The Fundamental Facts - Mental Health Foundation

The Fundamental Facts 

The latest facts and figures 

on mental health 

The 

Fundamental 

Facts

Acknowledgements 

The Mental Health Foundation would like to thank everyone who gave their time during the research and review phases 

of this publication. Our special thanks to: 

Andy Bell, Director of Public Affairs, Sainsbury Centre for Mental Health 

Charlie Brooker, Professor of Mental Health and Criminal Justice, University of Lincoln 

Alan Cohen, Director of Primary Care, Sainsbury Centre for Mental Health 

David Crepaz-Keay, Senior Policy Advisor: Patient and Public Involvement, Mental Health Foundation 

Catherine Jackson, Editor, Mental Health Today 

Jeremy Laurance, Health Editor, The Independent 

Dr Andrew McCulloch, Chief Executive, Mental Health Foundation 

Dr Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent 

Iain Ryrie, former Programme Director: Research, Mental Health Foundation 

Dr Mike Shooter, immediate past President, Royal College of Psychiatrists

The Fundamental Facts 

The latest facts and figures 

on mental health 

2007 edition 

Mental Health Foundation 

Researched and written by Ed Halliwell, Liz Main and Celia Richardson 

With information on the cost of mental health problems based on 

material provided by the Sainsbury Centre for Mental Health 

Edited by Isobel Booth

Foreword 

Mental health presents one of the greatest challenges that current and future generations will face. In health, economic 

and social terms, the burden created by mental health problems and mental illness in the UK is immense and growing. 

Mental health should be a concern for us all because it affects us all. On an individual level, mental health problems affect 

our ability to function day to day and our overall quality of life. When you consider such problems collectively, the effect 

on society is considerable. We need to find out how to turn the tide or future generations will be still further affected by 

mental ill health. 

Mental health and well-being are not nearly as well understood as other areas of health. We are not giving mental health 

the attention demanded by its impact on society. 

As a developed country, we could do better. We need to understand the balance of factors that both promote mental 

health and support the recovery of people with mental health problems. We need to acknowledge that the way we live 

and the decisions we make across all areas of policy have a profound impact on our collective mental health. 

The Fundamental Facts will help contribute to that understanding. 

David Brindle 

Public Services Editor, The Guardian

Introduction 

If we are to promote mental health and prevent and treat mental illness, better documentation, analysis and 

comprehension are crucial. 

Presenting the facts in a way that is accessible and useful to the many people who have a contribution to make is vital 

to improving understanding. The Fundamental Facts is designed to do this. It is a quick reference tool, full of thoroughly 

researched, fully referenced facts and figures. It is for anyone with an interest in mental health – from those who work 

mainly in the field to those who have an interest in gaining speedy and usable insight or reference material. 

A note on terminology and data: 

In most of the facts and figures presented, referenced authors’ terms and definitions have been used for accuracy. Very 

few mental health terms, or the diagnoses they describe, are uncontroversial. Where language has been used which 

reflects a certain way of seeing mental health, this does not mean that any particular model of mental health is either 

endorsed or rejected. 

The terms ‘mental health problems, mental distress and mental ill health’ are used interchangeably here. The term ‘mental 

illness’ is used specifically to refer to clinically recognised patterns or symptoms of behaviour that can be diagnosed as 

mental illnesses. 

The Mental Health Foundation has a holistic view of mental health which includes social, psychological and biological 

factors. Some of the sources quoted here subscribe to other models of mental health. 

A lot of studies have been carried out on mental health over recent years, some of them more scientifically robust than 

others. The Fundamental Facts is a compendium, with no commentary made on the research findings. 

The facts and figures are left to speak for themselves.

Contents 

1. THE EXTENT OF MENTAL HEALTH PROBLEMS 5 

- how many people experience mental health problems? 7 

- what are the main types of mental health problem? 8 

- common mental health problems 9 

- severe mental illness 17 

- other types of mental illness 19 

2. DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS 25 

- gender differences 27 

- black and minority ethnic groups 28 

- children and young people 28 

- older people 29 

- the prison population 30 

- homeless people 31 

- other groups 32 

3. FACTORS RELATED TO MENTAL HEALTH PROBLEMS 35 

- mental health and material deprivation 37 

- family related and social factors 38 

- physical health 39 

- spirituality 39 

- other factors 40 

4. TREATMENT AND CARE 43 

- how many people seek help and use services? 45 

- what treatment and care is available for mental health problems? 46 

- treatment and coping 50 

5. THE COST OF MENTAL HEALTH PROBLEMS 63 

- hidden cost 65 

- overall cost 66 

- health and social care costs 67 

- economic and social factors 70 

- mental health promotion 73 

- violence and mental health 74

1. 

The extent of mental 

health problems

THE EXTENT OF MENTAL HEALTH PROBLEMS 

Mental Health Problems: 1 in 4 British adults 1 

How many people experience 

mental health problems? 

Mental health problems are among the most common 

health conditions, directly affecting about a quarter of 

the population in any one year. Depression and anxiety 

are the most widespread conditions, while only a small 

percentage of people experience more severe mental 

illnesses. However, estimates of exactly how many people 

experience which mental health problems vary, and it is 

not easy to compare different measures. 

For example, some calculations are based on how many 

people have a mental health problem at any point in 

time, while others measure the likelihood of someone 

developing mental health problems in their lifetime. 

Others measure rates per year. Figures may relate to 

different populations such as the adult population, a 

regional population or a nation within the UK (eg. the 

North West or England), or an international population. 

Some examples of how many people are affected are: 

• The Office for National Statistics Psychiatric Morbidity 

report found that in any one year 1 in 4 British adults 

experience at least one mental disorder 1 , and 1 in 6 

experiences this at any given time. 

• Although mental disorders are widespread, severe cases 

are concentrated among a relatively small proportion 

of people who often experience more than one mental 

health problem. 2 

• It is estimated that approximately 450 million people 

worldwide have a mental health problem. 3 

• 1 in 4 families worldwide is likely to have at least one 

member with a behavioural or mental disorder. 4 

The Fundamental Facts 2007


What are the main types of 

mental health problem? 

Mental health problems are usually defined and classified 

by medical professionals. But some mental health 

diagnoses are controversial, and there is much concern in 

the field that people are too often treated according to, or 

described by their label. This can have a profound effect on 

their quality of life. For this reason, diagnostic labels should 

be used with caution, and do not indicate the severity of 

illness. Nevertheless, diagnoses remain the most usual way 

of dividing and classifying symptoms into groups. 

Most mental health symptoms 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. 


250 

200 

250 

women THE EXTENT OF MENTAL HEALTH PROBLEMS 

men 

all adults 

women 

men 

all adults 

150 

200 

100 

150 

50 

100 

0 

50 

16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 

0 

Neurotic disorders: Prevalence by age per 1000 8 

16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 

Common mental health 

problems 

• In a 2001 survey, 15% of British adults reported 

experiencing ‘neurotic symptoms’ in the previous week. 5 

• Mixed anxiety and depression is the most common 

mental disorder in Britain, with almost 9% of people 

meeting criteria for diagnosis. 6 

• About half of people with common mental health 

problems are no longer affected after 18 months, but 

poorer people, long-term sick and unemployed people 

are more likely to be still affected than the general 

population. 7 

• Overall, common mental health problems peak in 

middle age. 20-25% of people in the 45-54 years age 

group have a ‘neurotic disorder’. 8 As people age, neurotic 

disorders become less common, with the lowest level 

recorded in the 70-74 years age group. 

Depression 

The term ‘depression’ is used to describe a range of 

moods, ranging from low spirits to more severe mood 

problems that interfere with everyday life. Symptoms 

may include a loss of interest and pleasure, excessive 

feelings of worthlessness and guilt, hopelessness, morbid 

and suicidal thoughts, and weight loss or weight gain. A 

depressive episode is diagnosed if at least two out of three 

core symptoms have been experienced for most of the 

day, nearly every day, for at least two weeks. These core 

symptoms are: 

• Low mood 

• Fatigue or lack of energy 

• Lack of interest or enjoyment in life 

A depressive episode may be classed as mild, moderate 

or severe, depending on the number and intensity of 

associated symptoms, such as sleep disturbance, appetite 

and weight change, anxiety, poor concentration, irritability 

and suicidal thoughts. 

• Between 8% and 12% of the population experience 

depression in any year. 9 



England 

Northern Ireland 

Wales 

Scotland 

0 5 10 15 20 

Rates of suicide per 100,000 population 17 

• Only 2% of the population are experiencing a depressive 

episode without ‘co-morbid’ anxiety, 10 meaning 

‘occurring at the same time’. 

• Depression tends to recur in most people. More than 

half of people who have one episode of depression will 

have another, while those who have a second episode 

have a further relapse risk of 70%. After a third episode, 

the relapse risk is 90%. 11 For about 1 in 5 people, the 

condition is chronic. 12 

• Worldwide, 5.8% of men and 9.5% of women will 

experience a depressive episode in a 12 month period, a 

total of about 121 million people. 13 

• The World Health Organisation forecasts that by 2020 

depression will be the second leading contributor to the 

global burden of disease. 14 

Suicide and self-harm are not themselves mental illnesses, 

but they usually result from mental distress. 

Suicide 

The Government has set a target to reduce the death 

rate from suicide and undetermined injury by at least a 

fifth by the year 2010 (from a baseline rate of 9.2 deaths 

per 100,000 population in 1995/96/97 to 7.3 deaths per 

100,000 population in 2009/10/11). Data from the three 

years 2002/03/04 show a rate of 8.6 deaths per 100,000 

population – a reduction of 6.6% from the 1995/06/07 

baseline. 15 

• In 2004, more than 5,500 people in the UK died by 

suicide. 16 

• Scotland has the highest suicide rate in the UK at 20 in 

100,000, an increase of 1% over a decade and the only 

country in the UK to show a rise. In England the suicide 

rate is 10 per 100,000 people. In both Northern Ireland 

and Wales the suicide rate is 11 per 100,000. 17 

• The suicide rate in the EU is 17.5 people in 100,000 and 

15.1 in 100,000 worldwide. 18 

The Fundamental Facts 2007 

10


1979 

2:3 

2002 

1:3 

2002 

1:3 

Female to male gender ratios for suicide 22 

• Although the rate of suicide among young men reduced 

by 30% in the period from 1998 to 2005, suicide remains 

the most common cause of death in men under the age 

of 35. 19 

• British men are three times more likely than British 

women to die by suicide. 20 This is true of younger men in 

particular – those aged 25-34 are four times as likely to 

kill themselves as women in this age group. 21 

• Since 1979, the gender gap for people dying by suicide 

has widened. In 1979 the female to male gender 

ratio for suicides was 2:3. In 2002, it was around 1:3. 22 

Nevertheless, women are more likely to attempt suicide 

than men. 23 

• Younger suicides more often had a history of 

schizophrenia, personality disorder, drug or alcohol 

misuse, or violence than older suicides. 24 

• 4% of people who took their lives were the lone carers of 

children. 25 

Suicide and history of using mental health services 

• An inquiry into suicides in the five years to 2001 found 

that approximately a quarter of people who died by 

suicide in England and Wales, Scotland and Northern 

Ireland had been in contact with mental health services 

in the year before death – this amounted to about 1,200 

people each year. At the time of their death, 16% of 

cases in England and Wales, 12% in Scotland and 10% in 

Northern Ireland were psychiatric in-patients. 26 

• The same inquiry reported that 42% of people who took 

their own lives in England and Wales were diagnosed 

with either a depressive illness or bi-polar disorder, and 

20% had schizophrenia or a related disorder. 27 

• In around a quarter of suicide inquiry cases in England, 

Wales and Scotland and nearly a third in Northern 

Ireland, the person died within three months of 

discharge from in-patient care, with a peak in the first 

one to two weeks after discharge. In England and Wales 

40% died before the first follow up appointment. In 

Scotland this was 35% and in Northern Ireland 66%. 28 


11


75% 

Percentage of Black Caribbean suicides with a schizophrenia 

diagnosis 31 

Suicide and ethnicity 

• In the five years to 2001, 6% of people who took their 

own lives in England and Wales were from an ethnic 

minority group. In Scotland this was 2% and in Northern 

Ireland 1%. 29 The 2001 Census found that 9% of the 

population in England were from ethnic minorities. 

In Wales this was 2%, in Scotland 2% and in Northern 

Ireland 0.75%. 30 

• The National Confidential Inquiry into Suicide and 

Homicide by People with Mental Illness in the five years 

to 2001 found that people from ethnic minorities who 

died by suicide usually had severe mental illness. Three 

quarters of Black Caribbean people who took their own 

lives had a diagnosis of schizophrenia. 31 

Self-harm 

Deliberate self-harm ranges from destructive behaviours 

with no suicidal intent, but which relieve tension or 

communicate distress, through to attempted suicide. 

