asian/Asian British adults (1.3%). 

For more information: Table 2.16 and Table A2 for confidence intervals   

Employment status

In age-standardised analyses, receiving treatment for a mental or emotional problem among working age (16-64) adults varied by employment status. Due to the small number of participants in the unemployed group, these comparisons are based on the whole sample and not restricted to those with CMHC symptoms. The mean CIS-R score among people who were unemployed (12.6) or economically inactive (10.4) was twice that of people in employment (5.6), indicating different levels of need in the different groups. 

Those who were economically inactive (31.9%) or unemployed (29.8%) were twice as likely as those in employment to be in receipt of treatment for a mental or emotional problem (14.4%). 

One in four (27.5%) adults who were economically inactive and one in five (21.7%) of those who were unemployed were taking medication for a mental or emotional problem, compared with one in nine (11.0%) of those who were in employment.  

One in seven (14.4%) unemployed adults and one in ten (10.0%) of those who were economically inactive were receiving psychological therapy, compared with one in twenty (5.1%) among employed adults. 

For more information: Table 2.17 

Problem debt 

Problem debt was defined as being seriously behind with debt repayments or having utilities cut off. See the APMS 2023/4 Methods documentation for more information on how problem debt was derived. 

Being seriously behind with debt repayments or having utilities cut off was associated with greater likelihood of being in receipt of treatment for a mental or emotional problem (age-standardised) in those with CMHC symptoms.  

Among adults with CMHC symptoms, 56.1% of those with problem debt were receiving mental health treatment compared with 43.3% of those without.  

For more information: Table 2.18 

Area-level deprivation

Comparisons between IMD quintiles are based on age-standardised estimates. Among adults with CMHC symptoms, the proportion in receipt of mental health treatment was similar across IMD quintiles. 

For more information: Table 2.19

Region

In age-standardised analyses, apparent variation by region in the proportion of adults with CMHC symptoms receiving any treatment for a mental or emotional problem did not reach statistical significance. Caution is needed with these results given some base sizes are quite small. However, receipt of psychological therapy varied by region and was highest in the East of England (22.8%), the West Midlands (22.7%) and the South West (22.7%) and lowest in the East Midlands (5.5%). 

For more information: Table 2.20 

Comorbidity 

Physical health conditions

Receipt of treatment for a mental or emotional problem in those with CMHC symptoms (CIS-R 12+) was similar among those with (47.0%) and without (44.6%) a limiting physical health condition, in age-standardised analyses. 

For more information: Table 2.21

Unmet treatment requests

Overall, 2.8% of adults reported having asked for, but not received, a particular mental health treatment in the past 12 months. The proportion was similar in men (2.0%) and women (3.1%). Having an unmet treatment request was associated with severity of symptoms. Among adults with severe CMHC symptoms (CIS-R 18+), 13.6% had an unmet treatment request in the past 12 months, compared with 0.6% of those with few or no CMHC symptoms (CIS-R 0-5).  

For more information: Table 2.22 

Among adults with CMHC symptoms (CIS-R 12+) there was an association between unmet treatment requests and age. This ranged from 19.6% of 16 to 34 year olds with CMHC symptoms requesting but not receiving a particular mental health treatment, to 2.3% of those aged 75 and over. 

For more information: Table 2.23 

Among adults with CMHC symptoms and an unmet treatment request, a quarter (26.2%) were not receiving any psychotropic medication or psychological therapy around the time of the interview. 

For more information: Table 2.24 

This chapter presents information on trends and inequalities in mental health treatment and service use in England, drawing on APMS 2000, 2007, 2014 and 2023/4.  

