Introduction

Welcome to the Severe Mental Illness Profiling tool. It has been developed to support an intelligence driven approach to understanding and meeting need. It collates and analyses a wide range of publically available data on prevalence, risk, prevention, early intervention, assessment, treatment, outcomes and service costs. It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.

Tool structure - data are presented under the headings Risk and Related Factors, Prevalence, Services, Quality and Outcomes. Within this they are grouped by geography (Clinical Commissioning Group, Sustainability and Transformation Partnership, or local authority) and then ordered by topic (e.g. primary care followed by secondary care).

Tool content - data are drawn from many sources and vary by time period, population and presentation of values. Care should be taken with interpretation. Detailed meta data and any caveats are set out in the Definitions section.

June 2019 update

In this update the severe mental illness profile has been more closely aligned with other Public Health England fingertips profiles. This profile now uses the Red Amber Green or Purple Quintile indicator markers where possible to show where an indicator is better or worse than its bench mark. There are also the fingertips wide naming convention changes which ensures an indicator now has the same indicator name across all fingertips products to reduce the chances of ambiguity.

Psychosis Care Pathway

The Psychosis Care Pathway provides a high level summary using 15 key indicators to help users assess and benchmark how they manage this important condition. This pathway is consistent with and linked to the Commissioning for Value Psychosis packs to be published by NHS England.

Early Intervention in Psychosis Waiting Times

The Early Intervention in Psychosis Waiting Times data contains information on the number of people with first episode of psychosis who have accessed or are waiting for treatment.

The data collection is an interim aggregate experimental data collection which will run until data of sufficient quality are available from the Mental Health Services dataset (MHSDS).

 

Supporting Documents

Recent updates

August 2020

The following indicators have been removed:

Services domain

    • Adult acute mental health admissions: rate per 100,000 population aged 16-64
    • Adult acute mental health bed days: rate per 100,000 population aged 16-64
    • Older adult mental health admissions: rate per 100,000 population aged 65+
    • Older adult mental health bed days: rate per 100,000 population aged 65+
    • Contacts with Community Mental Health Teams: rate per 100,000 population aged 16+
    • Referrals received by Community Mental Health Teams: rate per 100,000 population aged 16+
    • Referrals received by Crisis Resolution and Home Treatment: rate per 100,000 population aged 16-64
    • Contacts delivered by Crisis Resolution and Home Treatment: rate per 100,000 population aged 16-64
    • Acute adult mental health beds: rate per 100,000 population aged 16-64
    • Community Mental Health Team caseload: rate per 100,000 population aged 16+ (snapshot)
    • Referrals accepted by Community Mental Health Teams: % of all referrals

Quality and Outcomes domain

    • Serious incidents: rate per 100,000 occupied bed days
    • Medication Incidents: rate per 100,000 occupied bed days
    • Use of restraint: rate per 100,000 occupied bed days
    • Complaints: rate per 100,000 occupied bed days
    • Adult acute readmissions: % readmissions within 30 days
    • Older adult readmissions: % readmissions within 30 days
    • Adult acute bed days lost to DTOC: % of bed days
    • Older adult bed days lost to DTOC: % of bed days
    • CMHT contacts which are face to face: % of all contacts
    • CRHT response: % of CRHT requests with response within 24 hours

January 2020

Thirty two indicators in Profile have been updated.

    • Seven indicators in the Psychosis pathways domain.
    • Two indicators in the Risk factors domain.
    • One indicator in the Prevalence domain.
    • Two indicators in the Services domain.
    • Twenty indicators in the Qualities and Outcomes domain

      September 2019

      Four indicators in the quality and outcomes domain.

      • Experience of access and waiting: overall patient experience score
      • Experience of safe, high quality, co-ordinated care: overall patient experience score
      • Experience of better information, more choice: overall patient experience score
      • Experience of building closer relationships: overall patient experience score

      Aug 2019

      Two indicators in the quality and outcomes domain.

      • Gate kept admissions: % (quarterly) admissions to acute wards that were gate kept by the CRHT teams
      • Follow up after discharge: % (quarterly) of patients on CPA
      • Delayed transfers of care due to NHS: Delayed Transfers of Care per 1,000 bed days
      • Delayed transfers of care due to social care: Delayed Transfers of Care per 1,000 bed days

      July 2019

      Indicator 93291 persons detained under Mental Heath Act is now also available for older persons (people over 65 + years)

      17 Quarterly indicators updated with the latest MHSDS data for Q4 2017/18

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

      June 2019

      RAG rating for all serious mental illness indicators has been added to align with other PHE indicators in fingertips.