• The UK has one of the highest rates of self-harm in 

Europe, at 400 per 100,000 population. 32 

• There is a high correlation between self-harming 

behaviour and mental health problems. Most of 

those who attend an emergency department after 

self-harming would meet the criteria for one or more 

psychiatric diagnoses. More than two thirds would meet 

the criteria for depression. 33 

• People with current mental health problems are 20 

times more likely than others to report having harmed 

themselves in the past. 34 

• People who have self-harmed are at significant risk of 

suicide. 35 A study found that the risk of a person dying 

by suicide within a year of being treated for self inflicted 

injury was 66 times the annual risk of suicide in England 

and Wales, and that there is a significant risk even many 

years later. 36 


12


Post-natal depression, also known 

as post partum depression, is 

believed to affect between 

8 and 15% of women. 39 

• Self-harming and suicide may be influenced by the 

depiction of similar behaviour in the media or taking 

place in peer groups. For example, one study showed a 

17% increase in presentations to hospital from selfpoisoning 

in the week after an overdose was depicted 

in a TV drama. 37 Similarly, a study of teenagers who selfharmed 

found that the strongest associated factor was 

awareness of friends who had also self-harmed. 38 

• Major public events may lead to amplification of existing 

distress. In the month following the death of Diana, 

Princess of Wales, the number of women dying by 

suicide increased by a third, with a 45% increase in the 

number of women aged 25-44 years taking their lives. 

Deliberate self-harm by women increased 65% and was 

up 44% overall. 

Postnatal depression 

There are two main types of mental health problem that 

a woman may experience following the birth of a child: 

postnatal depression and puerperal psychosis. Puerperal 

psychosis is classed as a severe mental health problem 

(see page 18). Post-natal depression, also known as post 

partum depression, is believed to affect between 8 and 

15% of women. 39 Post-natal depression is not the same as 

the ‘baby blues’ which are very common, but last only a 

few days. 

Seasonal Affective Disorder 

Seasonal Affective Disorder (SAD) is a form of depression 

that affects approximately 0.8% of the population at some 

point in their lives. There are two types of SAD: winter 

and summer depression. Winter depression occurs more 

frequently and is characterised by recurring episodes 

of depression that begin in Autumn/Winter as a result 

of inadequate bright light and go in Spring/Summer. 40 

SAD differs from other forms of depression in that those 

affected sleep more than normal, whereas people 

experiencing other forms of depression have difficulty 

sleeping. 


13


It often takes between 10 and 15 years 

for people to seek professional 

help for OCD. 44 

Anxiety 

Anxiety is a normal response to threat or danger and 

part of the usual human experience, but it can become 

a mental health problem if the response is exaggerated, 

lasts more than three weeks and interferes with daily 

life. Anxiety is characterised by worry and agitation, 

often accompanied by physical symptoms such as rapid 

breathing and a fast heartbeat or hot and cold sweats. 

‘Stress’ is not considered a mental health problem in its 

own right, but long-term stress may be associated with 

anxiety or depression. 

• Generalised anxiety disorder (GAD) is diagnosed after 

a person has on most days for at least six months 

experienced extreme tension (increased fatigue, 

trembling, restlessness, muscle tension), worry, and 

feelings of apprehension about everyday problems. 

The person is anxious in most situations, and there is no 

particular trigger for anxiety. 41 

• People who experience anxiety usually have symptoms 

that fit into more than one category of anxiety disorder, 

and are usually diagnosed with at least one other mental 

disorder, most commonly depression. 42 

• Social phobia, a persistent fear of being seen negatively 

or humiliated in social or performance situations, is the 

third most commonly diagnosed mental disorder in 

adults worldwide, with a lifetime prevalence of at least 

5%. 43 

Obsessive Compulsive Disorder (OCD) 

Obsessive compulsive disorder is a common form 

of anxiety characterised by obsessive thinking and 

compulsive behaviour. Obsessions are distressing, 

repetitive thoughts which may be seen as irrational, but 

cannot be ignored. Compulsions are ritual actions which 

people feel compelled to repeat in order to relieve anxiety 

or to stop obsessive thoughts. For example, someone may 

believe that their hands are constantly dirty so wash them 

over and over again. 

• 2-3% of people will experience Obsessive Compulsive 

Disorder during their lifetime. 44 It often takes between 10 

and 15 years for people to seek professional help. 

• 7% of British adults report ‘obsessions’ in any week, with 

4% reporting ‘compulsions’. 45 


14


Occurrences of phobias in men and women (per 1000) 46 

Phobias (including panic attacks) 

Phobias describe a group of disorders in which anxiety 

is experienced only, or predominantly, in certain welldefined 

situations that are not dangerous. As a result, these 

situations are avoided or endured with dread. The person’s 

concern may be focused on individual symptoms like 

palpitations or feeling faint and these are often associated 

with secondary fears of dying, losing control, or ‘going 

mad’. 

• Phobias are much more common in women than men, 

affecting about 22 in 1,000 women compared with 13 in 

1,000 men in Britain. 46 

• Agoraphobia is the term for a cluster of phobias that 

include fears of leaving home, entering shops, crowds 

and public places, or travelling alone in trains, buses or 

planes. 

• Social phobias are characterised by a fear of scrutiny by 

other people. Symptoms may include blushing, shaking 

hands, nausea or the urgent need to go to the toilet. 

• There are numerous phobias restricted to highly specific 

situations such as proximity to particular animals, 

heights, thunder, darkness, flying, closed spaces, using 

public toilets, eating certain foods, dentistry, or the sight 

of blood or injury. 

• Panic disorder occurs when there are recurrent, 

unpredictable panic attacks followed by at least one 

month of persistent concern about having another 

attack. 

• Panic attacks are usually contained episodes 

characterised by a sudden and intense sensation of 

fear and accompanied by physical symptoms, and the 

person may feel that they are dying. 47 


15


8.1% 8.1% 20.4% 20.4% 

Men 

Men 

Women Women 

Risk of developing PTSD after a traumatic event 48 

Post-traumatic stress disorder 

Post-traumatic stress disorder (PTSD) develops following 

a stressful event or a situation of an exceptionally 

threatening or catastrophic nature. Intentional acts of 

violence are more likely than natural events or accidents 

to result in PTSD. Common symptoms may include 

re-experiencing the event in nightmares or flashbacks, 

avoiding things or places associated with the event, 

panic attacks, sleep disturbance and poor concentration. 

Depression, emotional numbing, drug or alcohol misuse 

and anger are also common. 

In children, re-experiencing symptoms may take the form 

of re-enacting the experience, repetitive play or frightening 

dreams without recognisable content. 

• The risk of developing PTSD after a traumatic event is 

8.1% for men and 20.4% for women. 48 

• Symptoms of PTSD usually develop immediately after 

the traumatic event but for less than 15% of people 

affected, the onset of symptoms will be delayed. 49 

• PTSD sufferers may not seek treatment for months or 

years after the onset of symptoms. 


16


Less than a quarter of people who have 

distressing psychotic experiences at some 

time in their lives remain permanently 

affected by them. 51 

Severe mental illness 

Psychosis 

‘Psychosis’ describes a loss of touch with reality, which 

may include hearing voices, seeing something that no 

one else sees, holding unusual personally derived beliefs, 

experiencing changes in perception or assigning personal 

meanings to everyday objects. Psychosis is associated 

with schizophrenia, schizoaffective disorder, puerperal 

psychosis, severe depression and is often experienced 

during the ‘highs’ of bipolar disorder. Other illnesses such 

as dementia can also feature psychotic symptoms. 

• About 1 in every 200 adults experiences a ‘probable 

psychotic disorder’ in the course of a year. 50 

• Less than a quarter of people who have distressing 

psychotic experiences at some time in their lives remain 

permanently affected by them. 51 

• The average age of onset of psychotic symptoms is 22. 52 

• 4.4% of people in the general population say they have 

experienced at least one symptom of psychosis such as 

delusions or hallucinations. Risk factors include smoking, 

living in the country, little social support, adverse life 

events, neurosis and excessive drug or alcohol use. 

Paranoid thoughts are the most commonly reported 

symptom. 53 

Bipolar disorder 

Bipolar disorder, also known as manic depression, is 

associated with severe mood changes that fluctuate from 

elation, overactivity and sometimes psychosis (together 

known as mania or hypomania) to a lowering of mood and 

decreased energy and activity (depression). It is diagnosed 

after at least two episodes in which a person’s mood 

and activity levels are significantly disturbed, including 

on some occasions mania or hypomania and, on others, 

depression. A person usually recovers completely between 

episodes. 

During a phase of ‘mania’, people may exhibit grandiose 

ideas (an inflated belief in their own power, knowledge 

or relationship to important people or deities), an inflated 

sense of self esteem, a reduced need for sleep and 

impaired concentration and judgment. 

Hypomania is a milder mania, in which abnormalities of 

mood and behaviour are persistent and marked, but are 

not accompanied by hallucinations or delusions and do 

not result in severe disruption to work or social rejection. 

• Between 0.9% and 2.1% of the adult population 

experience a bipolar disorder at some point in their 

lives. 54 There is very little gender difference. 


17


Approximately 25% of people with 

schizophrenia make a full recovery and 

experience no further episodes. 

Between 10 and 15% will experience 

severe long-term difficulties. 60 

• Symptoms of bipolar disorder usually begin between 

the ages of 15 and 24. 55 The age of onset of mania is 

earlier in men than in women, although women have 

a higher incidence throughout the rest of adult life. 56 

However the first episode may occur at any age from 

childhood to old age. 

Schizophrenia 

The diagnosis of schizophrenia refers to a group of 

symptoms, typically the presence of hallucinations, 

delusions, disordered thought, and problems with feelings, 

behaviour, motivation and speech. When they occur 

together they represent a severe mental illness. 

• Schizophrenia is the most common form of psychotic 

disorder, affecting between 1.1% and 2.4% of people at 

any one time. 57 

• The most frequent age of onset for schizophrenia is 

between 20 and 30 years. 58 On average, men have an 

earlier age of onset than women by about 5 years. 59 

• After a first episode, approximately 25% of people with 

schizophrenia make a full recovery and experience no 

further episodes. Between 10 and 15% will experience 

severe long-term difficulties and the remainder will 

experience recurrent acute episodes with periods of 

remission or with only residual symptoms in between. 60 

Schizoaffective disorder 

The diagnosis of schizoaffective disorder is given to 

someone who experiences both symptoms of a mood 

disorder (ie. depression) and symptoms of the type 

experienced with schizophrenia at the same time, or 

within days of each other. 

• Symptoms usually begin in early adult life, with men 

tending to show symptoms earlier than women. 

• About 1 in every 200 people is thought to develop 

the disorder at some point, and it tends to affect more 

women than men. 61 

Puerperal psychosis 

Puerperal psychosis is rare, following between about 1 

and 2 in 1000 births. 62 The onset is abrupt, usually within 

days of the birth. The mother often starts to behave 

strangely, seeming puzzled and perplexed, sleeping poorly 

and being restless and erratic in the day. She may have 

paranoid delusions that often centre around the child, 

for example a belief that the child is the devil, or that the 

world is too evil for the child to live in. 


18


0.2% 1.9% 

Percentage of men and women who experience anorexia 63 

Other types of 

mental illness 

Eating disorders 

Symptoms of eating disorders include severely reduced 

eating, intense fear of weight gain, and self perception that 

is overly influenced by weight or body shape. They also 

include significant levels of self-induced vomiting, laxative 

abuse and strenuous exercise for weight control. 

• 1.9% of women and 0.2% of men experience anorexia in 

any year. 63 Anorexia is characterised by a failure to gain 

weight in relation to age, or excessive loss of weight, 

through avoiding food. In some cases death can occur 

because of the physical consequences of persistent 

starvation. Usually, the condition lasts for about 6 years. 

• Between 0.5% and 1% of young women experience 

bulimia at any one time. 64 The most common age of 

onset is in teenage years and early 30s. 65 Bulimia also 

involves a preoccupation with food but is characterised 

by episodes of intense binge eating, preceded and 

followed by periods of starvation and/or self-induced 

vomiting and purging. 

• About 40% of people referred to eating disorder clinics 

are classified ‘Eating Disorder Not Otherwise Specified’, 66 

with symptoms that don’t fit neatly into either the 

anorexia or bulimia classifications. 

