Mental health, current and upcoming work: March 2023

The World Health Organization (WHO) constitution states that "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Similarly, mental health is not the absence of a mental disorder or disability, but depends upon individuals being able to understand their personal abilities and cope with the stresses of life. Individuals should also be able to work productively and contribute to their community. A recent Office for Statistics Regulation review into mental health statistics in England (PDF, 505KB) showed some gaps in evidence which could be exploited through better data, data analysis and linking data.

While we acknowledge that poor mental health does not always result in suicide, there is a clear link between poor mental health and suicide. According to the WHO, "more than 700,000 people die because of suicide every year" worldwide. Our definition of suicide for England and Wales is defined using the WHO's International Classification of Diseases, Tenth Revision (ICD-10) for the years 2001 onwards, and suicides are determined based on verdicts supplied by coroners when a death is registered. Therefore, this workplan will also cover analysis being conducted on suicides.

This article outlines the analytical work we are undertaking relating to mental health and suicides. The analysis being completed on this topic area in the Office for National Statistics (ONS) is increasing in volume. This workplan provides our stakeholders and users with a single point of reference on what analysis is being done now and in the future. We will keep this workplan under review and provide regular updates with new insights and any new priorities which emerge.

We have published the following ad hoc bulletins on mental health and suicide during the coronavirus (COVID-19) pandemic. These articles include measures of self-reported depression, and depression diagnosed by general practitioner (GP), during the pandemic:

• Coronavirus and depression in adults, Great Britain: July to August 2021

• Coronavirus and GP diagnosed depression in England: 2020

• Deaths from suicide that occurred in England and Wales: April to December 2020

Our article on the Socio-demographic differences in use of Improving Access to Psychological Therapies services linked the Improving Access to Psychological Therapies (IAPT) dataset to the 2011 Census. It compared rates of access to the service by sociodemographic characteristics with data from the UK Household Longitudinal Study (UKHLS), which produced estimates of common mental disorders. This allowed us to understand which groups were underrepresented in the IAPT service.

We have also published the following ad hoc articles on the impacts of the cost of living crisis and winter pressures on depression:

• Cost of living and depression in adults, Great Britain: 29 September to 23 October 2022

• The impact of winter pressures on different population groups in Great Britain: 22 November to 18 December 2022

We also publish two regular series of bulletins on suicides. These include our Suicides in England and Wales statistical bulletins. These bulletins provide final annual statistics on suicides registered in England and Wales with breakdowns by sex, age, area of usual residence and suicide method. Our Quarterly suicide death registrations in England statistical bulletins provide provisional suicide estimates by quarter.

We also produce ad hoc publications on suicides and have recently published data to estimate suicides among people with severe health conditions, higher education students and sociodemographic inequalities. We have also matched data from the HM Prison and Probation Service to Office for National Statistics (ONS) mortality records to provide estimates on Drug-related deaths and suicide in prison custody in England and Wales: 2008 to 2019.

On a quarterly basis, we publish our Quality of the Life in the UK bulletins which consists of some self-reported measures of mental health, including depression and anxiety.

Mental health and the coronavirus (COVID-19) pandemic

We are conducting research investigating mental health outcomes following COVID-19 infection. This work is being done in collaboration with academics and analysis is being conducted using the OpenSAFELY platform. It will be the first analysis linking the COVID-19 Infection Survey with primary care data to look at mental health outcomes in those infected by COVID-19 compared with those who were not infected. We aim to publish this in spring 2023.

Common mental disorders and inequalities in accessing services

Following our published bulletin on Socio-demographic differences in use of Improving Access to Psychological Therapies services, we are repeating this work using more recent data (from 2018 to 2022). This will enable us to understand how access to the Improving Access to Psychological Therapies (IAPT) service has changed over time. It will also demonstrate any differences that occurred in accessing the service during the first year of the pandemic (2020 to 2021) and beyond. We hope to publish an updated publication in late 2023.

Mental health outcomes in different population groups

We aim to use data from Census 2021 linked with other administrative datasets including IAPT, Hospital Episode Statistics (HES) and death registration data, to understand mental health service use, treatments, and outcomes in different population groups. Our first project will focus on the mental health outcomes in the LGBTQ+ population. Our future plans will consider other groups, such as veterans, ethnic minorities, and disabled people, to understand their experiences in mental health services. We are also considering looking into specific occupations such as emergency service workers.

