Inpatient services

Welcome to the ZSA Facts for Action series

This page provides key information to explain what inpatient services are and will help build your understanding of the role this service has in suicide prevention.

Contents:

1. What are adult inpatient services?
2. Use of adult inpatient services
3. Why are these services important in the context of suicide prevention?
4. ZSA Suicide Prevention Resource Map - key takeaways
5. National guidelines for practice
6. Impact of COVID-19
7. Case studies
8. Recommendations for action
9. ZSA Suicide Prevention Resource Map - related indicators
10. References

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What are adult inpatient services?

An inpatient service is a defined as a service that provides acute 24-hour care in a hospital setting, providing a safe, therapeutic environment for individuals whose mental health needs cannot be met at home or in a less restrictive setting. Adult inpatient services support the delivery of mental health care for adults experiencing a mental health crisis that is expected to require intensive care over period of time, typically 32 days (NHS, 2021 [1]).

Inpatient services are made up of multidisciplinary teams; these can include consultant psychiatrists, pharmacists, psychologists, occupational therapists and housing and social care colleagues. This mix of skilled care professionals allow teams to devise treatment options based on formulating a collective understanding of a patient’s individual needs (NHS, 2015 [2]).

The ultimate aim of these services is to provide specialist treatments and support people to help stabilise their symptoms and help them gain or regain the skills to live successfully in their community (HSE Mental Health Services, 2021 [3]). These services are used for patients with significant mental health illnesses who have not responded to interventions in primary and secondary mental health services.

The service that people are admitted to will depend on the level of care needed. For example, those with more complex needs and present a high risk to themselves or others may require admission to a psychiatric intensive care unit (PICU) which have stricter precautionary measures and higher staffing levels. In comparison, a person admitted to an acute ward may be deemed less risky to themselves or others, but still require immediate care following a significant decline in mental state or are experiencing a first or reoccurring episode of their mental illness (Mental Health Network NHS Confederation, 2012 [4]).

Adult inpatient services also include specialist services to treat specific patient needs that are severe, complex and require an appropriate level of specialist input (Mental Health Network NHS Confederation, 2012 [4]) Examples of these include:

• Eating disorders services
• Learning disabilities services
• Obsessive Compulsive Disorder (OCD) services
• Perinatal services
• Substance misuse services
• Forensic services
• Older adult services
• Rehabilitation services
• Crisis houses

For more information on these services, visit our Facts for Action series on substance misuse services and crisis response services.

For people admitted to an adult inpatient service, a therapeutic environment provides the best opportunity for recovery. It is crucial that inpatient services provide purposeful, patient-orientated and recovery-focused care, which is implemented through involving patients within their own care planning (NICE, 2021 [5]).

Admission to inpatient services

Inpatient services are available for those who are detained under the Mental Health Act, as well as for those who are voluntarily admitted.

Involuntary admission

The Mental Health Act (MHA) 1983 is the legal basis for care of mental illness in the UK (Mental Health Act, 1983 [6]). The Act sets out in law the rights of people during assessment and treatment in hospital, treatment in the community and pathways into hospital such as civil and criminal routes (Mind, 2021 [7]). For more information about the sections under the MHA, visit the Cygnet Health Care summary website.

Voluntary admission

Voluntary patients have consented to their admission to inpatient services, and they are not in hospital under a section of the Mental Health Act. However, many voluntary patients have been in hospital under section and decided they want to stay until they feel well enough to leave (SLAM, 2021 [8]).

Out of area placements

Under NICE guidelines [5], patients should be treated in a location which helps them maintain contact with family, friends and care co-ordinators; however, inpatient beds in the local vicinity are not always available. An out of area placement (OAP) occurs when an adult assessed as requiring acute mental health inpatient care, is admitted to a unit that is not part of their local network of mental health services (NHS Digital, 2021 [9]). An OAP is appropriate if a person is in crisis when they are away from their local area or if there are safeguarding issues (Nuffield Trust, 2020 [10]). An OAP is inappropriate if the reason is non-availability of a local bed.

The ambition for NHS Long Term Plan [11] is to eliminate inappropriate adult acute OAPs by 2023.

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Use of adult inpatient services

NHS Digital publishes an annual bulletin which reports on the use of mental health services based on the Mental Health Services Data Set submissions by providers.

