Mental Health: Targets and Performance

Supporting Information

  • Lewisham spends 11% more than the average spending nationally on mental health, but is broadly in-line with similar urban areas and London more broadly.
  • Improving Access to Psychological Therapies (IAPT) has performed strongly with 48% of clients showing clinically significant improvement (national target of 50%), and referral patterns broadly reflective of ethnic distributions. High rates of satisfaction (>90%) have been shown. These place Lewisham’s IAPT within the top 5 performing IAPT services in London.
  • CMHTs perform highly in respect of patients managed. There may be an opportunity to step-down patients from these services into primary care.
  • Although admission rates are falling, there are a significantly larger proportion of individuals being detained under the Mental Health Act. Readmission rates however remain very low, at a third of the regional average.

 

IAPT Services 

Improving Access to Psychological Therapies (IAPT) has performed strongly with 48% of clients showing clinically significant improvement (national target of 50%), and referral patterns broadly reflective of ethnic distributions. High rates of satisfaction (>90%) have been shown. These place Lewisham’s IAPT within the top 5 performing IAPT services in London.

In 2011/12 waiting times were beginning to improve, with  38% of attenders were seen within 6 weeks, with 92% seen within 3 months. Waiting times were highlighted in the feedback as an issue for patients.

Effectiveness fell just short of the target at 48% (target 50%).

The marked success of the programme is reflected by the extremely high patient satisfaction ratings. Only 2% of attenders stated that they were dissatisfied with the service. Another major success of the local programme has been to exceed targets on moving people from sick and benefits and into work.

 

 

 

Investment 

Lewisham spends more on mental health than the national average, but this spend is broadly in line with London and similar demographically-profiled areas. The total spend in 2010/11 was £58m, of which 80% was spent directly on providing care. This figure comprises the total mental health spend, including both spending on common mental illness and severe mental illness.

 

 

Fig 4 Weighted Spending per head on Mental Health 2010-11

 

 

Source: Mental Health Datasheet

 

Activity

Primary Care
In 2010/11,  3423 patients (1.1%) registered at Lewisham GPs were recorded as having bipolar disorder, schizophrenia or other psychosis; this figure is 40% higher than the national average, demonstrating the higher need within Lewisham. Of these individuals, 90.3% had been reviewed within the last 15 months by their GPs (92.6% nationally).

 

 

Secondary Care Mental Health Services

Approximately 3000 service users come into contact with CMHT and other secondary care services each quarter, with approximately 225 admissions into hospital at the Ladywell Unit. Patients admitted to the Ladywell Unit go through the triage ward for initial assessment prior to being transferred to another ward for longer term treatment if appropriate.

Most secondary care services for SMI are delivered through CMHTs. An audit of referrals to Assessment and Brief Treatment services (ABT) at SLAM in 2009 found that Lewisham had higher rates of referrals despite lower psychiatric morbidity than neighbouring boroughs. Twenty five percent of referrals in the audit were classified as patients who could have been seen and treated in primary care. At the time of the audit the IAPT service was not yet operational. It was suggested that following the implementation of IAPT only 28.2% of referrals had a clear need for CMHT intervention.

IAPT is now imbedded and has been fully operational since 2010. It is possible that there remain opportunities for some of the individuals who have currently been managed in CMHTs to be stepped-down to primary care services and reduce the caseload within the CMHTs.

 

 

Acute Admissions

The directly standardised emergency hospital admission rates for mental health in Lewisham 2008/9 to 2010/11 (258.04 per 100,000) are similar to London (259.84 per 100,000) and higher than England (216.93 per 100,000)6. Given the high levels of local need this rate is lower than may be expected.

Fifty four percent of all patients admitted were detained under the Mental Health Act, a figure considerably higher than the London average, though not dissimilar to Lambeth and Southwark.

Over the twelve months to September 2010, there were 716 triage assessment admissions, of which 363 (50.7%) were subsequently admitted for on-going treatment.

 


Fig 5. Annual Admissions (2006/7 – 2009/10)

 

 

Fig 6. Proportion of Admissions Formally Detained (2006/07 – 2009/10)

Source: Mental Health Minimum Dataset, 2011

 


 

These two graphs show admission rates declining, which is seen consistently through both Lambeth and Southwark. A higher proportion however are being detained formally under the Mental Health Act, which is likely a result of the raised admission thresholds. 

Readmission rates were very low at less than a third of the London average (2.1% cf. 7.6%).

 

 

Suicide Rates

Suicide rates continue to fall and are not significantly different to the London average, though the numbers are small and rates are calculated over several years because of this. The standardised rate in 2009 was 4.7 suicides/100 000 population, which is broadly in-line with the recent downward trend (see Figure 6).

 

 

 


Fig 6. Annual Suicide Rate (directly standardised 3 year moving average, 1994 – 2008)

 


 

 

IAPT

Average referral rates to IAPT from primary care practices were 2.34% in 2010/11. In 2011/12 this increased to 2.6%.

In  2010/11  there were over 5,566 referrals to IAPT.  In 2011/12 this had increased to 6,546, an increase of 18%.  The total number of referrals was actually higher but this figure excludes those patients were the GP information was missing.

 

 

 

 References

  1. http://www.nepho.org.uk/cmhp/index.php?view=E09000023

 

 

 

 

 

Previous page Top of page Next page