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Mental health

Introduction

The World Health Organisation defines "mental health" as a state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to their own community (World Health Organisation (WHO), 2014).

This positive dimension of mental health is further stressed in their definition of health as, "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

'Mental ill health', mental illness or 'mental health problems' on the other hand, covers a very wide spectrum, from the worries and grief experienced as part of everyday life to the most bleak, suicidal depression or complete loss of touch with everyday reality (Mindful employer, 2014). http://www.mindfulemployer.net/managers/what-mental-health/

What do we know?

There are many issues that impact on our mental health including our physical health, our social situation, our living environment and/or genetic factors. This entails that everybody is at risk of developing a mental health problem at any time during their lives. As highlighted by Gofal (2015), the most important thing to realise is that the majority of the people who experience mental health problems do recover or learn to manage them and still lead meaningful and fulfilled lives.

'Mental health problems', 'mental illness' and 'mental ill-health' are all common terms that are used to refer to the full spectrum of diagnosed clinical conditions such as depression/unipolar disorder, anxiety, psychosis, bipolar disorder or schizophrenia. Symptoms of mental health problems have traditionally been divided into groups called either 'neurotic' or 'psychotic' symptoms. 'Neurotic' covers those symptoms which can be regarded as extreme forms of 'normal' emotional experiences such as depression, anxiety or panic. Conditions formerly referred to as 'neuroses' are now more frequently called 'common mental health problems,' although this does not always mean they are less severe than conditions with psychotic symptoms.

Less common are 'psychotic' symptoms which interfere with a person's perception of reality and may include hallucinations, delusions or paranoia, with the person seeing, hearing, smelling, feeling or believing things that no one else does. Psychotic symptoms or 'psychoses' are often associated with 'severe mental health problems.'

However, there is no sharp distinction between the symptoms of common and severe mental health problems. It is important to remember that some illnesses feature both neurotic and psychotic symptoms.

Facts, figures and trends

The department of Health's strategy, "Achieving Better Access to Mental Health Services by 2020" notes that:

  • Each year, about one in four of us in the United Kingdom will have a mental health problem (McManus S, Meltzer H, Brugha T et al. 2009); this can range from a short spell of depression or anxiety through to severe and persistent conditions that are massively disruptive, frightening and life threatening for those who experience them. The department of Health's strategy, "Achieving Better Access to Mental Health Services by 2020" notes that:
  • Mental health problems can also have a terrible impact on people's physical health (Nicholson A, Kuper H and Hemingway H , 2006);
  • For young people, mental illness is strongly associated with behaviours that pose a risk to their health, such as smoking, drug and alcohol abuse and risky sexual behaviour.

Research also shows that:

  • In the UK, mental health problems are responsible for the largest burden of disease- 28% of the total burden, compared to 16% each for cancer and heart disease (Ferrari et.al, 2013)
  • Around 50% of women with perinatal mental health problems are not identified or treated.
  • Postnatal depression in fathers has been associated with emotional and behavioural problems in their child (Ramchandani P.G et .al. 2008)

In Reading, excess under- 75 mortality rates in adults with serious mental illness has slightly decreased since 2009/2010 and at 375.9/100,000, it does not differ significantly from the national and regional averages (figure 1).

Depression

Although the recorded prevalence of depression appears lower than the national average, Reading has seen an increase in the year 2013/2014, compared to 2012/2013. The same can be said for the number of social care mental health clients receiving services in the locality (Figs 2-5). In line with the WHO forecasts that by 2020, depression will be the second leading contributor to the global burden of disease (WHO, 2001); the number of people in Reading aged 18-64 predicted to have a mental health problem will see an on-going rise by 2030 (figure 6).

Figure 1.Excess under-75 mortality rate in adults with serious mental illness in Reading(18-74 years)

image1

Source: Quality and Outcomes Framework (QOF) for April 2013 - March 2014, England) Please note: LA figures may not be shown for all graphs, due to small numbers being suppressed).

Figure 2: The percentage of patients aged 18 and over with depression, as recorded on practice disease registers.

image2

Source: Quality and Outcomes Framework ((QOF) for April 2014 - March 2015, England), NHS Health and Social Care Information Centre Please note: LA figures may not be shown for all graphs, due to small numbers being suppressed).

