What is harmonisation?
Harmonisation is the process of making statistics and data more comparable, consistent, and coherent.
This guidance is intended to assist statistical producers to improve the consistency of their statistics and accessibility for users. It helps users compare and combine statistics, when appropriate. It also suggests where to go to find further information.
What is covered in this guidance?
This guidance provides information on where to find recent mental health data (since 2010). Mental health related definitions, important reports, legislation, and clinical measures are also included. It does not cover causes, influences or societal perceptions of mental health.
This guidance focuses on adult mental health only, as adult and child mental health may have different requirements and scope.
Mental health definitions
Definitions of mental health vary across public and private organisations and across countries. Some definitions focus on the temporary, emotional wellbeing aspect of mental health, and its effects on everyday life and relationships. Other definitions focus on mental health condition diagnosis, and intervention by specialist health services.
There is further inconsistency with the terminology used. In legislation, such as the Mental Health Act 1983, the term ‘mental disorder’ is used and is defined as “any disorder or disability of the mind”. Many public organisations and charities use the term mental health or mental wellbeing. However, many sources vary in using any of the above terms, as well as mental health problems, mental illness, and mental distress to name a few.
There is not one consistent definition of mental health used across the UK.
The World Health Organisation’s definition of mental health is used by Public Health England, Public Health Wales, Department of Health Northern Ireland, and United Nations. The definition is as follows:
“Mental health is a state of well-being in which an individual realizes [their] own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”
However, Scottish Government use a similar but broader definition of mental health in their Mental Health Strategy: 2017-2027.
“The term mental health is used in many different ways. It applies to a continuum from emotional wellbeing like happiness and sadness, to mental disorder like the acute reaction that can happen to stress, to mental illness like schizophrenia. Environmental, social and individual factors help to determine mental wellbeing. Genetic and environmental factors affect the prevalence and level of severity of mental illness in a population. These interactions are complex, but they offer different ways to influence mental health at an individual and population level.”
The Office for Statistics Regulation (OSR) have conducted a systemic review of known data sources on mental health in England. The Mental Health Statistics in England review was published in September 2020. The review recommends that work should be done to enable meaningful comparisons, as well as developing better definitions to go with publications. This review information only covers England, however OSR have begun planning for their Northern Ireland review, and intend to conduct systemic reviews of Scotland and Wales.
Survey data sources
There is no consistency in surveys that ask more specific mental health questions. They range from general wellbeing, to general mental health conditions to diagnosed mental health conditions. The approach to asking the questions varies and is inconsistent, they are asked directly or indirectly, and some provide a list of medical conditions. For example:
Do you have a mental health problem nowadays? (Northern Ireland Health Survey)
Do you think that you have ever experienced any of these? (Adult Psychiatric Morbidity Survey)
- A phobia
- Panic attacks
- Post-traumatic stress disorder
- Attention deficit hyperactivity disorder (ADHD) or Attention deficit disorder (ADD)
- Bipolar disorder (or ‘manic depression’)
- Post-natal depression
- Dementia (including Alzheimer’s)
- An eating disorder
- Nervous breakdown
- A personality disorder
- Psychosis or schizophrenia
- Obsessive compulsive disorder (OCD)
- Seasonal affective disorder
- Alcohol or drug dependence
- Any other anxiety disorder
- Any other mental, emotional or neurological problem or condition
The Adult Psychiatric Morbidity Survey has the most comprehensive coverage of mental health conditions. Others mainly ask the long lasting health conditions and illness harmonised standard, activity restriction harmonised standard and impairment harmonised standard. The harmonised standards cover physical or mental health conditions or illnesses and their impact on day-to-day life.
The following list of surveys ask some or all of the above the harmonised standards. The last survey year reviewed is given in brackets.