Attention Deficit Hyperactivity Disorder 

Attention Deficit Hyperactivity Disorder (ADHD) is 

often used to describe children who display overactive 

(hyperactive) and impulsive behaviour and who have 

difficulty in paying attention. 

• A lack of consensus on the definition of, and criteria 

for, ADHD has produced widely divergent estimates 

of prevalence rate, varying between 0.5% and 26% of 

children. 67 This has been attributed in part to major 

differences in the way children from different cultures 

are rated for ADHD. 68 

Personality disorder 

This is a controversial diagnosis. Many people believe it is 

used in cases where symptoms do not obviously fit any 

other diagnosis. Personality disorder is used to diagnose 

a person who has difficulty coping with life and whose 

behaviour persistently causes distress to themselves or 

others. Personality disorders are characterised by longlasting 

rigid patterns of thought and behaviour. The 

attitudes of people with a disorder usually exaggerate part 

of their personality and result in behaviour at odds with 

expectations of what is regarded as normal. 


19


38% 38% 15% 15% 

Men 

Men 

Women Women 

Percentage of adults assessed as being ‘hazardous drinkers’ 72 

• Between 4 and 5% of people living in Britain meet the 

criteria for a personality disorder. 69 

• Obsessive compulsive personality disorder is estimated 

to be the most common, affecting about 2% of the 

population (see page 14). Less than 1% fall into each 

of the other categories, with the highest being 0.8% in 

avoidant or schizoid personality disorder, followed by 

paranoid or borderline personality disorder and antisocial 

personality disorder. 70 

• Fewer people with a personality disorder make 

contact with psychiatric services than those with 

other conditions such as schizophrenia or depression. 

The probability of people with a personality disorder 

withdrawing from treatment is higher. 71 

Alcohol and other substance misuse 

Definitions of alcohol and substance misuse vary. However, 

dependence is usually defined by preoccupation with use 

of the substance, inability to control use, and failure to cut 

back despite life-damaging consequences. 

• In 2000, a quarter (26%) of adults in Britain, including 

38% of men and 15% of women, were assessed as 

being ‘hazardous drinkers’. Hazardous drinking refers 

to a pattern of drinking alcohol that brings the risk of 

physical or psychosocial harm. Prevalence of hazardous 

drinking decreased with age. For women prevalence 

was highest in the 16-19 year old group (32%), whereas 

for men it was highest in the 20-24 age group (62%). 72 

• Worldwide, 1.7% of adults are thought to have an 

alcohol-use disorder. 73 

• 3.7% of adults in Britain are considered to be drugdependent. 

74 The number of people who are drug 

dependent appears to have doubled between 1993 and 

2000. 75 

• 30% of people who are dependent on alcohol and 

45% of people dependent on drugs also have another 

psychiatric disorder. 76 

• In 2004/05, there were around 35,600 NHS hospital 

admissions with a primary diagnosis of mental and 

behavioural disorders due to alcohol. Around two thirds 

(68%) of those were men. 77 

• ‘Binge drinking’ is best defined as drinking twice the 

recommended daily limit of alcohol units. An NHS survey 

found that, using this measure, 23% of men reported 

drinking more than 8 units on at least one day in a week. 

The proportion ranged from 33% of men aged 16-24 to 

6% of those aged 65 and over. 78 


20


5% 5% 20% 20% 

over 65 over 65 over 80 over 80 

Percentage of people affected by dementia by age group 82 

Dual diagnosis 

There is considerable overlap between substance 

misuse problems and other mental health problems. 

Such overlap affects many people with mental health 

problems. However, dual diagnosis, when an individual 

experiences a mental illness and a substance use problem 

simultaneously, affects far fewer people. 

• Between a third and half of people with severe mental 

health problems consume alcohol or other substances 

to levels that meet criteria for ‘problematic use’. 79 

• 51% of alcohol-dependent adults say they have a mental 

health problem. 80 

• 44% of people using services of Community Mental 

Health Teams in four urban centres reported problematic 

drug or alcohol use in the preceding year. 81 

Dementia 

Dementia is a progressive and largely irreversible condition 

that involves widespread damage to mental functioning. 

Someone with dementia may experience memory 

loss, language impairment, disorientation, change in 

personality, difficulties with daily living, self neglect, 

and behaviour which is out of character (for example, 

aggression, sleep disturbance or sexual disinhibition). 

• Dementia affects 5% of people over the age of 65 

and 20% of those over 80. About 700,000 people in 

the UK have dementia (1.2% of the population) at any 

one time. 82 

• Dementia is uncommon before the age of 65, but does 

affect 1 in 1,000 younger people. 83 

• About 60% of dementia cases are caused by Alzheimer’s 

disease. 

• About a fifth of cases of dementia are related to strokes 

or insufficient blood flow to the brain, these cases being 

known as vascular dementia. 84 

• In fronto-temporal dementia, which includes Pick’s 

disease, damage is usually focused in the front part of 

the brain. Personality and behaviour are initially more 

affected than memory. 

• People with multiple sclerosis, motor neurone disease, 

Parkinson’s disease, Huntington’s disease and Down’s 

syndrome are at increased risk of developing a type of 

dementia linked to their condition. 


21

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15. National Suicide Prevention 

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19. The National Service Framework 

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24. Safety First: Five-Year Report of 

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32. Horrocks, J, Self-poisoning 

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and secondary care, National 

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24

2. 

Differences in the 

extent of mental health 

problems

DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS 

10% 10% 25% 25% 

Men Men 

Women Women 

Men and women requiring treatment for depression during 

Difference in the extent of 

mental health problems 

Gender differences 

• Women are more likely to have been treated for a 

mental health problem than men (29% compared with 

17%). 85 

• More than half of contacts with the Samaritans are made 

by men – 53% compared with 43% by women. 4% were 

unidentifiable. 

• Depression is more common in women than men. 1 in 

4 women will require treatment for depression at some 

time, compared with 1 in 10 men. 86 The reasons for this 

are unclear, but are thought to be due to both social and 

biological factors. 

• Doctors are more likely to treat depression in women 

than in men, even when they present with identical 

symptoms. 87 

• Women are twice as likely to experience anxiety as men. 

Of people with phobias or OCD, about 60% are female. 88 

• Men are more likely than women to have an alcohol 

or drug problem. 67% of British people who consume 

alcohol at ‘hazardous’ levels, and 80% of those 

dependent on alcohol are male. Almost three quarters 

of people dependent on cannabis and 69% of those 

dependent on other illegal drugs are male. 89 

• The prevalence of schizophrenia is about the same in 

men and women, but the average age of onset is 18 in 

men and 25 in women. 90 

• All personality disorder categories are more prevalent in 

men, apart from the schizotypal category. Men are five 

times more likely than women to be diagnosed with 

anti-social personality disorder. 91 

• About 75% of people to die by suicide are men. This 

proportion has been about the same for more than a 

decade. 92 


27


Depression in ethnic minority groups has 

been found to be up to 60% higher than in 

the white population. 95 

Black and minority ethnic groups 

In general, rates of mental health problems are thought to 

be higher in minority ethnic groups in the UK than in the 

white population, 93 but they are less likely to have their 

mental health problems detected by a GP. 94 

• Depression in ethnic minority groups has been found to 

be up to 60% higher than in the white population. 95 

• Young Asian women are three times as likely to kill 

themselves as young white women. 96 

• A higher prevalence of diagnosed mental illness, 

particularly schizophrenia, has been found among Black 

Caribbean people in the UK. 97 They are twice as likely 

as white people to be diagnosed as having a psychotic 

disorder. 98 

• Mental health staff, including psychiatrists, are more 

likely to perceive black patients as being potentially 

dangerous, even though there is no evidence that 

they are any more aggressive than other patient 

populations. 99 

• Black African and Caribbean people are three times as 

likely to be admitted to hospital and up to 44% more 

likely to be detained under the Mental Health Act as 

white people. 100 

• Black people are more likely than white people to 

be given physical treatments, such as medication 

and ECT, and are likely to be prescribed higher doses 

of medication. They are less likely to be offered 

psychotherapy, counselling and other non-medical 

interventions. 101 

• Compared with White British patients, both African– 

Caribbean and Black African patients are less likely to be 

referred to mental health services by a GP, and are more 

commonly referred by a criminal justice agency. 102 

Children and young people 

• Estimates vary, but research suggests that 20% of 

children have a mental health problem in any given year, 

and about 10% at any one time. 103 

• The British Medical Association estimates that at any 

point in time up to 45,000 young people under the age 

of 16 are experiencing a severe mental health disorder, 

and approximately 1.1 million children under the age 

of 18 would benefit from specialist mental health 

services. 104 


28


aged 11-15 aged 11-15 

aged 5-10aged 5-10 

10.4% 10.4% 5.9% 5.9% 12.8% 12.8% 9.65% 9.65% 

Rates of mental health problems among children 

• Rates of mental health problems among children 

increase as they reach adolescence. Disorders affect 

10.4% of boys aged 5-10, rising to 12.8% of boys aged 

11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls 

aged 11-15. 105 

• In one study, 50-60% of adults with a diagnosed mental 

disorder had received a mental health diagnosis of some 

kind before the age of 15. 106 

• Among teenagers, rates of depression and anxiety have 

increased by 70% in the past 25 years. 107 

• Children of single-parent families are twice as likely 

to have a mental health problem as children of twoparent 

families (16%, compared with 8%). Also at higher 

risk are children in large families, children of poor and 

poorly-educated parents and those living in social sector 

housing. 108 

• 41% of British 11-15 year-olds who smoke regularly have 

a mental disorder, as well as 24% of those who drink 

alcohol at least once a week, and 49% of those who use 

cannabis at least once a month. 109 

Older people 

• Older people are less likely to have a neurotic disorder 

(or common mental health problem), other than 

depression, than other sections of the British population. 

10.2% of those aged 65-69 and 9.4% of those aged 70-74 

have a neurotic disorder, compared with 16.4% of the 

general population. 110 

• Depression affects 1 in 5 people over the age of 65 living 

in the community and 2 in 5 living in care homes. 111 

However, it is likely that only a small proportion of older 

people with depression are in contact with their GP or 

mental health services. 112 

• An estimated 70% of new cases of depression in older 

people are related to poor physical health. 113,114 


29


72% 72% 70% 70% 

Men 

Men 

Women Women 

Mental disorders among sentenced prisoners 117 

The prison population 

Prisoners have particularly high levels of mental illness. 

Until 2003, prison health care was the responsibility of the 

Home Office, but it now comes under the auspices of the 

NHS. 

• Prisoners with mental disorders are significantly overrepresented 

in the prison population. As many as 

12-15% of all prisoners have four concurrent mental 

disorders. 30% of all prisoners have a history of self-harm, 

and the incidence of mental health disorder is higher for 

women, older people and those from ethnic minority 

groups. 115 

• Up to 90% of prisoners have a diagnosable mental 

illness, substance abuse problem or, frequently, both. 116 

• 72% of male and 70% of female sentenced prisoners 

have at least one mental disorder and 1 in 5 prisoners 

has four major mental health disorders. 117 

• Male prisoners are 14 times more likely to have two 

or more disorders than men in general, and female 

prisoners 35 times more likely than women in general. 118 

• In one UK study, 5.2% of prisoners had displayed 

symptoms of psychosis in the past year compared 

with 0.45% of the general population. Psychosis was 

attributed to toxic or withdrawal effects of drugs and 

alcohol in a quarter of the prison cases. 119 

• The suicide rate for men in prison is five times that for 

men in the community. Boys aged 15-17 are 18 times 

more likely to kill themselves in prison than in the 

community. 120 

• National research found that 72% of people who died by 

suicide in prison had a history of mental disorder. 57% 

had symptoms suggestive of mental disorder at the time 

they entered prison. 121 

• A fifth of perpetrators of homicide with schizophrenia 

were sent to prison rather than hospital. 122 Over 90% of 

perpetrators with personality disorder had no symptoms 

of mental illness at the time of the offence and received 

a prison sentence. 123 


30


Less than 1 in 3 homeless people with mental health problems 

receive treatment 130 

• Women make up just 6% of the prison population. In 

2003 they accounted for 46% of all reported self-harm 

incidents with 30% of women reported to have harmed 

themselves, on average five times each, compared with 

6% of men, who on average harmed themselves twice. 124 

• Behavioural and mental health problems are particularly 

prevalent amongst children in prison. Of prisoners aged 

16-20, around 85% show signs of a personality disorder 

and 10% exhibit signs of psychotic illness. 125 

• More than half of all elderly prisoners suffer from a 

mental disorder, most commonly depression, which 

often emerges as a result of imprisonment. 126 

Homeless people 

• In 2005/06 there were 7,340 homeless people 

experiencing mental illness, more than double the 

number 15 years earlier. 127 

• The percentage of homeless people judged to be 

homeless and vulnerable due to mental illness or 

disability rose from 3.25% in 1991 to 7.8% in 2006. 128 

• 1 in 4 homeless people will die by suicide. 129 

• Less than a third of homeless people with mental health 

problems receive treatment. 130 

• 30-50% of homeless rough sleepers experience mental 

health problems. About 70% misuse drugs. 131 

• Behavioural problems have been found to be higher 

among homeless children living in temporary 

accommodation, and mental health problems are 

significantly higher among homeless mothers and 

children. 132 


31


30% 

Percentage of deaf people with mental health problems 136 

Other groups 

• People who provide substantial amounts of care to 

relatives are twice as likely to have a mental health 

problem as the general population. 133 

• A survey of carers in England found that female carers 

are 23% more likely to suffer from anxiety or depression 

than women in the general population. (Most carers 

are women.) People who spend 20 or more hours a 

week caring are twice as likely to suffer from anxiety or 

depression as those spending less time providing care. 134 

• Two thirds of refugees have experienced anxiety 

and depression, 135 which may often be linked to war, 

imprisonment, torture or oppression in their home 

countries, and/or social isolation, language difficulties 

and discrimination in their new country. 

