It aims to help those involved locally in the planning, commissioning and provision of care for people with or at risk of psychosis to identify gaps and check that services are in line with need.
The report forms part of an ongoing system-wide process to reduce unwarranted variation in access to care and support.
Data plays a vital role and there is more to do to ensure consistent, robust data collection and reporting.
Psychosis has long been surrounded by stigma and confusion, but this important area of health is now starting to become better understood by academics and public health professionals, with increasing recognition of the opportunities for prevention.
Psychosis is the name given to a set of mental health conditions characterised by hallucinations, delusions and a disturbed relationship with reality.
It is associated with diagnoses of schizophrenia, bipolar disorder and psychotic depression, and onset is most often in later adolescence and early adult years.
In England today, people with psychosis and their families often experience the illness for two-and-a-half years before they are referred and receive treatment.
Not receiving the right treatment interventions can mean young people are unable to access education, apprenticeships or employment.
For many, life-long poverty, loneliness, social isolation and unemployment follow.
And people with severe mental illness are at increased risk of poor physical health, and die on average 15 to 20 years earlier than the general population.
People with psychosis often require high cost specialist and institutional care. They account for one third of all admissions, and 65% of spend, in specialist mental health trusts and have the highest rates of escalation to high cost specialised commissioned inpatient care.
However, there is more positive news. In 2014 the World Health Organisation set out a new vision for schizophrenia as no longer an automatic life sentence, but a condition from which recovery is both possible and a natural right.
The sciences of genetics, epigenetics, neuroscience and immunology, psychological trauma-informed prevention and treatments, as well as digital and big data developments are continuously adding to our knowledge about the causes and treatment of psychosis.
Actions are also in place across the mental health system that will make a difference.
Implementing the Five Year Forward View For Mental Health will focus on early identification, early intervention and support for those with or at risk of psychosis. This will be a significant step in improving access to and equity in access to care and support.
We are also improving the way we collect data and inform ourselves about the state of care for people with psychosis.
This new report provides amalgamated intelligence from published routine national data sets with academic reports, targeted data collections and local developments at a point in time (November 2015).
England is leading the way in collecting data on mental health
The NMHIN is the newest of PHE’s health intelligence networks, and aims to provide information for every local authority, CCG and STP area on local determinants of mental health and ill-health; the groups at highest risk who would benefit from priority early intervention; and levels of prevention, access, standards, outcomes, and spend in community, primary, specialist CCG and social care services.
We now have the largest population mental health information data resource in the world (with data coming from education, workforce, housing, health care and more) and are seeking every opportunity to add to it.
PHE’s psychosis report is the result of collaboration between expert network partners: experts by experience with psychosis, carers, public health, primary and specialist clinicians, academics, government and professional bodies and commissioning experts.
Key findings along the pathway of care
- Incidence and prevalence and prevention: there is major variation in the incidence and prevalence of psychosis across England, with higher levels in inner city and urban areas and among the less affluent. This information now enables commissioners to benchmark services against comparable areas and plan to meet need accordingly. However, there is a pressing need to develop a more robust and locally sensitive method that particularly takes account of younger populations, cultural factors, and the presence of institutions.
- Access to commissioned services and the quality of care: the analysis found major variation in the level of commissioned services and access to safe, quality care in line with NICE guidelines across all parts of the pathway. For example:
- In primary care (CCG), the proportion of people with severe mental illness receiving the complete list of physical health checks ranged from 17.5% to 52.4%
- The proportion of people with psychosis who have a crisis plan in place ranges from 0.3% to 85.7%.
- Employment and safe accommodation are important factors for aiding recovery but only 5.8% (range 1% - 18.5%) of people with psychosis are in employment.
- Reducing premature mortality: the major causes of premature mortality for people with severe mental illness are cancer, cardiovascular, respiratory and liver diseases. Cardiovascular disease has the greatest number of excess deaths (189.3 per 100000), but liver disease has the greatest variation (365.3%).
The future for high quality data and psychosis care
The report reveals some questions about data quality and some gaps in data reporting. It also makes the point that digitally mature electronic care records that reduce the burden on clinical time are needed.
It is also worth repeating that services are improving now and Implementing the Five Year Forward View for Mental Health is driving that work.
Associated changes to data sets to help assess the effectiveness of this approach will be a significant step in improving data on psychosis. We will update reporting on psychosis as the Five Year Forward View psychosis standards and other new data sets become available.
This report aims to inform an on-going process whereby better data can drive better intelligence that helps to achieve improved care for those at risk of or suffering from psychosis.
We look forward to the future with optimism.