Mental Health Bulletin, 2022-23 Annual report

This section provides additional notes to aid people using and understanding the data contained Mental Health Bulletin. This publication provides the most comprehensive view of secondary mental health, learning disabilities and autism services. There are some general notes that are true across all metrics in the publication that are found below. Following that, there are specific notes relating to individual chapters of the Mental Health Bulletin.

General notes across the Bulletin:

• Figures for sub-national geographies or individual service providers have been suppressed or rounded to prevent disclosure of information about individuals. All values for these units of less than 5 have been replaced with a * in this table. All other values for these units values have been rounded to the nearest 5. Calculated values for these units, such as percentages or rates, have been Suppressed if any of the values they have been calculated from have been Suppressed, and otherwise rounded to the nearest whole number. Subtotals will also not add up to the total where rounding and suppression has been applied.

• A small number of people have an age recorded in the Mental Health Services Dataset (MHSDS) of zero years. While in some instances this may be accurate, this may also be due to an issue with the quality of the information recorded. The potential impact of these issues will be small when considering larger age groups, such as people aged under 18. However these potential issues will be greater when considering smaller age bands due to the smaller number of people within these groups. As such, figures presented here for the Under 5 age group are potentially unreliable and should be used with caution.

• The Gender reported in this publication uses the Gender Identity Code if available and otherwise uses the Person Stated Gender Code. This change is part of the improvements made to the MHSDS dataset in version 5. It should also be noted that version 5 of the dataset was implemented after October. Gender for people who only appeared in the data prior to October would be reported using the Person Stated Gender Code only. Further information on these changes are available at the links below:

  • Data Dictionary - Gender Identity Code

  • Data Dictionary - Gender Identity Same As At Birth

  • Mental Health Services Dataset - Tools and guidance

• It’s important to note that crude rates and percentages do not adjust for factors such as differences in the age, birth rates or underlying prevalence of mental health conditions between areas and populations. They therefore provide an indication of variation in activity, but further work is needed to establish more robust age-standardised metrics that adjust for variation in local populations and between demographics.

• Generally, the populations used within the Bulletin are based on the ONS Census from 2021. Where distinctions have been made, for example to limit a population to a particular age range, this will be noted within the notes for the specific chapter. Please note, that data for 2022-23 makes use of population data from the 2021 Census. As such there are instances where the populations have changed significantly between 2011 and 2021 and as such, this issue should be considered when comparing rates for 2022-23 with previous years

• The ethnic categories used for recording self assigned ethnic group in the NHS are the same as those used in the 2001 Census.  However ONS made some changes to the way ethnic group was recorded in the 2011 and 2021 Census.  MHSDS figures use the 2001 census categories.  The population figures are categorised using the 2021 census categories, which have slightly different descriptions and do not all map exactly to the 2001 categories. The 2011 Census introduced the new 'Gypsy/Traveller' and 'Arab' categories, the 2021 Census introduced the new 'Roma' category. This means comparability issues exist between these ethnic groups for the 2001, 2011 and 2021 Census. For the purpose of analysis in this table figures for the new 'Gypsy / Traveller', 'Arab' and 'Roma' categories have not been included. Data users should bear in mind that people using adult mental health services, who would have identified themselves as 'Arab' if given the opportunity, may not be grouped within the broad 'Any other ethnic group' category total within the MHSDS figures and this could affect the rate of access to services for the 'Any other ethnic group'.

• Data is presented in this publication by Indices of Multiple Deprivation (IMD). Further information about IMD deciles and quintiles can be found at https://www.gov.uk/government/collections/english-indices-of-deprivation.

• When interpreting individual breakdowns for Gender, Age, Ethnicity and IMD it is possible that the number of UNKNOWNs in each category may differ. This is because some records may record age but not ethnicity etc. Similarly, because of this, some of the subtotals in some cases will not sum back to the total presented for England.