- 1958 National Child Development Study (2013)
- 1970 British Cohort Study (2016)
- British Social Attitudes Survey (2018)
- Community Life Survey (2019-2020)
- Crime Survey for England and Wales (2019)
- English Housing Survey (2019-2020)
- Family Resources Survey (2020-2021)
- Health Survey for England (2018)
- Inpatient Patient Experience Survey (2014)
- Labour Force Survey (2020)
- Life Opportunities Survey – Wave 3 (2015)
- Living Costs and Food Survey (2018-2019)
- National Diet and Nutrition Survey (2016-2017)
- National Survey for Wales (2019-2020)
- National Travel Survey (2019)
- Next Steps (Longitudinal Study of Young People in England) (2016)
- Northern Ireland Health Survey (2018-2019)
- Opinions and Lifestyle Survey – Well-being module (January and May 2016)
- Scottish Crime and Justice Survey (2018-2019)
- Scottish Health Survey (2019)
- Scottish Household Survey (2019)
- Taking Part: The National Survey of Culture, Leisure and Sport (2019-2020)
The Scottish Health Survey (2019), Scottish Household Survey (2019) and Scottish Crime and Justice Survey (2018-2019) use the Scottish Surveys Core Questions, which includes the long lasting health conditions and illness harmonised standard.
The following surveys ask questions similar to the harmonised standards or different questions on mental health.
This survey covers Great Britain. The long lasting health conditions and illness and activity restriction standards are asked in this survey. A further question asks if work is affected, and a similar question to the impairment standard is asked, with ‘Depression or other emotional, nervous or psychiatric problem’ listed as a response. This leads to a final question that asks which problem the respondent has had from the following list:
- anxiety including panic attacks
- mood swings
- manic depression or bipolar disorder
- emotional problems
- other emotional, nervous or psychiatric problem
This survey sweep was a shorter questionnaire, previous sweeps include questions on visits to a doctor or specialist for mental health problems.
This survey covers Great Britain. As well as asking the long lasting health conditions and illness and activity restriction standards, it asks about any health problems they have developed since the last interview (list of 21 broad conditions and follow up questions to identify specific conditions), and whether the conditions have been diagnosed by a doctor.
More specific mental health questions are asked, including visits to doctor or specialist for listed ‘mental health problems’ and if respondent is still suffering.
This survey covers England. Asks about patient’s most recent stay in an NHS hospital. Asks questions similar to the long lasting health conditions and illness and activity restriction standards.
This survey covers England. Covers if a respondent has any of the mental health conditions listed, if this was diagnosed and their age when they first had the condition.
The survey also has questions on the therapy, medication or other treatment received, which includes in- or out-patient visits to hospital and use of community care services.
This survey covers England. The survey asks if the respondent has any ‘long-standing illness, disability or infirmity’, if it impacts on day to day activities or work and whether it is expected to last less than three months. It also asks if and when the respondent has been told by a doctor they have a listed condition, ‘an emotional, nervous or psychiatric problem’ is a response option.
Further questions ask which ‘emotional, nervous or psychiatric problem’ the respondent has, with a list provided and if they have experienced these problems over the last two years. Participants are asked whether they have received any treatment for depression.
This survey covers 33 EU countries, including the UK. Questions similar to the long lasting health condition and illness and activity restriction standards are asked in this survey, however, the questions ask if the conditions are expected to last six months or more.
Further questions on feelings over the last two weeks, and participant responds to statements such as:
- ‘I have felt cheerful and in good spirits’
- ‘I have felt calm and relaxed’
- ‘I have felt downhearted and depressed’
This survey covers the UK. As well as asking the long lasting health conditions and activity restriction standards, this survey also asks if anyone in the household receives any of the help or support listed, which includes ‘keeping an eye out,’ ‘being there’ and ‘social support and assistance’.
This survey covers England. Includes questions on the respondent’s recent visits to general practices, and which health professional they had their appointment with (‘a mental health professional’ is listed as a response option).
Similar questions to the long lasting health condition and illness and activity restriction standards are also asked.
This survey covers England. This survey asks the long lasting health conditions and illness, impairment, and activity restriction standards.
It also measures the respondent’s current health and wellbeing by asking if they are currently anxious/depressed, responses range from ‘I am not anxious or depressed’ to ‘I am extremely anxious or depressed.’
This survey covers Scotland. Asks if respondent has any of the listed conditions, which includes ‘a mental health problem or illness’.
This survey covers the UK. It asks the long lasting health conditions and illness standard, as well as a similarly phrased question that asks about previous conditions. This is followed by a question that provides a list of conditions for the respondent to choose from, options related to mental health include ‘depression, bad nerves or anxiety’ and ‘mental illness or suffer from phobias, panics or other nervous disorders’.
