Mental Health Services - Frequently Asked Questions (FAQ)
These Frequently Asked Questions have been collated from the range of questions that we receive into the Mental Health Analysis mailbox ([email protected]).
General information
Q: What is the difference in MHMDS, MHLDDS and MHSDS?
The Mental Health Minimum Dataset (MHMDS) was introduced in 2003. The original iteration covered Adult Mental Health Services only and did not collected data from the independent sectors prior to 2011-12. 2008 was the first publication (using data for 2003 to 2007).
From September 2014 it included data for people in contact with learning disabilities services. When the scope was updated, the name changed to the Mental Health and Learning Disabilities Dataset (MHLDDS) and From January 2016 the scope was updated again to include children's mental health services and became the Mental Health Services Dataset (MHSDS)
Q: Where are mental health patients referred from?
Patients can be referred to the providers of secondary mental health services from multiple sources, including self-referral, prison, justice system, GP, maternity services, health visitor and many others.
Q: What information is available on bed occupancy and availability?
NHS England collects data from all NHS organisations that operate beds, open overnight or day only. It publishes information on the average daily number of beds that are available and occupied by sector (including the Mental Illness sector) and by consultant specialty.
The Mental Health Services Monthly publication also contains data on the number of bed days, the number of bed days less leave and the number of bed days for children (aged 15 and under, 16 and 17) on adult wards in mental health hospitals.
Measures within MHSDS
Q: What are all the MH measures?
Measures within MHSDS can be wordy so these are abbreviated with an MH/AMH/ED and number identifier. A list of these can be found under the Mental Health List of Publications and Measures section called Mental Health Services publications list.
Q: How MHS69 (The number of children and young people, regardless of when their referral started, receiving at least two contacts (including indirect contacts) and where their first contact occurs before their 18th birthday) measure is constructed?
Pseudo SQL code required to construct the MHS69 measure are available.
MHS69 relies on the following tables being completed.
- MHS001MPI
- MHS002GP
- MHS101Referral
- MHS201CareContact
- MHS204IndirectActivity
Incomplete data being submitted in one or more of the tables listed above can cause data to be rejected.
Q: When is the MHS69 measure is calculated?
MHS69 is defined as: "the number of children and young people, regardless of when their referral started, receiving at least two contacts (including indirect contacts) and where their first contact occurs before their 18th birthday".
In those cases where a person has their first and second contact, and then subsequent contacts in another financial year, they will be counted once when they have two further contacts (as long as the person is under 18 at the time of the first subsequent contact). For example:
Person 1:
- Contact 1: February 2020 at age 17
- Contact 2: March 2020 at age 17
- Contact 3: April 2020 at age 17
- Contact 4: May 2020 at age 17
In this case the person is counted for 2019-20 in March 2020. They are then counted again in May 2020 having received a further 2 contacts.
Person 2:
- Contact 1: February 2020 at age 17
- Contact 2: March 2020 at age 17
- Contact 3: April 2020 at age 18
- Contact 4: May 2020 at age 18
The person is counted in 2019-20 as the person had two contacts and they were under 18 for the first contact. For 2020-21 the contact count effectively resets and because the person is aged 18 for the first contact in 2020-21 they are not counted any longer.
Q: If a patient has more than one 2nd contact in the age 17/18 year for different referrals, should the latest contact or the last contact be counted for MHS69?
As stated in the previous question, the patient should be counted if they have 2 contacts, so the second contact is counted to ensure that the patient is counted.
If they have subsequent referrals with more than two contacts, this should not matter since the patient would have already been counted and would not be counted again.
Q: What's the difference between MHS69 and MHS95?
MHS69 was the older version of the CYP Access metric but its definition was slightly confusing and hard for the audience to understand. MHS95 replaced that from a policy perspective and provides a 12 month rolling picture that is easier to understand and replicate for users.
Q: What is the definition of MHS26 (days of delayed discharge in the reporting period [RP]) measure?
The Mental Health Services dataset (MHSDS) collects Mental Health Delayed Discharge Periods for all ages, linked to the wider patient care pathway, allowing a greater range of national analysis to be produced.
