Building an evidence-based approach to mental health care

Good policy and successful services are built on sound data. Nowhere is this more important than for mental health care. Announcing the forthcoming review into the prevalence and support for mental health conditions, autism and ADHD, Wes Streeting acknowledged there’d been a massive growth in mental health and behavioural issues with no consensus on what was driving it.

We need an up-to-date evidence base to improve access to the right support in the right setting, recognising distinctions between different mental health and neurodiverse conditions, and shaping the wider health and care system’s use of resources.  The review will examine the challenges facing clinical services and explore different approaches within and beyond the NHS, that promote prevention and early intervention. 

An important data resource already available is the Adult Psychiatric Morbidity Survey (APMS). This charts the prevalence over time of treated and untreated mental health conditions in England, identifying trends, including inequalities and the level and nature of treatment and service use.

Rapidly rising prevalence

The most recent iteration, the first since 2014, came in two instalments. The first set of findings, published in June 2025, highlighted the rapidly rising prevalence over the last decade of common mental health conditions (CMHCs), comprising different types of depression and anxiety disorder. This was particularly marked among 16-24 year olds, rising from 17.5% in 2007 to 25.8% in 2023/24. 

The figures showed a worrying link with socioeconomic status. Prevalence was significantly higher in the most deprived areas, for people with problem debt, and for those who were unemployed or economically inactive. It was also higher among women (24.2%) than men (15.4%). 

While it was encouraging to see more people aged 16-74 reporting that they’d received treatment (47.7% compared with 39.4% a decade earlier), it’s a real concern that those from certain ethnic groups and people over 75 were less likely to get the treatment they needed, and overall the findings provided clear evidence of very significant unmet need, even as trusts work to expand services and improve support with the resources they have available.

The second tranche of findings from the survey, which came in November, concluded that the prevalence of other conditions including autism, psychotic disorder, bipolar disorder and personality disorders was stable, while the incidence of ADHD, eating disorders and self-harm have all increased. 

A further striking finding was how varied the trends in hazardous drinking have been across age groups over the last decade. While rates of hazardous drinking more than halved among 16-24 year olds, and fell among those under 44 more generally, they have not changed for over a decade in those aged 55-74 and even increased in those over 75. 

Worrying picture of mounting pressure

Taken together, the findings present a worrying picture of mounting pressure on mental health services as they strive to keep pace with growing demand. Trust leaders are keenly aware of the challenges. In our recent State of the Provider Sector survey fewer than one in ten leaders felt that investment matched demand for mental health services, and 60% said services lacked the capacity to reduce waits and intervene earlier. Two thirds (65%) were doubtful that mental health services would be given sufficient consideration in implementing the government’s 10-year health plan.

That is a difficult basis to build on. We see from all the clinical evidence available how important timely access to the right services and support is both to prevent mental ill health and, where possible, to avoid conditions worsening. This underlines the need for a continued focus on improving community services, and access to support around finances, employment, and physical health needs. 

We know this can be done, and is happening in the NHS today. The recent report on mental health community services by the HSCSC emphasised the role of 24/7 Neighbourhood Mental Health Centres. We have highlighted the transformative impact these new centres could  have in improving access while addressing inequalities. It’s early days but the early indications from staff on the ground are very encouraging. 

The NHS needs to do better at recognising, sharing and scaling up successful models   particularly where they help to address socioeconomic factors such as housing, debt, deprivation and unemployment, joining up clinical and social support to better recognise and meet people’s needs, and ensure a range of services and interventions that are appropriate and effective.

The scale of unmet need underlines the importance of ensuring that trusts have the resources to close treatment gaps and manage existing, and future, levels of demand. So it is very disappointing that the Mental Health Investment Standard (MHIS) is being watered down from next year and will not meet its original ambition for faster spending growth for mental health. We want to engage with national bodies on how the MHIS, or an alternative, can be designed to ensure mental health services receive sufficient funding growth to manage existing, and future, levels of demand.

Alongside this we should expect to hold the mental health sector to the same standards and expectations as other sectors on key areas such as improving patient flow, reducing variation in lengths of stay in inpatient settings, and managing waiting lists. Delivering this depends on consistently robust and relevant data. While some data availability has improved in recent years, trusts still face hurdles in turning this information into action. Challenges with data sharing and shortages of analytical skills continue to limit trusts’ ability to tackle health inequalities. Closing these gaps would be a further important step towards achieving parity of esteem.

Cross-government approach

And underpinning this, we need a cross-government approach to addressing wider determinants of health, backed by long term investment, to support education, training, housing and welfare. Get this right, and we can unlock skills, jobs and economic growth alongside health benefits. 

There is a growing perception among trust leaders of a waning political will and focus on addressing the systemic challenges facing the mental health sector and delivering the well-established principle of parity of esteem between mental and physical health care. Building on the evidence will be an important step forward but what we also need is a real commitment to act.

This article first appeared in Public Sector Focus