Figure 3: Social care mental health clients receiving services during the year: rate per 100,000 population:

image3

Source: Referrals, Assessments and Packages of Care (RAP) (requires password)https://nascis.ic.nhs.uk/Tools/Olap/Rap/Rap.aspx (Table P4).

Figure 4: Social care mental health clients aged 18-64 receiving day care or day services

image4

Source: Referrals, Assessments and Packages of Care (RAP) (requires password) https://nascis.ic.nhs.uk/Tools/Olap/Rap/Rap.aspx (Table P2F) All RAP data for 2013/14 also available here: http://www.hscic.gov.uk/searchcatalogue?productid=16628&topics=1%2fSocial+care%2fSocial+care+activity&sort=Relevance&size=10&page=1#top

Figure 5:

Proportion of adults with MH in paid employment
Proportion of adults with MH in paid employment

Source: ASCOF comparator report 2014/2015; National Adult Social Care Intelligent Service (NASCIS).

 

Figure 6: People in Reading aged 18-64 predicted to have a mental health problem, by gender, projected to 2030.

 

2015

2020

2025

2030

Males aged 18-64 predicted to have a common mental disorder

6,675

6,763

6,838

7,013

Males aged 18-64 predicted to have a borderline personality disorder

160

162

164

168

Males aged 18-64 predicted to have an antisocial personality disorder

320

325

328

337

Males aged 18-64 predicted to have psychotic disorder

160

162

164

168

Males aged 18-64 predicted to have two or more psychiatric disorders

3,685

3,733

3,774

3,871

Females aged 18-64 predicted to have a common mental disorder

10,126

10,126

10,165

10,244

Females aged 18-64 predicted to have a borderline personality disorder

308

308

310

312

Females aged 18-64 predicted to have an antisocial personality disorder

51

51

52

52

Females aged 18-64 predicted to have psychotic disorder

257

257

258

260

Females aged 18-64 predicted to have two or more psychiatric disorders

3,855

3,855

3,870

3,900

Source: Table produced on 12/12/15 at 08:49 from www.pansi.org.uk version 8.0

The Cost of Mental Health Problems

Economic studies have assigned costs to the different impacts of poor mental health and mental illness on the population (Figure 7).

  • Mental illness costs the United Kingdom economy as much as £100 billion per year (CMH,2010)
  • Mental illness results in 70 million sick days per year, making it the leading cause of sickness absence in the United Kingdom (SCMH, 2007).
  • 44% of Employment and Support Allowance benefit claimants report a mental health and/or behavioural problem as their primary diagnosis (DWP, 2013)
  • Poor mental health costs the economy at least £70 billion in lost output and costs the economy £10 billion in extra physical healthcare due to mental illness.

The overall economic burden of mental illness

 

Care Cost

Productivity Cost

Other costs

Sufferers

Treatment and service fees/payments

Work disability; lost earnings

Anguish/suffering; treatment side-effects; suicide

Family and Friends

Informal care-giving

Time off work

Anguish; isolation; stigma

Employers

Contributions to treatment and care

Reduced productivity

-

Society

Provision of mental health care and general medical care (taxation/insurance)

Reduced productivity

Loss of lives; untreated illnesses (unmet needs); social exclusion

Figure 7:(Source: WHO, investing in mental health, 2003)

National and local best strategies

The independent Mental Health Taskforce has brought together health and care leaders, people using services and experts in the field to create a Five Year Forward View for Mental Health for the NHS in England. This national strategy, which covers care and support for all ages, was published in February 2016 and signifies the first time there has been a strategic approach to improving mental health outcomes across the health and care system, in partnership with the health arm's length bodies.

'No health without mental health', a cross government mental health outcomes strategy for people of all ages sets a strong and compelling vision for improving mental health and wellbeing in England (Department of Health, 2011).

In 2013, a report, 'Lethal Discrimination' which highlights the plight of people with mental illness and the need for change was published by Rethink Mental Illness. This report notes that, "one in three of the 100,000 people who die avoidably each year have a mental illness. We know that people with mental illness are three times more likely to develop diabetes and twice as likely to die from heart disease. More than 40% of all tobacco is smoked by people with mental health problems".

Reading Borough Council in partnership with the Reading Youth Cabinet designed the booklet "Off the Record" to raise awareness of common mental health issues and to provide practical tips and information in order to help young people look after their own emotional wellbeing.

