Consultation summary and key recommendations

The Adult Psychiatric Morbidity Survey (APMS) series provides England’s National Statistics on the prevalence of treated and untreated mental health conditions in the general population, as well as information on the circumstances of people affected and inequalities faced. It is commissioned by NHS Digital, funded by the Department for Health and Social Care, and carried out by NatCen and University of Leicester.

The fifth Adult Psychiatric Morbidity Survey is due to go into field in 2022. A primary aim of the survey series is to generate temporal trends, and for this topics and measures need to be kept comparable. However, the interview is long (90 minutes) and has space for some rotating topics (that is, topics not included every wave). The last survey was carried out in 2014, and so some questions need to be updated or adjusted in response to changing circumstances and data needs. For example, the coronavirus (COVID-19) pandemic has led to shifts in how mental health treatment services are delivered, and the survey presents an opportunity to understand such changes. 

In order to collate views and priorities for APMS 2022, a public consultation was conducted. This involved an online survey, focus groups, guided interviews and network events. These were widely publicised, and around three hundred responses were received, some from individuals and some representing views from across an organisation. Some participants responded drawing on their experience of living with or caring for someone with a mental health condition. Some referred to their experience as policy makers, practitioners, researchers, and data analysts. Many, of course, drew on both personal and professional experience.

This report summarises the content of the consultation responses submitted, but does not present a definitive list of changes for the APMS 2022 questionnaire. With the limited space for new content in mind and responding to participants’ prioritisations, recommendations are only made here for the next stages of development work. Not all content highlighted for development will make it into the final questionnaire.

Throughout this report specific development recommendations are provided for each topic. The next stage of development work will involve starting with the module administered in 2014 (if there was one) and highlighting potential questions to cut, amend, or add. In summary, while all modules will involve development work, the following areas were identified as key to take forward:

Coverage of mental health conditions

• eating disorders and problem gambling, last included in APMS 2007, are a priority for the 2014 survey
• body dysmorphic disorder should be reviewed as a potential new addition
• while gender dysphoria could be considered as a new addition, including gender identity as a classificatory variable will be important
• the current assessment approaches to personality disorders and self-harm behaviours should be reviewed to ensure they are acceptable in current context
• help seeking and specific treatment is relevant in relation to all mental health conditions, including drug and alcohol dependence and self-harm behaviours

Understanding what the coronavirus pandemic means for mental health risk and treatment

• COVID-19 infection, including receipt of a positive test and persistence of symptoms
• social context: including loneliness in the context of social contact restrictions
• health care: help seeking, barriers to access and waiting lists, and experiences of remote (online and telephone) access to interventions
• employment: remote working and workplace adjustments, new psychosocial working environments, and insecure contracts and employment.

Understanding wider health behaviours and beliefs, including stigma

• traumatic events, including the context of violence and abuse, discrimination, and stigma​
• social media: in particular the subjective experiences of being online​
• health behaviours and environmental context: including new or amended coverage of diet, physical activity, sedentary behaviours, use of nicotine products, new psychoactive substances, and alcohol consumption

To make space for the new content, the following topics were prioritised for cutting:

• verbal fluency measure (as the Modified Telephone Interview for Cognitive Status (TICS-M) covers cognitive decline)​
• intellectual impairment self-identification (as the National Adult Reading Test (NART) provides predicted verbal IQ)​
• Menopause (although this was only asked of a small number of participants, so does not yield much space)​
• Severity of Alcohol Dependence Questionnaire (SAD-Q).

Alongside content, consultation participants expressed strong support for increasing the number of people in the sample a) aged under 25 years, b) from a minority ethnic group, and c) living in deprived neighbourhoods. This was seen as essential for enabling the data collected to be used for robust analyses of inequalities in disorder rates, treatment access, and wider context.

Participants also stressed the importance of comprehensive and consolidated reporting and accessible datasets for supporting extensive further analysis.

NHS Digital thanks everyone who replied to the online consultation, took part in focus groups, guided interviews and network groups. We are committed to ensuring that the APMS continues to meet the needs of users and your feedback is essential in helping us to do this.

NHS Digital:

• will consider feedback on the APMS and use this to inform the planning and development of the 2022 survey content and publication within the constraints of cost and feasibility.
• acknowledges the strong response from those with an interest in eating disorders and will ensure that due consideration is given to the inclusion of eating disorders in APMS 2022.
• Will feedback to the Department of Health and Social Care and the APMS Steering Group that there is strong support for the survey to continue and that the survey could be made more useful by a) increasing the overall sample size, and b) boosting younger age groups, minority ethnic groups or those living in deprived areas, and c) development of follow up studies for certain groups.  
• Data Access Programme are committed to reviewing our access processes and will take into consideration the points raised during the consultation to review data access and ways in which users can be supported to access the data whilst still meeting our legal obligations for data protection and confidentiality

The implementation of some of the needs/wants identified through this survey may be constrained by the scope of the survey, length of the questionnaire and level of funding available from sponsor organisations. Further comments can be submitted at any time to NHS Digital by emailing [email protected].