• 30% of deaf people using British Sign Language 

have mental health problems, primarily anxiety and 

depression. 136 

• 25-40% of people with learning disabilities are estimated 

to have a mental health problem. 137 


32

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available at http://england.shelter. 

org.uk (accessed June 2006) 

132. Research from Shelter, 

available at http://england.shelter. 

org.uk (accessed June 2006) 

133. Mental Health and Social 

Exclusion London: Office of the 

Deputy Prime Minister, quoting 

Singleton N et al (2002) Mental 

Health Of Carers London: The 


134. Office for National Statistics, 

Mental Health of Carers London: 


135. Burnett A, Peel M, Health 

Needs Of Asylum Seekers And 

Refugees, British Medical Journal, 

322 pp544-547, (2001) 




Deputy Prime Minister, (2004) 

137. Health Needs of People With 

Learning Disabilities, Foundation for 

People with Learning Difficulties, 

www.learningdisabilities.org.uk 


References 


34

3. 

Factors related to mental 

health problems

FACTORS RELATED TO MENTAL HEALTH PROBLEMS 

Factors related to mental 

health problems 

Mental health and material deprivation 

• Having a low income, being unemployed, living in poor 

housing, low levels of education and membership of 

social classes IV (partly skilled people) and V (individuals 

with no skills) are all associated with a greater risk of 

experiencing a mental health problem. 138 

• The poorest fifth of adults are at double the risk of 

experiencing a mental health problem as those on 

average incomes. 139 

• In a study of British adults taking the GHQ questionnaire 

(which measures psychological well-being), the 

prevalence of high scores (indicative of a psychiatric 

problem) increased as household income decreased. 140 

• Financial problems can be both a cause and a 

consequence of mental health problems. People with 

mental health problems are three times as likely to be in 

debt as the general population and more than twice as 

likely to have problems managing money. 141 

• Children in poor households are three times as likely 

to have mental health problems as children in well-off 

households. 142 

• People without a degree are almost twice as likely to 

experience depression as those with a degree. 143 


37


1 in 4 people using mental health services has no 

contact with their family 146 

1 in 3 people using mental health services has no 

contact with their friends 146 

Family-related and social factors 

• Social isolation is a factor in mental health problems. 

20% of people with common mental health problems 

live alone, compared with 16% of the overall 

population. 144 

• A person with a severe mental health problem is 

four times more likely than average to have no close 

friends. 145 

• 1 in 4 people using mental health services has no 

contact with their family, and 1 in 3 has no contact with 

friends. 146 

• Low levels of social support can reduce the likelihood of 

recovery – in one study 54% of women and 51% of men 

with mental health problems and good social support 

recovered over an 18 month period, compared with 35% 

of women and 36% of men with a severe lack of social 

support. 147 

• People with a common mental health problem are twice 

as likely to be separated or divorced as their mentally 

healthy counterparts (14%, compared with 7%), 148 and 

are more than twice as likely to be single parents as 

those without a mental health problem (9%, compared 

with 4%). 149 

• Between a third and two thirds of children whose 

parents have mental health problems will develop 

problems either in childhood or adult life. 150 Children 

of depressed parents have a 50% risk of developing 

depression themselves before the age of 20. 151 

• Almost half of children in care have a mental health 

problem. Children in care are 4 to 5 times as likely to 

have a mental health problem as other children. 152 

• Taking part in social activities, sport and exercise is 

associated with higher levels of life satisfaction. For 

example, 76% of those who play sport or exercise at least 

once a week are satisfied, compared with 70% of those 

who never or rarely play sport or exercise. 153 

• Other social and economic risk factors for mental health 

problems include: poor transport, neighbourhood 

disorganisation and racial discrimination. Social and 

economic protective factors for mental health include: 

community empowerment and integration, provision 

of social services, tolerance, and strong community 

networks. 154 


38


Diabetes 27% 

Hypertension 29% 

Stroke 31% 

Cancer patients 33% 

HIV/AIDS 44% 

0 10 20 30 40 50 

Percentage of people with poor physical health affected by depression 156 

Physical health 

People with poor physical health are at higher risk of 

experiencing common mental health problems, and 

people with mental health problems are more likely to 

have poor physical health. 

• A person with schizophrenia will, on average, live for 

10 years less than someone without a mental health 

problem. 155 

• Depression affects 27% of people with diabetes, 29% of 

people with hypertension, 31% of people who have had 

a stroke, 33% of cancer patients and 44% of people with 

HIV/AIDS. 156 

• People who experience persistent pain are four times 

as likely to have an anxiety or depressive disorder as the 


• 61% of people with schizophrenia presenting at GP 

surgeries and 46% of those with manic depression 

smoke, compared with 33% of the remaining 

population. 158 In one study smoking cessation had been 

offered to more of those with severe mental illness 

than to other patients who smoke, and more had been 

prescribed smoking cessation medication. 159 

Spirituality 

Spirituality means different things for different people 

at different times. Although for centuries spirituality has 

been expressed through religion, art, nature and the 

built environment, recent expressions of spirituality have 

become more varied. Underlying this is an assumption that 

trying to make sense of the world around us and our place 

within it is an intrinsic part of what it means to be human. 

• Research literature has consistently reported that 

aspects of religious and spiritual involvement are 

associated with desirable mental health outcomes. 160,161 

The Royal College of Psychiatrists notes that people who 

use mental health services identify the benefits of good 

quality spiritual care as being: improved self-control, self 

esteem and confidence; speedier and easier recovery; 

and improved relationships. 162 

• In a study of people with severe mental health problems 

across a range of diagnoses, 60% reported that religion/ 

spirituality had ‘a great deal’ of helpful impact on their 

illness through the feelings it fostered of being cared for 

and of not being alone. 163 


39


66% 

Percentage of people with mental health problems who believe 

that workplace stress was a factor 166 

• Studies have found that religious people, those who 

believe in a transcendent being or higher power, and 

people who belong to a community with others who 

share their values and offer support are more likely to 

recover from depression. 164 

Other factors 

• Overall, people with common mental health problems 

are more likely to live in an urban area than in the 

country. However, among rural areas, the most deprived 

and remote areas have the highest overall levels of 

mental health problems and suicide. 165 

• Workplace stress can frequently contribute to mental 

health problems. About two thirds of people with 

mental health problems believe that long hours, 

unrealistic workloads or bad management at work 

caused or exacerbated their condition. 166 

• Having a sense of control over one’s life is linked to good 

mental health. In one survey, of those who said they had 

‘complete control’ in their lives, only 14% said they had 

ever been told by a doctor that they had a mental health 

problem, compared with 56% of those who said they 

had ‘little control’. 168 

• Women who have been abused in childhood are 

four times more likely to develop major depression in 

adulthood. 169 

• People who experienced childhood sexual abuse are 

almost three and a half times as likely to be treated 

for psychiatric disorders in adulthood as the general 

population. They are five times as likely to have a 

diagnosis of personality disorder. 170 

• Mental health is adversely affected by war, conflict, 

extreme poverty, displacement and natural disasters. 

Worldwide, it is estimated that between a third and 

a half of those affected by such events suffer from 

diagnosable mental distress, especially post-traumatic 

stress disorder, depression and anxiety. 167 


40

References 

138. Based on Meltzer H, Singleton 

N, Lee A, Bebbington P, Brugha T, 

Jenkins R , The social and economic 

circumstances of adults with mental 

disorders Her Majesty’s Stationery 

Office (HMSO): London, (2002) 

139. Based on Meltzer H, Singleton 

N, Lee A, Bebbington P, Brugha T, 

Jenkins R , The social and economic 

circumstances of adults with mental 

disorders Her Majesty’s Stationery 

Office (HMSO): London, (2002) 

140. Department of Health, 

Health Survey for England 2003: 

Summary of Key Findings London: 

Department Of Health p10, (2004) 


Exclusion, Social Exclusion Unit, 

London: Office of the Deputy Prime 

Minister, p88, quoting Meltzer 2002, 

(2004) 

142. National Health Service: 

National Service Frameworks 

London: NHS, (1999) 


R, O’Brien M, Lee A, Meltzer H, 




(2001) 






(2001) 

145. Huxley P, Thornicroft G, Social 

Inclusion, Social Quality And Mental 

Illness, British Journal Of Psychiatry 

182 pp289-90, (2003) 

146. National Health Service: 

National Service Frameworks 

London: NHS p46, (1999) 

147. Singleton N, Lewis G. Better Or 





(2003) 






(2001) 






(2001) 




Minister, p75, quoting Falkov A, 

Crossing Bridge: Training Resources 

for Working With Mentally Ill 

Parents And Their Children London: 

Department of Health/Pavilion, 

(2004) 

151. Prevention Of Mental Disorders 

Geneva: World Health Organisation 

p29, (2004) 

152. Every Child Matters: Change 

for Children – Facts And Figures, 

Department for Education and 

Skills (2003) 

153. Donovan N, Halpern D, 

Life Satisfaction: the State Of 

Knowledge And Implications for 

Government London: Strategy Unit 

p26, (2002) 

154. Prevention Of Mental Disorders 

Geneva: World Health Organisation 

pp22-24, (2004) 

155. Healthy Body And Mind: 

Promoting Healthy Living for 

People Who Experience Mental 

Distress, National Institute for 

Mental Health In England, Leeds: 

NIMHE p4, (2004) 

156. Investing In Mental Health, 

Geneva: World Health Organisation, 

p11, (2003) 




Organisation p8, (2001) 

158. Equal Treatment: Closing 

the Gap Interim Report of a 

Formal Investigation into Health 

Inequalities, Disability Rights 

Commission, (2005), available 

at http://drc-gb.org/newsroom 


159. Equal Treatment: Closing 

the Gap Interim Report of a 

Formal Investigation into Health 

Inequalities, Disability Rights 

Commission, (2005), available 

at http://drc-gb.org/newsroom 


160. Swinton, J. (2001) Spirituality 

and Mental Health Care: 

Rediscovering a Forgotten 

Dimension. London: Jessica 

Kingsley, cited in Culliford L, 

Spiritual care and psychiatric 

treatment: an introduction, 

Advances in Psychiatric Treatment 

8: 249-258, (2002) 

161. Mentality – Adulthood (2004) 

available at www.library.nhs.uk/ 

mentalhealth (accessed June 2006) 

162. Culliford L. and Powell A, 

Spirituality and Mental Health, 

Royal College of Psychiatrists, 

(2005), available at www.rcpsych. 

ac.uk (accessed June 2006) 

163. Foskett J, Marriott J, and 

Wilson-Rudd F, Mental health, 

religion and spirituality: Attitudes, 

experience and expertise among 

mental health professionals and 

religious leaders in Somerset: 

Mental Health, Religion and 

Culture, 2004, v. 7, no. 1, p. 5-22 in 

Cornah D. The impact of spirituality 

on mental health: a review of the 

literature, London: Mental Health 

Foundation, (2006) 

164. Cornah D, The impact of 

spirituality on mental health: a 

review of the literature, London: 

Mental Health Foundation, (2006) 

165. Melzer D, Geographic 

variations in Health London: The 


166. Out At Work: Updates vol 3 

issue 16 London: Mental Health 





Organisation, p43, (2001) 


41

168. Well What Do You Think: The 

Second National Scottish Survey Of 

Public Attitudes To Mental Health, 

Mental Well-Being And Mental 

Health Problems, Scottish Executive 

(2004), available at www.scotland. 

gov.uk 





170. Spataro J et al, Impact Of Child 

Sexual Abuse On Mental Health 

British Journal Of Psychiatry 184 

pp416-21, (2004) 

References 


42

4. 

