Good stories are relatable. They speak to the reader. Stories that have data at the centre are no different. But at first sight, data on a spreadsheet can often feel impersonal, unrelatable and distant. So how do you make numbers resonate with the reader?
By Fatima Hudoon, freelance journalist
Editorial support: Tyler McBrien, Laura Ranca
Content Warning: there are mentions of suicide later in the article
Behind every number and data point there’s a potential human story waiting to be told. That’s what I learnt when I did my first data journalism course at the Centre for Investigative Journalism.
As a trainee journalist coming from a social science, non-tech background, data-driven stories were alien to me. But learning how to analyse a spreadsheet using basic techniques like sorting, filtering and pivoting opened a new door of potential impactful stories holding power to account.
Good stories are relatable. They speak to the reader. Stories that have data at the centre are no different. But at first sight, data on a spreadsheet can often feel impersonal, unrelatable and distant. So how do you make numbers resonate with the reader?
Putting human faces to numbers on a spreadsheet can help make a story more personal. The human story is a way-in - or lead-in - for the reader to care about the numbers as they resonate with the emotions.
In this article, I will show how I told the story of a spike in the UK’s National Health Service (NHS) patients in the South West region of England being sent to far away private mental health hospitals through the human stories of a former mental health patient and of a local carer - a person who looks after someone who is unwell, usually a family member.
This was part of a series I co-launched at The Bristol Cable called "Inside: Private mental health services in Bristol investigated".
The backstory
In February 2020, an inquest (judicial inquiry into an incident) was held at the main coroner’s court for Bristol and the surrounding region (Avon Coroner’s Court) that grabbed our attention at the Bristol Cable. It was a case looking into the death of a 25-year-old man who died a few days after attempting suicide in a nearby mental health hospital.
The inquest, which I partly attended, stood out for several reasons: it was two weeks long, involved a jury, and implicated one of the biggest private mental health providers in the UK, Cygnet Health Care.
The inquest asked: ‘Did Cygnet fail to adequately assess the young man’s suicide risk and take enough action?’ - The jury found Cygnet did not sufficiently protect the young man, Dom, in the lead up to his death. Read The Cable’s Matty Edwards full investigation into the inquest.
But there was one key issue that pointed to a bigger problem: No beds were available in Dom’s local NHS mental health provider in Devon and as a result the NHS paid for his admission to a private hospital some 80 miles away from his home. This is called an inappropriate Out of Area Placement (iOAP) – labelled “inappropriate” as it's due to the national health system's lack of available beds in mental health hospitals in Dom's home area. Read more on how this issue came about in our series blog.
Note - there's a difference between iOAPs (inappropriate Out of Area Placements) and OAPs (Out of Area Placements). Throughout this article, “iOAPs” specifically refers to out of area placements (OAPs) due to bed shortage, which the government wants to eliminate. The term “OAPs” in the article refers to all OAPs, including some that are necessary for other reasons which aren’t related to bed shortages.
Nationally, the issue of iOAPs due to bed shortages in mental health hospitals is a well-known problem that has been widely reported on. It is caused by underfunding of the NHS and decommissioning of beds and exacerbated by insufficient community mental health services.
Private mental health providers like Cygnet Health Care and Priory Hospital are being awarded tax payer-funded contracts worth millions of pounds to fill in the gaps to deliver NHS services. But in recent years these companies have come under attack after reports of poor quality of care and abuse. Read more about the background in this series’ blog.
Since The Bristol Cable is a local, community-owned paper in Bristol, what we tried to do was establish a local picture of this national problem. We wanted to go beyond national statistics that can often be hard to grasp locally, and identify cases that can reveal the presence and the impact of this issue on local communities.
Back to the inquest, I asked one question that unlocked the door to my data story:
- How many people in the South West of England are on inappropriate Out of Area Placements (iOAP)?
The research
Finding the data set you’re looking for isn’t easy. Asking yourself ‘who would be interested in collecting x data?’ could help in making a start on your search.
I began with researching the NHS website including research done by the NHS, and reading dozens of articles on the issue of iOAPs.
Many articles, like this 2019 BBC review - "More mental health patients sent 'hundreds of miles' for care" - cited the source of their data as NHS Digital. This led me to publicly available data collected by the NHS since 2016 as part of a national target to eliminate iOAPs caused by bed shortages altogether. We will call this data set ‘iOAP data’ from now on in this article.
iOAPs have been criticised for not only being too expensive but also often taking patients to far away hospitals and increasing the length of their hospital admission which impedes their recovery.