The latest publication from NHS Digital (2021 [12]) shows that in the year 2020/21*:

• There were 110,420 admissions in to inpatient services, with 107,185 discharges and 24,185 average daily occupied beds. This indicates that from 2019-20, there have been a 11% decrease in admissions, 14%% decrease in discharges and a decrease of 8% in beds used, suggesting a reduction of average length of stay for those admitted over the 2020/21 period*.
• In adults aged 18+, there was 104,410 admissions into inpatient services, with 101,483 discharges.
• 52% of adults aged 18+ who are admitted into inpatients are male compared to 48% that are female, this is indicative of over-representation of men in inpatient services compared to the general population. In the UK, women make up 51% of the population compared to men at 49% (GOV.UK, 2018 [13]).
• Black or Black British individuals were more likely to be subject to restrictive intervention when in contact with NHS funded secondary mental health services, with 89.2 per 100,000, an increase from 74.8 per 100,000 in 2019/20.

*This publication covers the 2020-21 reporting year and as such, will feature the impact of the COVID-19 pandemic in England.

Out of area placements

NHS Digital (2021 [14]) publishes monthly reports on OAPs in mental health services, which captures data from NHS providers in England. The most recent findings (April, 2022) include:

• Placement duration:
  • 40 placements were 1-7 nights.
  • 45 placements were 8-14 nights.
  • 95 placements were 15-30 nights.
  • 105 placements were 31-90 nights.
  • 25 placements were 90+ nights.

Table 1: Out of area placements (%) in mental health services, split by duration (2022)

• In England, £10,601,264 was spent on OAPs, with an average of £600 spent per day.
• At the end of April 2022 there were 680 OAPs active in England, of which 745 (98% of all OAP’s) were inappropriate.

Regional positions are summarised in Figure 1, which highlights that the Midlands had the highest number of inappropriate placements, whereas the South West and London had the lowest.

The high number of inappropriate OAPs nationally indicates that the mental health system is under pressure which increases pressure on the bed capacity, and increases the reliance on OAPs. However, it is important to note that the Midlands has a larger population size, therefore higher numbers of inappropriate out of area placements could potentially be expected.

High rates of admissions to inpatient units and use of out of area placements can be seen as a consequence of not having good community based prevention and crisis services. During the COVID-19 pandemic, OAPs increased over mental health Trusts due to inpatient beds being used to treat COVID-19 patients (The Royal College of Psychiatrists, 2021 [15]). Additionally, a number of beds were closed for prevention and control within hospitals, with a reduction of occupied mental health beds from 88.6% occupancy in January-March 2020 to 78.9% in April to June 2020 (NHS, 2021 [16]).

Figure 1 - The regional number of inappropriate Out of Area Placements in England (April 2022)

Mental health act

Additionally, NHS Digital [17] have published reports on mental health act (MHA) statistics. This publication contains official statistics about the uses of the Mental Health act in 2020/21 whereby people with a mental disorder are detained in inpatient hospitals. Findings include:

• 53,239 people were detained in hospital under the MHA in 2020/21. Of this number, detention rates were most prominent in ages 18-34 with 142.5 detentions per 100,000. Additionally, Black or Black British were the ethnic group with the highest rates of detention, with 343.5 detentions per 100,000.
• The rates of detention were higher in males with 91.8 per 100,000 compared to females at 84.4 per 100,000, indicating that males are more likely to be admitted than females.
• A higher proportion of detentions occurred on admission in NHS providers than independent providers (97.1% compared to 2.9%)
• People living in the most deprived areas had the highest rates of detention (160.7) detentions per 100,000 population).

Care Quality Commission (CQC)

In 2019, the Care Quality Commission [18] (CQC) reported on mental health rehabilitation inpatient services through requesting provider information (both NHS and independent) on their patients in adult inpatient services.

The CQC found that:

• Locked rehabilitation wards were the most commonly reported type of mental health rehabilitation ward, reporting 96 locked mental health wards in 2019.
• The median length of stay for NHS wards was 225 days, compared to 415 in independent provider wards.
• The median distance for patients in independent sector wards had increased from 29.9km in 2017 to 31.3km in 2019. In contrast, the median distance for NHS patients had decreased from 6.9km in 2017 to 6.4km in 2019.