Treatment and care

TREATMENT AND CARE 

27% 

Percentage of people with a mental health problem who receive 

ongoing treatment 172 

How many people seek 

help and use services? 

• Over an 18 month period, 23% of people in Britain said 

they received some treatment or service, not necessarily 

provided by the NHS, for a mental health problem. 171 

• It is estimated that only about a quarter of people in 

Britain with a mental health problem receive ongoing 

treatment, either because they have not gone to the 

doctor at all, have been misdiagnosed by a GP, or have 

refused treatment. 172 In a 12 month period, 3% of all 

people with mental illness (whether treated or not) saw 

a psychiatrist and 2% a psychologist. 173 

• 85% of people with a psychotic disorder receive 

treatment. 174 

• Only 2 in every 5 people experiencing anxiety or a 

substance misuse problem seek help in the year of the 

onset of the disorder. 175 

• Almost 40% of drug users with a psychiatric disorder 

receive no treatment for their mental health problem. 176 

• Around three quarters of 5-15 year-olds with mental 

health problems are not in contact with child and 

adolescent mental health services. 177 


45


30% 

Percentage of GP consultations related to mental health 178 

What treatment and care is available for 

mental health problems? 

Primary care 

• At the end of March 2006, around 19,000 people 

• Approximately 30% of all GP consultations are related to were receiving care from assertive outreach teams in 

a mental health problem. 178 

the community, usually because these people were 

reluctant to engage with other mental health services. 

• About 90% of people with mental health problems This represents an increase of 7% on the previous year. 184 

receive all their treatment from primary care services 

(as opposed to specialist mental health services), as do • 8,000 people received early intervention in psychosis 

at least a quarter of those with severe problems. 179 On treatment in 2005/06 (up from 4,600 in 2004/05) from 

average, a person with severe mental health problems 128 early intervention teams (compared with 109 in 

has 13 to 14 consultations per year with their GP. 180 

2004/05). 185 

Community care 

Community mental health teams now provide most local 

specialist mental health services. 

• Mental health nursing care is provided for 540,000 

people living in the community, and there are 2.1 million 

attendances a year at NHS day care facilities as well as 2 

million consultant outpatient attendances. 181 

• During 2005/06, crisis and home treatment teams 

provided 84,000 episodes of home treatment for people 

who would otherwise have been admitted to hospital. 182 

This was an increase from 69,000 in 2004/05, although 

the number of crisis resolution teams reduced to 266 in 

2006 from 343 in 2005. 183 

The Fundamental Facts 2007 46


1983 

82,000 

1999/00 

34,173 

2004/05 

31,667 

0 20 40 60 80 100 

Number of NHS hospital beds for mental health problems in England 186 

Hospital provision 

• The number of NHS beds for mental health problems in 

England was 31,667 in 2004/05. In 1999/2000 there were 

34,173 beds. 186 In 1983, there were 82,000 beds. 187 

• The NHS spent about £575 million on acute psychiatric 

in-patient hospital care in 2005/06, 188 about 68% of its 

budget for clinical mental health services. 

• In 2003/04, the average cost of a hospital bed was £225 

a day for an acute bed and £440 for intensive care. Costs 

of secure hospital care were £351 a day in low-secure 

units and £400 a day in medium-secure units. The 

weekly cost of local authority residential and nursing 

care for adults with mental health problems was £496 

per person in England in 2004/05. 189 

• While the number of NHS adult mental health 

admissions fell by about 10% over four years to 122,260 

in 2002/03, the average length of stay per admission was 

stable at roughly 18-19 days. 190 

• Child and adolescent psychiatric units are unevenly 

distributed across England and Wales, with a 

concentration in London and the South East. More than 

a quarter of child and adolescent beds are now provided 

by the independent sector. 191 In 2002, 124 NHS Trusts 

were identified as providers of specialised child and 

adolescent mental health services – between them they 

had 732 teams and 7,340 staff. 192 


47


46% 46% 29% 29% 

Men 

Men 

Women Women 

Percentage of people detained in mental health units under the 

Mental Health Act 194 

The Mental Health Act (1983) 

The Mental Health Act (1983) is the principal Act governing 

the treatment of people with mental health problems in 

England, Wales and Northern Ireland. It covers all aspects 

of compulsory admission and subsequent treatment. 

• There were 46,700 detentions under the Mental Health 

Act (1983) in 2004/05. On 26,752 occasions the Mental 

Health Act was used to admit a person to hospital (an 

increase from 25,642 in 1994/95). On almost 20,000 

occasions in 2004/05 the Mental Health Act was used to 

detain a person already admitted voluntarily to hospital 

in order to prevent them leaving, down very slightly 

from a decade earlier. 193 

• A mental health census in 2005 found that 46% of 

men and 29% of women in mental health units were 

detained under the Mental Health Act. 194 

• In 2005, 53% of compulsory admissions under the 

Mental Health Act to NHS hospitals were male, but at 

a given point in time there were almost twice as many 

men as women detained. The Office of National Statistics 

speculates that this could be due to a longer average 

period of detention for men or to more men being 

detained to prevent them leaving hospital following 

a voluntary admission, but notes these data are not 

collected. 195 

• The highest rate of detentions in 2005 was in London 

(134 people per 100,000) followed by the North West (93 

per 100,000). The East of England had the lowest rate (69 

per 100,000). 

• Research suggests that use of crisis plans, also known 

as advance statements or advance directives, drawn up 

jointly between professionals and patients can reduce 

the number of compulsory admissions under the Mental 

Health Act by more than 50%. 196 

• The 2005 mental health ethnicity census found that 

people from ethnic minorities are more likely to be 

detained under the Mental Health Act. Inpatients from 

the Black Caribbean, Black African, and Other Black 

groups were more likely (by between 33% and 44%) 

to be detained when compared with the average for 

all inpatients. The rate of detention for inpatients from 

the Other White group was also slightly higher than 

average. 197 



27% 

Percentage of carers turned away when trying to access help 206 

Users’ experience of staff 

• Most service users are positive about the way they 

are treated by mental health staff. In one study three 

quarters rated their care as good, very good or excellent, 

compared with 9% who said it was poor or very poor. 198 

• 15% of people using mental health services say they do 

not have enough say in decisions about their treatment, 

while 44% say they only have a say to some extent. 18% 

say their diagnosis has not been discussed with them. 199 

Informal care 

• In the UK adults with mental health problems receive 

about 21 million hours a week of informal (unpaid) care 

from family and friends. 200 

• Up to 420,000 people in the UK care for someone with a 

mental health problem, 201 including between 6,000 and 

17,000 children and young people. 202 Including carers 

of people with dementia, estimates rise to around 1.5 

million. 31% of these are involved in caring for more 

than 50 hours a week. 203 

• A 2003 survey found that 75% of people who care for a 

person with a mental health problem are women, and 

the average age of carers was 62 years. The average age 

of recipients of care was 39 years, and 68% were male. 

44% cared for a person with schizophrenia and 9% for a 

person with bipolar disorder. 204 

• 29% of the 175,000 young carers in the UK are looking 

after people with mental health problems. 82% of young 

carers provide emotional support to the person they 

care for. 205 

• 27% of carers said they had been turned away when 

trying to access help for the person they care for. 206 56% 

cited an access related issue as the most frustrating 

aspect of dealing with mental health services. 207 

A quarter of carers felt they do not have sufficient 

information available. 208 


49


Counselling 82% 

Antidepressants 60% 

Exercise 76% 

Counselling 42% 

Alternative therapies 60% 

Exercise therapy 2% 

Antidepressants 52% 

0 20 40 60 80 100 

0 20 40 60 80 100 

Percentage of people prepared to try various treatments 210 Treatments prescribed by GPs for depression 210 

Treatment 

and coping 

• People with mental health problems report a variety 

of treatments and coping mechanisms as helpful, but 

one survey found that more than half weren’t given any 

choice of treatment. 209 

• According to an online survey by the Mental Health 

Foundation, of those visiting their GP with depression, 

60% were prescribed anti-depressants, 42% were offered 

counselling and 2% were offered exercise therapy. 

The same survey found that 82% of people would be 

prepared to try counselling, 76% would be prepared to 

try exercise, 60% would be prepared to try alternative 

therapies, and 52% would be prepared to try antidepressants. 

210 

• Two surveys 211,212 of people with mental health problems 

found that useful techniques and coping strategies 

include: 

- Support from family and friends 

- Medication 

- Counselling or psychotherapy 

- Something worthwhile to do during the day 

- Peer support 

- Alternative therapies 

- Volunteering and working 

- Hobbies 

- Physical exercise 

- Advice from their GP 

- Spirituality and religion 



9.3% 

Percentage of prescriptions written for mental health problems 218 

• About half of people with mental health problems 

pay privately for treatments that are not prescribed, 

spending on average £61 a month. The most commonly 

paid for treatments are complementary therapies 

(63%), followed by counselling or psychotherapy (31%) 

and exercise (30%). 58% of people with mental health 

problems feel they miss out on treatment that would 

be helpful, the majority because they cannot afford 

it. The treatments most often cited as missed out on 

are counselling, psychotherapy and complementary 

therapies. 213 

Medication 

• A combination of therapies has been shown to be 

most effective in treating some common mental health 

problems. Guidance from the National Institute for 

Health and Clinical Excellence (NICE) states that a variety 

of psychological therapies, in addition to or instead of 

medication, can be helpful for managing anxiety 214 and 

depression, 215 and in some cases bipolar disorder 216 and 

schizophrenia. 217 

• In 2004, GPs wrote a total of 63.9 million drug 

prescriptions for mental health problems in England, 

representing 9.3% of the total prescriptions by volume. 218 

• Another survey found that 87% of people prescribed 

medication said they had not received enough 

information about the drugs they were given, and 86% 

said they were not warned of possible side effects. 219 

• Approximately 2 million people of working age in Britain 

are currently taking psychiatric drugs, most prescribed 

by their GPs. 220 


51


35% 55% 35% 55% 

Percentage of GPs who believe anti-depressants to be the most 

effective intervention for mild to moderate depression 225 

Percentage of GPs who believe counselling and psychotherapy to be 

the most effective intervention for mild to moderate depression 225 

Anti-depressants 

• In 2005, doctors wrote 29.4 million prescriptions for antidepressants, 

4 million more than in 2004. 221 The number 

of prescriptions written for anti-depressants has tripled 

since the early 1990s, after a newer class of drug called 

selective serotonin reuptake inhibitors (SSRIs) such as 

Prozac became available in the late 1980s. 222 

• NICE guidelines state that anti-depressants are 

not recommended for the initial treatment of mild 

depression because the risks may outweigh the benefits. 

Instead it recommends self-guided cognitive therapy 

or short courses of cognitive therapy with a therapist. 223 

NICE recommends that for severe depression a 

combination of anti-depressants and individual CBT 

should be considered as the combination is more costeffective 

than either treatment on its own. 224 

• Although 57% of GPs say that anti-depressants are 

over-prescribed, 55% use them as their first treatment 

response to mild or moderate depression. Only 35% 

believe they are the most effective intervention for mild 

or moderate depression, with 55% believing counselling 

and psychotherapy is the most effective intervention. 

More than three quarters (78%) have prescribed an 

anti-depressant in the last three years despite believing 

that an alternative treatment might have been more 

appropriate, most commonly because the alternative 

was not available or there was a long waiting list for it. 225 

• Female GPs and those with more years of GP experience 

are less likely to prescribe anti-depressants. 226 

• Unpleasant symptoms associated with anti-depressants 

often result in patients not continuing with medication. 

In one study, only 33% of patients completed ‘an 

adequate period of treatment.’ 227 

Anti-psychotics 

Anti-psychotics are used to treat symptoms of acute 

psychosis and to prevent further episodes. Anti-psychotics 

are generally divided into two classes: the older ‘typical’ 

agents (neuroleptics) and the newer ‘atypical’ agents, 

mostly developed since the early 1990s. Atypicals usually 

have less distressing side effects, and the National Institute 

for Health and Clinical Excellence recommends they be 

prescribed for all new cases of schizophrenia. 228 

• 5.7 million prescriptions for anti-psychotic medications 

were written in 2005 at a cost of £210.9 million. 229 A 

further 163,600 long-acting anti-psychotic injections 

were prescribed, costing £5.2 million. 