In 2021, the Inclusive Data Taskforce (IDTF) outlined eight important principles to improve the UK’s inclusive data infrastructure. Among them was the need to address critical data gaps around missing or harder to reach groups, as well as improving the inclusivity of data at the point of collection and making greater use of existing data sources. Accordingly, we are currently exploring the experiences of non-household populations (NHPs) who are captured in the IAPT administrative dataset. The first stage of our project is to focus on the experiences of prisoners in IAPT. We would then, where possible, replicate similar analysis for other NHPs such as those residing in care homes or students in halls of residence. For all NHPs eventually considered, and starting with prisoners, we aim to report descriptive information on the number of NHPs accessing IAPT mental health treatment for common mental disorders (CMDs). Such information will include the NHPs’ main demographics, the CMDs they are diagnosed with, the way in which they were referred, and their protected characteristics where available (as defined under the Equality Act 2010). We will also report on waiting times, number of appointments attended or missed, reasons for dropping out, and improvement rates.

Mental health and the labour market

We have recently received funding via the Evaluation Accelerator Fund to investigate the labour market effects of IAPT treatment, and integrated employment support. We will be using a unique method that combines the IAPT programme data linked with benefits data from the Department for Work and Pensions (DWP) and HM Revenue and Customs (HMRC), as well as data from the censuses. To estimate the effect of IAPT treatment on labour market outcomes, including employment, annual earnings, and receipt of social security benefits, we intend to compare the outcomes of participants who received IAPT treatment with the outcomes of people who were assessed for IAPT but did not receive treatment.

Dementia

We are working on a project investigating the risk of death during the pandemic in people with dementia compared with those without dementia, by place of death. This project is undertaken in collaboration with the adult social care team in the Office for National Statistics (ONS). It will use the ONS’s Public Health Data Asset (PHDA). This work is due to be published in March 2023.

Suicides

We are currently qualitatively analysing prevention of future death reports categorised by suicide between January 2021 and October 2022. This analysis will highlight any important themes arising from the concerns listed in the reports to feed into the implementation of suicide prevention policy. This work is due to be published in March 2023.

We will complete a project investigating suicide risk following a bereavement. Using data from the 2011 Census, linked with death registration data and the PHDA, we can understand the risk of suicide in families where a bereavement has occurred. We will specifically focus on close familial relationships. For instance, adults who have lost a spouse, partner or civil partner or child, and children who have lost a parent or sibling within the household. The results from this research will feed into future suicide prevention strategies. This work is ongoing, and we hope to publish this work in summer 2023.

We will complete analysis investigating suicide risk in veterans. The ONS is collaborating with the Office for Veterans Affairs (OVA) and the Ministry of Defence (MOD) to link 2011 Census data to MOD data on those leaving military service. This will enable veterans alive on 2011 Census Day to be identified. A cohort study will then be undertaken to compare suicide outcomes in this group with a matched control group. The results will be used by the OVA to inform priority work on improving mental health and reducing suicides in veterans. The ONS also plans to publish a regular annual release on suicides in veterans using new information from Census 2021.

We are also currently in the initial stages of finalising a project investigating the impact of the cost of living crisis on suicides. In addition, we will undertake follow-up work investigating the impact of the pandemic on suicides. This will be an update to previous analysis on suicides occurring during the pandemic. We will also provide updated analysis on suicides by occupation using 2021 Census data. This will ensure that there is a clear understanding of the occupations that are at a particular risk of suicide.

Quality of life

We will also continue to publish estimates from our measures of national well-being framework. These include a range of indicators across the 10 domains that matter most to quality of life in the UK. This will include a range of indicators on mental health and personal well-being. The next update, in May 2023, will also be accompanied by a recommendation for the future indicators to be included in our measures of national well-being framework.

In future, the team also hope to have access to the Mental Health Services Dataset (MHSDS) which will enable more in-depth analysis in secondary mental health services.

We hope to secure external funding to pursue other projects using the datasets we have available to us and would welcome any feedback on our future plans. We are also happy to have discussions about collaborating on projects.

This content will be reviewed on a biannual basis.

If you have any feedback or suggestions on the work we are doing around mental health, please contact us at health.data@ons.gov.uk.

We have the following publication dates scheduled:

• 28 March 2023: Dementia and a comparison of all-cause mortality and deaths involving coronavirus (COVID-19), England: 2020 to 2022

• 29 March 2023: Qualitative Analysis of Prevention of Future Death (PFD) Reports for Suicide submitted to coroners in England and Wales: January 2021 to October 2022

• 5 April 2023: Quarterly suicide death registrations in England: 2001 to 2021 registrations and Quarter 1 (Jan to Mar) to Quarter 4 (Oct to Dec) 2022 provisional data

• 12 May 2023: Quality of life in the UK: May 2023