Sources of Data
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Prevalence of Common Mental Health Problems: Survey of Psychiatric Morbidity Among Adults Living in Private Households (1993 and 2000)
The Survey of Psychiatric Morbidity Among Adults Living in Private Households is generally regarded as providing the best available data about the rates of common mental health problems, their treatment and impact on sufferers. The surveys have been carried out on two occasions, in 1993 and 2000, and include large samples (9,450 and 8,580 respectively).
The 1993 findings included associated surveys of adults living in institutions and homeless adults. The 2000 survey describes the prevalence of a range of mental disorders, including personality disorder, in the general household population. It also considers the changing prevalence of some of these disorders since the 1993 survey. It describes how people with particular disorders differ from those without any disorder on a range of factors: their background and personal characteristics, including employment and accommodation, physical health, current treatment and service use.
A report, comparing findings from 1993 and 2000 surveys, is available for downloading.
Survey findings have been applied to the East Midlands population and are presented in the report Profile of Mental Health in the East Midlands, 2006:
The Health Survey for England
The Health Survey for England (HSE) covers adults aged 16 and over and children aged 2 to 15 years. The survey is carried out annually and results for 2004 have recently been published. Measurements relevant to mental health include the prevalence of psychological well-being of children (assessed by the SDQ and GHQ questionnaires) and prevalence of reporting of long standing mental illness. Data on perceived stress and availability of social support are also available.
Selected HSE findings have been applied to the East Midlands population and are presented in the report, Profile of Mental Health in the East Midlands, 2006.
Attitudes to mental illness in England 2007
This is the most recent survey of people's attitudes to mental illness. The previous survey was conducted in 2003. The surveys act as a tracking mechanism, and in each report the most recent results are compared with those from the earlier surveys. The general public in England is still relatively understanding about mental illness:
- Nearly 9 out of 10 think those with mental health problems deserve our sympathy
- More than 4 out of 5 think society needs to be more tolerant towards mentally-ill people
- 9 out of 10 believe society has a responsibility to provide the best possible care
- Nearly 4 out of 5 disagree with the idea that people with mental health problems are a burden on society.
Mental Illness Needs Index (MINI)
MINI was designed to predict the distribution of mental health problems at small area level. It was developed by statistical modelling using hospital admissions as dependent variables and nationally available, ward level data about population characteristics as predictor variables. The latest version (MINI2000) uses 1998 admission data for England, with component variables from the Index of Multiple Deprivation, and the ONS Area Classification. MINI2000 produces predicted numbers and rates of admissions for both PCTs and local authorities.
MINI2000 data for the East Midlands population have been extracted and are presented in the report Profile of Mental Health in the East Midlands, 2006:
Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC)
EMPIRIC was the first major national study designed to provide detailed data about mental health problems in ethnic minority members of the population. It was conducted alongside the Survey of Psychiatric Morbidity Among Adults Living in Private Households (2000) and included individuals aged 16 to 74 identified from the Health Survey for England as belonging to one of five specific ethnic groups: Black-Caribbean, Indian, Pakistani, Bangladeshi and Irish. It investigated common and severe mental disorders, use of services, social support and the personal meaning of symptoms and their context.
In relation to common mental health problems, the survey findings were complex but generally suggested that there was little difference in prevalence rates between the minority ethnic groups and the white population. Specific group differences showed that Irish men and Pakistani women had higher rates, while Bangladeshi women had lower rates. However, evidence from the somatic symptoms of distress and lack of positive responses to wider psychological questions suggested that rates of common mental illnesses in Bangladeshi men and South Asian women may have been underestimated. While social factors commonly associated with mental ill health were widely prevalent, particularly in the Bangladeshi group, the link between these and illness seemed weaker than in the general population surveys.
In relation to severe mental health problems, significant variations were found. Black Caribbean people showed a two-fold excess. Pakistanis had a 60% higher, and Bangladeshis a 25% lower rate, both with no apparent gender difference. Irish people showed similar rates to the white population, though with a greater concentration in younger people.
Mental Health Service Mapping
The systematic mapping of mental health services for adults of working age in England has been carried out by the Durham University Mapping Team (based in the Centre for Public Mental Health) since 2000. It was developed to contribute to monitoring the implementation of the mental health national service framework (NSF) and has been adopted by the Department of Health as an exercise to provide regularly updated data on service provision. In recent years, the mapping has also been used as a source of data for measurement of progress against Public Service Agreement (PSA) targets by both the Department of Health and the Healthcare Commission. Data collection for 2005 is currently underway, and will be completed in March 2006.