20% 

Percentage of patients prescribed a dose of anti-psychotic medication 

above that recommended by the British National Formulary 235 

• Side effects of typical anti-psychotics may include 

shuffling and involuntary muscle twitches, jerks and 

spasms. 

• The side effects of atypical medication can include 

sedation, diarrhoea, constipation, muscle spasms, weight 

gain and heart problems, 230 and these frequently lead to 

people discontinuing treatment. 231 

• An audit study of prescription of anti-psychotic 

medication found that 20% of patients were prescribed 

a total dose of anti-psychotic medication above that 

recommended by the British National Formulary, a 

biannual manual that provides healthcare providers with 

information on choosing and prescribing medication. 232 . 

Sleeping and anxiety medication 

Minor tranquillisers and hypnotics, primarily 

benzodiazepines, are used to treat anxiety and sleep 

problems. They are usually prescribed on a short-term 

basis due to their addictive nature. These include 

benzodiazepines such as diazepam and hypnotics 

(sleeping pills). 

Mood stabilisers 

Mood stabilising medications are used to treat bipolar 

disorder. They are usually taken long-term, even when 

a person is not experiencing an episode of mania/ 

hypomania or depression. 

• The oldest mood stabiliser is lithium. 

• Anti-convulsant drugs developed to treat epilepsy are 

often used as mood stabilisers. These include sodium 

valproate, carbamazapine, and lamotrigine. 

• Some anti-psychotic medications appear to be effective 

as mood stabilisers. 

• In 2005, 786,300 prescriptions for lithium were written at 

a cost of £1.6 million. 234 

• The Department of Health does not quantify the overall 

number of mood stabilisers prescribed, because most 

individual drugs are also used for other conditions. 235 

• 16 million prescriptions for hypnotics and anxiolytics 

(drugs for anxiety) were written in 2005, costing £38 

million. 233 


53


88% 88% 88% 67% 67% 67% 30% 

30% 30% 

Percentage of people who found 

talking treatments helpful 241 

Percentage of people who found 

anti-depressants helpful 241 

Percentage of people who 

found ECT helpful 241 

Talking Therapies 

Talking therapies or psychological therapies are based on 

the idea that talking to a trained therapist can help people 

better understand their thoughts and feelings and how 

they relate to their behaviour, mood and psychological 

wellbeing. Talking therapies can help people find ways 

to change their lives by acting and thinking in a more 

constructive or positive manner. 

• Clinical trials show that cognitive behavioural therapy, 

a form of psychotherapy, is as effective as medication 

in treating anxiety and depression. 236 The relapse rate is 

also lower once the treatment has ended. 237,238 

• When asked, people with mental health problems are 

most likely to cite access to psychological therapies, 

such as psychotherapy and counselling, as their highest 

treatment priority, 239 and the lack of it their biggest 

complaint. 240 

• The vast majority of those with experience of talking 

treatments rate them as helpful or helpful at times 

(88%), compared with 67% of those who had used antidepressants 

and 30% of those who had received ECT. 241 

• The National Institute for Health and Clinical Excellence’s 

guidelines on treatment of depression state that 

‘cognitive-behavioural therapy should be offered, as it is 

of equal effectiveness to anti-depressants’. 

• A majority (55%) of GPs believe that counselling 

and psychotherapy are the most effective strategies 

for treating depression. However, only 32% refer to 

them as their first treatment response. 242 This is often 

because they are not available, despite the government 

recommending that talking treatments ought to be 

made available for the treatment of most mental health 

problems. 243 

• Waiting times for psychological therapies are on 

average six to nine months, and can be as long as two 

years. There is no target for reducing waiting times for 

psychological treatments. 244 

• Early psychological treatment can significantly reduce 

hospital admissions, GP visits and drug prescriptions. 245 

• Adding family therapy to medication for those with 

schizophrenia can reduce relapse rates by a half over 

both one year and two years. 246 



Electroconvulsive Therapy 

• The National Institute for Health and Clinical Excellence 

recommends that electroconvulsive therapy (ECT) 

should only be used for the treatment of severe 

depressive illness or a prolonged or severe episode 

of mania or catatonia, to gain fast and short-term 

improvement of severe symptoms after all other 

treatment options have failed, or when the situation is 

thought to be life threatening. 247 

• Around 11,000 people a year receive ECT in England. 248 

• A 2002 Department of Health survey found that use of 

ECT had fallen since 1999. 249 More than twice as many 

women as men were given ECT, and that nearly half of 

people given ECT were aged over 65. 250 

• Nearly three quarters of people who were given ECT 

were informal patients (not detained under the Mental 

Health Act). Of those patients that were detained, 60% 

did not consent to treatment. 251 

• A systemic review of patients’ experience of ECT found 

that at least one third of patients reported persistent 

memory loss. 252 

Psychosurgery 

• Neurosurgery for mental illness is occasionally carried 

out in the UK. The Mental Health Act Commission panel 

authorised seven operations in England and Wales in 

1999/2000, and two in 2000/01. 253 This compares to 23 

operations carried out in England, Scotland and Wales in 

1993. 254 

• Of 74 patients receiving psychosurgery, 12 were 

experiencing manic depression, 41 depression, 18 

obsessions, and 3 anxiety. Of 42 patients on whom data 

was available, doctors reported significant improvement 

in 12, some improvement in 22, no change in 6 and 

deterioration in 2. 255 


55


81% 

Percentage of patients who found exercise effective as a treatment 

for depression 261 

Exercise 

• Exercise has been shown to improve both physical and 

mental health for people with a range of mental health 

problems, including psychotic disorders, depression and 

anxiety 256 It can also help people with alcohol misuse 

problems and schizophrenia. 257 

• Studies have shown that exercise can be as successful at 

treating mild or moderate depression as psychotherapy 

or as medication. 258 

• The National Institute for Health and Clinical 

Excellence recommends that patients of all ages with 

mild depression should be advised of the benefits 

of following a structured and supervised exercise 

programme, typically up to 3 sessions per week of 45 

minutes to an hour for between 10 and 12 weeks. 259 

• Only 5% of GPs prescribe exercise therapy as one of 

their top three treatment responses to mild or moderate 


• A Mental Health Foundation survey found that a greater 

proportion of people who had tried exercise as a 

treatment for depression found it very or quite effective 

(81%) than found anti-depressants very or quite effective 

(70%). 261 

Alternative and complementary therapies 

The term ‘alternative therapy’ is used for therapies that 

offer alternatives to orthodox Western medicine. The term 

‘complementary therapy’ is generally used to indicate 

therapies that differ from orthodox Western medicine, 

and which may be used to complement, support, or 

sometimes, to replace it. 

• A survey found that of those who had tried alternative 

treatments, more than a third had to take the initiative 

and ask for it, and many had to pay for it themselves. 262 

• Herbal medicines, for example St. John’s Wort 

(hypericum), have been linked to the relief of mild to 

moderate depression. 263 There is some evidence that 

traditional Chinese medicine may be a useful adjunct to 

orthodox medicine for the treatment of schizophrenia, 

particularly in alleviating distress and the side effects of 

traditional medication. 264 

• Acupuncture can have a positive effect for some people 

diagnosed with schizophrenia. 

• Reflexology has been shown to aid relaxation, relieve 

stress and restore energy. It can help to reduce the side 

effects of psychotropic medication and can moderate 

the highs and lows of mood swings. 265 



• Transcendental meditation, hypnotherapy, yoga, 

exercise, relaxation, massage and aromatherapy have 

all been shown to have some effect in reducing stress, 

tension and anxiety and in alleviating mental distress. 266 

• Massage has been shown to reduce levels of anxiety, 

stress and depression in some people. 267 

• Aromatherapy has been successfully used to reduce 

disturbed behaviour, to promote sleep and to stimulate 

motivational behaviour of people with dementia. 268 

• Artistic pursuits can help people with mental health 

problems feel better about themselves, fostering 

creativity, self esteem and social networks. One survey 

found that half of people with mental health problems 

felt better after becoming involved in the arts. 269 

• Bright light treatment and dawn simulation is effective 

in treating Seasonal Affective Disorder, and there are 

indications that it may be as effective as anti-depressants 

for treating non-seasonal depression. 270 

• Bibliotherapy based on cognitive behavioural therapy 

principles has shown results comparable to medication 

or psychotherapy for people with depression. In 

bibliotherapy, a therapist ‘prescribes’ a self-help book for 

a patient to either read between sessions or as a standalone 

therapy. Some studies show that recovery is faster, 

and that patients who have used bibliotherapy have a 

lower relapse rate. 271 

• Animal-assisted therapy involves the use of trained 

animals to help patients’ recovery. Also known as pet 

therapy, it has been shown to reduce short-term anxiety 

levels of psychiatric inpatients with a range of disorders. 

The calming influence of dogs has also been useful 

in psychotherapy, because of the ability to alert the 

therapist early to clients’ distress and the facilitation of 

communication and interaction. 272 

Nutrition 

There is growing evidence that diet plays an important 

role in specific mental health problems including Attention 

Deficit Hyperactivity Disorder (ADHD), depression, 

schizophrenia and Alzheimer’s disease. A balanced mood 

and feelings of well-being can be protected by a diet that 

provides adequate amounts of complex carbohydrates, 

essential fats, amino acids, vitamins and minerals and 

water. 273 

• Research into nutritional and dietary medicine has 

demonstrated that food sensitivities may cause 

psychiatric symptoms, whilst a lack of folic acid has been 


57


Unequal intakes of Omega-3 and Omega-6 

fats are implicated in a number of mental 

health problems. 273 

associated with depression and schizophrenia and the 

supplementation of certain amino acids may relieve 


• Among some young offenders, diets supplemented with 

vitamins, minerals and essential fatty acids have resulted 

in significant reductions in anti-social behaviour. 275 

Food and depression 

• A number of studies have linked the intake of certain 

nutrients with the reported prevalence of different types 

of depression. For example, correlations between low 

intakes of fish by country and high levels of depression 

among its citizens – and the reverse – have been shown 

for many types of depression. 276 

• Complex carbohydrates as well as certain food 

components such as folic acid, omega-3 fatty acids, 

selenium and tryptophan may help to decrease the 

symptoms of depression. Those with low intakes of 

folate, or folic acid, have been found to be significantly 

more likely to be diagnosed with depression than those 

with higher intakes. 

• Similar conclusions have been drawn from studies 

looking at the association of depression with low 

levels of zinc and vitamins B1, B2 and C. In other 

studies standard treatments have been supplemented 

with these micronutrients resulting in greater relief 

of symptoms in people with depression and bi-polar 

affective disorder, in some cases by as much as 50%. 277 

Other interventions 

• Studies show that there are benefits to involving 

families in the treatment of people with schizophrenia, 

depression, alcohol problems and childhood behaviour 

disorders. Helping to change the nature of family 

interaction in the home is associated with a reduced risk 

of relapse. 278 

• School-based interventions and parent training 

programmes for parents of children with behavioural 

problems can improve these children’s conduct and 

mental well-being. 279 Long-term, universal school mental 

health programmes, involving changes to the school 

culture, can also be effective, probably more than brief 

class-based programmes. 280 

• Home-based social support for pregnant women at high 

risk of depression improves the mental health of both 

mothers and children. 281 


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in hospitals under the Mental 

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legislation, England: 1994-95 

to 2004-05, Office for National 

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203. Rankin J, Mental Health And 

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204. Who cares: The experiences 

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205. Dearden C. and Becker S, 

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209. Rankin J, A Good Choice for 

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210. Exercise and depression 

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211. Braunholtz S et al, Well What 

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232. Harrington M. et al The results 

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62

5. 

The costs of mental 

health problems

THE COST OF MENTAL HEALTH PROBLEMS 

1 in 4 unemployed people has a common mental health 

problem 283 

Hidden cost 

• The ‘hidden’ costs of mental illness have a significant 

impact on public finances: it has been estimated that 

the costs of depression through lost working days are 23 

times higher than the costs to the health service. 282 

• 1 in 4 unemployed people has a common mental health 

problem. 283 

• Childhood mental health problems can have a 

significant economic effect on society. It is estimated 

that a child with a conduct disorder will, by the age 

of 28, have generated costs (such as to the health, 

education, benefits and criminal justice systems) ten 

times as high as a child without conduct problems. 284 


65


The economic and social cost of mental 

health problems is greater than that 

of crime. 286 

Overall cost 

• In 2002/03, the economic and social cost of mental 

health problems in England was £77 billion. 285 Updating 

these figures and incorporating estimates for Scotland, 

Wales and Northern Ireland, it is calculated that in the 

UK, the economic and social costs of mental health 

problems in 2003/04 was £98 billion (£17 billion on 

health and social care, £28.3 billion in costs to the 

economy and £53.1 billion in human costs). 

