News

Will we see a surge in referrals in mental health?

ZPB data briefing by Anne Janssen, ZPB’s Analyst

ZPB’s analytic unit was commissioned by Ieso Digital Health to investigate the effect that COVID-19 had on referrals to NHS talking therapy, known as improving access to psychological therapy (IAPT) mental health services and what that might mean for demand once the lockdown is eased and patients are likely to use services as they did pre-pandemic.

We found that more than 400,000 people were not seen by IAPTs or are unlikely to be seen until October and it is likely that once services return to normal they will seek help then, resulting in a surge in demand on services. And this is without also taking into account the effect of the predicted second wave which could see the situation worsen.

Our analysis showed a surge in referrals in October will see hundreds of thousands of patients struggling and NHS mental health trusts unable to meet demand

In June, the Institute for Fiscal Studies warned that the coronavirus pandemic had worsened mental health unlike ‘anything seen in recent years’. It found that around 7.2 million people in the UK aged 16 and over are experiencing at least one mental health issue ‘much more than usual’. Meanwhile, UN health experts have warned of the likelihood of an upsurge in the number and severity of mental illnesses across the world and urged governments to put the issue “front and centre” of their responses.

Key findings
1. Our analysis showed a surge in referrals in October will see 400,000 patients struggling and NHS mental health trusts unable to meet demand
2. The NHS would need to carry out five months’ worth of additional work in October alone just to get back to pre-COVID-19 levels
3. Our research led to calls for “the wealth of digital technology” in mental health therapy to help tackle the problem

The IAPT programme, rolled out in 2009, helps people with common mental health conditions such as anxiety, depression, panic attacks, post-traumatic stress disorder and obsessive-compulsive disorder. In April 2015, NHS England brought in the target for 75% of people referred to IAPTs to start treatment within six weeks, and 95% within 18 weeks.

The aim of this analysis was to generate awareness of the need to find alternative solutions to face-to-face therapy to avoid half a million people not receiving help during the pandemic.

Our methodology
We used monthly statistics on IAPT data from NHS Digital to determine the trend in IAPT referrals from April 2017 to February 2020. Based on the trend and growth in IAPT referrals even pre-COVID, we predicted what referrals were likely to be for March through to October 2020, as we assumed that services would resume to normal then. Knowing the actual referrals that occurred in March, April, May and June 2020, we were able to predict statistically the difference in expected referrals and actual referrals for these months. Based on the average difference for these four months, we assumed the difference for July-September 2020 and calculated the sum of March – September 2020. This gave us the number of people who we would have expected to present to IAPT but as a result of COVID-19 did not.

Our analysis predicted a nearly four-fold (278%) increase in the number of people referred for IAPTs treatment in October as a result of COVID-19.

Based on the predictions for IAPTs referrals pre-COVID-19, combined with the expected surge in referrals for those who have put off or been unable to seek help during the lockdown, the data predicted that nearly 433,000 patients are likely not referred between March – September 2020 and if they all seek treatment through IAPT in October, services could experience a surge in demand of nearly 590,000 referrals compared to the normal 156,000 that were expected for October.

Current forecasts do not account for the additionally expected leap in demand for mental health services created by the pandemic itself and the subsequent economic fallout that is likely to leave the country reeling and push referral numbers much higher.

Chart 1: Showing the number of referrals that occurred since April 2017 as well as a forecast of where referrals were expected to be in a non-COVID scenario and the significant drop in the number of referrals between March and June 2020.

Chart 2: Showing the total number of referrals predicted for October 2020 (590,000), showing both the proportion that is due to normal demand (156,000) and the proportion that is due to backed-up demand as a result of COVID-19 (433,000).

Differences across regions
Additionally, we investigated regional variation by carrying out the analysis for each Sustainability and Transformation Partnership regions (STP), assuming that the referrals in an STP are the sum of the referrals in the Clinical Commissioning Group (CCG) that it contains. This highlighted variation between STPs both in terms of the absolute number of referrals that did not happen between March and June 2020 and in the percentage drops that represented compared to the previous year. We found that in the worst STP, the referrals seen in March – June 2020 were only 30% of what they were in the same time period in 2019, whereas in the best STP referrals were almost 90% of what they were in 2019.

Chart 3: Showing the percentage drop in 2020 referrals compared to 2019 referrals for March – June. This emphasises that across the country the number of referrals has dropped significantly and shows that there is regional variation in the amount that referrals have dropped.

What was the impact?
The findings were covered by The Observer and highlighted the possible mental health crisis that might hit later this year nationally and resulted in an interview on LBC news.

Dataset used:
For this analysis, NHS Digital monthly data publications were used. The total number of referrals across England was used for each month, going back as far as April 2017.


About
The ZPB analytics unit is part of ZPB Associates and works alongside ZPB’s strategy, marketing and PR specialists to combine bespoke analysis, understand of available data and statistical, health data and economic techniques to bring rigour, insight and value measurement to client challenges. This includes data-led PR stories, market analysis and segmentation, understanding the value of products and services if rolled out at scale and the economics and societal consequences of the policy being enacted. We have completed analysis for pharma companies, technology businesses and private providers of NHS services. We passionately believe that data adds another dimension to a story. It provides insight, legitimacy, enhancing your message creating impact and important context. It always needs to be handled with responsibility and integrity and that’s what we know how to do – using data to stand up a story that’s not valid is wrong – and ultimately damages your brand.

To understand how your organisation can work with the ZPB analytics unit please speak to Alex Kafetz, via alex@zpb-associates.com or 07826 552349

Copyright September 2020. Unless explicitly stated otherwise, all rights including copyright in the content of this analysis are owned by ZPB Ltd. The content of this analysis may not be copied, reproduced, republished, posted, broadcast or transmitted in any way without first obtaining the permission of  ZPB Associates Ltd. This report may be referenced or quoted (but not for commercial purposes) if copyright is acknowledged.