Mental Healthcare: A New Challenge for the NHS

Across the UK, NHS Trusts are facing unprecedented demand for mental health services. Karina Malhotra, Managing Director and Founder of Acumentice explores what is driving this rise, how the NHS is responding, and what more can be done to reduce waiting times.

NHS bosses recently confirmed that 1.4 million people have been left waiting for mental health care across England during the pandemic. The Independent newspaper reported in December that NHS mental health services were facing huge challenges, with hundreds of patients waiting over 12 hours in A&E. Almost all mental health hospitals in London were at Black Alert levels of bed availability during October and November 2021, meaning their wards were virtually full. A similar picture was painted across the rest of the UK.

Referrals to mental health crisis services have increased by 75 percent since the spring of 2020. In London, thousands of mental health patients attended A&E every week in the three months covering September to November 2021. Up to 50 patients per week were waiting more than 12 hours for a bed, compared with 35 during the same period in 2020. 

Demand drivers

We do not have to look far to find the main driver for demand; there is a clear and obvious link between covid and demand for mental health services. Bereavement, isolation, loss of income and fear are all factors that may trigger mental health conditions or exacerbate existing ones.

In England, the number of adults experiencing some form of depression has doubled since the start of the pandemic. More alarmingly, cases of psychosis also rose significantly in England, according to NHS data. The number of people referred to mental health services for their first suspected episode of psychosis increased by more than 29 per cent between April 2019 and April 2021, as highlighted in analysis by the charity Rethink Mental Illness.

Furthermore, a record number of young people have been referred to mental health services, according to analysis of NHS data by the Royal College of Psychiatrists. It found that annual referrals for children and young people were nearly double the levels seen before the covid pandemic.

More than 190,200 people aged 18 and under were referred to mental health services between April and June 2021, up 134 per cent on the same period in 2020 (81,170) and 96 per cent on 2019 (97,342). 8,552 children and young people were referred for urgent or emergency crisis care between April and June this year, up 80 per cent on the same period in 2020 (4,741) and up 64 per cent on 2019 (5,219). In total, 340,694 children were in contact with children and young people’s mental health services at the end of June, up 25 per cent on the same month last year (272,529) and up 51 per cent on June 2019 (225,480). 

The Health Foundation has estimated that the additional demand for mental health services as a result of the pandemic will cost from £1.6bn to £3.6bn over the next three to five years. However, this figure does not include primary care and other NHS services, that people with mental health issues also need access to.

NHS response

The NHS has commendably responded by treating record numbers of people. More people got a full course of NHS talking therapy treatment last year than ever before, despite the pressure on services from the pandemic.

Data from the NHS England’s Improving Access to Talking Therapies (IAPT) programme shows that a record 634,649 people completed the NHS Talking Therapy programme in 2020/21, up around 5 per cent on the 606,192 in the year before. It also found that more than half of people completing a course of treatment for conditions including depression and anxiety recovered from their condition. In line with the findings above, the data showed that a large proportion of referrals occurred after the first national lockdown.

In December, NHS chief Amanda Pritchard announced that NHS mental health crisis support lines, which were fast-tracked during the pandemic, were fielding between 180-200,000 calls per month with less than 2 per cent of calls resulting in A&E attendance.

Yet, this increase in provision of 5 per cent is being significantly outpaced by soaring demand. All this adds up to larger waiting lists and longer waiting times for many patients. In turn, this leads to increased pressure on mental health crisis services.

Trusts are facing the prospect of unmanageable waiting lists. They need new ways of looking at how they manage waiting times as their waiting lists grow. Effective action should include recording and accurately managing information about their service users so that they can properly prioritise, assess risk, and plan capacity. 

Elective model

The good news is that mental health service providers do not have to reinvent the wheel in order to address this challenge. A great example can already be found in elective care, which has a long track record of addressing similar, and unprecedented, pressures on services. Could implementing a similar approach, using similar methods, deliver the same benefits for mental health services as it has for elective care?

Currently, mental health services have access to huge amounts of data, sometimes from various platforms or systems, but with no proper tools to analyse it. Without a true understanding of the data, it becomes virtually impossible to implement effective change. 

At Acumentice, we understand the complexities and challenges of waiting list management across elective healthcare. By combining data analytics tools, AI and our expertise, we support the design of best practice elective care recovery programmes, delivering clear solutions that enable Trusts and CCGs to effectively manage patient backlogs and increased demand for elective care services and can apply this experience to support Mental Health Trusts effectively manage their waiting lists. 

For example, by helping mental health providers to create a PTL that consistently records, monitors and reports whole pathway waits, the collaboration that will be required by ICSs is met effectively, as well as providing the foundations for multiple Trusts and organisations to combat the challenges presented by increased demand. The outcome is improved patient experience, safety and access to care, as well as providing a more integrated, patient-centric experience.

From our work in elective care, we have learned that data insights can inform patient outcomes by capturing individual patient circumstances. This information can support the NHS to effectively prioritise patients, as well as enable safe booking strategies. It is also vital that any technological solution that is used in the NHS must be able to integrate with existing systems.

There are clear parallels in our experience with waiting lists in elective care and the opportunities to use similar, data-led insights to improve waiting times and outcomes for mental health service users. At Acumentice, we know that the key to successful collation and use of data is collaboration. You need specialists with the right skills and expertise to help you plan and implement a solution that delivers the best possible patient outcomes in a cost-effective and time-effective way that won’t add pressure on an already stretched workforce. 

By working in partnership, we are keen to support the NHS through this challenge, so that it can focus its limited time and resource in the best way possible, in tackling the increased demand on services, for patients.

Find out more at www.acumentice.co.uk