There is a  growing number of young people with mental health needs. Yet Allen Joseph and Whitney Crenna-Jennings argue that the way the NHS collects data about the speed with which children start receiving treatment for mental health issues are underestimating the waiting time before treatment commences. Without accurate data the Government’s initiative to reduce waiting times can fall short of addressing the real extent of the problem. 

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Last month, the government announced a series of reforms to increase access to appointments and reduce waiting times for people requiring healthcare. This is welcome given that 40 percent of patients – or three million people – are currently waiting more than 18 weeks for treatment to begin.

Yet delivering on this promise for the growing number of young people with mental health needs will be fraught with challenges unless the government confronts a fundamental issue: data on the number of young people accessing mental health services is seriously flawed.

The definition of being “in contact” is far from precise. Digging deeper into the data we’ve found that it can mean simply that a referral has been made, rather than an individual actually being in treatment.

At first glance, NHS England’s annual statistics on the number of children “in contact” with mental health services provides a clear picture of how many are receiving mental health treatment. The data shows that over 1.1 million people under the age of 18 are “in contact with secondary mental health, learning disability and autism services”. Around one in five 16- and 17-year-old girls in England are in contact with services compared with just over one in ten 16- and 17-year old boys – significant proportions of the population. Adolescent girls are the most likely of all age groups to be in contact with services.

The fact is that reliable waiting time data for children’s mental health services do not exist.

But the definition of being “in contact” is far from precise. Digging deeper into the data we’ve found that it can mean simply that a referral has been made, rather than an individual actually being in treatment. For many people, treatment may not have begun or even be on the horizon.

This is not how these figures are described in the NHS press release accompanying the data’s publication, nor how they were interpreted by the press.

Given that “contacts” may not refer to treatment starting, they are likely to be underestimating the long waiting times that young people are experiencing until they actually start treatment.

Why accurate data on waiting times don’t exist

The fact is that reliable waiting time data for children’s mental health services do not exist. Instead, many reports rely on a rule-of-thumb used by the Children’s Commissioner’s Office, which treats a child’s first recorded contact as a stand-in for an assessment of their needs and the second recorded contact as an indicator of the start of treatment. We’ve leaned on these figures ourselves. But given that “contacts” may not refer to treatment starting, they are likely to be underestimating the long waiting times that young people are experiencing until they actually start treatment.

The NHS documentation also clarifies that “contacts” can include those that are “indirect”  – a phone call with a parent, administrative activity related to the patient, or even a discussion between clinicians can be logged as contact. In other words, these interactions may not include the patient at all.

Counting these indirect “contacts” as a young person’s first or second contact with mental health services may create the appearance of more young people starting mental health treatment than really are. Much of what we think we know about how long young people wait for help is therefore based on an inaccurate (and overly generous) interpretation of NHS measures of access to services figures. It is possible that unlike the reported average waiting time of just 5 weeks, the actual average waiting time for treatment may be considerably longer.

Inaccurate data has far-reaching consequences. Commissioners may struggle to direct resources where they are needed most, ministers cannot allocate budgets wisely, and voters cannot hold their MPs to account.

The number of young people with open referrals to secondary mental health services is a useful metric, however the lack of differentiation between children who have been accepted by a service and are waiting for treatment, those who have been in indirect “contact” with a service (for example, according to discussions between clinicians about the patient, or a call between a clinician and their parent), and those who are actually in treatment, is a problem. The longstanding capacity issues in young people’s mental health services are well known—and this lack of clarity continues to mask the reality of how many young people are unable to access help.

Why accurate data are needed

Inaccurate data has far-reaching consequences. Commissioners may struggle to direct resources where they are needed most, ministers cannot allocate budgets wisely, and voters cannot hold their MPs to account. Without accurate data, the government’s proposed reforms, aimed at increasing access and reducing waiting times, risk being built on sand.

The stakes here are high. Many lifelong mental illnesses can develop during the teenage years; ignoring them now only shifts the burden to the future.

Data accuracy is not only an issue for health statistics. Many of the numbers meant to guide policy—whether it’s the number of adults working or even the number of children in the country—are less reliable than they seem.

The stakes here are high. Many lifelong mental illnesses can develop during the teenage years; ignoring them now only shifts the burden to the future. We are seeing this play out now: the number of young people in the workforce aged 16-24 reporting that their mental health limits the work they can do has quadrupled in the last decade.

Without reliable numbers, the most well-meaning efforts can fall short, and the public deserves clear evidence on whether progress is being made.

For the government to achieve its missions, and improve the experiences of those who require healthcare, the shortcomings in official statistics on waiting times and access must be addressed. Without reliable numbers, the most well-meaning efforts can fall short, and the public deserves clear evidence on whether progress is being made. We need the right data and metrics, and researchers, policymakers and leaders should be brave enough to admit what they don’t know.

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.

Image credit: Astafjeva in Shutterstock

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