Mental Health Services Monthly Statistics , Performance December 2022, Provisional January 2023

Integrated Care Systems (ICSs) were formally established across the NHS in England on 1 July 2022, with the introduction of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs), and abolition of CCGs.

Further information around the introduction of ICBs and ICPs is available via the relevant Organisation Data Service (ODS) is available. 

Breakdowns relating to commissioning structures as they existed prior to 1 July 2022 (CCG, STP, Region and Commissioning Region) are reflected in the Performance June 2022 data as normal. 

Breakdowns relating to the new commissioning structures (ICB, Sub ICB, Commissioning Region) which superseded legacy commissioning structures on 1 July 2022 are available for Performance December 2022. 

These breakdowns are, however, also substantially impacted by the cyber incident.  They are not an accurate reflection of activity for Performance December 2022, although some ICBs/Sub ICBs/Commissioning Regions are impacted more than others.   As such, these breakdowns have been separated out from all outputs that are part of this publication, and transferred to a dedicated ICB and Sub ICB location Supplementary Information page. 

Full details are available in the Metadata file and Mental Health Services publication list.

From Performance May 2022 onwards, the following new measure relating to care contacts has been added to the monthly release:

• MHS109 - Number of People aged 18 to 24 supported through NHS funded mental health with at least one contact (12 month rolling)

From Performance January 2022 onwards, six new DQ VODIM measures have been added to the DQ vodim CSV files. 

• MHS-DQM57 - Organisation Identifier (code of specialised responsible commissioner) - Referral
• MHS-DQM58 - Organisation Identifier (code of specialised responsible commissioner) - Care Contact
• MHS-DQM59 - Organisation Identifier (code of specialised responsible commissioner) - Indirect Activity
• MHS-DQM60 - Organisation Identifier (code of specialised responsible commissioner) - Group Session
• MHS-DQM61 - Organisation Identifier (code of specialised responsible commissioner) - Hospital Provider Spell Commissioner Assignment Period
• MHS-DQM62 - Organisation Identifier (code of specialised responsible commissioner) - Exceptional Package of Care

These look at specialised commissioning region and provider collaborative codes in the ORGANISATION IDENTIFIER (CODE OF COMMISSIONER) data item.

From Performance December 2021 onwards, 13 new measures were added to the monthly release.  Six relate to community services, 5 relate to acute admissions with and without prior contact and 2 are additional breakdowns of existing metrics relating to contact.  These are:

• MHS32c - Referrals starting in the RP to community mental health services for adult and older adults with severe mental illness
• MHS57b - People discharged from a referral in the RP from community mental health services for adult and older adults with severe mental illness
• MHS23d - Open referrals at the end of the RP to community mental health services for adult and older adults with severe mental illness
• MHS29d - Contacts in the RP with community mental health services for adult and older adults with severe mental illness
• MHS30f - Attended contacts in the RP with community mental health services for adult and older adults with severe mental illness
• MHS30h - Attended contacts in the RP by consultation medium
• MHS29f - Care contacts by Attended / did not attend code
• MHS106 - Adult and older adult acute admissions in the reporting period (this is based on a 3 month rolling RP)
• MHS106a - Adult and older adult acute admissions for patients with contact in the prior year with mental health services, in the RP (this is based on a 3 month rolling RP)
• MHS106b - Adult and older adult acute admissions for patients with no contact in the prior year with mental health services, in the RP (this is based on a 3 month rolling RP)
• MHS107a - Percentage of adult and older adult acute admissions for patients with contact in the prior year with mental health services, in the RP (this is based on a 3 month rolling RP)
• MHS107b - Percentage of adult and older adult acute admissions for patients with no contact in the prior year with mental health services, in the RP (this is based on a 3 month rolling RP)
• MHS108 - Number of people accessing community mental health services for adults and older adults with serious mental illness who received 2 or more care contacts within the RP (this is based on a 12 month rolling RP).

From Performance June 2022 onwards, a new monthly CSV file has been made available under 'Resources' on the main monthly publication page - 'Mental Health Services Measures to support the Adult Social Care Outcome Framework CSV'.

This CSV file contains the following five measures, all of which already feature in the existing 'Mental Health Services Selected NHS England Measures' quarterly output (also known as 'Five Year Forward View'):

• AMH03e - People in contact with adult mental health services aged 18-69 at the end of the reporting period
• AMH14e - People in contact with adult mental health services aged 18-69 at the end of the reporting period in settled accommodation
• AMH14e% - Proportion of people in contact with adult mental health services aged 18-69 at the end of the reporting period in settled accommodation
• AMH17e - People in contact with adult mental health services aged 18-69 at the end of the reporting period in employment
• AMH17e% - Proportion of people in contact with adult mental health services aged 18-69 at the end of the reporting period in employment

Each measure contains the following breakdowns, most of which do not occur in the Five Year Forward View quarterly output.