Patients receiving mental health rehabilitation in an independent sector ward were more likely to have Out of Area Placement care (74%) than those receiving treatment in an NHS ward (41%). In particular, ‘locked rehabilitation’ wards had the highest proportion of patients with an out of area placement.

In 2020, the CQC [19] released a report on mental health services in acute hospitals and whether patients receive the same high quality care for their mental health as for their physical health. CQC found that:

• People faced barriers in accessing help at times of crisis, with a lack of availability of 24/7 community crisis services.
• Acute hospitals did not see mental health care as the provision of care.
• If patients were admitted to emergency departments, they were not always provided with a safe, therapeutic environment. This does not meet guidelines for inpatient services.
• There was lack of staff education of the MHA in regards to the roles and responsibilities of acute trusts and the legal processes involved.
• Training of staff varied across different acute inpatient services, therefore staff were not confident in meeting the mental health needs of patients.

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Why are these services important in the context of suicide prevention?

Adult inpatient services form a critical component of mental health provision. These services work alongside community mental health teams, crisis teams and early intervention services to improve people’s wellbeing and functioning as well as reducing their risk of suicide, self-harm and harm to others.

As we discuss in our Facts for Action series on Severe Mental Illness (SMI), the percentage of people with severe mental illness is increasing (National Institute of Mental Health, 2019 [20]) and people with an SMI are at high risk of self-harm and dying by suicide (McManus et al., 2016 [21]), therefore it is important that effective treatment is accessible.

At the point of admission to an inpatient service, the patient is in an immediate mental health crisis, therefore the risk of suicide is high during the first seven days of admission (NICE, 2021 [5]). In 2017, there were 92 suicides by inpatients in the UK, with around a third taking place on the ward itself (The National Confidential Inquiry into Suicide and Safety in Mental Health, 2019 [22]).

As previously discussed, there is a possibility of patients having an Out of Area Placement (OAP’s) and sending acutely ill patients out of area increases any post-discharge suicide risk. In 2016, 11% of patients died by suicide after being discharged from a non-local inpatient unit (The National Confidential Inquiry into Suicide and Safety in Mental Health, 2018 [23]). Furthermore, OAP’s have challenges on patients recovery such as maintaining contact with friends and family, which runs counter to the core aim of rehabilitation services to support people going back into the community.

Lastly, the risk of suicide is highest during the period immediately following discharge from inpatient care than at any other time (Crawford, 2004 [24]). For example, 206 recorded suicides were within three months after hospital discharge (14% of all patient suicides) with the highest risk in the first one to two weeks after discharge (The National Confidential Inquiry into Suicide and Safety in Mental Health, 2019 [22]).

It is vital that mental health providers provide social support and continuous care from the point of admission to inpatient discharge back in to the community.

This highlights the need for inpatient services to adopt an individualised care approach to patients needs and to provide an effective discharge plan which is both collaborative and person centred. This needs to be delivered in conjunction with community mental health services, especially with patients that are placed out of area. Therefore, OAP providers need to be active partners with community based mental health services and maintain contact with service users to support good discharged planning.

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ZSA Suicide Prevention Resource Map data – key takeaways

Our ZSA Suicide Prevention Resource map developed with the NHS Benchmarking Network includes a number of metrics which provide a picture of the overall situation for adult inpatient services across England and shows wide variation in the number of people accessing these services and their experience in relation to key measures of relevance to suicide prevention. The data below relates to 2020/21 and is sourced from the NHS Benchmarking Project for Adult Mental Health Services unless stated otherwise*.

• Number of adult acute admissions where the patient was not previously known to the mental health service per 100,000 registered population (16-64) varies between 0 and 90 per 100,000, with a median average of 13, down from 14 in 2019/2020
• Number of adult acute admissions where the patient was of no fixed abode per 100,000 registered population (16-64) varies between 0 and 24, with a median of 3, down from 4 in 2019/20
• Number of adult acute admissions where the patient was under Mental Health Act section per 100,000 registered population (16-64) varies between 51 and 226, with a median of 103, up from 89 in 2019/20.  Note that the data completeness for this indicator is low.
• Number of occupied bed days for patients in clusters 10-17 across all bed types** per 100,000 registered population (16+) varies from 772 to 16,339 with a median average of 5,053, down from 5,650 in 2019/20.
• Number of self-harm incidents in inpatient care across all bed types per 10,000 occupied bed days excluding leave varies from 11 to 270, with a median average of 83, up from 50 in 2019/20. Note that the data completeness for this indicator is low.
• Number of ligature incidents in inpatient care across all bed types per 10,000 occupied bed days excluding leave varies from 2 to 171, with a median average of 37, up from 21 in 2019/20.

