Adult community mental health waiting times (referral spells) quick guide to submitting data

This guidance supports the improvement of the quality and completeness of data submitted to the Mental Health Services Dataset (MHSDS), used in the analysis of adult community mental health waiting times (referral spells).

Background

As part of the September 2024 performance publication in the Mental Health Services Monthly Statistics publication series, a new set of metrics were introduced which utilise a new methodology which groups sets of individual referrals into a referral spell. Using this methodology, a spell is defined as starting at the point the first referral that is in scope is received by a provider. From this point, other referrals can form part of a referral spell where they are open concurrently or where the next referral opens within 5 days of the previous referral ending. A spell is closed when the last referral is recorded as closed (using the service discharge date).

Only referrals which fall within the inclusion and exclusion criteria will make up the referral spell. Where a person has other open referrals within the same provider that are not in scope for either of the two pathways, these referrals will not be included in the spell.

The Clinically led Review of Standards recommended a move away from 'contact based' metrics towards understanding when meaningful activity has taken place. This means we will be reporting on the wait from referral to when help starts, and not just the first or second contact that a patient has with a service. The full details of the clock stop criteria are found in the sections below but the clock stops are made up of a combination of a baseline outcome, care plan, intervention and assessment being recorded for the referral spell. Once all of these elements are recorded, the full clock stop is recorded.

NHS England publishes 26 monthly measures for CMH Referral Spells in the MHSDS monthly publications.

See the list of 26 monthly measures

MRS01 Number of CMH referral-spells receiving a full clock stop in the RP
MRS01a Number of CMH referral-spells receiving a full clock stop in less than 4 weeks in the RP
MRS01b Proportion of CMH referral-spells receiving a full clock stop in less than 4 weeks in the RP
MRS02 Number of CMH referral-spells waiting for a full clock stop that were still open at the end of the RP
MRS02a Number of CMH referral-spells waiting more than 104 weeks for full clock stop that were still open at the end of the RP
MRS02b Proportion of CMH referral-spells waiting more than 104 weeks for full clock stop that were still open at the end of the RP
MRS02c Number of CMH referral-spells waiting more than 78 weeks for full clock stop that were still open at the end of the RP
MRS02d Proportion of CMH referral-spells waiting more than 78 weeks for full clock stop that were still open at the end of the RP
MRS02e Number of CMH referral-spells waiting more than 52 weeks for full clock stop that were still open at the end of the RP
MRS02f Proportion of CMH referral-spells waiting more than 52 weeks for full clock stop that were still open at the end of the RP
MRS03 Number of open CMH referral-spells waiting for a 2nd contact at the end of the RP
MRS03a Median time (days) for open CMH referral-spells waiting for a 2nd contact at the end of the RP
MRS03b 90th percentile time (days) for open CMH referral-spells waiting for a 2nd contact at the end of the RP
MRS04 Number of CMH referral-spells that started in the RP
MRS05 Number of CMH referral-spells that closed in the RP
MRS06 Number of CMH referral-spells that were still open at the end of the RP
MRS07a Number of CMH referral-spells waiting more than 104 weeks for a 2nd contact that were still open at the end of the RP
MRS07b Proportion of CMH referral-spells waiting more than 104 weeks for a 2nd contact that were still open at the end of the RP
MRS07c Number of CMH referral-spells waiting more than 78 weeks for a 2nd contact that were still open at the end of the RP
MRS07d Proportion of CMH referral-spells waiting more than 78 weeks for a 2nd contact that were still open at the end of the RP
MRS07e Number of CMH referral-spells waiting more than 52 weeks for a 2nd contact that were still open at the end of the RP
MRS07f Proportion of CMH referral-spells waiting more than 52 weeks for a 2nd contact that were still open at the end of the RP
MRS15 Number of CMH referral-spells receiving a 2nd contact in the RP
MRS20 Number of open CMH referral-spells that have had a full meaningful help clock stop at the end of the RP
MRS21 Number of open CMH referral-spells with 2+ contact at the end of the RP
MRS22 Proportion of open CMH referral-spells that have had a full meaningful help clock stop at the end of the RP

SNOMED reference sets

Clock-stops within referral spells are determined by aligning activity with specific SNOMED codes within four mental health reference sets. These reference sets are described below and can be downloaded by subscribing to the SNOMED CT human readable subset UK Clinical Extension on TRUD.