• The economic and social cost of mental health problems 

is therefore greater than that of crime (estimated at 

£60 billion for England and Wales in 1999/2000), 286 and 

larger than the total amount spent on all NHS and social 

services (£95.2 billion in the UK in 2003/04). 287 

• The World Health Organisation estimates that the cost 

of mental health problems in developed countries is 

between 3 and 4% of Gross National Product. 288 In the 

UK this is estimated to be 2% of GDP, 289 comprising the 

costs of public spending on health and social care and 

loss of paid work. 


66


Support 

Mentally disordered offenders 

Secure and high dependency 

Psychological therapies 

Personality disorder services 

Other professionals 

Mental health promotion 

Home support 

Direct payments 

Day services 

Continuing care 

Community Mental Health Teams 

Clinical services 

Carers’ services 

Accommodation 

Access and Crisis 

£43m 

£38m 

£142m 

£10.5m 

£86m 

£3m 

£91.5m 

£2.5m 

£150.5m 

£19m 

£384m 

£362m 

£369m 

£549m 

£660m 

£840m 

Health and social 

care costs 

0 200 400 600 800 1000 

Planned investment in services in England 2005/2006 292 

• £4.9 billion was spent on mental health services for 

adults of working age by the NHS and local authorities 

combined in England in 2005/06. This was the 

equivalent of £150 per head. 290 After taking account 

of estimated pay and price inflation, investment in 

these mental health services increased 3% in 2005/06 

compared to 9% in 2004/05. 291 

• The biggest increases in spending for 2005/06 reflect the 

Department of Health priorities for mental healthcare, 

and reinforce the trend over the past four years. 

These are: 

• Assertive outreach – more than £100 million in 2005/06 

(less than £50 million in 2001/02) 

• Crisis resolution/home treatment – more than £155 

million in 2005/06 (£26 million in 2001/02) 

• Early intervention in psychosis – £42 million in 2005/06 

(less than £4 million in 2001/02.) 

• Mental health priorities have changed over the past five 

years. While there has been a 25% overall real growth 

in total investment over the period, actual increases in 

specific service areas vary widely. 293 

• In 2002/03, spending on mental health accounted for 

11.8% of all public expenditure on health and social 

services in England. 294 Using a comparable ratio for the 

UK, this implies total public spending on mental health 

care in 2003/04 of £11.2 billion, equivalent to £190 per 

head of the population. 82% was spent by the NHS and 

18% by local authorities. 


67


Access and crisis services 117% 

Secure and high dependency services 100% 

Home support 54% 

Accommodation 20% 

Psychological therapies 14% 

Community Mental Health Teams 14% 

Continuing care 10% 

Clinical services 10% 

0 20 40 60 80 100 120 

Increases in investment between 2001/02 and 2005/06 295 

Staff costs 

• The cost of a consultant psychiatrist is estimated at £71 

per hour, or £216 per hour of direct patient contact. 

The cost of a community mental health nurse is £26 

per hour, or £71 per hour of direct patient contact. Each 

attendance at NHS day care facilities costs £29. 296 An 

average GP consultation costs £24. 297 

Private care 

• One study estimated that in England in 1996/97 private 

spending on counselling and related services was 

£108 million. Spending by mental health charities and 

voluntary organisations that was financed from private 

sources amounted to £12 million. This total of £120 

million corresponded to 2.1% of public spending on 

mental health care in the year concerned. 298 

Informal care costs 

• If the 21 million hours a week of informal (unpaid) care 

from family and friends of people with mental health 

problems was provided as paid work by nursing or care 

staff, it would cost £4.9 billion a year. This is equivalent to 

nearly half the cost of all mental health services provided 

by the NHS and local authorities. 299 

Voluntary sector 

• It is estimated that, in total, around 10% of all public 

spending on mental health services is now in the 

voluntary sector. 300 

• Residential care and supported housing accounts for 

about two thirds of this total, but the voluntary sector 

also supplies a wide range of other services. These 

include: day care; home and community support 

services; employment, education and training; services 

for carers; and information, advice and advocacy. 

• The largest purchasers of mental health services from 

the voluntary sector are social services departments, 

accounting for almost two thirds of all contracts. 

• Independent and voluntary sector agencies also play 

a major role in the Supporting People programme, 

introduced in 2003 by the Office of the Deputy Prime 

Minister to support vulnerable people in their own 

homes. In 2003/04, around 40,000 people with mental 

health problems in England received assistance through 

this programme at a cost of £250 million and, of this 

total, over 80% was spent on support services provided 

by private and voluntary organisations. 301 


68


Hypnotics 

£38.3m 

Anti-psychotics 

£223.6m 

Anti-depressants 

£338.5m 

Dementia drugs 

£49.3m 

Substance dependence 

£83.3m 

0 50 100 150 200 250 300 350 

Cost of drug treatments in 2005 302 

Drug and talking therapy costs 

• The cost of drug prescriptions for mental health 

problems in England has risen rapidly over recent 

years, from £159 million in 1992/93, 303 to £540 million in 

2002, 304 and £854 million in 2004. Relative to the drugs 

bill as a whole, prescriptions for mental health problems 

represented 10% by cost. Anti-depressants accounted 

for 47% of total spending on drugs for mental health 

problems and anti-psychotics for 26%, with other 

formulations accounting for the remaining 27%. 305 

• In 1992, the cost of anti-depressant prescriptions 

dispensed in the community in England was 

£18.1million. By 2003, this had risen to £395.2million. 

This rise is linked to the introduction of SSRI (selective 

serotonin reuptake inhibitor) anti-depressants, such 

as Prozac, in the 1990s. These drugs were both more 

expensive and more widely prescribed than other 

classes of anti-depressants. 306 The cost of prescribing 

SSRIs has fallen in recent years as branded drugs have 

become available as generic compounds. 

• NICE recommends short talking therapies such as 

cognitive behavioural therapy as an alternative or 

adjunct to anti-depressants. The cost of this is about 

£750 for 16 sessions of CBT. 307 

• In 2002 in England, expenditure on anti-psychotics 

was £165.3million. 308 In 2005, it was £223.6million. 309 

This increase reflects the impact of guidance from the 

National Institute for Health and Clinical Excellence on 

the new atypical anti-psychotic drugs for schizophrenia, 

which are much more costly than the drugs they 

replace. However, evidence from cost-effectiveness 

studies shows that these higher costs are more than 

offset by reductions in hospital inpatient stays, with 

savings estimated to average £1,000 per patient year. 310 


69


2001/02 £3.254bn 

2002/03 £3.709bn 

2003/04 £3.943bn 

2004/05 £4.52bn 

2005/06 

£4.904bn 

0 1 2 3 4 5 

Investment in Mental Health Services in England for working age adults 311 

Economic and 

social factors 

Mental health and employment 

• People with a common mental health problem 

aged between 16 and 74 years are more likely to be 

economically inactive (39%, compared with 28% of 

those with no mental health problem), and less likely to 

be employed (58%, compared with 69%). 312 

• Less than a quarter of people with a long-term mental 

health problem are employed, the lowest rate for any 

group of disabled people. 313 However, this group of 

people form a relatively small proportion of all the 

people who experience a mental health problem. 

(About three quarters of the overall working age 

population are in employment.) 

• Unemployment is even more prevalent among people 

receiving secondary mental health care. About one in 

ten people in psychiatric care has a job, and, typically, 

they earn two thirds of the average national hourly 

rate. 314 

• 35% of adults with long-term mental health conditions 

say they want to work (compared with 28% of those 

with other health problems). 315 

• People with mental health problems are at more than 

twice the risk of losing their jobs compared with the 


• Of those people with mental health problems who 

have lost their jobs, 55% make unsuccessful attempts 

to return to work, and of those that do return, 68% have 

less responsibility, work fewer hours and are paid less 

than before. 317 

• Fewer than 4 in 10 employers would consider hiring a 

person with a mental health problem, compared with 

more than 6 in 10 who would hire a person with a 

physical disability. 318 

• Most employers who have employed people with 

mental health problems in a supported work placement 

would do so again, but few other employers would. 319 

• 7 in 10 managers have had experience of managing a 

staff member with a diagnosed mental health problem 

(50%) or a suspected mental health problem (20%). Less 

than a quarter felt they knew enough about managing 

someone with a mental health problem to handle it and 

deal with it ‘OK’. 320 

• A survey of people with mental health problems 

found that 67% had disclosed their condition to close 

colleagues, 61% had told their manager and 1 in 10 

had told everyone. 321 About 1 in 10 of those who had 

disclosed said colleagues made snide remarks, and 1 in 

10 reported that colleagues had avoided them. 


70


Service categories 2001/02 

(£m) 

2002/03 

(£m) 

2003/04 

(£m) 

2004/05 

(£m) 

2005/06 

(£m) 

Community Mental Health Teams 483 526 530 570 549 

Access and crisis services 170 203 254 316 369 

Clinical services 764 754 811 878 838 

Secure and high dependency 330 376 474 621 661 

Continuing care 349 372 380 404 384 

Mentally disordered offenders 35 33 53 43 58 

Other community and hospital professionals 52 50 47 67 86 

Psychological therapies 125 142 143 149 142 

Home support services 59 63 70 108 91 

Day services 178 163 172 156 151 

Support services 37 47 43 43 43 

Carer’s services 10 11 15 18 19 

Accommodation 301 315 369 366 362 

Mental health promotion 6 3 3 2 3 

Direct payments 6 3 6 3 2 

Personality disorder services 0 0 1 4 10 

Investment in Mental Health Services in England for working age adults by category 322 

The cost of mental health problems at work 

• Stress, anxiety and depression accounted for a third of 

the 168 million working days lost in the UK for health 

and related reasons in 2004, translating to a cost of 

sickness absence of about £4.1 billion. 323 

• Each case of stress-related ill health leads to an average 

of 30.9 working days lost. 324 In a typical year, about 30 

times as many working days are lost through mental ill 

health as from industrial disputes. 325 

• Over 900,000 people in England are in receipt of sickness 

and disability benefits for mental health problems, more 

than the total number of unemployed people claiming 

Jobseekers’ Allowance. 326 The number of people claiming 

Incapacity Benefit because of mental health problems 

has almost doubled since 1995, 327 and makes up more 

than 40% of the total number of claimants. 328 However, 

almost half the people in contact with community 

mental health teams do not receive the full amount of 

welfare benefits to which they are entitled. 329 


71


Psychotic 

disorder 

% 

Any psychiatric 

disorder % 

No 

disorder 

% 

Living alone 43 21 15 

In rented accommodation 62 38 24 

With accommodation problems 49 48 33 

No educational qualifications 40 28 27 

Social class IV (partly skilled people) or V (individuals with no skills) 40 25 21 

Economically inactive 70 32 29 

Household income less than £200 a week 25 17 13 

Receiving Income Support 30 11 4 

With debt problems 33 24 9 

Any difficulty with activities of daily living 60 37 16 

Experience of violence within the home 37 16 4 

Experience of sexual abuse 31 9 2 

Severe lack of perceived social support 30 12 6 

Social isolation (two or fewer friends seen in last week) 55 30 22 

Mental health problems and personal and social factors among adults in England, Scotland and Wales 330 

Human costs 

• The human costs of mental health problems are 

estimated to be nearly five times as large as the costs of 

all mental health services provided by the NHS and local 

authorities, amounting to around £53 billion in the UK 

in 2003/04. 331 This includes the adverse effects of mental 

health problems on health-related quality of life and – as 

a major risk factor for suicide – on length of life. 