* All data from NHS Benchmarking Network projects is subject to change dependent upon permissions being receiving from provider organisations to have their data included in the map.  The information reported reflects the data available as at 06/09/22.

** Clusters 10 to 17 are used for people experiencing symptoms associated with psychosis. High usage of inpatient beds by people in clusters 10 to 17 may suggest that these individuals are not accessing or receiving effective community services until they reach the point of a significant mental health crisis.

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National guidelines for practice

National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) aim to help people who use mental health inpatient services have a better transition from community care, to inpatient settings and then through to discharge. NICE have published a number of pathways, guidance and quality standards relevant to adult inpatient services and the transition from community or home settings.  Links to these have been provided below:

• Pathways
• Guidance
• Quality standards

NHS Long Term Plan

The NHS Implementation Plan[25] (2019/21) and The NHS Long Term Plan [11] (2023/24) set out that the NHS will:

• Improve therapeutic inpatient mental health services by increasing investment in interventions and activities resulting in better patient outcomes.
• A reduction in length of stay for all services to 32 days (or fewer) in adult acute inpatient mental health settings.
• Eliminate inappropriate adult acute OAPs by working to improve system and bed capacity management and unwarranted variation in length of stay.
• Improve the experience of patients who need to transition from children and young person inpatient services to adult inpatient services.
• Ensure that acute mental health care remains therapeutic and purposeful from the outset.
• Increase access to multi-disciplinary staff groups such as peer support workers, psychologists, occupational therapists and other Allied Healthcare Professionals throughout an inpatient admission.

The Royal College of Psychiatrists

The Royal College of Psychiatrists (RPsych) have published standards in relation to acute inpatient services for working age adults. These standards can be used to assess the quality of inpatient services.

The standards cover the follow topics:

• Admission and Assessment
• Care Planning and Treatment
• Referral, Discharge and Transfer
• Patient and Carer Experience
• Staff and Training
• Environment and Facilities
• Governance

To find out more about RCPsych standards, visit their working age adult guidelines.

RCPsych have also published standards in relation to other inpatient services, you can find out more by visiting their publications:

• Psychiatric inpatient intensive care guidelines
• Older adults inpatient guidelines
• Forensic inpatient guidelines
• Adult inpatient eating disorder guidelines
• Perinatal inpatient guidelines
• Learning disability inpatient guidelines

The National Association of Psychiatric Intensive Care Units

The National Association of Psychiatric Intensive Care Units (NAPICU) aim to ensure that there is high quality multidisciplinary care provided in intensive care and low secure care units. NAPICU have worked with the Department of Health to create good practice guides for mental health providers which enable the delivery of high quality adult inpatient services.

To find out more about the NAPICU national minimum standards, visits the NAPICU website.

National Clinical Audit of Anxiety and Depression

The National Clinical Audit of Anxiety and Depression [26] (NCAAD) have worked with the Royal College of Psychiatrists to create an audit focused on inpatient services. Within this audit, the NCAAD have provided 13 standards that represent the best practise within adult inpatient services, which include:

1. The Trust routinely collects data to assess equity of access.
2. Service users have timely access to inpatient care when required.
3. Service users’ assessments are comprehensive and include consideration of:
   1. Identification of social support and/or stressors in relation to finance, education/employment and relationships;
   2.  Previous traumatic experiences or associated symptoms;
   3. Previous treatments and response to them (if applicable);
4. Service users’ physical health is considered as part of their assessment and treatment, with support, advice or onward referral offered where appropriate.
5. The needs of service user’s family members, friends or carers are considered as part of the assessment process and they are offered an assessment of their needs.
6. Care plans are jointly developed with service users and their family member, friend or carer (if applicable), and they are given a copy with an agreed date for review.
7. Psychotropic medication is provided in line with the relevant NICE and BNF guidance for the service user’s diagnosis/condition.
8. Psychological therapies are provided in line with relevant NICE guidance for the service user’s diagnosis/condition.
9. Within 24 hours of discharge a discharge letter is sent to the service user’s GP and a copy of the service user’s care plan is sent to the accepting service (if applicable).
10. The service user and their family member, friend or carer (if applicable), receives at least 24 hours’ notice of discharge and this is documented.
11. Service users discharged from an inpatient setting receive a follow-up within 48 hours of discharge.
12. Service users have a crisis plan agreed and in place prior to discharge from an inpatient service.
13. Assessments include the use of an appropriately validated outcome measure(s) (e.g. symptoms, level of functioning and/or disability) which are used to monitor, inform and evaluate treatment.