This survey covers the UK. The survey asks the activity restriction standard, and the long lasting health condition and illness question with slightly different response options. Also asks about chronic health conditions that have been diagnosed by a health professional, as well as medication and treatment of the chronic health condition.
Asks if the respondent has any ‘emotional, psychological or mental ill health conditions’ that have lasted or expected to last 12 months or more. Questions also ask about its severity and impact on activities.
This survey covers the UK. Asks the long lasting health conditions and illness, activity restriction and personal wellbeing harmonised standards.
This survey covers England. Questions on experiences of community mental health services.
This survey covers the UK. Asks the long lasting health condition and illness, activity restriction, impairment and personal wellbeing harmonised standards.
This survey covers the UK. A question asks if the respondent has received treatment for any medical conditions listed in the past 12 months – list includes depression or any other mental health condition. Then asks if a person is currently taking any prescribed medication for depression or another mental health condition.
This survey covers Great Britain. As well as the long lasting health condition and illness, activity restriction and impairment standards, the survey asks respondents if they have self-harmed in the past year and the frequency of the self-harming.
This survey covers Northern Ireland. As well as including the long lasting health condition and illness and activity restriction standards, a list of medical conditions is given, which includes ‘long-term mental health problem.’ The follow-up questions for this response option include if the respondent has been diagnosed and who is their main point of contact in the health service.
There is also a question which asks if the respondent has a mental health problem nowadays.
This survey covers Scotland. Includes similar questions to the long lasting health conditions and illness and activity restriction standards, as well as asking what medical conditions they have. The self-completion section of the survey asks if the respondent has experienced depression, worry, tension, anxiety, phobias, and self-harm (including ever attempted suicide).
This survey covers Scotland. The long lasting health conditions and illness and activity restriction standards are asked in this survey.
The survey asks if the respondent has a medical condition, and ‘mental health problems’ is a response option. Other questions ask if they have been unfairly treated or experienced discrimination for any of the characteristics listed, including ‘mental ill-health’.
This survey covers England. Asks if respondent has any of the listed conditions, which includes ‘a mental health problem or illness’.
This survey covers Northern Ireland. Asks the long lasting health condition and illness and activity restriction standards, but the spontaneous response options will be included from 2021.
This survey covers the UK. Similar questions to the long lasting health condition and illness and impairment standards are asked in this survey. Other questions ask if the respondent has been told by a doctor or health professional that they have any of the medical conditions listed, which includes ‘an emotional, nervous or psychiatric problem’.
This is followed by asking at what age the participant was told they had that condition, and what type of emotional, nervous or psychiatric problem from a list provided (future response options will be taken from the Adult Psychiatric Morbidity Survey).
This survey covers the UK. The survey asks if the respondent has been told by a doctor or health professional that they have any of the medical conditions listed, which includes ‘an emotional, nervous or psychiatric problem’. This is followed by being asked what type of problem, with a list provided (response options taken from the Adult Psychiatric Morbidity Survey).
This survey covers England. Asks about respondent’s visit to A&E or Urgent Care Centre. Questions similar to the long lasting health conditions and illness and activity restriction standards are included and ask if a respondent has any of the medical conditions listed, which includes ‘mental health condition’.
This survey covers Wales. A list of medical conditions is provided, and the survey asks if the respondent is currently being treated for any listed. The medical conditions include depression, anxiety and ’another mental illness’.
This survey was incorporated into the National Survey for Wales from 2016. Respondents continue to be asked about existing medical conditions (and can record up to 6 conditions). In addition, they are also asked the long lasting health conditions and illness and impairment standards.
Administrative data is collected as part of operational or management systems. Below are administrative datasets that relate to mental health, and their owners.
