Mental health: Using evidence to improve care

5 May 2026

HQIP’s CEO, Chris Gush, explains why data is pivotal to the national review of services and the transformation of mental health care.

With one in four adults in England and Wales experiencing a mental health problem every year, and emergency referrals for young people in England rising by over 50% in just 3 years*, mental health is a national concern. The announcement of a national review of mental health services, led by NHS England’s Chair, is a significant and welcome moment for the system. It follows a broader conversation about how the NHS measures, learns from, and improves the care it delivers; one that HQIP has been contributing to directly, ensuring that the data we already have is the cornerstone of building an NHS that is Fit for the Future. Another recent article, Measure, Learn, Improve, sets out more specifically how HQIP-commissioned data and evidence (from the National Clinical Audit and Patient Outcomes Programme, NCAPOP), supports service improvement. Here, I apply that principle to mental health care…

Around one in five adults in England lives with a common mental health problem, and there were 2.8 million referrals to adult community mental health services in 2023/24. Yet compared to major physical health conditions, where large national audits on cancer and cardiovascular disease have generated rich, longitudinal datasets, the mental health evidence base, while growing, remains less comprehensive. Indeed, many working in mental health and the voluntary sectors argue it is an area where high-quality, systematic data collection has historically lagged behind need.

The evidence we hold is based on real-world findings; the programmes are active; and the findings are already being used, making a difference to patients’ lives”

Through the NCAPOP, HQIP commissions and manages national mental health audit and clinical outcome review work on behalf of NHS England and the Welsh Government, with some programmes extending across all four UK nations. These programmes generate important evidence on quality, safety, outcomes and patient experience, and they produce practical, clinically-led recommendations grounded in real-world delivery. They do not cover everything. Areas such as depression, anxiety and community mental health care remain relatively under-served in national audit terms, and harnessing routinely collected data such as the Mental Health Services Data Set has proved technically challenging. But what we do have is substantial, and it matters. The data from these programmes has the power to transform mental health care in an efficient and sustainable way.

It is also worth noting that there are two parallel national reviews underway. Alongside the NHS England mental health review, the Department of Health and Social Care launched its own review in December 2025, covering mental health conditions, ADHD and autism. Both highlight a system that recognises the scale of the current unmet need and the urgency for reform, and both signal an opportunity for audit and outcomes data to shape what comes next.

As these reviews progress, there is a real opportunity to use the existing evidence base to align national priorities, reduce duplication, and focus improvement activity where it will deliver the most meaningful benefit for patients. We do not need to start from scratch. We already have mature national programmes producing evidence on access, safety, outcomes and patient experience. The opportunity is to use that intelligence systematically.

Our data – a rich, national source of evidence

The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH)

The Mental Health Clinical Outcome Review Programme, known as NCISH, is one of the Clinical Outcome Review Programmes commissioned by HQIP. Run by the University of Manchester, it provides internationally respected evidence on suicide and patient safety, examining suicide and homicide for people who have been in contact with mental health services, as well as sudden and unexplained deaths of psychiatric inpatients. The programme extends across England, Wales, Scotland and Northern Ireland.

Its annual reports and themed analyses provide recommendations at national and local level, directly informing suicide prevention strategy across all four nations. The programme has helped services better understand risks and opportunities for safer care, including through its widely cited ten key elements for safer mental health services.

The National Clinical Audit of Psychosis (NCAP)

The National Clinical Audit of Psychosis aims to ensure that everyone with psychosis receives high-quality, evidence-based care wherever they live. The programme is currently delivered by the Royal College of Psychiatrists, and covers all NHS-funded Early Intervention in Psychosis teams in England and Wales, providing a nationwide benchmark for the treatment and care that people with their first episode of psychosis receive.

Lived experience is central to how we approach that commissioning. Through ongoing engagement with service users and carers, we have heard clearly about delays in access to treatment, staff shortages and the variability of care across the country. Inconsistent care affects people’s ability to build meaningful relationships and find support in times of crisis. HQIP is committed to ensuring the audit’s priorities reflect those experiences, embedded in both the specification and how we monitor the contract. The most recent State of the Nation report was co-produced with clinical and service user advisors, a Service User and Carer Reference Group, and a steering group of over 30 clinicians, commissioners and NHS England staff. It found improvements in performance since the start of the audit in 2018/19 on the majority of the NICE quality standards, and highlighted key areas for improvement.

The National Audit of Eating Disorders (NAED)

Commissioned by HQIP in August 2024, the National Audit of Eating Disorders is a significant new addition to the national clinical audit portfolio. It seeks to drive improvement in the identification and appropriate management of eating disorders, and the quality and consistency of services for children and young people, adults of working age and older adults. A Service Mapping Report published in December 2025 drew on data collected from services across England, and achieved an outstanding 97% participation rate from eligible teams. Patient-level data collection commences in July 2026, with the first State of the Nation report due in July 2027.

The National Child Mortality Database (NCMD)

The National Child Mortality Database, which aims to reduce preventable child mortality, has produced some of the most widely cited work on child suicide in recent years. Its 2021 thematic report on suicide in children and young people identified 108 deaths assessed as highly or moderately likely to be due to suicide in a single year, equating to approximately two child suicides every week in England. Importantly, it also makes a number of important recommendations for suicide prevention. A full follow-up report drawing on cases since that publication is expected in 2027.

The Maternal, Newborn and Infant Clinical Outcome Review Programme (MBRRACE-UK)

The Maternal, Newborn and Infant Clinical Outcome Review, known as MBRRACE-UK, undertakes confidential enquiries into all maternal deaths from mental health-related causes. Mental ill health remains one of the leading causes of maternal death during pregnancy and in the first postnatal year, accounting for around a third of deaths, with substance misuse and other psychiatric causes among the leading factors. In April 2026, the Parliamentary Office of Science and Technology published a report on maternal mental health drawing directly on MBRRACE-UK’s findings, a clear signal that this programme’s evidence is shaping national policy conversations at a national policy level.

The impact of this work

The data and outputs from our national programmes are an invaluable, publicly available resource that shine a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve not only mental health care but also outcomes and patient experience more widely. Alongside published reports, our impact reports and programme outputs bring together learning from across the system, highlighting where improvement is being made and where further focus is needed. Every project within NCAPOP has been established to address clinical areas where healthcare improvement is required. For mental health care, from suicide prevention and psychosis care to eating disorders and maternal mental health, that body of evidence is growing and becoming ever more important – in spite of the areas where gaps in national audit coverage remain.

What this means for national mental health care

With this robust body of evidence that is trusted by clinicians and patients alike, HQIP stands ready to support both the national mental health reviews and ensuring that clinical audit and outcomes data are central to shaping the next phase of mental health services. The evidence we hold is based on real-world findings; the programmes are active; and the findings are already being used, making a difference to patients’ lives. Trusts and other providers, and ICBs and regional clusters, do not need to wait for the completion of the reviews to act. Existing audit and benchmarking data can support local and national improvement now.

There is a real opportunity to use the existing evidence base to align national priorities, reduce duplication, and focus improvement”

At the same time, HQIP is clear about what audit cannot achieve on its own. Improving mental health services at scale requires investment in data infrastructure, better use of routinely collected data, and a serious commitment to addressing the areas – including anxiety, depression, ADHD and autism – where the national audit evidence base remains insufficient. We call on those running these reviews to take the opportunity to join us in addressing this issue.

Our shared task is to ensure that the evidence generated across the system is used effectively, consistently and at pace to support improvement – and deliver mental health services that meet our growing need; leading to a population that is both healthier and happier than it is currently.

*Mind, May 2026