Care Quality Commission

CQC have recommended guidelines from their findings from the mental health rehabilitation inpatients service report [18], these include:

• CCGs, NHS trusts and local authorities should work together to identify all patients in mental health rehabilitation wards whose care they are responsible for and to review the appropriateness of these patients’ current placement.
• CCGs, NHS trusts and local authorities should consider whether the care provided is enabling the person’s rehabilitation and whether there are active plans for discharge.
• Lengths of stay should be minimised through the development of local service pathways and innovative commissioning models.
• NHS Improvement’s NHS Get It Right First Time Programme should be used to support inpatient rehabilitation for people with severe or complex needs.

CQC have recommended guidelines from their findings from acute services report, these include [19]:

• CCG’s, NHS trusts and local authorities should work together to improve care planning so that all patients have access to physical, mental and social care.
• All acute trusts should have a mental health strategy with mental health care being considered frequently by all acute trusts.
• Emergency departments should promote psychological and physical safety, therefore ensuring safe rooms are therapeutic and provide essential food, drink, medicines and communication with friends and family.
• Acute trusts should have appropriate processes for administrating and monitoring the Mental Health Act 1983.
• Acute trusts should have efficient training for staff which will give staff knowledge, skills and confidence to meet patients mental health needs.

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Impact of COVID-19

It has been forecast that up to ten million people, the equivalent of nearly 20% of the total population, will need new or addition support for their mental health needs as a result of the COVID-19 pandemic (Centre of Mental Health, 2020 [27]).

The Strategy Unit (2020 [28]) has undertaken work to predict the potential increase in demand for mental health services. The Strategy Unit has predicted a 33% increase in overall demand between 2021 and 2023 and has estimated a surge of 2058 additional admissions to adult inpatient services.

Impact on demand

At the start of the pandemic, in early 2020, adult inpatient services had a large decrease in admissions, falling from over 10,000 in January 2020 to 7,646 in April 2020 (CQC, 2020 [29]). As restrictions began to lift, this number began to rise.

The NHS highlighted that after lockdown there was a 20% increase in demand across all of their mental health services, while also facing a 10-30% reduction in how many patients they can care for at any one time (NHS Providers 2020 [30]).

Impact on discharge from service

The COVID-19 pandemic has had a substantial impact on adult mental health services in regard to discharge from services.

In March 2020, all NHS hospitals were instructed by the NHS Chief Executive to free up inpatient capacity and maximise staff availability (NHS, 2020 [31]), which led to inpatient discharge where it was possible and safe to do so. In March 2020, discharges of patient in inpatient services increased by 26%, with 11,829 patients being discharged (NHS Digital, 2020 [32]).

In April-May 2020, monthly discharges from adult inpatient services fell to 7,835, indicating a sharp drop in numbers, which may have been an outcome of fewer admissions during March (NHS Digital, 2020 [33]). Worryingly, only 72% of patients were followed up within 72 hours of being discharged, which may have contributed to the rise in re-admissions rates reported in May (NHS Digital, 2020 [33]).

Impact on the mental health act and detentions

The COVID-19 pandemic has presented challenges to both patient and mental health services.

Figure 2 highlights that the total number of people that were detained under the MHA decreased from 15,602 in February 2020 to 13,890 in April (NHS Digital, 2021 [34]). Additionally, the number of patients detained in acute adult inpatient services decreased from 5,724 in February to 4,688 in April.

Figure 2 also highlights that detention rates under the MHA spiked when COVID-19 restrictions begin easing (July, 2020) and then decreased when restrictions were tightened (December, 2020). A high proportion of detentions under the MHA suggests that people within the community may not be accessing effective services until they reach the point of a significant mental crisis.