      17 Quarterly indicators updated

       

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

      January 2019

      Updates 17 indicators updated

       

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

        December 2018

        27 new indicators updated using the latest MHSDS and QOF data

         

        Psychosis Pathway

        •Severe mental illness recorded prevalence (QOF): % of practice register (all ages)

        Risk and related factors

        •Learning disability QOF prevalence: % of people on GP practice registers

        Services

        •Contact with specialist mental health services: rate per 100,000 population aged 18+

        •People on Care Programme Approach (CPA): rate per 100,000 population aged 18+

        •Mental health admissions to hospital: rate per 100,000 population

        •People subject to Mental Health Act: rate per 100,000 population aged 18+

        •Persons detained under MHA: rate per 100,000 population

        •CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded

        •Mental health service users on Care Programme Approach: % of mental health service users

        •Service users in hospital: % of mental health service users

        Quality and outcomes

        •CPA adults in employment: % of people on CPA (aged 18-69)

        •Persons detained under MHA: proportion of people in contact with mental health services Stable and appropriate accommodation: % of people on CPA (aged 18-69)

        •Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

        •Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded

        •Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded

        •Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded

        •Service users with crisis plans: % of people in contact with mental health services

        •People with SMI who have comprehensive care plan: % of people with SMI

        •Patients on lithium therapy with record of serum creatinine and TSH: % with record in the preceding 9 months

        •Patients on lithium therapy with levels in therapeutic range: % within preceding 4 months

        •Exception rate for severe mental illness (SMI) QOF indicators: % of patients excluded from mental health quality indicators

        •Patients with SMI with alcohol consumption check: % with record in preceding 12 months

        •Female patients with SMI who had cervical screening test: % tested in preceding 5 years

        •Smokers on GP registers (certain conditions) offered cessation support and treatment: % within preceding 12 months

        •Staff training: % of staff receiving job-relevant training, learning or development in last 12 months

        •Staff health & safety training: % of staff receiving mandatory training in last 12 months

        •Staff witnessing potentially harmful errors, near misses or incidents: % staff witnessing in last month

        •Staff engagement: overall score

         

         

Recent updates

August 2020

The following indicators have been removed:

Services domain

    • Adult acute mental health admissions: rate per 100,000 population aged 16-64
    • Adult acute mental health bed days: rate per 100,000 population aged 16-64
    • Older adult mental health admissions: rate per 100,000 population aged 65+
    • Older adult mental health bed days: rate per 100,000 population aged 65+
    • Contacts with Community Mental Health Teams: rate per 100,000 population aged 16+
    • Referrals received by Community Mental Health Teams: rate per 100,000 population aged 16+
    • Referrals received by Crisis Resolution and Home Treatment: rate per 100,000 population aged 16-64
    • Contacts delivered by Crisis Resolution and Home Treatment: rate per 100,000 population aged 16-64
    • Acute adult mental health beds: rate per 100,000 population aged 16-64
    • Community Mental Health Team caseload: rate per 100,000 population aged 16+ (snapshot)
    • Referrals accepted by Community Mental Health Teams: % of all referrals

Quality and Outcomes domain

    • Serious incidents: rate per 100,000 occupied bed days
    • Medication Incidents: rate per 100,000 occupied bed days
    • Use of restraint: rate per 100,000 occupied bed days
    • Complaints: rate per 100,000 occupied bed days
    • Adult acute readmissions: % readmissions within 30 days
    • Older adult readmissions: % readmissions within 30 days
    • Adult acute bed days lost to DTOC: % of bed days
    • Older adult bed days lost to DTOC: % of bed days
    • CMHT contacts which are face to face: % of all contacts
    • CRHT response: % of CRHT requests with response within 24 hours

January 2020

Thirty two indicators in Profile have been updated.

    • Seven indicators in the Psychosis pathways domain.
    • Two indicators in the Risk factors domain.
    • One indicator in the Prevalence domain.
    • Two indicators in the Services domain.
    • Twenty indicators in the Qualities and Outcomes domain

      September 2019

      Four indicators in the quality and outcomes domain.