Department for Work and Pensions (DWP)
DWP holds data from the following sources:
- Attendance Allowance
- Disability Living Allowance
- Employment and Support Allowance
- Employment and Support Allowance Work Capability Assessment
- Incapacity Benefit and Severe Disablement Allowance
- Personal Independence Payment
- Sanction Decisions
Department of Health Northern Ireland (DoH NI)
DoH NI holds data from the following sources:
- Hospital statistics: inpatient and day case activity
- Hospital statistics: outpatient activity statistics
Higher Education Statistics Agency (HESA)
HESA holds data from the following source:
- Student collection
Ministry of Defence (MoD)
MoD holds data from the following sources:
- UK armed forces mental health
Ministry of Housing, Communities & Local Government (MHCLG)
MHCLG holds data from the following sources:
- Homelessness Case Level Collection (H-CLIC)
National Records of Scotland (NRS)
NRS holds data from the following sources:
- Dementia and Alzheimer’s deaths
- Drug-related Deaths in Scotland
- Probable Suicides: Deaths which are the Result of Intentional Self-harm or Events of Undetermined Intent
NHS Digital holds data from the following sources:
- Assuring Transformation
- Community services dataset (CSDS)
- Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005
- Emergency care data set (ECDS)
- Guardianship under the Mental Health Act, 1983
- Hospital episode statistics (HES)
- Improving access to psychological therapies (IAPT)
- Mental health services dataset (MHSDS)
- NHS workforce statistics
- Out of area placements in mental health services
- Personal demographic system (PDS)
- Recorded dementia diagnoses
- Safeguarding adults collection (SAC)
NHS England holds data from the following sources:
- Dementia assessment and referral (paused – currently under consultation)
- Early intervention in psychosis waiting times
- Mental health community teams activity
- Physical health checks for people with Severe Mental Illness
NHS Wales Informatics Service (NWIS)
NWIS holds data from the following sources:
- Maternity and birth statistics
- NHS beds
- Outpatient activity minimum dataset
- Outpatient Referral Dataset
- Patient episode database for Wales (PEDW)
- Psychiatric census
- Quality and Outcomes Framework (QOF)
Office for National Statistics (ONS)
ONS holds data from the following sources:
- Drug-related deaths and suicide in prison custody in England and Wales
- Estimating suicide among higher education students, England and Wales
- Suicides in England and Wales statistical bulletins
Public Health England (PHE)
PHE holds data from the following sources:
- Dementia profile
- National drug treatment monitoring system (NDTMS)
- Substance misuse treatment for adults
- Substance misuse treatment in secure settings
Public Health Scotland (PHS)
PHS holds data from the following sources:
- Acute hospital activity and NHS beds
- Adult Mental Health Benchmarking
- Care Home Census
- Dementia benchmarking toolkit
- Dementia post diagnostic support
- Emergency Department Activity & Waiting Times
- Medicines used in mental health
- Mental Health Inpatient Activity
- Mental Health Inpatient and Day Case
- NHS Performs
- Psychological therapies waiting times
Scottish Government holds data from the following sources:
- Drug Related Hospital Discharge
- Home Care Client Group
- Home Care Client Living Arrangements
- Mental Health & Learning Disability Inpatient Bed Census
Welsh Government holds data from the following sources:
- Admission to mental health facilities
- Detentions under Section 135 and 136 of the Mental Health Act
- Mental Health Measure
- NHS hospital activity
Clinical and validated measures of mental health
The following clinical measures are monitoring, screening and diagnosis tools used by NHS and other mental health services. They vary in specificity and sensitivity, scoring and validation methods, and vary in scope of measurement – some tools measure general wellbeing, whilst others are used to measure or screen for a specific mental health condition.
Self-completed questionnaire used to assess and monitor the impact of health on respondent’s day to day life. Short version of the full SF-36 questionnaire. Covers the following eight domains:
- general mental health
- energy and fatigue
- bodily pain
- general health perceptions
- limitations on physical activity due to health
- limitations on social activity to due physical or emotional conditions
- limitations on day-to-day activities due to physical health
- limitations on day-to-day activities due to emotional health
Self-completed measure of depression related symptoms. Can be used to detect the presence of depression and monitor changes to symptoms. 20-item questionnaire, which covers four domains:
- depressed affect
- positive affect
- somatic complaints
- interpersonal problems
An interview used to detect the presence of common mental disorders. Covers the following 14 neurotic symptoms:
- somatic symptoms
- concentration and forgetfulness
- sleep problems
- worry about physical health
- depressive ideas
- compulsions and obsessions
Assessment and monitoring questionnaire. It is self-completed or completed by the therapist on the individual’s behalf.
