Mental health in adults

Introduction

Mental health is defined by the World Health Organisation (WHO) as “not just the absence of mental disorder. It is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Mental health should be considered as important as physical health for a person’s wellbeing.

This section considers adult mental health. Children’s mental health and dementia is considered separately.

What do we know?

‘No health without mental health’ the national mental health strategy (Department of Health, 2011) states that;

  • mental illness is the single largest cause of disability in the UK
  • at least one in four people will experience a mental health problem at some point in their life and one in six adults have a mental health problem at any one time
  • about one in 100 people has a severe mental health problem
  • 90% of all prisoners are estimated to have a diagnosable mental health problem (including personality disorder) and/or a substance misuse problem
  • the costs of mental health problems to the economy in England have recently been estimated at a massive £105 billion, and treatment costs are expected to double in the next 20 years

As a result mental health was highlighted as the second top priority in last year’s Joint Strategic Needs Assessment (JSNA).

The national strategy highlights the six objectives to improve mental health as:

  • more people will have good mental health
  • more people with mental health problems will recover
  • more people with mental health problems will have good physical health
  • more people will have a positive experience of care and support
  • fewer people will suffer avoidable harm
  • fewer people will experience stigma and discrimination

Facts, figures and trends

Table 1. People aged 18-64 in Bracknell Forest predicted to have a mental health problem projected to 2030.

People aged 18-64 predicted to have a mental health problem, projected to 2020

 

2014

2015

2020

2025

2030

Common mental disorder

11,939

12,016

12,318

12,485

12,606

Borderline personality disorder

334

336

344

349

352

Antisocial personality disorder

260

262

269

274

277

Psychotic disorder

297

299

306

310

313

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

5,342

5,378

5,514

5,592

5,649

Source: IPC pansi database

Figures may not sum due to rounding. Crown copyright

Source: Projected Adult Needs and Service Information

In 2014 18,172 people are predicted to have some form of mental health disorder. This is projected to rise to 19,197 by 2030 (an increase of 1000 people).

Table 2. Data from Bracknell Forest Community Mental Health profiles 2013

Indicator

Year

Bracknell Forest

South East

England

Significance

Percentage of adults with depression

2011/12

10.28

11.62

11.68

Significantly better

Percentage of referrals entering treatment for IAPT

2011/12

62.9

64.4

60.1

Not significantly different

Improving Access to Psychological Therapies- Recovery Rate

2011/12

44.1

47.0

43.8

Not significantly different

Directly standardised rate for hospital admissions for mental health

2009/10-2011/12

139

181

243

Significantly better

Numbers of people using adult and elderly NHS secondary mental health services, rate per 1000 population

2010/11

1.7

2.0

2.5

Significantly lower

Number of total contacts with mental health services, rate per 1000 population

2010/11

284

265

313

Significantly lower

The percentage of adults with depression in 2011/12 was significantly better than both the South East and the England average. Access to the service could, however, be improved with the numbers of people using adult and elderly NHS secondary mental health services being significantly lower than the England  average.

Suicide

Between 2011 and 2013 there are approximately 29 deaths due to suicide in Bracknell Forest. This equals a rate of 8.67 for every 100,000 people living in Bracknell Forest, which is similar to both the national average and deprivation decile rates. 

Self harm

Between Q2 (July, August and September) 2012/13 and Q2 2013/14 the Berkshire East CCG Federation found that the number of cases of people deliberately self harming rose by 60, from 76 to 136.

Admissions to hospital

Between Q2 2012/13 and Q2 2013/14 the Berkshire East CCG Federation found that the number of referrals due to a mental health condition rose from 1725 to 2422.

Around 150 in 100,000 people living in the Bracknell Forest area are admitted to hospital due to mental ill health. This is a lower rate than the national and South East Region rates and is also lower than the average for Local Authorities with a similar level of deprivation as Bracknell Forest. Bracknell Forest has significantly less admissions to hospital for neuroses and schizophrenia than the national average.

Data from the Bracknell Forest Health Profile 2014 shows that in 2012/13 there were 141 hospital stays for self harm per 100,000 population.

Contacts with mental health services

People in the Bracknell Forest area have around 275 contacts with mental health services for every 1,000 people in the population. This is a count of the total number of contacts with services and not the number of people who are seen by services. Each person will often be seen more than once with some seen on numerous occasions.

Table 3. Number of clients with mental health disorders in Bracknell attending assessments and making a full recovery in 2013/14 Q1, Q2 and Q3.

People with MH disorder making a full recovery

Source: Talking Therapies Berkshire East Performance Report April-December 2013

Although the number of referrals has increased between Q1 and Q2 2013/14, the number of clients who have had their first assessment has declined from 506 in Q2 to 475 in Q3. The recovery rate has remained similar throughout the 3 quarters, just below the national target of 50%.

Physical health checks

Physical health can influence a person’s mental health and vice versa. It is therefore important to maintain a good physical state. Physical health checks are offered to those clients who are on care programme approaches (CPA) within action for mental health (AMH). They allow for recognition of physical health issues which may prompt a person to be referred for treatment. Physical health checks include assessment of BMI, blood pressure, bowel and bladder movements, smoking habits, substance and alcohol abuse, diet, contraception, and exercise. The aim for 2013/14 is to offer 97% of AMH people on CPAs physical health checks. Currently, in Bracknell Forest, 81% of people have been offered checks, with 52% of people accepting (current target is 75%). We are, however, on track to meet these targets by March 2014, showing the improvement in the attention to physical health indicators in mental health services (Commissioning for Quality and Innovation, 2013).  

National & local strategies (current best practices)

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

Healthy Minds: A Commissioning Strategy for Adults with Mental Health Needs 2013-2018 reflects these objectives in Bracknell Forest.

Rethink Mental Illness (2013) published a report ‘Lethal Discrimination’ in September 2013 which highlights why people with mental illness are dying early and needlessly. The report highlights what needs to change.

It states 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”.

What are the key inequalities?

People with long term conditions are two to three times more likely to experience mental health problems than the general population.

25% of people receiving support from Bracknell Forest CMHT identify themselves as being from a non white ethnic group.

People who are in receipt of secondary mental health services need to have the provision of stable and appropriate accommodation.

People with mental health problem are less likely to have their physical health needs addressed.

What are the unmet needs/ service gaps?

Training for professionals on mental health may need to be enhanced, for example general awareness of mental health and wellbeing.

Support for individuals in the community after discharge from hospital may need to be bolstered in terms of, for example, appropriate accommodation. 

Access to preventative services may not be consistent for example smoking cessation.

People who have mental health problems as well as other health problems may not have access to comprehensive support.   

Recommendations for consideration by other key organisations

  • The following recommendations would be beneficial in improving mental health:
  • Ensuring a seamless and comprehensive service provision for people with additional health problems
  • Providing appropriate and comprehensive training for all professionals
  • Capability to address high cost placements and facilitate early discharge back into local services
  • Suitable and appropriate accommodation after discharge from hospital.
  • Continued awareness raising among residents
  • Systematic access to prevention for people with mental health problems for example smoking cessation
  • Review of the physical needs of people with mental health problems

 

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