As one mental health chief told me: “treating patients close to home speeds up recovery, reduces the risk of suicide and shortens hospital stays”.
The NHS pledged to reach zero iOAPs due to bed shortages by March 2021. However, the NHS failed to do so - nationally and locally - due to COVID-19 pandemic restrictions, as the same data will show a year after I published the first story.
The data
When looking at any data-set, you’re often looking for a trend or a pattern:
- Is there an increase of something?
- Or a decrease?
- Is there a name that keeps popping up?
- Perhaps there is something you didn’t expect to see?
- Or something that should’ve been included but isn’t?
What I wanted to know was very simple:
- How many iOAPs were under Bristol’s local mental health provider?
- How does it compare to the previous years?
- How does it compare with other NHS providers?
The Out of Area Placements (OAP) data listed each local NHS mental health provider in England and stated the number of inappropriate Out of Area Placements (iOAPs) each month, length of hospital admission, average cost of bed, location and name of the receiving hospitals and how much receiving hospitals were paid by the sending NHS provider.
I filtered down to Bristol’s local mental health provider, Avon and Wiltshire NHS Partnership Trust (AWP), a trust that serves approximately 1.8 million people living in large parts of South West England.
Using the sorting and pivoting technique I collated the data for each month in 2019, available in the NHS past statistics datasets, and compared it to 2017 and 2018. Note that 2019 was the most recent full year of data available at the time of my research, you can see the most recent statistics now here.
Here’s what I found:
- An increase of nearly 20% in iOAPs due to bed shortage by Avon and Wiltshire NHS Partnership Trust (AWP) in 2019 compared to 2018 but an overall fall since 2017.
- The average length of these placements rose to 23 days – an increase of nearly half compared to 2018.
- Patients were being sent as far as 250 miles away from home.
- AWP’s annual bill for iOAPs increased from £2.9m in 2018 to £4.4m in 2019 - in 2020 the bill shot up to £5m.
- All but four (out 38) receiving hospitals used by AWP were privately-run; 16 were Cygnet Health Care and 15 by The Priory Group.
For years, stories of patients being sent hundreds of miles away from their home to be admitted into a mental health hospital gripped national headlines (see here and here.) My colleague and I were interested in finding out how this national problem is playing out on a local level.
The data analysis was the first step. I visualised the key data findings in colourful box outs but I also used a map to supplement the overall article and make it more interactive. It illustrated where in England patients were being sent, who owns the different hospitals and scaled the bubbles (see below) according to the total length of time spent there.
Image of mapped data, by Fatima Hudoon
The second step was finding a local human voice close to the story to make the data meaningful and personal for the reader.
The human profile
Having gone to the inquest and read similar national stories, I saw how much these iOAPs affected patients and their families.
I wanted to know:
- How does it feel to be sent hours away from your familiar environment when you’re in a vulnerable state?
- How does it impact a family to have their vulnerable loved ones sent far away?
It helps to create a hypothetical human profile of who you’re looking for before setting out on your search for a case study. This will help to narrow down where to look for these sources.
As a local paper, I was interested in finding someone who had some experience with inappropriate Out of Area Placements (iOAPs), as a former patient or as a relative of a former patient, in Bristol via the Avon and Wiltshire NHS Partnership Trust (AWP), sent far away and ideally in 2019 (in line with the most recent data available at the time).
I reached out to the Bristol Cable network of members, personal contacts and online platforms to look for strong leads. I also contacted local and national mental health charities and independent organisations.
My hypothetical profile was specific enough to ensure relevance for The Bristol Cable and the data findings but also open to speaking to secondary sources instead of primary sources. Talking about mental health, particularly mental illness that requires institutional treatment, can be a sensitive subject and involves vulnerable individuals. In these cases, it can be difficult to find primary sources willing to go on record.
Secondary sources, in this case families of current or former patients, who are still close enough to the story can offer an alternative but still strong human voice from the perspective of a relative. Including them in the initial story could then lead to primary sources, as it did with my second iOAP article.
After weeks of researching and chasing, a national organisation put me in touch with Rachel.
When data met human face
Rachel is a carer to her son, who has been in and out psychiatric hospitals (NHS & private) for over 20 years. We had multiple informal conversations before officially doing an interview which was crucial in order to build that trust and rapport.
