A presentation given to the QualityWatch 2015 annual conference by Holly Dorning, Research Analyst, Nuffield Trust.

1. © Nuffield Trust and Health Foundation © Nuffield Trust
November 16, 2015
Focus on: People with mental ill health
and hospital use
Holly Dorning
Nuffield Trust

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Questions to cover
1. How does poor physical health affect people with
mental ill health?
2. What could hospital use tell us about quality of care
for people with mental ill health?
3. Where next?

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How does poor physical health affect
people with mental ill health?

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Mental health doesn’t exist in isolation

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People with mental ill health die younger and the
reasons are often linked to ‘physical’ health

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What could hospital use tell us about
quality of care for people with mental ill
health?

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Our approach
We used hospital data to identify :
MH cohort – patients who’d used
hospital services for mental health.
SMI subgroup – a subset of MH
cohort who had a diagnoses
classed as a serious mental illness.
PH cohort – patients who’d used
hospital services but had no record
of mental ill health.

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Our approach

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Finding: People with mental ill health used more
emergency care

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Finding: The majority of this care was for physical
health needs

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Finding: Deprivation is strongly associated with
emergency hospital use

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Finding: People with mental ill health had a higher
rate of potentially avoidable emergency admissions

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Finding: People with mental ill health used slightly
less planned inpatient care

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Finding: For some common procedures people with
mental ill health were more likely to:

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What next?

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Implications:
• High levels of emergency care use is an indicator of poor quality
care. It is distressing for patients and families and is costly.
• As the majority of this is for physical health needs, it suggests
these needs are not been identified and/or well-managed.
• The link with deprivation highlights one area where planning care
provision or more targeted interventions could have an impact.
• Higher rates of potentially avoidable emergency admissions may
benefit from improved primary and community care.
• As this group are using care for mental health needs these
encounters represent an opportunity to identify and support other
care needs.

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The reality:
• This is a group of people with very complex care needs.
• Lifestyle behaviours (for example smoking and alcohol) and
medications impact on the improvements that could be made in
physical health care.
• Overshadowing effect of mental health diagnosis means this often
takes priority, particular for those with more severe needs.
• Mental ill health is still often treated in isolation which can make it
tricky to know who is responsible for their physical health.
• Staff and the care system are under increased pressure.
• Ongoing funding constraints.

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Where next...
• we know there are areas across the country who are doing this
well and it is important we share this and ensure the funding and
support is there to make these improvements more widespread
• the King’s Fund are doing some work to gather case studies and
experiences of services tackling the physical health care of people
with mental ill health
• please share with us your ideas, thoughts and experiences so we
can spread them further.

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To recap...
• People with mental ill health die younger and the reasons are
often linked to ‘physical’ health needs.
• We found that people with mental ill health used much more
emergency care and that the majority was to support physical
health needs.
• We also found a strong link between emergency care use and
deprivation; that people with mental ill health have more
potentially avoidable admissions; and are more likely to be an
emergency admission and stay longer in hospital.
• We’d like to hear from you so we can share your ideas,
thoughts and experiences further.

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November 16, 2015
Holly.dorning@nuffieldtrust.org.uk
@Ron_direction