Mental Health

Mental Health Overview

Mental Health conditions can be difficult to identify within health data. The conditions can be transitory or episodic, meaning coding does not necessarily reflect the patient's current health. The experience and treatment of a mental health issue is also individual to a patient, meaning the presence of a code, particularly for Common Mental Health Disorders, does not provide a clear indication of the severity of the condition, the impact it has on the patient's life and wellbeing, or the way the condition is being managed. Patients may also exhibit multiple mental health problems, which a clinician may choose to code and treat in different ways depending on perceived priorities or causations. Finally, clinicians and patients may prefer to use or accept particular diagnoses, which can affect the coding used in the patient's record.

Mental Health data is provided across a series of registers.

Anxiety

The anxiety table includes codes associated with the Common Mental Health Disorders, with the exclusion of Depression, as defined by NICE:

generalised anxiety disorder
panic disorder
obsessive-compulsive disorder (OCD)
post-traumatic stress disorder (PTSD)
social anxiety disorder
depression

Inclusion is for codes recorded in the last 24 months, as a reasonable timeframe for ensuring patients are currently being managed, to some level, for their condition.

Depression

The depression table contains all patients who have been coded for depression since 01/04/2006 (QOF definition). The latest code is provided, as well as the earliest, so it is possible to filter for patients who have been recently coded with depression eg in the last 12 or 24 months.

Depression codes, however, are not consistently or regularly re-entered and there are many patients who appear to be receiving ongoing treatment for depression, but who have no recent depression coding. Conversely, the 'depression resolved' code is not consistently applied, so the register will also include patients who are no longer be treated as depressed.

Antidepressants

The prescribed_antidepressants table contains all patients who have been prescribed anti-depressant medication (BNF 04:03 excluding amitriptyline) in the past six months. Amitriptyline is excluded as it is not recommended for treating depression and is more commonly prescribed for pain relief. Other drugs within this chapter may also be prescribed for conditions other than depression, sometimes with differing dosages:

BNF	VTM	Medication	Dosage	Other Conditions + Dosage
403010	F0	Clomipramine Hydrochloride	>=10mg	Phobia + OCD >=10mg
403010	L0	Doxepin	>=75mg	Pruritus in Eczema 3-12mg (cream)
403010	N0	Imipramine Hydrochloride	>=75mg	Childhood Bedwetting 25-75mg
403010	X0	Trazodone Hydrochloride	>=100mg	Anxiety 75-300mg
403020	K0	Moclobemide	>=150mg	Anxiety 300-600mg
403030	D0	Citalopram Hydrobromide	10-40mg	Panic 10-40mg
403030	Z0	Citalopram Hydrochloride	40mg/1ml	Panic 40mg/1ml
403030	X0	Escitalopram	5-20mg	Anxiety, OCD & Panic 5-20mg
403030	E0	Fluoxetine Hydrochloride	20-60mg	Bulimia 40-60mg, OCD 20-60mg, Menopause 20mg
403030	L0	Fluvoxamine Maleate	50-300mg	OCD 50-300mg
403030	P0	Paroxetine Hydrochloride	20-50mg	OCD 20-60mg, Panic 10-60mg, Menopause 10mg
403030	Q0	Sertraline Hydrochloride	50-200mg	OCD 50-200mg, Panic, PTSD & Anxiety 25mg-200mg
403040	Y0	Duloxetine Hydrochloride	60mg	Anxiety 30-120mg, DM Neuro 60-120mg, Female Incontinence 20-40mg
403040	W0	Venlafaxine	>=75mg	Anxiety 75-225mg, Panic 37.5mg-225mg, Menopause 37.5mg-75mg

Patients may be instructed to take multiple tablets per day and may have concurrent prescriptions for different strength medications. The particular dosage shown in the latest6m_name field should only be taken as a rough indicator of the medication dosage that has been advised for the patient and whether they are being treated for a condition other than depression.

The prescribed product shown in the latest6m_code and name is the latest prescription within a prescription course for that medication and dosage. That prescription course may be a Repeat course (allowing the patient to re-order the prescription) or an Acute course (a one-off prescription). The table provides the latest Repeat prescription or, if no Repeat prescription has occurred in the last six months, the latest Acute (one-off) prescription. This is shown in the prescription_type column. The prescription_count gives the number of prescriptions that have been made within the prescription course to date and the prescription_earliest_date gives the date of the first prescription within the course.

Active Depression

The prescribed_antidepressants table can be joined to the depression table, in order to identify patients with both a depression code and a current anti-depressant medication. As described above, there is no guarantee however that the patient isn't being medicated for an alternative condition. Attention may want to be given, therefore, to the type of prescription, how long the prescription has been in place and to the dosage.

The prescribed_antidepressants table could also be cross-referenced against the anxiety and eating_disorder registers to further identify patients that are possibly receiving the medication for these conditions, rather than depression.

Patients with depression may also follow talking therapies rather than take medication. It is advisable, therefore, to also include patients without an anti-depressant prescription but with a recent depression code.

Eating Disorder

The eating_disorder register contains patients with mental health conditions linked to beliefs about their weight or body shape, such as Anorexia Nervosa, Bulimia and Binge Eating. These conditions are not listed by NICE as CMHD.

The register does not include patients with Other Specified Feeding or Eating Disorder (OSFED), whose condition is linked to other beliefs or concerns, or patients with Avoidant/Restrictive Food Intake Disorder (ARFID), who choose to avoid or limit their intake of certain foods. It is expected that these patients will also have more general codes in their records that will place them into the anxiety or severe_mental_illness registers.

Severe Mental Illness

The severe_mental_illness register includes persistent long term mental health conditions, such as schizophrenia and bipolar disorder. It also includes anyone currently prescribed lithium.

Personality Disorder

The personality_disorderregister is a non-QOF register specific to personality disorders. It uses codes that do not appear in the MH_COD codeset used for severe_mental_illness. Patients may have been coded however to appear in both tables.

Backlinks:

Prescriptions

See Antidepressants for more detail of the medications included.

Registers

For full information on the range of Mental Health registers and prescribing see Analysis: Mental Health

> Severe Mental Illness (SMI) includes both schizophrenia and bipolar disorder and anyone on lithium who is not also coded having these conditions. For full information on the range of Mental Health registers and prescribing see Analysis: Mental Health