Demand and Flow

Mental illness is the largest cause of disability amongst working-age adults in England (Kirk-Wade, 2022)
In any given week, one in six adults (17%) experiences depression and/or an anxiety, a greater proportion than in the 1990s (NHS Digital, 2014). Using this figure, we estimate that there are around 123,500 working-age adults in Cambridgeshire and Peterborough with a common mental health condition.
It is also estimated that there will be a 15.6% increase in the number of working-age adults in Cambridgeshire and Peterborough from 2021 to 2041.

Timely access to mental health care is important. As GIRFT highlights, the more time that passes before treatment is accessed, the greater the likelihood that a condition will become more chronic and difficult to treat. Delays to access also make crisis presentations more likely. Presentation in crisis often reduces available options and may lead to a breakdown in community support, making recovery harder to achieve. Timely, equitable access to care must lead to timely effective interventions; otherwise, people can end up in sub-optimal care pathways (Davidson, 2021).

The key issue is that patients must be able to step the intensity of their care up or down as and when is necessary; in essence, people should receive the lowest intensity of service that meets their need. When people do need more intense care, they should have timely access to the appropriate interventions.
National data shows that when people’s healthcare moves between teams, over 20% do not reach the new team (Healthwatch, 2023b; NHS England, 2019). This may be because their referral was rejected (Healthwatch, 2023b), complex referral process and transition between services (NHS England, 2019), or a lack of support to meet multiple needs (NHS England, 2019).
People report this is frustrating, anxiety inducing and can cause harm in some circumstances (Healthwatch, 2023b). It may also lead increased demand in other areas of the healthcare system, such as crisis services (Healthwatch, 2023b).
When multiple services provide care, people may have to go through multiple assessments, which can be distressing for the individual. It increases the chance they will drop out of services, delays their access to treatment and is a poor use of resources.
Some groups are more likely to ‘bounce around’ services. For example, people with co-occurring substance use and mental health needs can often experience difficulties accessing continuous care and may fall through the gap between services

Older adults

It is predicted that almost 1 in 5 (19.6%) of people in Cambridgeshire and Peterborough will be aged 65+ by 2031 (PHI team, 2023). This means that there is a growing demand for older people’s mental health services. This mental health needs assessment showcases the predicted increase in the older people with mental health conditions.

Transitions between mental health services should be needs-led, and the needs of older people should be reviewed to establish if they should be supported by specialist older people’s mental health services, on remain in more generalist services (Royal College of Psychiatrists, 2019a). A substantial proportion of older people have multiple and long-term needs that require support from multiple services and professionals, including across both health and social care. Guidance for commissioners highlights that older people’s mental health service should take an integrated approach with social care; as well as working closely with closely with primary care and community-based services (Raffertys, 2013).

GIRFT highlights primary care, community care and social care and the wider health and social care system must work well together for older adults to receive high quality care (Davidson, 2021).
In 2018 the Care Quality Commission highlighted that health and social care systems in England are not always joined-up, which means that some people receive fragmented care (Care Quality Commission, 2018).

References

Full list of references is included at the end of this chapter.