- subjective wellbeing
- physical, trauma
- general functioning
- close relationships
- social relationships
- risk to self
- risk to others
Self-completed questionnaire that is used to measure active and beneficial experiences of later life. Contains 19 questions based on four domains:
Self-completed questionnaire that is designed as a cross-cutting symptom measure, which measures symptoms over the past two weeks. It covers 13 psychiatric domains, including:
- somatic symptoms
- suicidal ideation
- sleep problems
- repetitive thoughts and behaviours
- personality functioning
- substance abuse
An assessment tool used to identify and assess an individual’s current state, over the past week. It can be used to monitor symptoms. Covers physical, psychological, social, and spiritual wellbeing.
Self-completed questionnaire that measures the range and severity of eating disorders, which is administered after an investigator-based interview.
EQ-5D is self-completed or by proxy descriptive and visual scale of 5 dimensions. The five dimensions cover mobility, self-care, usual activities, pain/discomfort and anxiety/discomfort. EQ-VAS is a visual vertical scale of the respondent’s health that day.
Self-completed, screening measure for non-psychotic and minor psychiatric disorders. It measures current state and compares to the individual’s usual state.
Self-completed patient questionnaire used as a screening and severity measure for Generalised Anxiety Disorder. Can also be used as a screening tool for three other common disorders – panic disorder, social anxiety disorder and post-traumatic stress disorder.
Self-completed scale that measures anxiety and depression in hospital and community settings, which can be used as a psychological screening measure. It is used as a screening tool to monitor severity and change in anxiety and depression symptoms.
Self-completed 24-question set, which is used to measure psychological distress. Questions cover somatic and emotional symptoms.
Self-completion questionnaire that is used to monitor severity and response to treatment. Not a screening tool for depression but can determine whether an individual meets the criteria for a depressive disorder.
Structured clinical vocabulary and terminology used in electronic health records, it allows for accurate collection of data, patient care and improve analysis and reporting of clinical data. NHS Digital states that all mental health systems and provider organisations must have adopted SNOMED CT by April 2020.
A measurement tool of mental wellbeing and the outcomes of interventions. Covers the following domains:
- clarity of thought and positive relationships
- feeling relaxed
- energy to spare
Self-completed measure of current mental wellbeing, over the past two weeks. Can be used to screen for depression, and measure outcomes in clinical trials.
The above clinical and validated measures are sometimes used in surveys.
The following surveys use some of the measures:
- 1958 National Child Development Study (previous sweeps and sweep currently in progress) – SF-36, WEMWBS, CASP-12 and Malaise inventory
- 1970 British Cohort Study (2016) – WEMWBS, SF-36 and Malaise inventory
- Adult Psychiatric Morbidity Survey (2014) – CIS-R
- English Longitudinal Study of Ageing (2018-2019) – CES-D, CASP-19 and Personal wellbeing harmonised standard (GAD-7 will be included in the next wave of data collection)
- Health Survey for England (2018) – WEMWBS (WEMWBS, GHQ-12, EQ +5D and Personal wellbeing harmonised standard questions are in rotation)
- Mental Health of Children and Young People (2020) (Not entirely an adult survey, but does have specific questionnaire for 17 to 22 year olds) – GHQ12 and the Loneliness harmonised standard, and other child mental health measures
- National Survey for Wales (2018-2019) – WEMWBS
- Next Steps (Longitudinal Study of Young People in England) (2016) – GHQ-12
- Northern Ireland Health Survey (2018-2019) – WEMWBS and GHQ-12 in rotation
- Scottish Health Survey (2019) – WEMWBS and GHQ-12
- Scottish Household Survey (2017) – shortened WEMWBS
- Understanding Society (2021) – GHQ-12, Loneliness harmonised standard and SF-12 (short WEMWBS in rotation)
- Understanding Society COVID-19 study (2020) – GHQ-12
CLOSER have put together a Catalogue of Mental Health Measures, which is a database of mental health measures in 30 British longitudinal studies.
Mental Health Act 1983
The provisions of the Mental Health Act 1983 cover care and treatment of ‘mentally disordered’ patients, including the management of their property. This Act applies fully in England and Wales, and partially in Scotland and Northern Ireland. The Act defines mental disorder as ‘any disorder or disability of the mind.’ The following are clinically recognised conditions that would fall within the definition (this list is not exhaustive):
- Affective disorder, such as depression and bipolar disorder
- Schizophrenia and delusional disorders
- Neurotic and stress-related disorders, such as
- phobic disorders
- obsessive compulsive disorders
- personality disorders
- eating disorders
- personality and behavioural changes caused by brain injury or damage
- learning disabilities
- Autistic spectrum disorders (including Asperger’s syndrome)
Taken from the Mental Health Act Code of Practice (PDF 5.1MB).