Reference set	Description
Assessment procedures	MHSDS assessment procedures simple reference set
Medication and physical therapy interventions	MHSDS medication and physical therapy interventions simple reference set
Psychological therapies	MHSDS psychological therapies simple reference set
Psychosocial interventions	MHSDS psychosocial interventions simple reference set

Data needed for recording in-scope referrals for CMH referral spells

Inclusion criteria

MHS001MPI

Data item	Description	Notes specific to CMH referral spells
NHSNumber	A number used to identify a patient uniquely within the NHS in England and Wales	Needed to link single patient with multiple referrals into single or multiple referral spells
PersonBirthDate	The date on which a PERSON was born or is officially deemed to have been born	Needed to derive Age at Referral Request Received Date. People aged 18 and over are in scope for CMH referral spells.

MHS101Referral

Data item	Description	Notes specific to CMH referral spells
ReferralRequestReceivedDate	This is the date the REFERRAL REQUEST was received by the health care provider	Needed to calculate waiting times and combine overlapping referrals into a spell. Only referrals from 1 January 2016 are included
ServDischDate	Service Discharge Date is the date a PATIENT was discharged from a SERVICE. This would occur once all the services or teams (for example as part of a multidisciplinary team) have finished treating a patient under a specific referral	Needed to calculate waiting times and combine overlapping referrals into a spell
ReferRejectionDate	The date the referral request to a health care provider's service was rejected by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient	Where a referral is rejected, this is used as the end date of the referral if no service discharge date is populated

MHS102OtherServiceType

Note that this table only needs to be submitted where a patient is referred to more than one service/team within the same referral. For more information read the guidance for reporting service or team type quick guide to submitting MHSDS.

Data item	Description	Notes specific to CMH referral spells
ReferRejectionDate	The date the referral request to a health care provider's service was rejected by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient	Where a referral is rejected, this is used as the end date of the referral if no service discharge date is populated
ReferClosureDate	The date the referral request to a health care provider's service was closed by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient	If no service discharge date and no referral rejection date is populated, this is used as the end date of the referral

MHS902ServiceTeamDetails

Data item	Description	Notes specific to CMH referral spells
ServTeamTypeMH	The type of service or team within a mental health service that a patient was treated by	Only certain service team types are in-scope for CMH referral spells. The following service team types are in scope: Primary Care Mental Health Service (A05), Community Mental Health Team - Functional (A06), Assertive Outreach Team (A08), Community Rehabilitation Service (A09), Psychotherapy Service (A12), Psychological Therapy Service (non IAPT) (A13), Personality Disorder Service (A16), Community Eating Disorder Service (C10)

Data item

Description

Notes specific to CMH referral spells

ServTeamTypeMH

The type of service or team within a mental health service that a patient was treated by

Only certain service team types are in-scope for CMH referral spells. The following service team types are in scope:

Primary Care Mental Health Service (A05), Community Mental Health Team - Functional (A06), Assertive Outreach Team (A08), Community Rehabilitation Service (A09), Psychotherapy Service (A12), Psychological Therapy Service (non IAPT) (A13), Personality Disorder Service (A16), Community Eating Disorder Service (C10)

Exclusion criteria

Exclusions for in-scope referrals for CMH referral spells

Providers	Excluding digital providers	Excluding referrals with provider code ‘DFC’ or ‘S9X2N’
Inpatients	Non-inpatient only	Excluding any referrals with an associated hospital spell record

Construction of CMH referral spells

In order for a spell to be considered 'open' at the end of the reporting period, both of the following conditions must be met:

At least 1 'in-scope' referral must flow to MHSDS in the reporting period. For example, a spell can only be considered open at the end of the 'May-25' reporting period if an 'in-scope' referral was included in the May-25 submission.
At least 1 of the referrals within the submission for the reporting period must be considered open at the end of the reporting period.

Below are 3 examples which demonstrate the construction of spells.

Example 1

Referral 1 is received on 1st January 2024 and is submitted each month until April 2024, with no discharge date recorded. It is categorised as closed (inactive) from 30 April 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 with a discharge date recorded on 7 September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because these referrals are open concurrently, referral 1 and referral 2 are combined into a spell. The resulting referral-spell is counted as starting on 1 January 2024 and categorised as open to 7 September 2024 where it is closed.

Example 2

Referral 1 is received on 1 January 2024 and is submitted each month until April 2024, with a discharge date recorded on 14 April 2024. It is categorised as closed (discharged) from 14 April 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 and discharged on 7 September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because referral 2 opens within 5 days of referral 1 ending, referral 1 and referral 2 are combined into a spell. The resulting referral-spell is counted as starting on 1 January 2024 and categorised as open to 7 September 2024 where it is closed.