Chapter 1 provides counts of people in contact with secondary mental health, learning disabilities and autism services in the year. 

• For the purposes of the breakdown by provider type, 'NHS providers' includes people in contact with any provider listed as, or belonging to, an organisation labelled as an NHS Trust or Care Trust in information held by the Organisation Data Service (ODS). 'Non-NHS providers' includes people in contact with any provider listed as, or belonging to, an organisation labelled as an Non-NHS Organisation, Independent Sector Provider, or Local Authority in information held by ODS.

• A person may have been in contact with both an NHS provider and a Non NHS provider during the year. Due to this, the number of people in contact with NHS and Non NHS providers separately will be greater than the total number of people in contact with all providers.

• The 'Admitted' category identifies people that spent time in hospital in the year. They may also have used community-based or outpatient mental health services

• The 'Non-admitted' category identifies people who were only in contact with community-based or outpatient mental health services.

Please note, chapters 2 and 3 were included in historical editions of the Mental Health Bulletin. These chapters have since been removed but the chapters have not been reordered in order to aid users in navigating across years.

This metric captures the number of bed days recorded within each provider across the year.

• Please note that due to the use in-year bed days as a denominator in chapter 7 when calculating the number of restraints per 100,000 occupied bed days, the groupings for age groups Under 14, 14-15 and 16-17 have been amalgamated to create an Under 18 age group. This is to align with the data presented in Chapter 7. 

Chapter 5 counts the total number of admissions and discharges within the reporting year. For the mean daily occupied bed days, this is calculated by taking the number of bed days (Measure 4a) and dividing by 365. The following should also be noted when interpreting data for this chapter:

• In a small number of cases, it is not possible to define a single bed type for some admissions. In these cases, the sum of the breakdowns by bed type will be greater than the totals for England.

The Care Contact table within MHSDS should reflect Care Contact instances from a patient perspective. If multiple Care Professionals are involved in a single Care Contact, this represents a single Care Contact record. For the data presented in the Bulletin, this is broken down by Service or Team Type as well as Attendance. Please note the following when interpreting data for this chapter:

• The data for this chapter uses a distinct count of row IDs from the Care Contact table. This is because in a small number of instances, care contact IDs were reused across the year by providers. In those instances, if a distinct count of care contacts was used, the totals for attendance etc would not sum back to the total for England. This is a data quality issue. As such the distinct count of rows IDs provides a consistent way of counting contacts across time periods which extend beyond a single month. 

The MHSDS is derived from administrative systems rather than being a specific purposeful collection. The quality and completeness of particular data items from particular data providers is dependent on the use to which the data has so far been put. Due to this, data items which are used regularly for analysis or have been the focus of particular attention will be of better quality than less frequently used items, or those for which in depth analysis has not yet taken place. This is the fourth publication of annual figures on the use of restrictive intervention in inpatient mental health, learning disabilities and autism services. The data used to derive the information on restraints was also changed as part of version 5 of the dataset. As such, data for 2022-23 uses a different methodology to account for the change in structure of the data.

The data used to derive these falls into this latter group, as it is only reported on an annual basis, and may be of lower quality than other data used in this publication. See the data quality section of this publication for more information on how these figures can be interpreted.

Further information on the use of restraints can be found in the restraints dashboard.

Please note the following when interpreting data within this chapter: 

• The data used to derive these figures may contain duplicates. Multiple interventions with identical dates and details (intervention type and duration) for the same individual have been identified. Currently it is unknown if these values are duplicates, record errors or genuine separate incidences therefore no data has been excluded. These potential issues may lead to the number of restrictive interventions shown in this table being unreliable. As such these figures should be used with caution.

• The way that data for restraints is recorded changed in version 5 of the dataset. In version 4.1 of the dataset, data are derived from the MHS505RestrictiveIntervention table. Data from version 5.0 of the dataset are derived from the MHS515RestrictiveInterventionType table. The data from these two tables was combined to present the view of the year in 2021-22. Data for 2022-23 now uses a new methodology which is aligned to that used in the Mental Health Services Monthly Statistics publication.