The APMS series has strengths and weaknesses. APMS relies on self-report data and survey participants are not always aware precisely what treatments and services they use or are able to recall exactly when they used them. Misclassifications, under-reporting, and over-reporting are all possible. The checking of participants’ medication packaging for drug names will have helped, but there was little that could be done to verify the classification of types of psychological therapy and health records were not checked. While there has been much consistency in how the data have been collected, there were some changes between survey years. APMS has to balance the need for consistency with ensuring that questions reflect current context, provision and terminology. For example, the 2023/4 survey did not use a showcard to ask about psychotropic medications, instead recording medications using a computer-based directory. Changes like this can affect comparability between surveys and the robustness of trends. The questionnaire covered a wide range of types of treatments and services, delivered in NHS primary, secondary, acute and community care settings, as well as by private therapists and other providers. The 2023/4 survey also covered additional types of community services, such as social prescribing.

Unmet treatment requests largely came from people reporting symptoms, and rarely from those without symptoms, indicating requests for treatment were driven by unmet need. One in seven adults with severe CMHC symptoms reported requesting a treatment in the past year which they did not receive. A quarter of those with symptoms and an unmet treatment request were receiving no other form of mental health medication or therapy.

The proportion receiving treatment has increased. While there may be a substantial amount of unmet mental health treatment need in the population, this appears to be at its lowest ever level. Almost half of people with a CMHC were receiving medication and/or psychological therapy, compared with one in three in 2014 and one in four in 2007. Although medication use is more prevalent than use of psychological therapies, the proportion reporting each has doubled over the past twenty years. This steep rise closely reflects upward trends in both antidepressant prescribing (NHS Business Services Authority 2024; Bogowicz et al. 2021) and NHS Talking Therapies outcome data (NHS England 2024). The increased use of psychotropic medications should, however, be considered in the context of NICE guidelines not to offer antidepressants routinely for mild depression (NICE 2022).  

There is little evidence of socioeconomic inequalities in treatment. That is, while those who struggled financially or lived in more deprived neighbourhoods were much more likely to have poor mental health, they did not appear to be less likely than others with symptoms to get treatment. It should be noted, however, that while this comparison was based on adults with CMHC symptoms, the analysis did not fully adjust for the extent of higher and more complex need among those in poverty or facing socioeconomic adversity.  

Patterns of treatment use by gender and age have changed. The previous survey in the APMS series found that among people with CMHC, women with CMHC symptoms were more likely than men to receive treatment (Lubian et al. 2016): this difference was no longer evident in 2023/4. It may be that services have become better at recognising and responding to mental health need in men, it could also be that reduced stigma around mental health has contributed to greater help-seeking among men (Sagar-Ouriaghli et al. 2019). Age-related patterns in treatment use may have also changed. In previous APMS, both the youngest and oldest age groups were the least likely to use mental health treatment (Lubian et al. 2016). Treatment use among 16 to 24 year olds, especially among women, is now more similar to those in midlife. People aged 75 or more, however, continue to be the least likely age group to receive treatment while also being the least likely to report an unmet treatment need, suggesting that lack of treatment use may stem, at least in part, from lack of help-seeking.  

Ethnic inequalities persist in mental health treatment receipt. Consistent with analyses of previous surveys in the APMS series (Ahmad et al. 2022), people in Black, Asian and Mixed/multiple/other ethnic groups were found to be less likely to get mental health treatment than those who identified as White British. Due to small numbers of adults in some ethnic groups with CMHC symptoms, it was not possible to analyse the variation in mental health treatment use. Therefore, it is unclear whether the observed differences represent a real disparity in unmet need. Ethnic inequalities in treatment access have also been noted in linked primary care data (Catalao et al. 2024), and may have been exacerbated during the COVID-19 pandemic (Taxiarchi et al. 2023). Bansal and colleagues argue that strategies to tackle entrenched ethnic inequalities in mental healthcare requires addressing barriers at individual, systemic, and structural levels (Bansal et al. 2022). 

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Please cite this chapter as:  

Clery, E., Morris, S., Wilson, C., Cooper, C., Das-Munshi, J., McManus, S., & Weich, S. (2025). Mental health treatment and service use. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.), Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.