Thousands of people omitted from mental health statistics

Thousands of patients are omitted from official health statistics because they are not seen by hospitals or GPs, according to a new analysis of ambulance data in England.

The analysis, carried out by the Yorkshire ambulance service (YAS) and the Association of Ambulance Chief Executives (AACE), showed that more than a third of people who made calls attended by YAS last year – 288,000 of about 800,000 – did not go to hospital, the Guardian reported. Many of these patients had mental health problems.

Some people were treated by ambulance staff at the scene, or later saw a GP or attended A&E of their own accord. Conditions that are not commonly treated in hospital, however, such as mental illness or substance misuse, are likely to be dramatically undercounted, the researchers say.

For example, NHS figures show that in 2022-23, 870 people under the age of 18 were admitted to hospital for mental health problems. In the same period, however, YAS received about 3,300 calls for this age group. Verity Bellamy, senior public health analyst at YAS, said: “This suggests we’re missing almost three-quarters of those young people by just using hospital data.”

The highest number of mental health calls was from girls and young women aged between 15 and 24. Bellamy said: “If we want to measure the prevalence of mental health need in young people, we need to think about using ambulance data [as well as] hospital data.”

The analysis showed that 55% of all calls relating to mental health were for under-40s, with almost a quarter for under-25s. People in the poorest fifth of society were five times more likely to call an ambulance for a mental health concern.

Homeless people and refugees may choose not to attend hospital

The findings of the study, carried out by Bellamy and her colleague Ruth Crabtree, AACE’s national lead for public health, were presented at the NHS ConfedExpo in June. The pair now plan to carry out an England-wide analysis of ambulance data.

Crabtree said it was the first time an ambulance service had systematically examined its data in this way. “As a sector, we tend to measure performance and demand, rather than this kind of more upstream way of looking at things,” she said. “So it’s very interesting that Verity has come in and seen something that surprised her and that is quite different to what we’ve seen before.”

Dr Steven Dykes, deputy medical director at YAS, said that ambulances increasingly provided care in situ to people who did not want to go to hospital. This included homeless people, refugees and older, more frail people. “One of the key things for us was that the ambulance rate for those in the most deprived areas is double that of the least deprived,” he said. “There’s a greater amount that [ambulance crews] are actually managing at home and when you see that in the data, it’s really quite shocking”.

Bellamy said the ambulance service could act as an “early warning system” for other parts of the health service: “We’re probably likely to see this before, perhaps, commissioners of mental health services, for example. So we’re trying to share this data with the right bits of the system, so they can plan properly.”

She added: “We think a lot about how we get ambulances faster to people but actually, if we start thinking more upstream, we can get into prevention. And that’s a much better thing for people as well.”

Dykes said that YAS was working with mental health trusts and charities to help patients get better access to those services, adding that there was a major problem with transition from child to adult services: “Is it that the services just aren’t there for them and they fall in between the gaps in this age group? That’s why it’s important for us to turn this data around and reflect it back into the system.”