Example 3

Referral 1 is received on 1 January 2024 and is submitted each month until March 2024, with no discharge date recorded. It is categorised as closed (inactive) from 31 March 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 and discharged on 7th September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because the ‘end date’ of referral 1 is assumed to be 31March 2024, referrals 1 and 2 are not open concurrently and referral 2 does not open within 5 days of referral 1 ending – the referrals are not combined into a spell. Therefore these 2 referrals constitute 2 separate referral spells – referral 1 is spell 1 and referral 2 is spell 2.

In March 2024 reporting, spell 1 is considered ‘open at the end of the reporting period’ because referral 1 has been submitted to MHSDS in March 2024 and no discharge date has been populated. In April 2024 reporting, spell 1 is not considered ‘open at the end of the reporting period’ as referral 1 was not submitted to MHSDS in April 2024. The start date of spell 1 is 1 January 2024 and the end date is 31 March 2024.

In August 2024 reporting, spell 2 is considered ‘open at the end of the reporting period’ because referral 2 has been submitted to MHSDS in August 2024 with no discharge date in the August 2024 submission. In September 2024 reporting, spell 2 is not considered ‘open at the end of the reporting period’ as referral 2 was submitted to MHSDS in September 2024 with a discharge date of 7 September 2024. The start date of spell 2 is 15 April 2024 and the end date is 7 September 2024.

Data needed for recording full clock stops for CMH referral spells

Definition of full clock-stop

The full clock stop for adult community mental health waiting time is defined below.

Criteria	Description
Care Contact	The spell must have at least one care contact
Baseline Outcome	The spell must have a baseline outcome recorded
Assessment SNOMED code	The spell must have a SNOMED assessment code recorded where either: the spell started after 1 April 2024 or the spell started before 1 April 2024 and had no care contact recorded before 1 April 2024
Care Plan or SNOMED intervention code	The spell must have any one of these conditions met

Recording of care contacts

MHS201CareContact

Data item	Description	Notes specific to CMH referral spells
CareContDate	The date on which a Care Contact took place, or, if cancelled, was scheduled to take place	To include care contact assessments which only took place during the CMH referral spell
AttendStatus	This indicates whether or not an APPOINTMENT for a CARE CONTACT took place. If the APPOINTMENT did not take place it also indicates whether or not advanced warning was given	Include where 5 - Attended on time or, if late, before the relevant CARE PROFESSIONAL was ready to see the PATIENT 6 - Arrived late, after the relevant CARE PROFESSIONAL was ready to see the PATIENT, but was seen
ConsMechanismMH	The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT	Include where 01 - Face to face 02 - Telephone 04 - Talk type for a person unable to speak 11 - Video consultation

Data item

Description

Notes specific to CMH referral spells

CareContDate

The date on which a Care Contact took place, or, if cancelled, was scheduled to take place

To include care contact assessments which only took place during the CMH referral spell

AttendStatus

This indicates whether or not an APPOINTMENT for a CARE CONTACT took place. If the APPOINTMENT did not take place it also indicates whether or not advanced warning was given

Include where

5 - Attended on time or, if late, before the relevant CARE PROFESSIONAL was ready to see the PATIENT

6 - Arrived late, after the relevant CARE PROFESSIONAL was ready to see the PATIENT, but was seen

ConsMechanismMH

The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT

Include where

01 - Face to face

02 - Telephone

04 - Talk type for a person unable to speak

11 - Video consultation

Recording of care plans

MHS008CarePlanType

Data item	Description	Notes specific to CMH referral spells
CarePlanLastUpdateDate	The date that the care plan was last updated for a patient. Where the care plan has not otherwise been updated this will be the same as the care plan creation date.	To include care plans which only took place during the CMH referral spell.
CarePlanCreatDate	The date that a care plan was created for a patient.	To include care plans which only took place during the CMH referral spell.

Data item

Description

Notes specific to CMH referral spells

CarePlanLastUpdateDate

The date that the care plan was last updated for a patient.

Where the care plan has not otherwise been updated this will be the same as the care plan creation date.

To include care plans which only took place during the CMH referral spell.

CarePlanCreatDate

The date that a care plan was created for a patient.

To include care plans which only took place during the CMH referral spell.

MHS009CarePlanAgreement

Data item	Description	Notes specific to CMH referral spells
CarePlanID	A unique identifier for a care plan	Needed to link to MHS008 record. Only agreed care plans are included.

Recording of SNOMED interventions

MHS201CareContact

Data item	Description	Notes specific to CMH referral spells
CareContDate	The date on which a care contact took place, or, if cancelled, was scheduled to take place	To include care contacts which only took place during the CMH referral spell.