Berkshire Healthcare NHS Foundation Trust (BHFT) provide a Talking Therapies service to the adult population of Reading in line with the Department of Health's 'Improving Access to Psychological Therapies (IAPT) programme. The focus of the service is on primary care, to meet the needs of clients experiencing common mental health problems. In 2014/2015, recovery rates were above the national average for Reading. The Reliable Improvement demonstrates that patient's outcome measures improve considerably after receiving an intervention at the primary care level (Figure 8).

Figure 8. Reading CCGs IAPT Recovery rates 2014/2015 

Reading CCGs IAPT Recovery rates 2014/2015
Reading CCGs IAPT Recovery rates 2014/2015

Source -  http://www.hscic.gov.uk/pubs/psycther1415 Health and Social Care Information Centre. All Rights Reserved

What is this telling us?

Mental health is fundamental to the good quality of life and productivity of the population. The health, social and economic benefits are not just the result of the absence of mental illness but are also owing to positive mental health (pressman & Cen, 2006).

A public health approach will include enhancing the protective factors for mental health, which is not entirely equivalent to the absence of risk factors for mental illness. Some of the factors associated with positive mental health include; personality traits, various demographic factors, income and socioeconomic status, emotional and social literacy, levels of trust, reciprocity, participation and cohesion within communities, purposeful activity including work, self-esteem, and values such as altruism (Abbott RA, Ploubidis GB, Croudace TJ, et al 2008).

Positive mental health has also been associated with enhanced psychosocial functioning, improved learning and academic achievement, increased participation in community life, reduced sickness absence, improved productivity, reduced risk-taking behaviour, improved physical health, reduced mortality, reduced health inequality as well as recovery from mental illness (NICE, 2009).

The need to secure positive mental health and resilience

A public health approach considers protective factors for mental health as well as risk factors for mental illness. Important interventions include high-quality maternal care, nurturing upbringing and safe early experiences. Examples of specific interventions are parental training, school-based and work-based mental health promotion programmes.

The emphasis on well-being, community cohesion and productive, long working lives requires strategies to encourage and empower individuals to secure positive mental health.

Mental health problems have multiple determinants; prevention needs to be a multipronged effort

Social, biological and neurological sciences have provided substantial insight into the role of risk and protective factors in the developmental pathways to mental disorders and poor mental health. Biological, psychological, social and societal risk and protective factors and their interactions have been identified across the lifespan from as early as foetal life. Many of these factors are malleable and therefore potential targets for prevention and promotion measures. High comorbidity among mental disorders and their inter-relationship with physical illnesses and social problems stress the need for integrated public health policies, targeting clusters of related problems, common determinants, early stages of multi-problem trajectories and populations at multiple risks.

Additionally, given the high prevalence rate and associated negative effects of mental health problems, the need to prevent their development has become essential. One means of achieving this goal has been the implementation of prevention programs in schools. Masia-Warner, Nangle and Hansen (2006), reiterate this in their argument that schools are viewed as the ideal environment in which to present these prevention initiatives as they have unparalleled contact with young people and therefore represent a place in which the majority can be reached.

What are the key health inequalities?

Mental illness is an important cause of social inequality, violence and unemployment as well as a consequence (FPH, 2010). Mental health problems in childhood and adolescence:

  • Reduce educational achievement and employability (NICE, 2009) and also
  • Increase the risk of impaired relationships, drug and alcohol misuse, violence and crime (Richards M, Abbott R, 2009)

The experience of mental illness further exacerbates social inequalities because of its impact on employment and housing status. Half of all mental illness starts by the age of 14 and 75% by mid 20s (Kessler RC et al. 2007)

Low income, debt, violence, stressful life events and unemployment are key risk factors for mental illness (McCrone et. al. 2008). The two-way relationship between mental illness and social inequality can prove difficult to unravel with common epidemiological approaches. Levels of deprivation are a key determinant of mental health disorders - mental health problems are more likely to be seen in people living in deprived areas.

People from black and minority ethnic (BME) communities tend to have poorer mental health and have more difficulty in accessing mental health care than the majority of the population (NIMHE, 2003).

Data published by the Health and Social Care Information Centre (HSCIC) in February 2013 showed that mortality among mental health service users aged 19 and over in England was 4,008 per 100,000 (83,390 deaths in total) compared to the general population rate of 1,122 per 100,000. This mortality rate was 3.6 times the rate of the general population in 2010/11.