      • Experience of access and waiting: overall patient experience score
      • Experience of safe, high quality, co-ordinated care: overall patient experience score
      • Experience of better information, more choice: overall patient experience score
      • Experience of building closer relationships: overall patient experience score

      Aug 2019

      Two indicators in the quality and outcomes domain.

      • Gate kept admissions: % (quarterly) admissions to acute wards that were gate kept by the CRHT teams
      • Follow up after discharge: % (quarterly) of patients on CPA
      • Delayed transfers of care due to NHS: Delayed Transfers of Care per 1,000 bed days
      • Delayed transfers of care due to social care: Delayed Transfers of Care per 1,000 bed days

      July 2019

      Indicator 93291 persons detained under Mental Heath Act is now also available for older persons (people over 65 + years)

      17 Quarterly indicators updated with the latest MHSDS data for Q4 2017/18

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

      June 2019

      RAG rating for all serious mental illness indicators has been added to align with other PHE indicators in fingertips.

      17 Quarterly indicators updated

       

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

      January 2019

      Updates 17 indicators updated

       

      Quality and Outcomes

      • CPA adults in employment: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • Stable and appropriate accommodation: % of people on CPA (aged 18-69) (end of quarter snapshot)

      • CPA review: % of people on CPA for more than 12 months who have had a review (end of quarter snapshot)

      • CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded (end of quarter snapshot)

      • Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded (end of quarter snapshot)

      • Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded (end of quarter snapshot)

      • Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded (end of quarter snapshot)

      • Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

      • Service users with crisis plans: % of people in contact with mental health services (end of quarter snapshot)

       

      Services

      • People on Care Programme Approach (CPA): rate per 100,000 population aged 18+ (end of quarter snapshot)

      • People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Contact with specialist mental health services: rate per 100,000 population aged 18+ (end of quarter snapshot)

      • Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot)

      • Service users in hospital: % of mental health service users (end of quarter snapshot)

      • Mental health admissions to hospital: rate per 100,000 population

      • Persons detained under MHA: proportion of people in contact with mental health services (end of quarter snapshot)

      • Persons detained under MHA: rate per 100,000 population (end of quarter snapshot)

        December 2018

        27 new indicators updated using the latest MHSDS and QOF data

         

        Psychosis Pathway

        •Severe mental illness recorded prevalence (QOF): % of practice register (all ages)

        Risk and related factors

        •Learning disability QOF prevalence: % of people on GP practice registers

        Services

        •Contact with specialist mental health services: rate per 100,000 population aged 18+

        •People on Care Programme Approach (CPA): rate per 100,000 population aged 18+

        •Mental health admissions to hospital: rate per 100,000 population

        •People subject to Mental Health Act: rate per 100,000 population aged 18+

        •Persons detained under MHA: rate per 100,000 population

        •CPA users with HoNOS assessment: % of people on CPA with HoNOS recorded

        •Mental health service users on Care Programme Approach: % of mental health service users

        •Service users in hospital: % of mental health service users

        Quality and outcomes

        •CPA adults in employment: % of people on CPA (aged 18-69)

        •Persons detained under MHA: proportion of people in contact with mental health services Stable and appropriate accommodation: % of people on CPA (aged 18-69)

        •Delayed discharges: days of delayed discharges in the quarter: rate per 1,000 bed days

        •Recording of employment status: % of people in contact with mental health and learning disability services with employment status recorded

        •Diagnosis coding: % of people in contact with mental health services with a diagnosis or provisional diagnosis recorded

        •Recording of accommodation status: Percentage of people in contact with mental health services with accommodation status recorded

        •Service users with crisis plans: % of people in contact with mental health services

        •People with SMI who have comprehensive care plan: % of people with SMI

        •Patients on lithium therapy with record of serum creatinine and TSH: % with record in the preceding 9 months

        •Patients on lithium therapy with levels in therapeutic range: % within preceding 4 months

        •Exception rate for severe mental illness (SMI) QOF indicators: % of patients excluded from mental health quality indicators

        •Patients with SMI with alcohol consumption check: % with record in preceding 12 months

        •Female patients with SMI who had cervical screening test: % tested in preceding 5 years

        •Smokers on GP registers (certain conditions) offered cessation support and treatment: % within preceding 12 months

        •Staff training: % of staff receiving job-relevant training, learning or development in last 12 months

        •Staff health & safety training: % of staff receiving mandatory training in last 12 months

        •Staff witnessing potentially harmful errors, near misses or incidents: % staff witnessing in last month

        •Staff engagement: overall score