Mental health

Mental ill health is the single largest cause of disability in the UK. One in four of us will have mental health problem at some time in our lives. (NHS Choices). It is estimated that approximately 450 million people worldwide have a mental health problem. (World Health Organisation, 2001).

This section focuses on mental ill health in the adult population in Slough age 18-64. It excludes Child and Adolescent Mental Health (CAMHs), Maternal mental health and older person’s mental health which are covered in separate sections.

The NHS is facing significant upwards cost pressure over the coming years as a result of a growing demand for healthcare and associated costs. If NHS funding is held flat in real terms beyond this Spending Review period, the NHS in England could experience a funding gap worth between £44 billion and £54 billion in 2021/22, unless productivity gains can be delivered to offset this . Figure 1 shows current and projected future costs by mental health disorder in England. Though the overwhelming increase is seen in dementia, other common adult mental health conditions also contribute a sizable increase in costs.

Figure 1: Suicide rate 2009-2011. Source: Public Health England – Public Health Outcomes Framework.

What do we know?

Mixed anxiety & depression is the most common mental disorder in Britain, with almost 9% of people meeting criteria for diagnosis. (The Office for National Statistics Psychiatric Morbidity report, 2001). Between 8-12% of the population experience depression in any year. (The Office for National Statistics Psychiatric Morbidity report, 2001)

Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of people who experience more than one mental health problem. (The British Journal of Psychiatry, 2005)

About half of people with common mental health problems are no longer affected after 18 months, but poorer people, the long-term sick and unemployed people are more likely to be still affected than the general population. (Better Or Worse: A Longitudinal Study Of The Mental Health Of Adults In Great Britain, National Statistics, 2003)

Facts, Figures and Trends

Prevalence

The prevalence of mental health conditions in Slough is rising. It is estimated that over the next ten years there will be additional 1,300 adults under the age of 65 with common mental disorders in Slough. We also know that there is a significant gender difference in terms of prevalence of mental ill health, with women more commonly diagnosed with common mental disorders.
(Source: PANSI data table 2015)

Based on GP (QOF) prevalence data over 2012/13 the percentage of adults with depression in Slough is recorded as 4.1%, a reduction from recorded value of 9.4% 2011-12. This compares with figures for England of 11.7%, falling to 5.8% in 2012-13. Mixed anxiety and depression is the most common mental disorder in Britain, with almost 9% of people meeting criteria for diagnosis. The rate of mixed anxiety and depression in Slough is second only to that of Reading in Berkshire.

The number of people in Slough with a serious mental illness known to GPs over 2014/15 was 1,372, equivalent to 0.91% of Slough’s population. This is similar to the national prevalence rate of 0.88%, and an increase from the previous year’s rate of 0.89%.It is estimated around 30 new cases of psychosis arise per year in Slough (rate of 33 per 100,000) which is significantly higher than England average 24 (based on 2011 estimate).

(Source: Public Health England Severe Mental Illness Profile 2015 and Community Mental Health Profiles, 2014).

Service use and outcomes

Contacts with mental health services

The indicator ‘the number of total contacts with a mental health service’ measures all contacts with mental health staff, including Consultant Psychiatrists, Community Psychiatric, Nurses, Clinical Psychologists, Occupational Therapists, Physiotherapists, Consultant Psychotherapists and Social Workers. This is shown a rate per 100,000 population aged 18 and over.

There are almost 1,973 people made contact with mental health services in Slough for every 100,000 people in the population. This counts the number of contacts made and not number of people accessing services. The majority of people will have more than one contact with some having numerous contacts with services.

Improving Access to Psychological Therapies (IAPT)

Improving access to psychological therapies is a national programme that makes ‘talking therapies’ quickly available primarily for people who have mild to moderate mental health difficulties, such as depression, anxiety, and phobias.

In the last quarter of 2014/15 there were over 800 referrals to IAPT for Slough residents. Of those referred in 2014/15 over 95% were seen within 28 days of referral which is significantly better than the national average (Figure 3)

The IAPT recovery rate measures the number of people who are moving to recovery as a rate per 100 people who have completed treatment. In Slough 52 out of every 100 people who have completed treatment using psychological therapies were moving towards recovery (2012-2013). This compares with national recovery rate figures of 45.9%.

