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Mental Health

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Introduction

Mental health is defined by the World Health Organisation (WHO) 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 problems are among the most common forms of ill health. They can affect people at any point in their lives. Mental health and physical health are inextricably linked. Poor physical health may increase the likelihood of developing poor mental health, and poor mental health may increase risks of developing, or not recovering, from physical health problems.

The national Mental Health Strategy 'No Health Without Mental Health'1  states that nationally:

    • mental illness is the single largest cause of disability in the UK
    • at least 1 in 4 people will experience a mental health problem at some point in their life and 1 in 6 adults have a mental health problem at any one time
    • about 1 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

Facts and Figures

Traditionally a distinction has been drawn between severe and enduring mental illness and 'less serious' mental health problems:

    • Severe and enduring mental health problems include those mental health problems such as psychotic disorders (including schizophrenia) and bipolar affective disorder (manic depression)
    • Common mental health problems include problems such as anxiety, depression, phobias, obsessive compulsive and panic disorders
    • Personality disorder is defined as "an enduring pattern of inner experience and behaviours that deviates markedly from the expectation of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment"

The organisation and delivery of services has been significantly influenced by this distinction between severe mental illness and other conditions. However, it is increasingly recognised that diagnosis alone is a poor indicator of severity, complexity, or disability in mental illness.

Figure 1 displays the number of people aged between 18 and 64 estimated to have a mental health disorder in Blackpool.

Figure 1 - Mental Health Disorders - NHS Blackpool CCG
 20142015202020252030
People aged 18-64 predicted to have a common mental disorder 13,458 13,438 13,179 12,907 12,543
People aged 18-64 predicted to have a borderline personality disorder 376 375 368 360 350
People aged 18-64 predicted to have an antisocial personality disorder 294 294 290 286 280
People aged 18-64 predicted to have psychotic disorder 334 334 327 321 311
People aged 18-64 predicted to have two or more psychiatric disorders 6,025 6,017 5,908 5,792 5,638
Source: Projecting Adult Needs and Service Information (PANSI)

The Common Mental Health Disorders Profile developed by Public Health England illustrates that the prevalence of depression, both identified by GPs and self-reported within the GP patient survey, is significantly higher in Blackpool than the England average. 17.5 % of the towns population self-reported moderate or extreme anxiety or depression compared to 12.7% of the population of England as a whole. Figure 2 shows Blackpool's prevalence of GP diagnosed depression is the second highest in the country at 13.5%, significantly higher than the national average of 8.3%. NHS Blackpool CCG GP practices have some of the highest rates of prescribing antidepressants in England2.

Figure 2: Diagnosed depression prevalence funnel plot analysis at CCG level (2015/16 QOF)

Depression QOF Prevalence 201516
Source: NHS Digital, Quality Outcomes Framework, 2015/16

The Blackpool Health Behaviours Survey 2014 used the SWEMWBS tool to measure wellbeing; feelings of contentment, enjoyment, confidence and engagement with the world which are all a part of mental health and wellbeing. The average score for respondents in Blackpool was 22.6, slightly lower thanthe national average of 23.6. The survey identified:

      • Males, young (16-24) and middle aged people (45-59) and the disabled were more likely to have lower wellbeing scores, as are people who are finding it difficult to manage financially
      • Older people (60+), BME communities and those who are financially secure are more likely to feel positive about things
      • Positivity increases in each age group as prosperity increases except in young people
      • Mental wellbeing decreases as affluence increases for people who are obese
      • Females and those from BME communities are more likely to feel optimistic about the future
      • Males, people with a disability and those who are obese are less likely to feel useful
      • Older people (60+) feel significantly better at dealing with problems than working age people
      • Middle aged people (45-59), those with a disability and people not in work are significantly less likely to feel close to others
      • People with a disability and those people who are not in work find it significantly more difficult to make their own mind up about things
      • Overall, those who are struggling financially and those who are not working are significantly less likely to report feeling optimistic about the future, feeling relaxed or able to deal with problems

Figure 3 - Summary of Blackpool Responses to SWEMWBS Questions

Figure1
Source: Blackpool Health Behaviours Survey 2014
 

Views of the Local Community

Healthwatch Blackpool surveyed patients using community based adult mental health services provided by Blackpool Clinical Commissioning Group (CCG). The report, Community Adult Mental Health Services, summarises the views of people using the service to provide a broader and clearer picture of service provision across the area.

 

National and local strategies (current best practices)

No Health Without Mental Health (Department of Health, 2011) a cross government mental health outcomes strategy forpeople of all ages sets a clear vision for improving mental health and wellbeing in England

Lethal Discrimination (Rethink Mental Illness,2013) highlights why people with mental illness are dying early and needlessly and identifies what needs to change

Closing the Gap: Priorities for essential change in mental health (Department of Health, 2014) identifies 25aspects of mental health care and support where government – along with health and social care leaders, academicsand a range of representative organisations – expect to see tangible changes.

The Public Mental Health Action Plan 2016-2019 uses a public health approach to promoting mental wellbeing and preventing mental health problems.  It incorporates interventions at both a universal level (to improve the mental health of our local population) and targeted (targeting those groups and communities most at risk of poor mental health).

Advice and useful links are available from Blackpool Council’s mental health and wellbeing site

 

Risk Factors

'Fair Society Health Lives (Marmot Review)' identifies a number of factors that have a negative impact on mental health.These include:

    • Being unemployed
    • Being homeless
    • Being poor
    • Having a physical illness
    • Having a drug or alcohol problem

Mental health, individual resilience and social exclusion are influenced by a range and interaction of different factorsacross the life course such as social position, education, housing, employment and exposure to crime or violence. The Marmotreport of 2010 described the role of addressing the wider determinants of health in improving health and reducing inequalities,and the contribution of positive mental wellbeing to preventing mental illness.

There are higher levels of substance misuse amongst people with psychosis. Approximately 40% of people with psychosis arereported to have misused substances at some point in their life and this is around double the rate seen in the general population.

 

 


[1] Dept of Health,No Health Without Mental Health, 2011

[2] PHE, Common Mental Health Disorders Profile