• A person may have multiple restrictive intervention types recorded as part of a single restrictive intervention incident.

• The number of restraints per 1,000 occupied bed days is calculated as the number of restrictive interventions (Measure 7b) divided by the number of occupied bed days (Measure 4a) multiplied by 1,000

Chapters 8, 9 and 17 focus on the number of children and young people accessing NHS funded secondary mental health, learning disability and autism services. Chapter 8 was replaced by Chapter 17 from 2021-22 onwards. For each chapter, first and second contact are used as a proxy for people accessing services. This is to distinguish between those people who have a referral recorded but then no subsequent care contact. The following should be considered when interpreting data within these chapters:

• Please note that measure 9a has been changed, from 2019-20 onwards the methodology has been brought in line with the methodology of the monthly statistic and this has become the official statistic for children’s access to mental health. The fundamental change is that it now takes into account activity outside of the annual period, so a first contact could have occurred prior to the reporting year. 

• For 2021-22 onwards, measure 8a has been replaced with measure 17a. This is to align more closely to the existing to the children and young peoples data published in the Mental Health Services monthly publication. Measure 17a now uses the same as MHS95 in the monthly publication whilst measure 9a uses the same methodology as MHS69. 

• Values where the age is Unknown are the result of data quality issues. These include cases where a person may have had a contact aged 17 or under and now be over the age of 18 in the latest reported data in the year. In these cases it is because the methodology used assigns a person an age based on the latest reported data in the year.

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For chapter 9 and 17, the population used is limited those aged 0 to 17.

The Early Intervention in Psychosis (EIP) pathway is defined in NHS England Guidance for Access and Waiting Times. The Data Collection Board (DCB) approved the decommissioning of the interim collection of EIP waiting times information, known as NHS England Unify Collection within this publication. Waiting times for EIP for October 2019 activity onwards are now monitored using data from the Mental Health Services Data Set (MHSDS).

These open referrals are for people who have entered treatment – a figure related to the number entering treatment in the reporting period, except it excludes any referrals that were discharged before the end of the reporting period. This analysis is limited to referrals received on or after 01/01/2016 as pathways cannot be assessed using sources in use prior to the introduction of the Mental Health Services Data Set (MHSDS). This will not be comparable with statistics produced using other sources which include referrals before this date.

Referrals without a discharge date which were not submitted in the final month of the reporting period are not included as the current status of these referrals cannot be determined. Methods for including these referrals where earlier submissions indicated that the person referred entered treatment will be explored for future publications.

The following should be considered when interpreting data within this chapter:

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For chapter 10, the population used is limited those aged 18 to 64.

This metric counts the number of people in contact with specialist perinatal or maternal mental health community services in the reporting period. Additionally, NHS England publishes a quarterly output in the Mental Health Monthly Statistics publication series which is a linked analysis of mothers from the Maternity Services Dataset (MSDS) combined with data from MHSDS. The following should be considered when interpreting data within these chapters:

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For chapter 11, the population used is limited to Females aged 15 to 54.
• For access metrics, it is possible for a person to be counted in multiple providers or Sub ICBs etc across the year.

Further information about perinatal mental health can be found at:

• NHS England » Perinatal mental health
• NHS England » Maternal mental health services

Discharges eligible for 72 hour follow up is the total number of hospital spells with a discharge date within the reporting period. Due to the follow up period needed, this measure takes the last 3 days from the previous years' data, and excludes the last 3 days from the current years' data. These measures exclude those who died before the follow up could be conducted and discharges eligible for follow up. The following should be noted when interpreting data in this chapter:

• The proportion of discharges from adult acute bed that were followed up within 72 hours (Measure 12c) is calculated by taking the number of discharges from adult acute bed that were eligible for 72 hour follow up (Measure 12a) divided by the the number of discharges from adult acute bed that were followed up within 72 hours (Measure 12b).