Care Programme Approach (CPA)

The Care Programme Approach (CPA) was first introduced in 1990 to provide a framework for the care of mentally ill people, requiring health and social care authorities to work together. The CPA has four key elements; a systematic assessment of health and social care needs, an agreed care plan the appointment of a named care co-ordinator, a regular review of needs and plan. In the first quarter of 2015/16 there were 330 adults in Slough on CPA which is similar to the number in the previous year.

Of those on CPA in Slough, 8.6% were in employment by 2015/16 Q1, this is similar to the England average over that time, and 88% were in settled accommodation (this means that current living arrangements are secure over the medium to long term) which is significantly better than the England average.

Hospital admissions

Local data shows that during 2015, mental health admissions in Slough have significantly increased. The most recent national benchmarking data available is for Q2 of 2014/15 showing that at that time the rate of mental health admissions in Slough was around 65 per 100,000, compared to around 70 per 100,000 in England.

Assessments and detentions under the Mental Health Act (MHA)

Activity under the Mental Health Act in Slough has increased steadily over the years, from 198 assessments in 2003/04, to 211 in 2010/11, but then increased significantly to 306 in 2014/15. The number of people detained under the Mental Health Act has increased from 120 in 2010/11 to 164 in 2014/15 which was higher than the England and regional rate of detentions, though this difference was not statistically significant (Figure 2).

Figure 2. Rates of detention under the Mental Health Act (2013/14 Q1)

Figure 2: detentions

Suicide rates

Slough’s mortality rate from suicide (adjusted for age) and injury of undetermined intent is 9.6 per 100,000 population over 2012/14. This is higher, but not statistically significantly different, than the England average of 8.9. There has been an increase in suicide since 2008 though current rates have not exceeded that seen in 2001. Of the 40 suicide deaths in Slough during this time, over 80% were in males which is a similar picture to nationally.

Funding

The allocated average mental health spend per head 2011/12 was £157 per head, compared to England average of £183 per head. Poor mental health costs Britain £70 billion a year through productivity losses, higher benefit payments and the increased cost to the NHS – equal to 4.5 per cent of Gross Domestic Product.

National & Local Strategies (Current best practices)

No Health without Mental Health (2011).
This strategy sets out how the government, working with all sectors of the community and taking a life course approach, will:

  • Improve the mental health and wellbeing of the population and keep people well
  • Provide high-quality services that are equally accessible to all.

The strategy identifies six outcomes:

  1. more people will have good health
  2. more people with Mental Health problems will recover
  3. more people with Mental Health problems will have good physical health
  4. more positive experience of care and support
  5. fewer people will suffer avoidable harm
  6. reduced stigma and discrimination

Adult Social Care Outcomes Framework (ASCOF) 2015-16. supports councils to improve the quality of care and support services they provide and gives a national overview of adult social care outcomes,
ASCOF defines four domains across all care groups including mental health:

  1. enhancing quality of life for people with care and support needs
  2. delaying and Reducing the need for care and support
  3. ensuring that people have a positive experience of care
  4. safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm

National Institute for Health and Care Excellence (NICE) guidance for mental health and behavioral conditions sets standards for healthcare provision and promotes healthy living.

Medically unexplained symptoms

Medically unexplained symptoms tend to be quite general problems, such as fatigue, pain, headaches, dizziness and feeling sick. These are often experienced alongside depression and/or anxiety. Medically unexplained symptoms account for 20-30% of all GP consultations and almost 10% of secondary care referrals. The NHS Operating Plan for England in 2012 noted there was scope to commission additional support for GP training to understand how best to refer and treat medically unexplained symptoms

What is this telling us?