She raised issues around distance, communication, at times poor quality of care, and the power and racial dynamics in the mental health sector, especially when it comes to patients from ethnic minority backgrounds. Rachel is of Jamaican-Maltese background and her son also has mixed heritage.
An example of when Rachel answered the question of how iOAPs impact the families of patients was when she talked about the financial difficulties she experienced as a result.
She said: “I’ve got bins of debt because I couldn’t pay my bills because my son had to come first... and he was so far away. I have had a debt relief order, I nearly hit bankruptcy”.
Rachel sharing her personal experience as a carer for her son helped to make the data more meaningful - and more relatable. Human emotion is a powerful tool.
Rachel was also actively involved in bringing change to the sector by setting up her own grassroot organisation called The 2 Way Street which helps other parents, particularly those from African Caribbean backgrounds, navigate the complex mental health system so that they don’t struggle like she did.
Publishing Rachel’s story led to other people closer to the iOAP issue reaching out. One of those people was the mother of Safia (not her real name), who was at the time recently admitted for about 6 weeks.
Safia was admitted to a mental health hospital for the first time whilst pregnant at the age of 21. Initially hesitant to speak to me, she shared her harrowing experience of waking up in a mental health hospital over 90 miles away after suffering a psychotic episode for the first time.
Unable to remember all the details, her mother helped to fill in the gaps to tell the full story. In this second article, the data was not the main focus. Rather the article was more narrative driven, zooming into the human experience with references to previous data coverage and updated figures. The article served to further consolidate the initial data findings.
Behind the iOAP data, the stories of Rachel as a carer and Safia as a former patient and her mother were waiting to be told.
More than a year on, stories like theirs continue to exist.
Bristol’s local mental health provider, AWP, like many other trusts, missed the March 2021 deadline for eliminating iOAPs due to COVID-19 infection control measures reucing bed capacity. Rachel, however, says there’s a deeper systemic issue. “The [mental health] system isn’t built up to be proactive or preventative, it waits for it to get in crisis and we don’t have the spaces here in Bristol, we physically don’t,” she said.
It’s unclear now what the future holds, but nationally the government is under fire for continuing to “fail mental health patients.”
Note:
Sometimes the strong story is in what’s missing in the data rather than what’s there. For example the NHS data I used didn’t collect information related to the ethnicity of patients being sent to mental health hospitals. This was an issue that came up in interviews with Rachel, Safia and her mum. Independent Reviews of the UK’s mental health system found that black people were eight times more likely to be detained under the Mental Health Act than their white counterparts. The NHS data on out of area placements also didn’t collect information on children who are sent to mental health hospitals. The Cable’s Matty Edwards covered this issue extensively as part of the series.
Key learnings
- Know what the data is telling you and not telling you, and be aware of the questions you ask the data. It only tells you what not why.
- Sometimes data stories can come from unexpected places like an inquest hearing - so keep your eyes and ears peeled for your next data story.
- Narrow down your focus to start with and if you need to expand later do so. In my case, I was only interested in Bristol’s mental health provider but data on other providers was also helpful in drawing comparisons
- Make your story relatable: Ask yourself, why should the reader care about your findings?
- Build a hypothetical human profile which will help you to identify where to find the person or people you’re looking for.
Related resources
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“Data Acquisition for Beginners” - a guide By Lylla Younes in the Exposing the Invisible Kit.
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DataJournalism.com – a website that helps you learn new data skills and increase your data journalism knowledge. It provides articles, tutorials, and a Data Journalism Handbook.
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School of Data – a network of individuals and organizations working on empowering civil society organizations, journalists and citizens with skills they need to use data effectively. It provides a series of free online data research courses and tutorials for beginners at https://schoolofdata.org/courses/
About the author:
Fatima Hudoon is a Bristol-based freelance journalist, formerly Early Career Journalist at The Bristol Cable, a local media cooperative. She freelances for the Cable and various publications like the The National News, BBC and the Bureau Local. Fatima is also a 2021 Lyra Mckee Bursary recipient at the Centre for Investigative Journalism, where she is receiving training in investigative and data journalism.
This article is part of a series of resources and publications produced by Exposing the Invisible during a one-year project (September 2020 - August 2021) supported by the European Commission (DG CONNECT)
This text reflects the author’s view and the Commission is not responsible for any use that may be made of the information it contains.