MHS26 measures the number of days of delayed discharge in the reporting period and is calculated from the Start Date and End Date (Mental Health Delayed Discharge Period) and the start and end dates of the reporting period. It has been amended to bring it into line with NHS England guidance on delayed transfers of care and to include additional breakdowns such as delay reason and organisation attributable to. It is reported on monthly basis and is not an official statistic.
Small differences in the categories existed between MHSDS (v1.1) and the MSitDT (Monthly Situation report for Delayed Transfers). The DHSC and NHS England agreed a review of the categories was required and have been focusing on understanding better what is causing delays in the mental health system. From the review, a single revised list of Mental Health Delayed Discharge Reason categories has been agreed for future use from April 2017. These new categories are fit for purpose for all mental health reporting requirements and are for use across mental health only.
Q: Do you publish annual statistics for delayed transfer of care?
NHS Digital collects data on Delayed Transfer of Care (MHS26) which is published in the main monthly "final" (termed "performance" from April 2020 onwards) csv files. The data goes back to 2016 and is accessible from our monthly publication:
Q: What do MHS32 (New referrals) and AMH01 (People in contact with adult mental health services at the end of the reporting period) measures mean and what is the difference between them?
MHS32 (Referrals starting in the reporting period[RP]) is a count of referrals that have started within that month to any secondary mental health services.
AMH01 (People in contact with adult mental health services at the end of the reporting period) is a count of people who are in contact with secondary mental health services but where the service is deemed to be for adult mental health (i.e. not children or Learning Disabilities [LD]).
Q: What do MHS01 (People in contact with services at the end of the reporting period), MH01 (People in contact with mental health services at the end of the reporting period) measures mean and what is the difference between them?
We usually split Mental Health Service (MHS) measures into three service areas, Adult Mental Health (AMH), Children and Young People (CYP) and Learning Disabilities (LDA).
The AMH and CYP categories together make up the MH measures and therefore effectively exclude those ward stays and referrals which are categorised as learning disabilities.
Q: What does "in contact with mental health services" mean?
“In contact” simply means that the people who have an open referral. This does not necessarily mean that they have had any care activity as part of that referral, but that the referral for treatment is still active and ongoing at the end of the month being reported.
Q: Would it be possible to define how far along the process of each of these measures (MHS32 (New referrals) and AMH01 (People in contact with adult mental health services at the end of the reporting period)) go?
MHS32 is the count of new activity, this counts referrals that start in the reporting-period, so this is the very start of the process.
AMH01 would depend as it counts open activity, so some referrals may have been open for a long time or have opened in that reporting period. It is not possible to say how far along the referral goes based on AMH01 alone.
Q: What assaults information is available?
MHSDS (mental health services dataset) only holds details of assaults on patients by the other patients.
The data model introduced as part of MHSDS v5 now captures if the patient and / or staff got injured as part of a restraint.
Q: Is the MHS32 (New referrals) measure the beginning of the process in terms of someone getting help for mental health problems, for example by visiting their GP and being referred? Or is the AMH01 (People in contact with adult mental health services at the end of the reporting period) measure earlier?
MHS32 is the beginning of the process in secondary mental health services and is earlier than AMH01, this means that they will have been referred to services by some means (see previous answer around sources of the referral) already.
Q: If a patient has more than 1 contact, does this include non-targeted interventions or is it only for targeted interventions? Further, does this include group (targeted or non-targeted interventions) or only 1-1 interventions?
For the purposes of this return, any care contact with the individual or indirect activity concerning the individual would be counted. This would include targeted and non-targeted services.
Group activity would not be counted, however. We would only count care contacts where the patient has been face-to-face or spoken over the phone, and where the patient actually attended (i.e. missed appointments would not count).
Referrals information
Q: Does MHSDS hold data for Referrals to outpatient adult mental health services?
This data is held within the Mental Health Services Dataset (MHSDS) but not currently published. Since this data is held, it is available via the Data Access Request Service (DARS):
https://digital.nhs.uk/services/data-access-request-service-dars
We also publish similar statistics in the Mental Health Services Monthly publication on monthly basis. In this publication we publish the number of new referrals by provider. This is presented as metric MHS32 – Referrals starting in the reporting period. However, this metric would include all referrals to secondary mental health services and not just referrals to outpatient adult mental health services. The publication series is available here:
Q: Does the Mental Health Services dataset (MHSDS) hold data on referrals rejection reasons?