Figure 2 – Number of patients detained under the mental health act in Adult inpatient services (2020-21)

Impact on out of area placements

The COVID-19 pandemic presented challenges on bed availability, with services being urged to free up bed capacity for patients admitted with COVID-19 and to reduce any risk of infection throughout hospitals (Mind, 2020 [35]).

In March 2020, the number of inappropriate OAPs fell to 210, which coincides with the reduction of admissions, and increase in discharges (NHS Digital, 2020  [9]) previously discussed. This also highlights that due to discharges of inpatients, new admissions to inpatient care were able to be within local services or mental health providers (Nuffield Trust [10]).

Table 2 highlights that the number of inappropriate OAPs began to rise after March 2020, indicating that there was a lack of beds available within home trusts for inpatient admissions. These figures emphasise the impact that the COVID-19 pandemic placed, with huge demands on available beds.

Month (2020)	Inappropriate out of area placements
March	210
April	365
May	475
June	555
July	575

Table 2 – Number of inappropriate out of area placements within mental health services (2020)

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Case studies

Examples of excellent practice in line with national guidance for adult inpatient services are included here.

Assessment suites

An assessment suite is a place where people experiencing a mental health crisis are referred to, which offers a safe environment to allow mental health staff take assessments and agree what the best follow up support for them will be. 

Lotus assessment suite

Background

The lotus assessment suite aims to reduce admissions through the provision of a more prolonged and informed assessment of needs/risk as well as enabling the right community support where feasible. The suite includes reclining chairs in partitioned bays and is integrated with the existing two s136 suites with an overall seven person capacity. Patients have full access to shower/washing facilities and there is a full meal service. Referrals are made via Street Triage, Crisis & Home Treatment Teams or Liaison Psychiatry services as potentially requiring inpatient admission from initial community based assessments.

Outcomes:

• 26% reduction in informal admission
• 17% reduction in 0-5 day admissions
• Reduced demand for occupied beds days by 8.4
• 71% of people have been referred to community services
• 23 hours is the average length of assessment (target 16 hours)
• 59% of assessments are completed with the patient transferred within 24 hours

For more information, visit the CQC report on acute trusts. 

Treatment facilities

Treatment facilities are an area which patients are referred to following an psychiatric assessment.

East London Foundation Trust: triage ward

Background

The triage ward is a 15-bedroom unit, with self-contained, en-suite facilities with capacity for nine male and six female patients. Patients admitted to the triage ward stay for a maximum of 7 days. After this time, if they need to continue as an inpatient for a further spell they are transferred to a longer stay inpatient ward. Turnover of patients is high with approximately 1,100 admissions to the unit per year.

Outcomes

• The average length of stay on the triage ward is 4.8 days, compared to 18.2 days for the acute average across Newham.
• The triage ward has a low readmission rate of 8.2% within 28 days with 45% of patients being discharged home and requiring no further treatment.

For more information, visit the CQC report on acute trusts. 

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Recommendations for action

• All adult inpatient services need to be provided in line with guidelines (RPsych) to improve the quality of care delivered.
• Ensure that mental health providers minimise OAPs in inpatient services, through investment in local rehabilitation services and investment into community services to prevent re-admission and reduction of detentions.
• Eliminate all inappropriate OAPs in inpatient services by managing bed capacity appropriately and reducing length of stays to 32 days for each patient.
• Mental health providers, CCGs and local authorities should work together to identify patients in their inpatient services, and review whether the service is appropriate and consider whether there are any active plans for discharge. This will ensure that the use of OAPs is decreased.
• Ensure that mental health providers follow the NHS Get It Right First Time Programme to improve treatment pathways and improve outcomes of inpatient care.
• Mental health inpatient services and community teams need to work proactively and collaboratively throughout the patient’s admission and in planning for their discharge. This will ensure that 100% of patients that are discharged from inpatient services are receiving follow up within 72 hours.