The Mental Health Act 1983 and the Mental Capacity Act 2005 were both amended by the Mental Health Act 2007. The Mental Health Act 2007 revisions and amendments have been considered in the information presented above.
Parts of the Act is only applicable to England and Wales, for example Section 135 (the warrant to search for and remove patients) and Section 136 (removal etc of mental disordered persons without a warrant).
The Mental Health Act has undergone an independent review. Modernising the Mental Health Act suggests improving the purpose of the Act and introducing a set of four new principles, which cover choice and autonomy, least restriction, therapeutic benefit, and the person as an individual.
Mental Health (Care and Treatment) (Scotland) Act 2003
This applies in Scotland only.
The Mental Health (Care and Treatment) (Scotland) Act 2003 applies to those who have a mental disorder, meaning anyone who has a mental illness, personality disorder, learning disability or any related condition. It covers emergency and short-term detention; compulsory treatment orders; safeguarding treatments; mental health officers and mental health tribunals. Also covered is independent advocacy, the right to choose a named person and the rights of carers.
This Act was amended by the Mental Health (Scotland) Act 2015. The revisions and amendments made to the Mental Health (Care and Treatment) (Scotland) Act 2003 by the Mental Health (Scotland) Act 2015 have been considered in the information presented above.
Equality Act 2010 (Great Britain)
Mental health is covered by the disability protected characteristic in the Equality Act 2010. The Act makes it unlawful to discriminate or treat someone unfairly because of mental health and provides the right to challenge any unfair treatment and the right for reasonable adjustments. Protection covers mental impairments if it has a substantial and long-term effect on carrying out day-to-day activities. As well as a diagnosis of a mental impairment, it also includes the effects and symptoms that the impairment has on a person.
Disability Discrimination Act 1995
Mental health is covered in Northern Ireland by the Disability Discrimination Act 1995. According to this Act, a person is disabled if they have a physical or mental impairment which has a substantial and long-term effect on their ability to carry out day-to-day activities. The provisions of this Act make it unlawful for employers, services and public or private organisations to discriminate against disabled people. The Act also states that employers and service providers should make reasonable adjustments to help disabled people overcome barriers.
Protection for disabled people in educational settings in Northern Ireland is covered by the Special Educational Needs and Disability (Northern Ireland) Order 2005.
The following links include further national strategies, legislation and guidance, systemic reviews, and proposed measures for mental health across the UK.
- Mental Capacity Act 2005
- Mental Capacity Act (NI) 2016
- Public Sector Equality Duty
- HM Government No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages (Feb 2011)
- NHS England Five Year Forward View for Mental Health (Feb 2016)
- Office for Statistics Regulation Mental Health Statistics in England Systemic Review (2020)
- Scottish Government Mental Health Strategy (2017-2027)
- Scottish Government National Health and Wellbeing Outcomes (2015)
- Scotland’s public health priorities (2018)
- Public Health Scotland Mental health quality indicator profile (2020)
- Department of Health Northern Ireland Mental Health Action Plan (May 2020)
- Welsh Government Together for Mental Health: A strategy for Mental Health and Wellbeing in Wales (2012)
- Welsh Government Review of the Together for Mental Health Delivery Plan 2019-2022 in response to Covid-19 (2019-2022)
- UK Parliament Parity of Esteem for Mental Health (2015)
- World Health Organisation Mental Health Action Plan (2013-2020 (extended to 2030))
- OECD Mental Health Performance Framework (PDF 1.5MB) (2019)
- the UK has agreed to the United Nations (UN) Convention on disability rights, which requires the UK to regularly report to the Committee on their implementation of the rights stated in the Convention
Health harmonised standards
Other health harmonisation standards that may be useful:
- Long-lasting health conditions and illness
- Activity Restriction
- General Health
- Personal wellbeing
We are always interested in hearing from users so we can develop our work. If you use or produce statistics based on this topic, get in touch: firstname.lastname@example.org.