Chapter 13 is based on the number of referrals and contacts to those referred to memory services teams. This team type is recorded through the use of code "A17" in the MHS102 table. It should be noted that this does not necessarily mean that a person has a recorded diagnosis of dementia. Diagnosis recording across the dataset is generally poor with around 25% of people having a recorded diagnosis. As such, any attempt to include diagnosis as a criteria in metrics would result in undercounts. The following should be considered when interpreting data within this chapter:

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For the metrics in this chapter, the population used is limited those aged 65 and over.

This chapter presents the number of people accessing community mental health services for adults and older adults with a serious mental illness who received two or more contacts in the year. This is the same methodology as metric MHS108 in the Mental Health Monthly Statistics publication series. For the purposes of this data, a person is said to be accessing services if they have received two or more contacts in the previous year. This can be both through care contacts or indirect activity. Please note the following when interpreting data in this chapter: 

• For 2023-24, this metric will be expanded to include Early Intervention Psychosis and Individual Placement Support teams. This change has already happened in the monthly publication and will be reflected in the next edition of the Mental Health Bulletin.

This chapter presents data for acute admissions in the year. The contacts included for the purposes of "prior contact" must be indirect activity or a care contact. In the case of a care contact, the contact must be attended and either have taken place via face to face contact, telephone, talk type or video consultation. This prior contact must have occurred from up to a year before admission up to 3 days before admission. The following should be considered when interpreting data within this chapter:

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 15o, 15r and 15u the population used is limited those aged 0 to 17.
• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 15p, 15s and 15v the population used is limited those aged 18 to 64.
• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 15q, 15t and 15w the population used is limited those aged 65 and over.

The data presented in this chapter shows the number of people discharged by age group and by length of stay. Two main length of stays are included within the data, those with a length of stay of over 60 days and those with a length of stay of over 90 days. This data can also be found in the Mental Health Services Monthly publication series as metrics MHS100 through to MHS105.The following should be considered when interpreting data within these chapters:

• The demographic data presented is that on discharge. Therefore counts may sum back to more than the total for England as a person will only be counted once nationally but could have had different demographic associated with each discharge.

• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 16k and 16l the population used is limited those aged 0 to 17.
• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 16g and 16h the population used is limited those aged 18 to 64.
• For the creation of crude rates, the populations used are based on the ONS Census from 2021. For metrics 16i and 16j the population used is limited those aged 65 and over.

This chapter presents data on the number of referrals accessing individual placement support. Individual placement support is identified in the dataset either through the use of the service or team type being recorded as 'D05' (Individual Placement and Support Service) in the MHS102 table or through the recording of SNOMED codes in the MHS202 care activity table. The SNOMED codes which are included for the purposes of the metric are 1082621000000104 and 772822000 (Individual Placement and Support) where the SNOMED Procedure Qualifier is not 443390004 (refused).

This chapter presents the number and proportion of children and young people (aged 0-17 years) discharged with at least two care contacts, those with two contacts and an assessments and then those that have two contacts and a paired score. Additionally, for those with a paired score, the outcome of that score split by perspective of the assessor (child, parent or clinician). Paired outcomes are essential to understanding the benefit that children and young people are experiencing from services and essential to measure change. For information on these metrics, please see guidance here.

Comparing the number of CYP who have at least two contacts, and those that have a single score (assessment) with those who have a paired score provides and indication of the completeness of the outcomes data provided.

For information on these metrics, please see guidance here (please note that an NHS email address is required in order to sign up to NHS Futures).

Please note the following when interpreting data in this chapter:

• The referrals considered for the purposes of the metric are based on those referrals for people aged 0 to 17 when the referral was received. The data presented broken down by Age is based on the latest age in the year. As such, and particularly for referrals that have been open for a long period of time, it is possible that the person was aged 18 and over