We do collect a referral rejection reason in the dataset, but the responses are limited to the following three options below.
01 | Duplicate REFERRAL REQUEST (PATIENT already undergoing treatment for the same condition at the same or other Health Care Provider). |
02 | Inappropriate referral request (Referral request is inappropriate for the services offered by the Health Care Provider). |
03 | Incomplete referral request (incomplete information on the referral request). |
Q: Does Mental Health Services dataset (MHSDS) hold data on patients rejected because the service lacked the capacity to support the patient?
Mental Health Services Dataset (MHSDS) does not hold data on patients rejected because the service lacked the capacity to support the patient. As stated in the question above, there are referral rejection reasons held within the dataset, but the options recorded do not include an option around the service lacking the capacity to support or treat the patient, only whether the referral was inappropriate.
Access and Wait times
Q: What access and waiting times data does NHS Digital hold?
Currently access and waiting times standards exist for:
- Improving Access to Psychological Therapies (IAPT) services:
- Early Intervention for Psychosis (EIP) services:
https://www.england.nhs.uk/statistics/statistical-work-areas/eip-waiting-times/
- Children and Young People's Eating Disorder Services:
https://www.england.nhs.uk/statistics/statistical-work-areas/cyped-waiting-times/
Of these, NHS Digital are the official source of IAPT waiting times, NHS England is the official source for the other two services.
NHS England collects and publish monthly information on the number of children and young people (CYP) with an eating disorder who have access or are waiting for treatment. This information is used to monitor the referral to treatment (RTT) element of the CYP ED standard as introduced in Mental health services: achieving better access by 2020 and described in the Access and Waiting Time Standard for Children and Young People with an Eating Disorder Commissioning Guide
- Monthly CYP ED waiting times data has been published since quarter 1 2016/17.
- NHS England publishes these data each month. For further information please visit the NHS England website.
Assessment scales
Q: What data on depression scales and health-related quality of life scales exist in MHSDS?
There is some information on assessment scales related to depression held within the dataset, RCADS (Revised Children's Anxiety and Depression Scale) for example.
Information from other assessment scales are also recorded within the dataset. These can all be found in the User Guidance or in the Technical Output Specification documents which can be found in the link below.
Diagnosis information
Q: Does MHSDS hold data on diagnoses?
Generally, diagnosis and treatment of mental health conditions can happen in primary, secondary and tertiary care settings. NHS Digital collects information on the number of people diagnosed with certain specific conditions in England across these settings but is not exhaustive for all mental health conditions. For example, some mental health prevalence information is sourced from General Practices in England which participated in the Quality and Outcomes Framework (QOF) – dementia, depression, epilepsy, learning disabilities, general mental health are included. The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. The final payment is adjusted to take account of surgery workload, local demographics, and the prevalence of chronic conditions in the practice's local area. More information about QOF is available here: https://qof.digital.nhs.uk/
These statistics only cover those who are in contact with primary care services so are an undercount of the total number of people with these diagnoses.
NHS Digital collects information in the Mental Health Services Data Set (MHSDS) on people in contact with secondary mental health services with a diagnosis of a mental health disorder. The MHSDS is a very big and complex dataset so in order to balance the burden on the NHS, some tables/fields are mandatory whereas others are not. The diagnoses tables are not mandatory so not all providers necessarily submit this information. The recording of diagnoses within MHSDS needs to be entered using clinical coding which some providers may be unable to do for various reasons. Additionally, it can take a long while for a diagnosis to be confirmed for some patients. There are also other data quality issues around non-completion of the diagnosis information. We are working with providers and partner organisations to address such issues. For example, of the people in contact with secondary mental health, learning disabilities and autism services on 30 June 2018, only 25% had ever had a primary diagnosis code recorded, including invalid codes. The corresponding percentage was 27% for those in contact with services on 30 June 2020, and 21% for those in contact with services on 30 June 2022.
(Note: the last of these estimates is likely to be revised upwards in the future. Providers can make multiple submission window model (MSWM) resubmissions of June 2022 data until the close of submissions for 2022/23, and this is likely to have a positive impact on diagnosis recording rates.)
Q: Is information on depression or anxiety available in Mental Health Services Dataset (MHSDS)?