• CASSR (Councils with Adult Social Services Responsibilities)
• CASSR;Gender
• CASSR;Provider
• CASSR;Provider;Gender
• England
• England;Gender
• Provider
• Provider;Gender

Further information on the Adult Social Care Outcomes Framework is available here.

From Performance May 2022 onwards, additional breakdowns (specified in italics) have been made available within each of the following five measures:

• MHS29a  - Contacts with perinatal MH team in the Reporting Period
  • England; Attendance
  • CCG - GP Practice or Residence; Attendance
  • Provider; Attendance

• MHS29d - Contacts in the RP with community mental health services for adult and older adults with severe mental illness
  • England; Attendance
  • CCG - GP Practice or Residence; Attendance
  • Provider; Attendance

• MHS30a - Attended contacts with perinatal MH team in Reporting Period
  • England; Consultant Mechanism
  • CCG - GP Practice or Residence; Consultant Mechanism
  • Provider;  Consultant Mechanism

• MHS30f - Attended contacts in the RP with community mental health services for adult and older adults with severe mental illness
  • England; Consultant Mechanism
  • CCG - GP Practice or Residence; Consultant Mechanism
  • Provider;  Consultant Mechanism

• MHS91 - Perinatal Access showing the number of people in contact with Specialist Perinatal Mental Health Community Services (12 month rolling)
  • England; Ethnicity

From Performance May 2022 onwards, the following additional demographic breakdowns will be added to the Restrictive Interventions CSV file

• England; Restrictive Intervention Type; Age Group; Upper Ethnicity
• England; Restrictive Intervention Type; Gender; Lower Ethnicity
• England; Restrictive Intervention Type; Gender; Upper Ethnicity

These will not be added to the Restrictive Interventions dashboard as the dashboard reports on single demographics only.

The Specialised Service Type breakdown has also been amended to now include "Non-specialised Service", "No associated Ward Stay" and "Invalid Specialised Code used".

From Performance April 2022 onwards, additional demographic breakdowns which include:

• Accommodation Type
• Age
• Disability
• Employment Status
• Ethnicity
• Gender
• IMD Decile
• Sexual Orientation

have been published for the following selected measures

• MHS01 - People in contact with mental health services at the end of the RP
• MHS07 - People with an open hospital spell at the end of the RP
• MHS29 - Contacts in the RP
• MHS32 - Referrals starting in the RP   (this is the version of MHS32 based on a one month reporting period rather than three months).

From Final September 2021 onwards, 3 new measures were added to the monthly release.  These are:

• MHS27a - Admissions to hospital in the RP by Hospital Bed Type
• MHS32d - Referrals starting in the RP to specialist perinatal Mental Health services
• MHS57c - People discharged from a referral in the RP from specialist perinatal Mental Health services

From Performance May 2022 onwards, the methodology for each of the following measures:

• MHS29d - Contacts in the RP with community mental health services for adult and older adults with severe mental illness
• MHS30f - Attended contacts in the RP with community mental health services for adult and older adults with severe mental illness

has been improved to align with other care contact measures for consistency. 

At national level, the change in methodology results in a 3.1% decrease for MHS29d and a 3.2% decrease for MHS30f.

From Performance April 2022 onwards, the methodology underpinning construction of the restrictive interventions measures has changed.  This was necessary due to the changes within the restrictive interventions dataset tables introduced in MHSDS v5.  The methodological change review involving NHS England, CQC and NHS Digital resulted in an agreed new methodology to calculate the existing set of measures.

For further details, please refer to the Announcement of methodological changes to the Restrictive Intervention Statistics published on 29 June 2022 as well as the the metadata file.

Please also note there is a known DQ issue affecting MHSDS v5 data (October 2021 data onwards) allowing providers to submit restrictive intervention ‘incident’ data to the MHS505 table without specifying a corresponding restrictive intervention ‘type’ in the MHS515 table.

Incident data which does note have the corresponding restrictive intervention ‘type’ data is not counted as part of our current restrictive intervention measures, as these currently only use data from the MHS515 table.

We are working with providers to resolve this issue.

The move to MHSDS version 5 from the October 2021 reporting period onwards brings with it changes to the dataset, and the construction of some metrics has changed as a result.  In particular, the way in which contacts are reported has changed to allow a more detailed view of how patients interact with services.  Some of the codes used in version 4.1 are now invalid yet continue to flow, and this has caused issues with metrics which used these fields such as the CYP access measures, as well as measures which show a breakdown by Consultation Mechanism.

Additionally, changes have been made to the way in which the Clinical Response Priority for referrals is reported.  A new code for ‘Very Urgent referrals’ has been added, and this is now used in the methodology of metrics which use this field.

Furthermore, where a code was previously valid in version 4.1 but is no longer valid in version 5, NHS Digital has contacted providers to try and ensure that future submissions of the dataset are rectified to only include codes that are valid. This is particularly in relation to the Consultation Mechanism for care contacts and the service or team type referred to for referrals.

Full details of the changes to the dataset are available in the Technical Output Specification.