  • Rising incidence of mental illness amongst adults in Slough.
  • Complexities associated with BME profile, cultural stigma, requirement for interpreters etc.
  • Mental illness profile is compounded by high local use of alcohol and illegal substances.
  • Employment of people with severe mental illness appears lower than England average. .
  • Hospital admission rates for people with psychosis are reducing, however local data during 2015 indicates a significant rise in the number of mental health hospital admissions and resultant pressures
  • Existing Community based crisis support is under significant pressure and there is a lack of crisis beds
  • Supported living is largely based on a group home model and there are opportunities to review how further step down to independent tenancy can be achieved
  • Rising numbers of forensic MH cases which require specialist AMHP expertise and coordination

What are the key inequalities?

The following inequalities are sourced from the Royal College of Physicians (RCP) position paper that preceded the national strategy (RCP 2010).

Mental illness is consistently associated with unemployment, deprivation, low income, poor education, poor physical health, and increased health risk behaviour. Particular groups with a higher risk of mental ill health include; looked after children, children who experienced abuse, those with certain types of learning disability, homeless people. Prisoners have a 25 fold increased risk of psychosis and 63% of males on remand have an antisocial personality disorder compared to 3% of the population.

Mental health is the biggest single source of the burden of disease and is associated with a range of conditions such as obesity, heart disease, as well as smoking, with over 70% of inpatients reported as smoking (RCP 2010). The same paper also notes that depression is associated with a 50 per cent increased risk of death, after controlling for risk factors.

Inequalities and areas of concern in relation to variations based on ethnicity have been highlighted in the national census of psychiatric inpatients; Count me in, the final edition of which was published in February 2011.

Similar concerns are evident within national reports on monitoring the use of the Mental Health Act.54 Whilst numerous initiatives, at a national and local level, have aimed to improve access, experience and outcomes for BME service users, concrete evidence of improvement is still lacking. Making real strides in terms of outcomes for service users from BME groups, and delivering culturally appropriate services, is a critical challenge for the future. The fact that our population is predicted to become ever more diverse over the coming decades, makes the scale of this challenge all the more apparent.

Mental health and learning disability

The mental health needs of those with learning disability are described in a Public Health Observatory report (2011) which noted that estimates of the prevalence of mental health problems vary from 25-40%, depending on the population sampled and the definitions used. The summary of research evidence, cites prevalence rates of  3% for schizophrenia (three times greater than for the general population), with higher rates for people of South Asian origin and similar rates as the general population for anxiety and depression (though higher in people with Down syndrome).

What are the unmet needs/service gaps?

  • Preventative mental health / health promotion.
  • Alcohol, substance misuse and mental health (dual diagnosis).
  • Supported housing for mental health with tailored support and skills development
  • Liaison psychiatry including a community psychology service to prevent re attendance at A+E.
  • Services for people with autistic spectrum / Aspergers.
  • ADHD services for adults.
  • Services for people with Cognitive impairment arising from head injury/alcohol (Wernickes, Korsakovs and Acquired brain injury).

Recommendations for consideration by other key organisations

Alcohol, substance misuse and mental health/dual diagnosis

A multi-agency approach is being taken with regards managing the increasing incidence of dual diagnosis /drug and alcohol issues. This work is relatively new and needs to be monitored and evaluated.

Liaison psychiatry

Parity of Esteem investment has been made to enhance the liaison service, however there is further enhancement required to provide a full Psychological medicine service.

Supported living

Specialist housing related support and supported living options which provides flexible tailored step up and step down opportunity, and focusses on developing sustained independent living skills will assist in promoting independence and efficient use of mental health commissioning funds.

Developing resilient communities

Supports those with poor mental ill-health and promotes mental wellbeing protecting those likely to develop mental ill-health problems. There are key actions which can be taken to address this.

Improving mental wellbeing

  • The Department of Health’s “No health without mental health” implementation framework (Department of Health, 2012b and the follow up report “Mental Health, Priorities for Change 2014) provides guidance on how better public mental health can be made a reality by local organisations both individually and collectively. This includes the role of clinical commissioning groups (CCGs), providers of mental health and community health services, local authorities, health and wellbeing boards, social services, community groups, schools and colleges, and the criminal justice system.
  • The challenge for policy implementers is to embed mental health promotion throughout wider policy rather than create a new discipline separate and discrete from other areas, for example, mental health is often seen within its own chapter in Health and Wellbeing strategies whilst work to support parenting and early child interventions sit in a different place.