Mental Health Services Dataset (MHSDS) collects data on people of all ages who have been referred for talking therapies for conditions such as depression or anxiety. However, recording levels of diagnoses in the Mental Health Services Dataset (MHSDS) are usually too low for analysis except in some specific cases. This is because depending on the type of service referred to or the type of care professional involved in care, we may not expect to have a clinically coded diagnosis recorded for the person as part of their care. These issues mean that while MHSDS can provide information on the number of people with a diagnosis of depression or anxiety, the information will be incomplete, making any interpretation difficult to carry out.
However, NHS Digital publishes information on talking therapies carried out for treating adults with depression or anxiety from the Improving Access to Psychological Therapies (IAPT) dataset. Link to the latest reports (monthly, quarterly and annual) which provide numbers of referrals and numbers who received treatment for anxiety/depression as well as information on waiting times and outcomes can be found here:
The latest information available for children and young people’s mental health and anxieties can be found in the survey findings from the Mental Health and Children and Young People (MHCYP) series:
Q: What attention deficit hyperactivity disorder (ADHD) data NHS Digital hold?
NHS Digital also holds information on people in contact with secondary mental health services in England who have a recorded diagnosis of a mental disorder, or who have been referred for talking therapies for conditions such as ADHD. Recording levels of diagnoses in the Mental Health Services Dataset (MHSDS) are usually too low for analysis except in some specific cases. This is because depending on the type of service referred to or the type of care professional involved in care, we may not expect to have a clinically-coded diagnosis recorded for the person as part of their care. These issues mean that MHSDS cannot provide definitive information on the number of people with a diagnosis of ADHD.
The Adult Psychiatric Morbidity Survey (APMS) series is England's key data source for the prevalence of treated and untreated mental disorders in the adult general population. APMS is designed to provide an estimate of the prevalence of mental disorders in the population regardless of whether these have been diagnosed by a clinician. As such, these numbers represent people who have been assessed rather than those who have received a diagnosis. The latest survey was completed in 2014 and published in 2016. The information held by NHS Digital only relates to England.
APMS 2014 includes statistics on the proportion of people aged 16 or over in England estimated as screening positive for possible ADHD (chapter 8):
The next survey is this series is being conducted in 2022, with results expected to be published in 2023.
The Mental Health of Children and Young People (MHCYP) survey series is England's key data source for the prevalence of treated and untreated mental disorders in children and young people in the general population. The MHCYP survey series includes an estimate of the number of children and young people assessed as having hyperkinetic disorder (Hyperactivity Disorders chapter). The International Classification of Diseases 10th Revision (ICD-10) classification of hyperkinetic disorder is similar to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) classification of ADHD. Both classification systems require symptoms to present themselves in several settings such as school or work, home life and leisure activities. However, ICD criteria for hyperkinetic disorder tends to be more restrictive than the DSM-5 criteria for ADHD in identification of hyperactivity disorders. For example, an ADHD diagnosis requires symptoms to be present by twelve years of age while symptoms of hyperkinetic disorder must be present by the age of seven. As a result, the rates of hyperactivity disorders derived from the MHCYP survey series (based on ICD-10 criteria for hyperkinetic disorder) are likely to be lower compared to other surveys which utilise DSM-5 criteria (ADHD). The latest main survey conducted in 2017 with findings published in 2018 include this information:
Q: Why is there no single dataset to monitor prevalence of attention deficit hyperactivity disorder (ADHD) nationally?
Diagnosis of ADHD may be undertaken in a variety of care settings and therefore there is currently no single established dataset to monitor the number of ADHD diagnoses nationally. NHS Digital is working to improve the quality of relevant datasets, such as the Mental Health Services Dataset and the Community Services dataset.
Q: Does MHSDS hold data on dementia?
Mental Health Services Data Set (MHSDS) holds data on people referred to memory clinics for dementia. This is published in our annual publication (Mental Health Bulletin): https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-bulletin
Mental Health Data Hub also has some information on dementia that is available from the following link:
Early intervention in Psychosis (EIP)
Q: Does EIP Waiting time include a criterion that a person has an assigned care coordinator within an EIP team?