The main features of the mapping include:
- Holistic approach to mental health provision to ensure inclusion of health, social services, voluntary and private sector services
- Data collection at the level of individual services. For every service information is collected on service type, location, targeting, capacity and staff
- Emphasis on geographical location generating reports for LITs, PCTs, SHA, local authorities and NHS provider trusts
- Data collected and maintained on the Internet on the Durham University website.
- LIT Leads provided with secure access to their LIT data for revision purposes
- Permanent open access to the database and reports of findings for all web users.
Results can be reported by LIT, PCT, SHA, Trust or Local Authority. The data are very flexible and have a wide range of possible uses, for example:
- comparing profiles of care between areas
- identifying all services of a particular type
- identifying the range of availability of a particular service type
- examining patterns of staff deployment
Data extracted from the Service Mapping Atlas, showing the availability if a range of treatment facilities for people with severe mental health problems in the East Midlands, are presented in the report Profile of Mental Health in the East Midlands, 2006.
Hospital Episode Statistics (HES)
HES provides information on admitted patient care delivered by NHS hospitals in England from 1989 onwards. Each financial year around 12 million records for inpatients and day cases are generated containing data such as age, sex, dates of admission and discharge, diagnoses and operations and procedures.
Although comprehensive, HES data are of limited usefulness in understanding mental health care as only a small proportion of people who experience mental health problems are admitted to inpatient care.
Mental Health Minimum Data Set (MHMDS)
All providers of specialist mental health services for adults and older adults in England have been required to collect the Mental Health Minimum Data Set (MHMDS) since 1 April 2003. The MHMDS was developed to improve information on mental health services usage and need. The data set describes the care received by service users during an overall spell of care. It is person-centered so that all the care received by individuals can be studied, and includes details of clinical problems, treatments given, outline aspects of social care and outcomes. Geographic markers allow analysis by any type of health, GP or local authority administrative categories.
Uses for PCTs
The MHMDS gives PCT's a more detailed understanding of the services they commission. It supports detailed, population bases analysis of who is using mental health services, and what care packages they are getting. This can be related to GP lists, small areas of the PCT, such as electoral wards, or even mapped by the service users places of residence. PCT's can use this source to compare the care their population is using with that received by similar populations in other areas. In their role of service developers, data can be used to identify areas in need of particular developments.
Uses for Trusts
The MHMDS is designed to support local clinical audit. A number of national benchmarks are likely to be based on it, including readmission, follow up after hospital discharge, and the use of new specialist teams. The data can also give detailed breakdowns of areas of heavy service demand, or apparently inefficient practice.
Uses for Strategic Health Authorities
The MHMDS provides the first source of data to give a detailed picture of clinical work in mental health care on a comparable basis across areas served by more than one Trust and several PCT's and social services authorities. This is valuable for strategic planning and performance management.
Uses for Local Government
The MHMDS provides some information about people receiving help from local government about mental health problems, however it is restricted to those who are also using specialist NHS services. Among these, if CPA records are accurate and complete, it can show the profile of people using all types of social care and being treated under compulsion.
Research Perspective
Most research projects study relatively small samples of patients in great depth. The MHMDS can provide a sampling frame of all the patients of a Trust, and show how sample members relate to this. It can provide detail, including chronological patterns, of the care activity received by patients, to which special recordings of treatments, outcome and user-satisfaction assessments can be added. Nationally it will be able to indicate the numbers and distribution of patients for whom new treatment approaches are applicable.
Count me in: a national census of inpatients in mental health hospitals and facilities in England and Wales 2005
This census was intended primarily to:
- obtain reliable information about the number of inpatients using mental health services on March 31st 2005
- encourage all providers of mental health services to have accurate, comprehensive and sustainable procedures for collecting, recording and monitoring ethnicity that will enable them to collect data of a high quality on the ethnicity of inpatients
Information was collected concerning 33,828 inpatients in 212 NHS and independent
sector organisations in England and Wales, which equates to approximately 99% of all inpatients eligible for inclusion in the census.
Ethnic origin was recorded for 98.7% of inpatients covered by the census. Overall, 79% of inpatients were White British and 19% were from black and minority ethnic groups. Nine per cent of those from black and minority ethnic groups were Black Caribbean, Black African, Other Black or White/Black Mixed, 3% were Other
White, 3% were Asian, 2% were Irish, and 3% were from other ethnic groups (including Chinese).