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ZSA Suicide Prevention Resource Map - related indicators

Direct indicators

Admissions

• Number of adult acute admissions where the patient was not previously known to the mental health service per 100,000 registered population (16-64)
• Number of adult acute admissions where the patient was not previously known to the mental health service per 100,000 weighted population (16-64)
• Number of adult acute admissions where the patient was of no fixed abode per 100,000 registered population (16-64)
• Number of adult acute admissions where the patient was of no fixed abode per 100,000 weighted population (16-64)
• Number of adult acute admissions where the patient was under Mental Health Act section per 100,000 registered population (16-64)
• Number of adult acute admissions where the patient was under Mental Health Act section per 100,000 weighted population (16-64)

Occupied bed days

• Number of occupied bed days for patients in clusters 10-17 across all bed types per 100,000 registered population (16+)
• Number of occupied bed days for patients in clusters 10-17 across all bed types per 100,000 weighted population (16+)

Incidents

• Number of self-harm incidents in inpatient care across all bed types per 10,000 occupied bed days excluding leave
• Number of ligature incidents in inpatient care across all bed types per 10,000 occupied bed days excluding leave

Indirect indicators

• Number of people in contact with mental health services aged 18+ per 100,000 registered population
• Number of people in contact with mental health services aged 18+ per 100,000 weighted population
• Number of Section 136 assessments per 100,000 registered population (16-64)
• Number of Section 136 assessments per 100,000 weighted population (16-64)
• Total CCG spend on mental health (all ages) per 100,000 registered population (£)
• CCG spend on mental health (all ages) as a percentage of CCG base allocations

All data from NHS Benchmarking Network projects is subject to change dependent upon permissions being receiving from provider organisations to have their data included in the map.  The information reported reflects the data available as at 23/08/22.

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References

[1] NHS (2021). Crisis and Acute Mental Health Services. Available at: https://www.england.nhs.uk/mental-health/adults/crisis-and-acute-care/ 

[2] NHS (2015). Working Towards an Effective Multidisciplinary Team. Available at: https://www.england.nhs.uk/wp-content/uploads/2015/01/mdt-dev-guid-flat-fin.pdf 

[3] HSE Mental Health Services (2021). Severe and Enduring Mental Illness and Complex Needs. Available at: https://www.hse.ie/eng/services/list/4/mental-health-services/rehabilitation-recovery-mental-health-services/model-of-care-for-people-with-severe-and-enduring-mental-illness-and-complex-needs.pdf 

[4]  Mental Health Network NHS Confederation (2012). Defining mental health services. Available at: https://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Defining_mental_health_services.pdf 

[5]   National Institute for Health Care and Excellence (2021). Admission and Stay in an Inpatient Mental Health Service. Available at: https://pathways.nice.org.uk/pathways/transition-between-community-or-care-home-and-inpatient-mental-health-settings/admission-and-stay-in-an-inpatient-mental-health-service 

[6] Mental Health Act. (1983). Available at: https://www.legislation.gov.uk/ukpga/1983/20/contents (accessed on 06/05/2021)

[7] Mind (2021). The Mental Health Act 1983. Available at: https://www.mind.org.uk/information-support/legal-rights/mental-health-act-1983/about-the-mha-1983/ 

[8] South London and Maudsley NHS Foundation Trust (2021). The Mental Health Act and Voluntary Patients. Available at: https://www.slam.nhs.uk/patients-and-carers/mental-health-act/voluntary-patients/ 

[9]  NHS Digital (2021). Out of Area Placements. Available at: https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/out-of-area-placements-oaps 

[10]  Nuffield Trust (2020). Out of Area Placements. Available at: https://www.nuffieldtrust.org.uk/resource/out-of-area-placements#background 

[11]  NHS (2019). The NHS Long Term Plan. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf 

[12] NHS Digital (2021). Mental Health Bulletin 2020-21 Reference Tables v2. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-bulletin/2020-21-annual-report 

[13] GOV.UK. (2018). Male and Female Populations. Available at: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/male-and-female-populations/latest#:~:text=data%20shows%20that%3A-,according%20to%20the%202011%20Census%2C%20women%20and%20girls%20made%20up,and%20boys%20made%20up%2049%25 

[14] NHS Digital (2022). Out of Area Placement in Mental Health Services. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/out-of-area-placements-in-mental-health-services/april-2022

[15] The Royal College of Psychiatrists. (2021). Lack of beds leaves patients with serious mental illness without treatment during the pandemic. Available at: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/01/29/lack-of-beds-leaves-patients-with-serious-mental-illness-without-treatment-during-the-pandemic 