About half of people with common mental health 

problems are limited by their condition, and around a 

fifth are disabled by it. 332 

• In total, more than 40% of the World Health 

Organisation’s ‘years lived with disability’ are caused by 

mental health problems or alcohol abuse. 333 

• Mental health problems are associated with a wide 

range of adverse personal and social problems. People 

with mental health problems are more likely than the 

rest of the population to live alone, have no educational 

qualifications, be economically inactive, and have a 

household income of less than £200 a week. They are 

almost three times as likely to have debt problems, more 

than twice as likely to be receiving income support, 

more than four times as likely to have experienced 

sexual abuse, and twice as likely to report a lack of social 

support. The differences are even more stark among 

those with a psychotic disorder (for example, they are 

almost three times as likely to be living alone, five times 

as likely to report a lack of social support and more 

than fifteen times as likely to have experienced sexual 

abuse). 334 

• One in four tenants with mental health problems is in 

serious rent arrears and is at risk of losing their home. 335 


72


 

Less than 1% of the £4.9 billion spent by 

the NHS and local authorities in 2005/06 

on mental health for adults of working 

ages was earmarked for mental 

health promotion. 341 

Mental health promotion 

Mental health promotion involves any action to enhance 

the mental well-being of individuals, families, organisations 

and communities, recognising that everyone has mental 

health needs, whether or not they have a diagnosis of 

mental illness. Mental health promotion programmes that 

target the whole community will also include and benefit 

people with mental health problems. 336 The emotional 

and cognitive skills and attributes associated with positive 

mental well-being include feeling satisfied, optimistic, 

hopeful, confident, understood, relaxed, enthusiastic, 

interested in other people and in control. 337 

Examples of factors that promote well-being include: 

eating well, keeping physically active, drinking in 

moderation, valuing yourself and others, talking about 

your feelings, keeping in touch with friends and loved 

ones, caring for others, getting involved and making a 

contribution, learning new skills, doing something creative, 

taking a break, and asking for help. 338 

• Evidence shows that mental health promotion can 

contribute to the prevention of common mental 

health problems, for example anxiety, depression and 

substance abuse. 339 It can also contribute to health 

improvement for people whether or not they are at risk 

of mental illness, as well as for people living with mental 

health problems. 3340 

• Interventions to reduce stress in the workplace, to 

tackle bullying in schools, to increase access to green, 

open spaces and to reduce fear of crime all contribute 

to health gain through improving mental well-being, 

in addition to any impact they may have on preventing 

mental disorders. 341 

• Less than 1% of the £4.9 billion spent by the NHS and 

local authorities in 2005/06 on mental health for adults 

of working age was earmarked for mental health 

promotion. 342 


73


People with severe mental illness are 

more likely to be the victims than 

the perpetrators of violence. 344 

Violence and 

mental health 

There is widespread public fear that people with mental 

disorder pose a significant risk of interpersonal violence, 

but research has shown that the degree of association 

between violence and mental disorder is small 343 and is 

accounted for by a small minority of patients. 344 

• People with severe mental illness are more likely to 

be the victims than the perpetrators of violence. 345 In 

one study 16% of people with psychosis living in the 

community had been violently victimised. 346 

• A third of people who committed homicide had a 

lifetime history of mental disorder, but in most cases this 

was not a severe mental illness. Most had not attended 

psychiatric services, and only 10% had symptoms of 

mental illness at the time of the offence. The most 

common diagnoses were personality disorder, and 

alcohol and drug dependence. 90% of the perpetrators 

were male. 347 

• 5% of all perpetrators of homicide in England and Wales, 

and 2% in Scotland, had a diagnosis of schizophrenia. 

9% of people convicted of homicide had a diagnosis of 

personality disorder. 348 

• 7% of people convicted of homicide in England and 

Wales, and 6% in Scotland, were committed to a 

psychiatric hospital. 349 

• Mentally ill perpetrators were less likely to kill a stranger 

than those without mental illness. 350 


74

References 

282. Knapp M Hidden costs of 

mental illness, British Journal of 

Psychiatry 182, (2003) 




Prime Minister, (2004) p13, quoting 

Singleton N, Bumpstead R, O’Brien 

M, Lee A, Meltzer H. Psychiatric 

Morbidity Among Adults Living In 

Private Households, (2000) London: 


284. Scott S et al Financial Cost 

Of Social Exclusion: Follow-Up 

Study Of Anti-social Children In 

Adulthood British Medical Journal 

323 p191, (2001) 

285. The Economic and Social Costs 

of Mental Illness, Policy Paper 3, p1, 

The Sainsbury Centre for Mental 


286. Brand, S and Price, R, The 

Economic and Social Costs of Crime 

Home Office Research Study 217, 

Table 4.1, (2000) available at www. 

niamh.co.uk 

287. Public Expenditure Statistical 

Analyses 2005, HM Treasury, 

available at www.hm-treasury. 

gov.uk 

288. Investing In Mental Health, 

Geneva: World Health Organisation, 

(2003) 

289. Layard L, Mental Health: 

Britain’s biggest social problem. 





Services. London: Department of 


















of Mental Illness, Policy Paper 3, p3, 

London: The Sainsbury Centre for 

Mental Health, (2003) 






296. Estimates of unit costs are 

given in Netten, A. and Curtis, L, 

Unit Costs of Health and Social 

Care 2005 Personal Social Services 

Research Unit, (2006) 

297. Estimates of unit costs are 

given in Netten, A. and Curtis, L, 

Unit Costs of Health and Social 

Care 2005 Personal Social Services 

Research Unit, (2006) 

298. Patel A and Knapp A, Costs of 

Mental Illness In England Mental 

Health Research review 5, May 1998 

pp5-6, (1998) 

299. Based on an estimate for 

England in Economic and Social 

Costs of Mental Illness in England, 

London: Sainsbury Centre for 


300. All figures on the independent 

sector relate to England only and 

are taken from Matrix Research 

And Consultancy with Compass 

Partnership (2002) Mental Health 

Services In The Voluntary Sector 

(unpublished) 

301. RSM Robson Rhodes, Review of 

the Supporting People Programme 


Minister p28, (2004) 

302. Department of Health: 

England, Prescription Cost Analysis 



303. Patel A and Knapp M, The Cost 

of Mental Health in England, Centre 

for the Economics of Mental Health, 

Mental Health Research Review 5 

(1998) 




Minister, p13, quoting Department 

of Health statistical bulletin, 

prescriptions dispensed in the 

community: England 1992-2002, 

at www.publication.doh.gov.uk, 

(2004) 


Prescription Cost Analysis England: 

(2004), available at www.dh.gov.uk 


Therapy And The Treatment Of 

Mild Or Moderate Depression 

In Primary Care London: Mental 

Health Foundation p13 (2005), 

quoting National Institute for 


Depression, NICE Guideline, Second 

Consultation London: NHS pp19-21 

(2003) and Department Of Health 

Prescription Cost Analysis 2003 

London: Department Of Health 

p117, (2004) 

307. Layard R (2006) The case for 

psychological treatment centres, 

Centre for Economic Performance, 

London School of Economics, 

available at http://cep.lse.ac.uk/ 

layard (accessed October 2006) 

308. Prescription Cost Analysis 

England 2002 available at www. 

dh.gov.uk. Department of Health, 

(2003) 

309. Prescription Cost Analysis 

2005, available at www.ic.nhs. 

uk (accessed August 2006) 

Department of Health, (2006)) 


and Clinical Excellence, Guidance 

on the Use of Newer (Atypical) Antipsychotic 

Drugs for the Treatment 

of Schizophrenia, Technology 

Appraisal no.43. p7, (2002) 











(2001) 

313. Office for National Statistics 

Labour Force Survey August (2003). 

Figures are for England only. 

314. Huxley P and Thornicroft G, 

Social Inclusion, Social Quality and 

Mental Illness British Journal Of 

Psychiatry pp289-90, (2003) 

315 Office for National Statistics, 

Labour Force Survey August (2003). 

Figures are for England only. 


75




Prime Minister, p11, (2004) quoting 

Burchardt T, Employment Retention 

And The Onset Of Sickness Or 

Disability: Evidence From The 

Labour Force Survey Longitudinal 

Datasets, In-house report 109, Table 

6 London: Department Of Work 

And Pensions, (2003) 

317. Life’s Labours Lost: Project 

Summaries, London: Mental Health 

Foundation pp2-3, (2003) 

318. ONE Evaluation, Department 

for Work and Pensions, (2001), cited 

Mental Health and Social Exclusion 


Minister, p27, (2004) 

319. Bunt K, Shury J, and Vivian 

D, Recruiting Benefit Claimants: A 

qualitative study of employers who 

recruited benefit claimants, DWP 

Research Report No 150, Leeds: 

CDS, available at www.dwp.gov.uk 


320. Diffley C, Managing Mental 

Health, Research into the 

management of mental health in 

the workplace and the information 

and guidance available to 

managers, The Work Foundation, 

London p9, 10, (2003) 

321. Out at Work: A survey of 

the experiences of people with 

mental health problems within the 

workplace, London: Mental Health 







323. Confederation of British 

Industry, Who cares wins: absence 

and labour turnover 2005 London: 

CBI, (2005) 




Prime Minister, p14, quoting 

Incapacity Admin Data, (August 

2003), England only, and Office 

for National Statistics, Labour 

Market Statistics, London: Office for 

National Statistics (May 2004) 




Minister, p62, (2004) 

328. Hutton W, Let’s Work To Make 

Britain Sane, The Observer, (May 

22 2005) 

329. Huxley P and Thornicroft G, 

Social Inclusion, Social Quality and 

Mental Illness British Journal Of 

Psychiatry pp289-90, (2003) 

330. Based on calculations for 

England only, The Economic and 

Social Costs of Mental Illness, Policy 

Paper 3, The Sainsbury Centre for 



of Mental Illness, Policy Paper 3, The 

Sainsbury Centre for Mental Health, 

(2003) 



Report London: Office of the 


quoting Meltzer et al, Social 

Inequalities And The Distribution 

Of The Common Mental Disorders, 

Maudsley Monograph, Hove: 

Psychology Press (2004) 



London: Strategy Unit p6, (2004) 

334. All figures taken from Office for 

National Statistics, The Social and 

Economic Circumstances of Adults 

with Mental Disorders London: The 


337. National Institute for Mental 

Health in England, Making it 

possible: Improving mental health 

and well-being in England, London: 







339. Strategies for living: report 

of user led research into people’s 

strategies for living with mental 

distress, London: Mental Health 

Foundation, (2000) cited in National 

Electronic Library for Health Mental 

Health Promotion available at www. 

nelmh.org (accessed June 2006) 

340. Strategies for living: report 

of user led research into people’s 

strategies for living with mental 

distress, London: Mental Health 

Foundation, (2000) cited in National 

Electronic Library for Health Mental 

Health Promotion available at www. 

nelmh.org (accessed June 2006) 









Services, London: Department of 






143-147. This study was carried out 

as part of the National Confidential 

Inquiry into Suicide and Homicide 

among People with Mental Illness, 

(2006); Walsh E. et al. Prevalence 

of violent victimisation in severe 

mental illness, The British Journal of 

Psychiatry 183: 233-238, (2003) 

References 

324. Health and Safety Executive, 

www.hse.gov.uk (accessed June 

2006) 

325. Confederation of British 

Industry, Who cares wins: absence 

and labour turnover 2005 London: 

CBI, (2005) 



Report London: Office of the 


quoting Shelter, House Keeping: 

Preventing Homelessness through 

tackling rent arrears in social 

housing London: Shelter (2003) 

336. Mentality, What is mental 

health promotion? Factsheet, 

available at www.mentality.org.uk 


344. Walsh E. et al, Violence and 

schizophrenia: examining the 

evidence, The British Journal of 

Psychiatry 180: 490-495, (2002) 

345. Walsh E. et al. Prevalence of 

violent victimisation in severe 

mental illness, The British Journal of 

Psychiatry 183: 233-238, (2003) 


76





143-147, (2006). This study was 









143-147, (2006). This study was 









143-147, (2006). This study was 





References 





143-147, (2006). This study was 









143-147, (2006) .This study was 






77

NOTES 


About the Mental Health Foundation 

Founded in 1949, the Mental Health Foundation is the leading UK charity working in 

mental health and learning disabilities. 

We are unique in the way we work. We bring together teams that undertake research, 

develop services, design training, influence policy and raise public awareness within one 

organisation. We are keen to tackle difficult issues and try different approaches, many of 

them led by service users themselves. We use our findings to promote survival, recovery 

and prevention. We do this by working with statutory and voluntary organisations, from 

GP practices to primary schools. We enable them to provide better help for people with 

mental health problems or learning disabilities, and promote mental well-being. 

We also work to influence policy, including Government at the highest levels. We use our 

knowledge to raise awareness and to help tackle stigma attached to mental illness and 

learning disabilities. We reach millions of people every year through our media work, 

information booklets and online services. We can only continue our work with the 

support of many individuals, charitable trusts and companies. 

To support our work, please visit www.mentalhealth.org.uk 

Mental Health Foundation 

Sea Containers House 

20 Upper Ground 

London SE1 9QB 

020 7803 1100 

Scotland Office 

Merchants House 

30 George Square 

Glasgow G2 1EG 

0141 572 0125 

Registered charity number 801130 

UK: £30.00 

© Mental Health Foundation 2007 

ISBN 978-1-903645-93-2

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