MHS202CareActivity

Data item	Description	Notes specific to CMH referral spells
Procedure	A structured combination of one or more SNOMED CT concept identifiers which are used to describe a Patient Procedure	To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set. Note – SNOMED CT codes for 'Signposting', 'Consultation' and ‘Discussion about subject of record with care professional (situation)'do not count.

Data item

Description

Notes specific to CMH referral spells

Procedure

A structured combination of one or more SNOMED CT concept identifiers which are used to describe a Patient Procedure

To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set.

Note – SNOMED CT codes for 'Signposting', 'Consultation' and ‘Discussion about subject of record with care professional (situation)'do not count.

MHS204IndirectActivity

Data item	Description	Notes specific to CMH referral spells
IndirectActDate	The date that the indirect activity took place	To include care contacts which only took place during the CMH referral spell
IndActProcedure	A structured combination of one or more SNOMED CT concept identifiers which are used to identify a patient procedure for an indirect activity	To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set. Note – SNOMED CT codes for 'Signposting', 'Consultation' and ‘Discussion about subject of record with care professional (situation)'do not count.

Data item

Description

Notes specific to CMH referral spells

IndirectActDate

The date that the indirect activity took place

To include care contacts which only took place during the CMH referral spell

IndActProcedure

A structured combination of one or more SNOMED CT concept identifiers which are used to identify a patient procedure for an indirect activity

To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set.

Note – SNOMED CT codes for 'Signposting', 'Consultation' and ‘Discussion about subject of record with care professional (situation)'do not count.

Recording of SNOMED assessments

MHS201CareContact

Data item	Description	Notes specific to CMH referral spells
CareContDate	The date on which a care contact took place, or, if cancelled, was scheduled to take place	To include care contact assessments which only took place during the CMH referral spell.

MHS202CareActivity

Data item	Description	Notes specific to CMH referral spells
Procedure	A structured combination of one or more SNOMED CT concept identifiers which are used to describe a Patient Procedure	All adult CMH waiting times must have at least one SNOMED code from the assessments group of the reference set recorded in order to stop the waiting time clock

MHS204IndirectActivity

Data item	Description	Notes specific to CMH referral spells
IndirectActDate	The date that the indirect activity took place	To include care contact assessments which only took place during the CMH referral spell
IndActProcedure	A structured combination of one or more SNOMED CT concept identifiers which are used to identify a Patient Procedure for an Indirect Activity	All adult CMH waiting times must have at least one SNOMED code from the assessments group of the reference set recorded in order to stop the waiting time clock

Recording of outcomes

MHS201CareContact

Date item	Description	Notes specific to CMH referral spells
CareContDate	The date on which a Care Contact took place, or, if cancelled, was scheduled to take place	This is used to assign the date of outcomes where the outcomes was recorded as part of a care contact

MHS606CodedScoreAssessmentRefer

Data item	Description	Notes specific to CMH referral spells
AssToolCompTimestamp	The date, time and time zone on which the assessment took place	This is used to assign the date of outcome where the outcome was recorded as part of a referral but not during a care contact
CodedAssToolType	The SNOMED CT concept ID which is used to identify an assessment in SNOMED CT	This includes all outcome measures that can flow to MHSDS excluding 'Current View'

MHS607CodedScoreAssessmentAct

Data item	Description	Notes specific to CMH referral spells
CodedAssToolType	The SNOMED CT concept ID which is used to identify an assessment in SNOMED CT	This includes all outcome measures that can flow to MHSDS excluding 'Current View'

Mandatory tables needed for each MHSDS submission

The following 4 tables need to be submitted in each submission with their respective mandatory and required fields. More information can be found in the MHSDS user guidance and Technical Output Specification.

Table	Description
MHS000Header	Uniquely identifies each MHSDS submission made by the provider
MHS001MPI	Uniquely identifies every patient and records personal details of each patient
MHS002GP	Records details of the GP of every patient*
MHS101Referral	Records details of every referral

Footnote

* While this is not specific to CMH referral spells, each patient must have a GP code recorded for their records to be accepted into the dataset. If you do not know the patient's GP code then the default 'V81997 - No Registered GP Practice', 'V81998 - GP Practice Code not applicable' or 'V81999 - GP Practice Code not known' codes can be used. Note that by using a default code, this may result in an ICB not being assigned to the patient.

Further information

Github

Access the code used to create the CMH referral spells measures

Last edited: 2 July 2025 9:48 am