Why is it an issue?
There is a clear association between well-being, good mental health and improved outcomes for people of all ages and social classes. It is clear that mental health problems place a considerable burden on public health, the economy, and individual and social relationships.
Poor mental health and well-being can have an impact on every area of a person’s life; physical health, education, employment, family, relationships, and the effects can last a lifetime. It plays an important part of in contributing to and maintaining health and social inequalities.
Good mental health and well-being are associated with improved outcomes for individuals including longevity, physical health, social connectedness, educational achievement, criminality, maintaining a home, employment status and productivity.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
Children’s Mental Health
- According to local data from September 2009, there were 817 known to the ADHD clinic (1.73% of the school population) and 1,615 were known to have ‘Behavioural, Emotional and Social Discord’ (BESD) needs. Whilst the number of children with statements relating to ADHD has remained static since 2006, there has been an almost doubling of children with statements as a result of BESD over the same period (CJSNA, 2010).
- The 2008/09 performance returns for NI 50: Emotional Health of Children indicates a score of 62.6%. This is lower than each of the averages of England, Yorkshire and Humber area and statistical neighbour group (63.3, 65.1% and 65.7% respectively) (CJSNA, 2010).
- In terms of the effectiveness of child and adolescent mental health (CAMHS) services, in 2008/09 Wakefield scored 13 (out of 16) and this measure also compared closely to the England and Yorkshire and Humber area (13.3 and 13.8 respectively). The statistical neighbour group score was the same as the England average (CJSNA, 2010).
- Wakefield’s Year 6 children & young people stated in the Health Related Behaviour Questionnaire that SATS/Tests, Crime and Family problems were the problems that worried them the most, with females generally being more worried than males about these issues (CJSNA, 2010).
- In Year 10, the problems that worried males and females the most were Exams & Tests and the way they look, with females being almost twice as worried as males in these areas. The top six areas were consistent between males and females. Three out of the six areas were relationship based (CJSNA, 2010).
Common Mental Health Disorders
- Common mental disorders (CMDs) are mental conditions that cause marked emotional distress and interfere with daily function, but do not usually affect insight or cognition. They comprise different types of depression and anxiety, and include obsessive compulsive disorder. Estimates suggest that there are currently 32,700 people in Wakefield who have such a disorder (PANSI, 2010).
- SystmOne analysis places the figures of unresolved depression close to 28,000 across the district. One should berar in mind that the condition is transient, often-long-standing and difficult to measure objectively. As such, these figures should only be regarded as a tentative measure of the buden of this disorder Estimates also suggest a high correlation with deprivation, with rates exceeding 10% of the population in those areas
- Mental well-being is strongly linked both to overall health levels and to social and economic factors, with levels of low mood and feelings of isolation being much more prevalent among those on lower incomes, and those in receipt of benefits, including those who are unemployed (Lifestyle Survey – Mental Health Analysis, 2009).
- The role of caring for others tends to fall proportionately more on older age groups, and most heavily on women aged 45-64, and hence they often have some medical condition of their own. Comparing all carers and non-carers by age group shows that the carers are more likely to experience low mood than non-carers of the same age. Correspondingly there is significantly higher incidence of carers suffering from depression, anxiety or other nervous illness than those who are non-carers (Lifestyle Survey – Mental Health Analysis, 2009).
More Severe Mental Health Disorders
- Prevalence of the more severe mental health conditions (as defined by QOF registers) is on average lower than the England average but is higher within the city centre and our priority neighbourhoods (HEA, 2010).
- Psychoses are disorders that produce disturbances in thinking and perception severe enough to distort perception of reality. The main types are schizophrenia and affective psychosis, such as bi-polar disorder. There are estimated to be approximately 810 people aged 18-64 predicted to have psychotic disorder (PANSI, 2010).
- Personality disorders are longstanding, ingrained distortions of personality that interfere with the ability to make and sustain relationships. Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are two types with particular public and mental health policy relevance. There are estimated to be approximately 910 people aged 18-64 predicted to have a borderline personality disorder (PANSI, 2010).
- Antisocial personality disorder is characterised by disregard for and violation of the rights of others. People with ASPD have a pattern of aggressive and irresponsible behaviour which emerges in childhood or early adolescence. They account for a disproportionately large proportion of crime and violence committed at a national level. There are estimated to be approximately 710 people aged 18-64 predicted to have an antisocial personality disorder (PANSI, 2010).
- Psychiatric comorbidity – or meeting the diagnostic criteria for two or more psychiatric disorders – is known to be associated with increased severity of symptoms, longer duration, greater functional disability and increased use of health services. Disorders included the most common mental disorders as well as those mentioned above, along with; eating disorder; posttraumatic stress disorder (PTSD); attention deficit hyperactivity disorder (ADHD); alcohol and drug dependency; and problem behaviours such as problem gambling and suicide attempts. There are estimated to be approximately 14,600 people aged 18-64 predicted to have two or more psychiatric disorders (PANSI, 2010).
What’s the trend and what can we predict?
- Estimates suggest that by 2030, the number of people aged 18-64 predicted to have a common mental disorder will have risen from 32,700 to 33,500, assuming that the underlying prevalence remains static (PANSI, 2010).
- Estimates suggest that by 2030, the number of people aged 18-64 predicted to have two or more psychiatric disorders will have risen from 14,600 to 15,000, assuming that the underlying prevalence remains static (PANSI, 2010).
- Estimates suggest that by 2030, the number of people aged 18-64 predicted to have a borderline personality disorder will rise by 3-8 people every five years; antisocial personality disorder will rise by 7-9 people every five years, assuming that the underlying prevalence remains static (PANSI, 2010).
- The number of referrals to the CAMHS Service in 2009/10 is, on average, approximately 180-190 at any one time. Current referral levels are similar for the first couple of months of 2010/11. The total live caseload for the team has risen consistently over the 2009/10 financial year from approximately 1200 to 1300, a trend which continues in 2010/11 (CJSNA, 2010).
- Suicide rates are not expected to rise based on demographic change. They have not reacted to the 2007/08 economic shocks, but we do not currently know how a second round of shocks (or sustained recession) would impact on the likelihood of suicide.
What are we doing and what can be done differently?
- Review community mental health provision to enhance our support of prevention activity, promoting independence and choice for the individual.
- Recruit up to 15 individuals in mental health to participate in a pilot project supporting the use of personal health budgets.
- Continue to invest and develop the Improving Access to Psychological Therapies (IAPT) service to reach the 7 identified potentially marginalized groups within our communities.
- We will expand the range of talking treatments available in IAPT with the provision of Inter-personal Therapy (IPT).
- Complete a baseline review of the prescribing of anti-psychotic medication in older people with dementia.
- In partnership, we will review and map our pathways in relation to dementia, ensuring the balance of resources between identification, diagnosis and treatment services are appropriate.
- We will review and improve the timeliness of information available to those with dementia, working with service users, carers and the community to identify the most appropriate routes to receiving the support people need and the direction to enable them to receive early access to diagnostic services and treatment.