Mental Health Services Monthly Statistics, Provisional October, Provisional November 2021

From September 2021 Final 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

Full details of these are available in the associated Metadata file.

From Performance June 2021 onwards, 14 Perinatal measures have been added that provide further analysis of women in contact with mental health services who are new or expectant mothers. These measures will be refreshed on a quarterly basis, and look in more detail at mothers accessing services between their antenatal booking appointment and 24 months. The analysis also looks at those accessing services between 12 and 24 months post pregnancy for the first time. This includes those who are either new to services or continuing with services. Addition breakdowns now include by Indices of Multiple Deprivation (IMD):

• PMH23b - Number of people aged 16 or over in the period between booking and 24 months post pregnancy in the reporting period
• PMH24b - Number of people aged 16 or over in the period between booking and 24 months post pregnancy with a mental health referral open in in the reporting period and during the perinatal period
• PMH25b - Number of people aged 16 or over in the period between 12 and 24 months post pregnancy who are continuing with services with a mental health referral open in in the reporting period and during the perinatal period
• PMH26b - Number of people aged 16 or over in the period between 12 and 24 months post pregnancy who are new to services with a mental health referral open in in the reporting period and during the perinatal period
• PMH27a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between booking and 24 months post pregnancy
• PMH28a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are continuing with services
• PMH29a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are new to services
• PMH30a - Number of maternities for people aged 16 or over in the period between booking and 24 months post pregnancy in the reporting period
• PMH31a - Number of maternities for people aged 16 or over in the period between booking and 24 months post pregnancy with a mental health referral open in in the reporting period and during the perinatal period
• PMH32a - Number of maternities for people aged 16 or over in the period between 12 and 24 months post pregnancy who are continuing with services with a mental health referral open in in the reporting period and during the perinatal period
• PMH33a - Number of maternities for people aged 16 or over in the period between 12 and 24 months post pregnancy who are new to services with a mental health referral open in in the reporting period and during the perinatal period
• PMH34a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between booking and 24 months post pregnancy
• PMH35a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are continuing with services
• PMH36a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are new to services

As part of an improvement initiative, the two existing Restrictive Interventions measures:

• MHS76 - Number of people subject to restrictive intervention
• MHS77 - Number of restrictive interventions

have now been supplemented by four new measures

• MHS96 - Restraints per 1,000 occupied bed days in Reporting Period
• MHS97 - Percentage of people in hospital subject to restrictive intervention in Reporting Period
• MHS98 - Average Minutes of restraint in Reporting Period
• MHS99 - Maximum Minutes of restraint in Reporting Period

These are available in a new standalone csv file from Performance April 2021 onwards. This file also contains many new breakdowns for the two longstanding measures, MHS76 and MHS77.  These are listed in the Mental Health Services publications list.

In addition, a new interactive report based on these new measures has been made available on the Mental Health data hub.  This allows users to further explore this data.

Unlike the longstanding Restrictive Interventions measures for which both Performance and Provisional files exist, these new measures are currently available for Performance only.  

As of July 2021 Performance, the legacy csv files and legacy interactive report have been discontinued, and are replaced by the new standalone csv file and new interactive report.

Please 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.

These statistics have been produced by both NHS Digital and NHS England and as such are dual-badged.  NHS Digital has worked with NHS England in assuring the statistics before they are published here.

From Performance June 2021 onwards, 12 length of stay measures were added to the monthly release.  The measures are related to people being discharged from adult acute and older adult acute beds as well as those being discharged aged 0 to 17. These metrics also include a rate of people discharged per 100,000 at CCG level:

• MHS100 - The number of people discharged in the RP from adult acute beds aged 18 to 64 with a length of stay of 60+ days
• MHS100a - Rate of people discharged per 100,000 in the RP from adult acute beds aged 18 to 64 with a length of stay of 60+ days
• MHS101 - The number of people discharged in the RP from adult acute beds aged 18 to 64 with a length of stay of 90+ days
• MHS101a - Rate of people discharged per 100,000 in the RP from adult acute beds aged 18 to 64 with a length of stay of 90+ days
• MHS102 - The number of people discharged in the RP from older adult acute beds aged 65+ with a length of stay of 60+ days
• MHS102a - Rate of people discharged per 100,000 in the RP from older adult acute beds aged 65 and over with a length of stay of 60+ days
• MHS103 - The number of people discharged in the RP from older adult acute beds aged 65+ with a length of stay of 90+ days
• MHS103a - Rate of people discharged per 100,000 in the RP from older adult acute beds aged 65 and over with a length of stay of 90+ days
• MHS104 - The number of people discharged in the RP aged between 0 and 17 with a length of stay of 60+ days
• MHS104a - Rate of people discharged per 100,000 in the RP aged 0 to 17 with a length of stay of 60+ days
• MHS105 - The number of people discharged in the RP aged between 0 and 17 with a length of stay of 90+ days
• MHS105a - Rate of people discharged per 100,000 in the RP aged 0 to 17 with a length of stay of 90+ days

From Performance June 2021 onwards, three Early Intervention in Psychosis (EIP) measures were added to the monthly release. These measures are related to EIP caseload and how many of these have NICE concordant SNOMED codes or any other SNOMED codes associated with their referral. These metrics use NHSE methodology:

• EIP68 - EIP Caseload (Number of Referrals open to EIP services with at least one attended contact at the end of the reporting period)
• EIP69a - Number of open Referrals with any valid SNOMED-CT activity submitted that were linked to an EIP team in the reporting period
• EIP69b - Number of open Referrals with any NICE concordant EIP SNOMED-CT activity submitted that were linked to an EIP team in the reporting period

There are five new MHSDS monthly statistics that have been introduced from Final March 2021 onwards. These measures will be refreshed on a monthly basis and have been produced by both NHS Digital and NHS England.  As such, they are dual-badged.  NHS Digital has worked with NHS England in assuring the statistics before they are published here. These five new statistics are:

• MHS91 Number of people in contact with Specialist Perinatal Mental Health Community Services (12 month rolling)

• MHS92 Closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days and a paired score

• MHS93 Closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days

• MHS94 Percentage of closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days and a paired score

• MHS95 Number of children and young people aged under 18 supported through NHS funded mental health with at least one contact (12 month rolling)

The methodologies for the construction of each measure is available in the associated Metadata Tab. The key difference to consider when using the statistics listed above is the methodology for assigning Clinical Commissioning Group (CCG) to activity; a brief explanation of the different methodologies is presented below and any CCG level statistics should be used with consideration of these differences. For the above statistics, the NHS England methodology for assigning CCGs has been adopted.

• NHS Digital – the CCG is assigned to activity based on the most recent information about an individual and, as such, activity measured will be attributed to a single CCG. The CCG methodology also assigns a CCG based on the CCG of GP Practice or Residence.

• NHS England – the CCG is assigned to activity based on the information available at the time of activity and, as such, activity measured may be attributed to multiple CCGs. The CCG methodology is based on CCG of Residence only.

• The statistics listed above includes data for residents in England only.

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 and the updated constructions for all measures in this publication are available in the metadata file.

From Performance June 2021 onwards a new methodology has been introduced for MHS95 (number of CYP aged under 18 supported through NHS funded mental health with at least one contact (12 month rolling)) see the methodology section below.  This methodology has also been used to refresh the metric values published from March 2021 onwards.

From Performance June 2021 onwards the CYP Eating Disorder metrics ED85 to ED90 (and their breakdowns) have been incorporated into the main monthly file and no longer appear as a standalone file in the publication:

• ED85 - Referrals with eating disorder issues entering treatment in RP, aged 0-18
• ED86 - Referrals with eating disorder issues categorised as urgent entering treatment in RP, aged 0-18
• ED87 - Referrals eating disorder issues categorised as routine entering treatment in RP, aged 0-18
• ED88 - Referrals with eating disorder issues waiting for treatment at end of RP, aged 0-18
• ED89 - Referrals with eating disorder issues categorized as urgent waiting for treatment end RP, aged 0-18
• ED90 - Referrals with eating disorder issues categorized as routine waiting for treatment end RP, aged 0-18

With the publication of the Community Mental Health Framework, CPA has now been superseded nationally.  As such, measures relating to CPA have been removed from all MHSDS outputs from April 2021 data onwards.  These measures include:

• MHS02 - People on CPA at the end of the reporting period
• AMH02 - People in contact with adult mental health services on CPA at the end of the reporting period
• AMH03 - People on CPA aged 18-69 at the end of the reporting period (adult mental health services only)
• AMH04 - People in contact with adult mental health services CPA at the end of the reporting period with HoNOS recorded
• AMH05 - People on CPA for 12 months at the end of the reporting period (adult mental health services only)
• AMH06 - People on CPA for 12 months with review at the end of the reporting period (adult mental health services only)
• AMH14 - People aged 18-69 on CPA at the end of the reporting period in settled accommodation (adult mental health services)
• AMH15 - Proportion of people aged 18 to 69 on CPA at the end of the reporting period in settled accommodation (adult mental health services)
• AMH17 - People aged 18-69 on CPA (adult mental health services) at the end of the reporting period in employment.
• AMH18 - Proportion of people aged 18 to 69 on CPA (adult mental health services) at the end of the reporting period in employment
• ACC02 - The number of people on Care Programme Approach (CPA) at the end of the reporting period with an associated Care Cluster open at the end of the reporting period with a valid Adult Mental Health Care Cluster Code (Final) recorded
• ACC53 - The proportion of people on Care Programme Approach (CPA) at the end of the reporting period with an associated Care Cluster open at the end of the reporting period with a valid Adult Mental Health Care Cluster Code (Final) recorded
• CYP02 - People in contact with children and young people's mental health services on CPA at the end of the reporting period

Number of changes to CCGs were made operationally effective from 1 April 2021. These changes included 38 former CCGs merging to form 9 new CCGs.

The Organisation Data Service (ODS) is responsible for publishing organisation and practitioner codes, along with related national policies and standards.

An error has been found in the Early Intervention in Psychosis (EIP) and Children’s Eating Disorders (ED) metrics. The error means that version 4.1 data is being evaluated using version 5 criteria, and as such, activity from September 2021 or earlier that forms part of the pathway and is valid under version 4.1 but not under version 5 has been wrongly excluded from the calculation of the metric. 

This impacts published Performance data for October 2021 to February 2022. 

The error has been corrected for the March 2022 Final data published on 9 June 2022.  It has also been corrected in the ‘End of Year Final’ data for each month between October 2021 and February 2022, published on each of the relevant monthly publication pages on 14 July 2022.

Neither Performance nor Provisional data for October 2021 to February 2022 will be corrected, as these data have now been superseded by the corrected ‘End of Year Final’ monthly data.

When comparing uncorrected and corrected versions of March 2022 Final data, the impact of this error at national level was found to be small.

• For count-based eating disorder metrics, the average change is a decrease of 0.8%, with the metric ED87d (Referrals with eating disorder issues categorised as routine entering treatment after 12 weeks, in RP, aged 0-18) showing the greatest change with a decrease of 4.0%.
• For count-based EIP metrics, the average national change is a decrease of 0.3%, with EIP65a (Referrals not on EIP pathway, Receiving a first contact and assigned a care co-ordinator with any team more than two weeks after referral aged 0 to 17) showing the greatest change, a decrease of 4.8%. 

When comparing uncorrected Performance data with corrected Final data for each month between October 2021 and February 2022:

• The average percentage change in the count-based eating disorder metrics varied between a decrease of 0.5% (February 2022 Performance vs February 2022 Final) and an increase of 5.4% (November 2021 Performance vs November 2021 Final).  The average of the average percentage changes across the 5 months was 3.1%.
• The average percentage change in the count-based EIP metrics varied between an increase of 2.8% (November 2021 Performance vs November 2021 Final) and an increase of 6.5% (December 2021 Performance vs December 2021 Final).  The average of the average percentage changes across the 5 months was 4.4%.

The latter set of comparisons are not on a comparable basis with the former.  This is because for the former, the change is due exclusively to the correction of the error whilst for the latter, a proportion of the change is due to the correction of the error, and a proportion is due to the submission of new or revised data as part of the Multiple Submission Window Model (MSWM).  The MSWM typically experiences a significant increase in activity at the end of the financial year, and this may have been exacerbated in 2021/22 due to the mid-year MHSDS version change.