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Networked Data Lab: Mental Health in Clinically Extremely Vulnerable People

New research by the Health Foundation’s Networked Data Lab (NDL), of which ICHP is a key partner, reveals the extent to which the pandemic has had a devastating and lasting impact on the more than four million people who were identified as being ‘clinically extremely vulnerable’ (CEV) and asked to shield.

The analysis, released today in a new national report, suggests that there is now significant unmet health need and worsening mental health among this group. Based on the findings, the Health Foundation is calling for these patients to be prioritised by the NHS so their health needs do not deteriorate further. This national report was based on research conducted by all local Networked Data Labs, including North West London, in order to be able inform profile of people that were asked to shield during the pandemic, what was their use of care and how it changed during the pandemic.

Today ICHP, which runs the NDL for North West London in collaboration with Imperial College London’s Institute of Global Health Innovation (IGHI), Imperial College Healthcare NHS Trust and North West London’s CCGs, also publishes its first Satellite Analysis Report focusing on the mental health of shielding patients in North West London during COVID-19.

In North West London the key findings from our local analysis show: 

  • The numbers of shielding patients with a long-term condition of anxiety and depression prior to the introduction of shielding were relatively high, at 17.5% and 21.78% respectively.
  • The frequency of shielding patients presenting to their GP with signs of suicide risk increased during the pandemic, but most shielding patients (98.92%) had no evidence of suicide risk assessment before, during or after shielding.
  • Age appears to play a large role in the shielding population as to whether patients have a long-term condition of anxiety, depression or serious mental illness, with the 50-59 year age category having the highest incidence. 
  • People in the most deprived category had 1.66 times greater odds of having a long-term condition related to mental health recorded than those in the least deprived areas.
  • Those in the severely frail category had 2.06 times greater odds of having a long-term condition related to mental health than those in the fit category. 

These findings should be interpreted with caution but give us greater insight into the potential psychological impact of shielding across our population.

Our approach 

In North West London we worked closely with our local community to identify local research priorities in relation to this theme, holding a virtual workshop as well as an online prioritisation survey through which 112 community members had their say. Emerging priorities included the impact of COVID-19 on the diagnosis of other conditions, the impact on underserved communities and the impact on mental health. Of these, the team identified mental health as the topic which could be most directly explored using our data set and selected two key areas for analysis:  

  1. Mental health needs of shielded patients  
  2. Suicide risk assessments and coding in Discover data   

For this study we used our Discover dataset, which extracts data from over 400 provider organisations across North West London including 360 GP practices, 2 mental health and 2 community trusts and all acute providers attended by patients in North West London.  

The work was conducted by a joint team of analytics experts from ICHP and IGHI. Our analysts have been conducting their work using ‘R’, an open-source programming language and free software environment. ‘R’ was chosen by the Health Foundation as the main platform for all the analysis to be conducted by the NDL. ‘R’ enables NDL labs to process large amounts of data, conduct statistical analyses, and visualise data in new ways. This can allow us to obtain new insights and help us understand problems better.  

To aid our analysis we connected shielded patient lists for both primary and shielded patient datasets – which is a new capability of linking data. We have made this code publicly available via GitHub to enable learnings to be shared amongst other analysts to help spread this work further.  

Next steps  

We will be working to share the Health Foundation and our insights across our networks, both locally and nationally, to ensure the experiences and needs of the clinically extremely vulnerable are better understood as we transition into future phases of the pandemic.  

One of the themes that emerged during the initial conversations around topic one, was the impact of COVID-19 on children and young people’s mental health – and we were pleased when this was announced as the second theme. Work is already underway, and we have been working with healthcare professionals and children and young people across North West London to understand their priorities. You can read about our approach here.  

The NDL has enabled us to collaborate and strengthen our partnership with analysts across the UK, as well as strengthening our local relationships with Imperial College London, ICHT and the North West London CCGs. We are keen to continue building on this network and to collaborate with others for the future of population health. If you would like to find out more, please contact Sadie.myhill@imperialcollegehealthpartners.com.