Sarah Markham: Tracking trends in mental health provision to improve outcomes

New publicly available data tool: Mental Health Watch, is already helping to identify issues in mental health provision on a local and national level, says Sarah Markham

Mental Health Watch is a new tool from the Royal College of Psychiatrists, the purpose of which is to provide information demonstrating how well the mental health system in England is performing. The website has been designed to track trends and progress in mental health care provision in Clinical Commissioning Groups, at STP level, or nationally, and to measure the performance of mental health services against government targets. Users can browse up to 25 indicators, divided into six themesaccess, care, finance, leadership, quality, and workforce. The data itself is drawn from NHS England’s quarterly dashboard and includes information from the NHS Staff Survey, Care Quality Commission, NHS Improvement and Open Prescribing.

As a long-term user of a variety of mental health services, I think the tool is a great innovation. It is straightforward to use and I think that patients and carers will find it informative and potentially empowering. People can use it to determine service provision in their local and other areas to identify unmet needs. The information from the website, including charts, can be downloaded and shared on social media to raise awareness of local services. People are also encouraged to tell their MP about the tool and how it can be used to make the case for better care locally, which could be useful in terms of holding the system to account.

It would be great if data and information from the national clinical audits relating to mental health, such as the National Anxiety and Depression Audit, and from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) could be included in further iterations of the tool.

A recent news story in The BMJ reports a rise in out of area mental health placements (OAPs), which is based on data from the Mental Health Watch website. The article criticises seven NHS trusts which made up more than half of all inappropriate OAPs for acute mental health inpatients’ care between December 2018 and February 2019. The objection against OAPs is understandable; patients are placed in units outside of their local services, normally away from their family and care coordinator. Being in hospital in any circumstance can be an isolating and upsetting experience, potentially much more so, if you are suffering from the stress and distress of a mental health condition. At such times you need your friends and family to be able to visit you, something which can be difficult if you have been placed far from home.

Mental Health Watch is already demonstrating its value by highlighting inequities in national mental health provision.

However there is one small note of caution with regard to what is undoubtedly a very important issue. In my experience as a patient and from talking to other patients, NHS Trusts do what they can to keep patients in local areas, especially as this is often the cheapest option. Although the tool can be used to provide data about OAPs, it doesn’t necessarily provide the full picture. For example, I am aware that the closure of the women’s secure and forensic services at Ashworth and Broadmoor, which was hailed as a triumph at the time, has created increased pressure on beds available in WEMSS (Women’s Enhanced Medium Secure Services) and this may have increased the number of out of area placements for women forensic patients. This serves to illustrate that sometimes the cause of high numbers of OAPs may stem from causes external to the mental health trusts themselves.

I agree that it is important to support trusts to reduce the number of OAPs, but am concerned that such an emphasis may obscure the fact that, as highlighted by the Independent Review of the MHA 2018, regardless of whether you are placed in or out of area, in general, patients’ experience of detention for assessment, treatment, and care is poor and needs to be improved.

Sarah Markham is an academic mathematician and patient representative currently pursuing a second PhD in theoretical computer science. She is a member of the BMJ Patient Advisory Panel.
Twitter: @DrSMarkham

Competing interests: None declared.