The EIP waiting times does include a criterion that a person has an assigned care coordinator within an EIP team. This is defined in the calculation as a record where the assigned care coordinator is associated with an Early Intervention Team for Psychosis team. This is recorded as A14 in the CARE PROFESSIONAL SERVICE OR TEAM TYPE ASSOCIATION (MENTAL HEALTH) field in the MHS006MH Care Coordinator table.
Suicide information
Q: Does MHSDS holds data for suicide enquiries?
MHSDS does not collect data on suicides, however, ONS are the official source of data on suicides. The ONS data can be found here:
OHID publish some of the ONS data via their Suicide Prevention Profile:
https://fingertips.phe.org.uk/profile-group/mental-health/profile/suicide
Manchester University are the official source of data on suicides for people with mental health issues. Their published reports are available from the following link:
https://sites.manchester.ac.uk/ncish/reports/
Some limited information is available the Adult Psychiatric Morbidity Survey:
Children and Young People
Q: Does Mental Health Services dataset (MHSDS) hold children’s data on Cognitive Behavioural Therapy (CBT) for depression and anxiety?
Children’s information could be extracted from the Mental Health Services Dataset, but we wouldn’t be able to produce figures for Cognitive Behavioural Therapy (CBT) specifically. It would be more about children referred for psychological conditions. We would need to develop an agreed methodology for this and do some exploratory work around data quality (DQ) on the necessary fields. This information could be requested with a cost associated through Data Access Request Service (DARS) if a customer would like to pursue with such a request:
https://digital.nhs.uk/services/data-access-request-service-dars
However, this would not guarantee definitive information.
Q: Can you confirm if Children & Young people (CYP) accessing adult Improving Access to Psychological Therapies (IAPT) services can be counted towards the access target?
Children & Young people (CYP) accessing adult Improving Access to Psychological Therapies (IAPT) services is not included in Mental Health Services Data Set (MHSDS), there is a separate Improving Access to Psychological Therapies (IAPT) collection. The IAPT guidance document can be found here:
Q: Is the Children and Adolescent Mental Health Services (CAMHS) Tier Framework still used to commission or provide mental health services universally across England?
The Children and Adolescent Mental Health Services (CAMHS) Tier Framework is no longer used to commission or provide mental health services universally across England. This change in practice led to the removal of CAMHS Tier from the national Mental Health Services Data Set (MHSDS) information standard in April 2020. This in turn led to a change in the methodology used to identify activity within this national data set that would have historically been delivered under this framework. The new methodology uses an algorithm to determine whether a service predominantly used is for children and young people or adults. This fundamental change means that caution is advised when using these measures and care must be taken when comparing data spanning both methodologies.
Tier 4 (i.e. CYP inpatients) is the exception to this. MHSDS reports this activity by specialised commissioning.
Ethnicity data
Q: What is the availability of ethnicity data for Mental Health Act Statistics?
In terms of ethnicity in the Mental Health Act publication, we only have data available from 2016 onwards which is available from the following link:
The annual publication provides data tables which include separate breakdowns by ethnicity for detentions, short term detention orders and community treatment orders.
Before 2016, data on detentions under the Mental Health Act 1983 were collected in aggregate form in the KP90 collection and unfortunately this did not include demographic breakdowns. These breakdowns only became available after 2016 when the data began to be produced from the Mental Health Services Data Set.
Autism
Q: What data on autism spectrum disorders is available in Mental Health Services Dataset (MHSDS)?
In relation to autism, we do publish some measures on waiting times and new diagnosis of autism from the Mental Health Services Dataset (MHSDS). However, this data only relates to those patients on autism spectrum disorder (ASD) diagnostic pathways within mental health services. Most children with autism would not be being treated in a hospital setting and their data would not subsequently be recorded in MHSDS.
The information collected from MHSDS is available here:
https://digital.nhs.uk/data-and-information/publications/statistical/autism-statistics/
For children and young people, autism prevalence information is published in the Mental Health of Children and Young People, main survey series with the last one conducted in 2017:
Q: What is the best source of data on autism prevalence?
The best source of data on autism prevalence is the indicator in the Network Contract DES (MI) - NHS England Digital.
