What progress are we making to transform our population’s mental health?

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at the National Institute for Health and Care Excellence - NICE - provides her view of the newly published NICE impact report on mental health.

Mental health conditions are the largest single cause of disability in the UK, with one in 4 adults experiencing a mental health condition in any given year. Without proper support, care and advice from dedicated mental health services, some of the most vulnerable people in our society can face increasing difficulties in their lives. When left untreated, poor mental health can cause physical health problems as well - affecting people’s lives in many other ways, making it difficult for them to stay in work, keep fit and healthy and manage financially.   

NICE plays a key role in setting high standards for the care of people with mental health conditions. Since 2002 and the publication of NICE’s first guideline, which was on schizophrenia, we have published a large suite of 33 guidelines and 18 quality standards to support the identification and management of common and severe mental health conditions in children, young people and adults.

To highlight how NICE’s recommendations are being implemented to improve mental health in England, we have published a new mental health impact report. The report shows where significant improvements in mental health care and services are being made, as well as identifying where more progress is needed.

One key area the report focuses on is how we are tackling common mental health disorders such as depression and anxiety disorders by improving access to NICE-recommended psychological therapies. Our report highlights the positive impact of NHS England’s Improving Access to Psychological Therapies (IAPT) programme, which launched in 2008, with the aim of transforming the treatment of adult anxiety disorders and depression in England.

The programme has proved a success with data showing that the number of people who accessed NICE-recommended psychological therapies through IAPT has more than doubled from 435,000 in 2012/13 to over 1 million in 2017/18. NHS England is now working to expand the programme’s services further to enable at least 1.5 million adults each year to access NICE-recommended care by 2020/21.

This is great news and shows we are moving in the right direction, but there is still more work to be done.

For example, our impact report also draws attention to inequalities for black, Asian and other minority ethnic groups (BAME) accessing psychological therapies. Recent data shows that rates of IAPT treatment completion and recovery vary by ethnicity. In 2017/18, around 43% of all people referred to IAPT went on to complete treatment. But, for people from black, Asian or other minority groups who were referred, only around 37% completed treatment and recovery rates were poorer.

To help address this problem, NHS England’s Quality Premium, which rewards Clinical Commissioning Groups (CCGs) for improvements in the quality of services they commission, introduced a focus on improving mental health outcomes for people from BAME groups in 2017. To meet their Quality Premium target, CCGs must show improvements in the recovery rate of people from black, Asian or other minority groups accessing IAPT services. Progress against this measure is now being tracked in the quarterly Mental Health Five Year Forward View Dashboard.

Eating disorders in children and young people is another important focus of our impact report. Eating disorders are serious mental health conditions which most commonly start in adolescence. They can have severe psychological, physical and social consequences. Early assessment and treatment of eating disorders is particularly important because people with eating disorders have better recovery rates and a reduced risk of relapse when they receive early intervention.

To improve rates of early intervention, NHS England’s eating disorders pathway and waiting time standard for children and young people was introduced in August 2015. The standard states that children and young people who are referred to eating disorder services should start treatment within 4 weeks, or within 1 week if the case is urgent. Our report shows that the standard has had a significant impact on the timely delivery of treatment. For example, in just over 2 years, from 2016, the percentage of children and young people who started treatment for their eating disorder within the recommended 4 weeks, increased from 65% to 80%.

It’s clear from the findings in our impact report that we are making some serious headway to transform the mental health of our population for the better. We have the guidance and systems in place to assess, treat and manage the vast array of mental health conditions that affect a great many people. But only an ongoing commitment to really step up this work will truly safeguard our nation and the future of our NHS from the impact of poor mental health and the potential complications it brings.

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