People in contact with specialist mental health services had a higher death rate for most causes of death, but in particular:

  • Nearly four times the general population rate of deaths from diseases of the respiratory system (at 142.2 per 100,000 service users, compared with 37.3 per 100,000 in the general population);
  • Just over four times the general population rate of deaths from diseases of the digestive system (at 126.1 per 100,000, compared with 28.5 per 100,000 in the general population);
  • 2.5 times the general population rate of deaths from diseases of the circulatory system (at 254.0 per 100,000 compared with 101.1 per 100,000 in the general population).

Within these disease areas, specific conditions that accounted for a high proportion of deaths among service users (under the age of 75) were:

  • Diseases of the liver; at 7.6 percent of deaths (1,430 in total);
  • Ischaemic heart diseases; at 9.9 percent of all deaths (1,880 in total).

What are the unmet needs / service gaps?

Co-ordination with preventative and health improvement services

Mental wellbeing is a fundamental component of good health and its lack underpins many physical diseases, unhealthy lifestyles and social inequalities in health.

The latest public health and mental health strategies recognize that mental health and physical health should be treated with 'parity of esteem'. In order to achieve this parity, there is a need to enhance knowledge and skills relating to the mental health components of public health practice.

People with mental health problems still need to be better supported to live healthy lives, making real progress towards bringing life expectancy on a par with the rest of the population.

Training and support for frontline workers to enable them to spot the early signs of mental health problems, provide initial help and signpost people accordingly remain inadequate in many services.

In Reading, MotherTongue, a multilingual counselling service, conducted a pilot project with IAPT in 2015, where they found that due to the higher numbers of BME clients accessing their service, there has been an increased demand for interpreters in the South Reading area.

Actions across the life course

A public mental health approach focuses on wider prevention of mental illness and promotes positive mental health across the life course. This supports Andrews G, et. al' s (2004), argument that as optimal treatment for mental disorders will only avert 28% of the burden of mental illness, the need for prevention cannot be over-emphasized.

Prevention and promotion interventions are relevant at each life stage. Robust evidence exists for a wide range of interventions which prevent mental disorder, promote well-being and help strengthen resilience against adversity, ensuring a positive start in life and healthy adult and older years:

  • interventions to improve parental health
  • pre-school and early education interventions
  • school-based mental health promotion and mental illness prevention
  • prevention of violence and abuse
  • prevention of suicide
  • early intervention for mental illness
  • alcohol, smoking and substance abuse reduction and prevention
  • promoting healthy lifestyle behaviours
  • promoting healthy workplaces
  • prevention of mental illness and promotion of well-being in older years
  • housing interventions
  • reduced stigma and discrimination
  • positive mental health and recovery from mental illness
  • ensuring that people's access to psychological therapies is not hindered by their ethnicity, culture, faith or socio-economic status through targeted mental health promotion of and use of culturally-appropriate services.
  • building strength, safety and resilience will address inequalities and ensure safety and security at individual, relationship, community and environmental levels.

There is a need to develop a sustainable, connected community in order to create a socially-inclusive Reading that promotes social networks and environmental engagement. More support should be provided to employers to promote workplace wellbeing. By helping staff to cope, employers can increase productivity and prevent the build-up of unmanageable stress at work (Department of Health, 2014).

People of all ages with mental health problems should receive at least the equivalent level of access to timely, evidence-based, clinically effective, recovery focused, safe and personalised care as people with a physical health condition. The physical needs of people with mental health conditions need to be assessed routinely alongside their psychological needs and vice versa.

Links to other sections in the JSNA

Children & Adolescent Mental Health

Offenders

Social & Environmental Context

Suicide & Self Harm

References:

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Andrews G, et al. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 2004; 184:526-533.

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British Medical Journal 318: 1460-1467; Nicholson A, Kuper H and Hemingway H (2006) Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal27(23): 2763-2774).

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Department of Health, (2014) 

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https://www.google.co.uk/?gfe_rd=cr&ei=AGRgVvLwBIjj8wfKuIeAAw&gws_rd=ssl#q=The+health%2C+social+and+economic+benefits+are+not+just+the+result+of+the+absence+of+mental+illness+but+are+also+owing+to+positive+mental+health

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