[16] NHS. (2021). Bed Availability and Occupancy Data. Available at: https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/ 

[17] NHS Digital (2020). Mental Health Act Statistics, Annual Figures 2020-21. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures/2020-21-annual-figures 

[18]  Care Quality Commission (2019). Mental Health Rehabilitation Inpatient Services. Available at: https://www.cqc.org.uk/publications/themed-work/mental-health-rehabilitation-inpatient-services-%E2%80%93-2019-update

[19]  Care Quality Commission (2020). Assessment of mental health services in acute trusts. Available at: https://www.cqc.org.uk/publications/themed-work/assessment-mental-health-services-acute-trusts 

[20] National Institute of Mental Health (2019). Mental Health Information: Serious Mental Illness.  Available at: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#:~:text=Serious%20mental%20illness%20(SMI)%20is,or%20more%20major%20life%20activities.

[21] McManus S, Hassiotis A, Jenkins R, Dennis M, Aznar C, Appleby L. (2016). ‘Chapter 12: suicidal thoughts, suicide attempts and self-harm,’ in McManus S, Bebbington P, Jenkins R, Brugha T. (eds) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Available at: https://webarchive.nationalarchives.gov.uk/20180328130852tf_/http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-suicide.pdf/ 

[22]  The National Confidential Inquiry into Suicide and Safety in Mental Health (2019). Annual report: England, Northern Ireland, Scotland and Wales. Available at: https://documents.manchester.ac.uk/display.aspx?DocID=46558 

[23] The National Confidential Inquiry into Suicide and Safety in Mental Health (2018). Annual report: England, Northern Ireland, Scotland and Wales. Available at: https://documents.manchester.ac.uk/display.aspx?DocID=38469 

[24] Crawford, M. J. (2004). Suicide following discharge from in-patient psychiatric care. Advances in Psychiatric Treatment, 10(6), 434-438. Available at: https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/suicide-following-discharge-from-inpatient-psychiatric-care/7E449D5063BB0E1E823A9406FA78F6D6 

[25] NHS (2019). NHS Mental Health Implementation Plan 2019/20 – 2023/24. Available at: https://www.longtermplan.nhs.uk/publication/nhs-mental-health-implementation-plan-2019-20-2023-24/ 

[26] National Clinical Audit of Anxiety and Depression (2019). Inpatient Mental Health Services. Available at: https://www.hqip.org.uk/resource/national-clinical-audit-of-anxiety-and-depression-inpatient-mental-health-services/ 

[27] Centre for Mental Health (2020).  Covid-19 and the nation’s mental health: October 2020. Available at: https://www.centreformentalhealth.org.uk/publications/covid-19-and-nations-mental-health-october-2020 

[28] The Strategy Unit (2020). Mental Health Surge Modelling app. Available at: https://strategyunit.shinyapps.io/MH_Surge_Modelling/ 

[29] Care Quality Commission (2020). Monitoring the Mental Health Act in 2019/20: The Mental Health Act in the coronavirus (COVID-19) pandemic. Available at: https://www.cqc.org.uk/publications/major-report/monitoring-mental-health-act-201920-mental-health-act-coronavirus-covid-19 

[30] NHS Providers (2020). Restoring Services: NHS Activity Tracker. Available at: https://nhsproviders.org/media/690316/restoring-services-october.pdf

[31] NHS (2020). Letter to Staff. Available at: https://www.hsj.co.uk/download?ac=3044892 

[32] NHS Digital (2020). Learning Disability Services Monthly Statistics - (AT: March 2020, MHSDS: January 2020 Final. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics/provisional-statistics-at-march-2020-mhsds-january-2020-final 

[33]  NHS Digital (2020). Learning Disability Services Monthly Statistics (AT: May 2020, MHSDS: March 2020 Final. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics/provisional-statistics-at-may-2020-mhsds-march-2020-final 

[34] NHS Digital (2021). Mental Health Services Monthly Statistics. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-services-monthly-statistics 

[35] Mind (2021). The Impact of Coronavirus on Mental Health Hospital Discharge. Available at: https://www.mind.org.uk/media-a/6293/the-impact-of-coronavirus-on-mental-health-hospital-discharge-briefing.pdf 

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Content reviewed and updated 06/09/22