It was indicator NCDMI137 in 2023/24, and is now HI21 in 2024/25. The indicator is in the Tackling Health Inequalities section, so the data (count of people with an autism diagnosis) can be found in data by ruleset file. It is one row per GP Practice. As of August 2023 the latest data published is June 2024, but what usually happens is GP Practices are slow to sign up each new financial year and so coverage and numbers are low in early months. The end of the year has good coverage. In order to get the total number of patients registered at each GP Practice (to calculate a percentage) then you can use the denominator from NCDMI200 (2023/24) or HI02 (2024/25) as this is in the same ruleset/datafile (Tackling Health Inequalities)
Improvements in collection
Q: What step NHS Digital is taking to improve the Children and Young People's (CYP) data collection?
NHS Digital has been working with providers to support them in understanding the CYP metrics within Mental Health Services Dataset (MHSDS), and to improve the data quality of reporting against these measures, there has also been work done to increase the number of providers submitting to MHSDS. In 2018-19, we had between 106 to 171 providers, 2019-20 between 210 to 274 providers and in 2020-21 between 285 to 313 providers submitting. So, whilst we have seen an increase, part of this increase will be down to the improved data quality within MHSDS and the increase in providers submitting data.
Q: What steps NHS Digital is taking to improve the collection of data in relation to the level of extreme anxiety, self-harm, and suicide?
NHS Digital collects information in the Mental Health Services Data Set (MHSDS) on people in contact with secondary mental health services who self-harm whilst an inpatient. The MHSDS is a very big and complex dataset so in order to balance the burden on the NHS, some tables/fields are mandatory whereas others are not. The self-harm table is not mandatory so not all providers necessarily submit this information. Month on month reporting by providers can be irregular. We are working with providers and partner organisations to address such issues.
Useful information for providers/matching up with local records
Q: Is it possible to request the Unique Service Request IDs for Performance figures validation?
It is possible to request the Unique Service Request IDs for the calculation from our Data Quality team. Please send an email to: [email protected], who will be able to assist further with obtaining these IDs. The IDs are not suppressed and would allow the requester to match with local records.
Q: I am a provider and my local figures do not match those published by NHS Digital - why is this?
It is always difficult to answer why colleagues at Provider level are producing data different to that published by NHS Digital. This is essentially down to coding definitions and the different data assets that are being used.
The MHSDS Metadata document contains the SQL code required to construct some of the published measures. The embedded SQL code can be found on the relevant tables to help providers to match with the local records.
The second reason why local figures do not match the published data is the NHS Digital’s suppression rules, which mean that published data for all geographies except England are rounded to the nearest 5.
Another common reason is that the local data is on live systems, and a referral’s status may have changed since the data were last submitted to NHS Digital.
Q: If a provider identifies issue(s) with the submitted data, are they able to correct it?
If a provider identifies issue(s), they are able to put it right for that financial year. It can be done retrospectively for all months from April onwards as part of the multiple submission window model (while the windows remain open for the financial year). Further details available here:
Q: Does NHS Digital publish a list of suppliers of clinical systems?
The most relevant information we have is in the following set of publications:
Users wanting to do any further analysis using MHSDS
Q: Can a user reproduce published data/ do their own analysis using MHSDS?
Use of published data
If a customer would like to re-use any information from the MHSDS publications, including doing their own analysis of the published data, then please follow the guidelines of the Open Government Licence, which covers appropriate acknowledgements:
http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/
Use of un-published data
If a user requires access to unpublished information or need access to more data from MHSDS, then this can be requested from the Data Access Request Service (DARS):
https://digital.nhs.uk/services/data-access-request-service-dars
Before submitting a request, it is worth checking the data quality dashboards for the measures of interest to understand how well they are completed in MHSDS as this will impact on any additional analysis being carried out.
Q: Where can I get MHSDS Copyright licensing information from?
Please find this information on the following web page:
https://digital.nhs.uk/National-Clinical-Content-Repository
There is also a licensing mailbox (also available from above web page): [email protected]
MHSDS Publication style guide
Q: What statistical disclosure control/Data Quality/Data suppression rules does NHS Digital follow?
To prevent the release of disclosive information, any sub-national figures are rounded to the nearest 5 or suppressed and denoted with a “*” when the figure is less than 5.
Latest information on statistical disclosure control/data Quality/data suppression rules are available on the Data Quality section in the latest Mental Health monthly publication:
Last edited: 14 August 2024 7:13 am