While NHS spending on antidepressants increased above inflation over four years, mental health care in England remains in crisis. Sian Norris reports with the Byline Intelligence Team

The prescription spend on antidepressants has risen from £266 million in 2016 to £374 million in 2020 – an inflation-busting 30.06% in a four year period. 

The data analysed by the Byline Intelligence Team, revealed during Mental Health Awareness Week, is based on the NHS Prescription Cost Analysis report for England. It shows that, alongside the rising prices of heart disease treatments and diabetes drugs, some medicines are seeing above inflation cost increases that are putting pressure on NHS budgets and GP budgets in particular. 

Between January and March 2021, a total of 20.2 million antidepressant drugs were prescribed in England: a 3% increase from 19.6 million items for the same quarter in 2019/20. The majority of those prescriptions were for selective serotonin reuptake inhibitors (SSRI) medicines.

The mental health impacts of lockdowns meant that more people were seeking antidepressant prescriptions than had initially been forecast. Between March 2020 and March 2021, there were 803,000 more antidepressant prescription items issued than expected based on historical trends. The NHS Business Services Authority noted that while this was higher than expected, it was not a “significant increase for the period”. 

In 2021, 5,203 suicides were registered in England: equivalent to a provisional rate of 10.5 suicide deaths per 100,000 people. The Office for National Statistics noted that this was a small increase from 2020, but one that most likely reflected the resumption of coroner’s inquests following the initial COVID-19 lockdown periods in 2020, as opposed to a genuine increase in suicide. In 2016, the suicide rate in England was 9.5 per 100,000 people. 

Although the data analysed by the Byline Intelligence Team represents a significant rise in prescription cost of antidepressants since 2016, it’s important to note that this may not indicate a rise in the number of people diagnosed with depression. SSRIs can be offered to people living with post-traumatic stress disorder, anxiety, and even menopausal symptoms such as hot flushes.

Other reasons why prescription costs may have increased is due to doctors prescribing more frequent prescriptions for the same number of patients (e.g. providing a packet of pills that cover two weeks, rather than one month – this can be a safety measure for vulnerable patients); and could be linked to a small increase in the same number of patients needing treatment for a longer period of time. 

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Mental Health Crisis

While there may be numerous explanations for why the spending on antidepressants has increased, it remains the case that mental health care is in crisis in the UK.

People with severe mental illness are far more likely to die prematurely (before the age of 75) than their peers – and the number of people dying early has increased. 

Data for 2016 to 2018 for England showed that over the three year period, 95 people with severe mental illness died per 100,000 adults. Based on the same data set, in England people with severe mental illness are 4.5 times more likely to die prematurely than those who do not have a similar diagnosis. The inequality in life expectancy is the same for men but greater for women, who are 4.7 times more likely to die prematurely than their female peers.

Worryingly, the inequality for excess premature mortality has increased over time. For all people with severe mental illness, the increase in the excess premature mortality was 355% to 365% – or 10% – when comparing data for the periods 2015 to 2017 and 2016 to 2018. For men it was a 9% increase; for women 10%. 

Beyond prescriptions for antidepressants, people struggling with severe mental illness are facing barriers to accessing appropriate treatment.

As previously reported in this paper, the number of mental health patients receiving treatment out of area is concerningly high. The latest data for January 2022 shows that in England, 700 of 770 placements are considered to be “inappropriate”, or where “patients are sent out of area because no bed is available for them locally, which can delay their recovery”. 

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The highest rate of inappropriate placements is in the North West, where 100% (215 out of 215) of placements were found to be “inappropriate”. 

There are limitations to the data, for example, only 79% of organisations providing acute mental health care participated in the collection for January 2022. The data only includes out of area placements that have started since the beginning of the collection: 17 October 2016.  

Of the patients placed out of area, 60 in England were being treated more than 300km from their homes. The majority (235 patients) were being treated 50-100km away. 

While there are some examples where treatment out of area could conceivably be helpful – for example moving people away from toxic situations – overwhelmingly it’s agreed that going through treatment away out of area creates barriers to recovery. It can be harder for loved ones to visit a patient, patients are treated away from their support networks such as family and friends, and away from local specialist services which they may have previously engaged with.

There has been a 14% fall in the number of mental health beds from 2014/15 to 2018/19. Reducing the number of mental health beds has formed part of strategic commitment to support people in the community, however as the growth in out of area care shows, not all treatment can be provided in a community setting. 

Increasingly, what mental health beds are left in the NHS are being run by private providers: it is estimated 30% of mental health hospital capacity is now in the private sector – with 98% of private facilities’ earnings coming from the health service. In Bristol, North Somerset and Gloucestershire, 95% of mental healthcare beds are owned by private providers, and three-fifths are owned by US companies. 100% of patients in the South West (65) were being treated in out of area placements in January 2022. 

Additional reporting by Iain Overton

This article was produced by the Byline Intelligence Team – a collaborative investigative project formed by Byline Times with The Citizens. If you would like to find out more about the Intelligence Team and how to fund its work, click on the button below.

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