The Fundamental Facts - Mental Health Foundation
The Fundamental Facts - Mental Health Foundation
The Fundamental Facts - Mental Health Foundation
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<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong><br />
<strong>The</strong> latest facts and figures<br />
on mental health<br />
<strong>The</strong><br />
<strong>Fundamental</strong><br />
<strong>Facts</strong>
Acknowledgements<br />
<strong>The</strong> <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong> would like to thank everyone who gave their time during the research and review phases<br />
of this publication. Our special thanks to:<br />
Andy Bell, Director of Public Affairs, Sainsbury Centre for <strong>Mental</strong> <strong>Health</strong><br />
Charlie Brooker, Professor of <strong>Mental</strong> <strong>Health</strong> and Criminal Justice, University of Lincoln<br />
Alan Cohen, Director of Primary Care, Sainsbury Centre for <strong>Mental</strong> <strong>Health</strong><br />
David Crepaz-Keay, Senior Policy Advisor: Patient and Public Involvement, <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
Catherine Jackson, Editor, <strong>Mental</strong> <strong>Health</strong> Today<br />
Jeremy Laurance, <strong>Health</strong> Editor, <strong>The</strong> Independent<br />
Dr Andrew McCulloch, Chief Executive, <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
Dr Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent<br />
Iain Ryrie, former Programme Director: Research, <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
Dr Mike Shooter, immediate past President, Royal College of Psychiatrists
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong><br />
<strong>The</strong> latest facts and figures<br />
on mental health<br />
2007 edition<br />
<strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
Researched and written by Ed Halliwell, Liz Main and Celia Richardson<br />
With information on the cost of mental health problems based on<br />
material provided by the Sainsbury Centre for <strong>Mental</strong> <strong>Health</strong><br />
Edited by Isobel Booth
Foreword<br />
<strong>Mental</strong> health presents one of the greatest challenges that current and future generations will face. In health, economic<br />
and social terms, the burden created by mental health problems and mental illness in the UK is immense and growing.<br />
<strong>Mental</strong> health should be a concern for us all because it affects us all. On an individual level, mental health problems affect<br />
our ability to function day to day and our overall quality of life. When you consider such problems collectively, the effect<br />
on society is considerable. We need to find out how to turn the tide or future generations will be still further affected by<br />
mental ill health.<br />
<strong>Mental</strong> health and well-being are not nearly as well understood as other areas of health. We are not giving mental health<br />
the attention demanded by its impact on society.<br />
As a developed country, we could do better. We need to understand the balance of factors that both promote mental<br />
health and support the recovery of people with mental health problems. We need to acknowledge that the way we live<br />
and the decisions we make across all areas of policy have a profound impact on our collective mental health.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> will help contribute to that understanding.<br />
David Brindle<br />
Public Services Editor, <strong>The</strong> Guardian
Introduction<br />
If we are to promote mental health and prevent and treat mental illness, better documentation, analysis and<br />
comprehension are crucial.<br />
Presenting the facts in a way that is accessible and useful to the many people who have a contribution to make is vital<br />
to improving understanding. <strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> is designed to do this. It is a quick reference tool, full of thoroughly<br />
researched, fully referenced facts and figures. It is for anyone with an interest in mental health – from those who work<br />
mainly in the field to those who have an interest in gaining speedy and usable insight or reference material.<br />
A note on terminology and data:<br />
In most of the facts and figures presented, referenced authors’ terms and definitions have been used for accuracy. Very<br />
few mental health terms, or the diagnoses they describe, are uncontroversial. Where language has been used which<br />
reflects a certain way of seeing mental health, this does not mean that any particular model of mental health is either<br />
endorsed or rejected.<br />
<strong>The</strong> terms ‘mental health problems, mental distress and mental ill health’ are used interchangeably here. <strong>The</strong> term ‘mental<br />
illness’ is used specifically to refer to clinically recognised patterns or symptoms of behaviour that can be diagnosed as<br />
mental illnesses.<br />
<strong>The</strong> <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong> has a holistic view of mental health which includes social, psychological and biological<br />
factors. Some of the sources quoted here subscribe to other models of mental health.<br />
A lot of studies have been carried out on mental health over recent years, some of them more scientifically robust than<br />
others. <strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> is a compendium, with no commentary made on the research findings.<br />
<strong>The</strong> facts and figures are left to speak for themselves.
Contents<br />
1. THE EXTENT OF MENTAL HEALTH PROBLEMS 5<br />
- how many people experience mental health problems? 7<br />
- what are the main types of mental health problem? 8<br />
- common mental health problems 9<br />
- severe mental illness 17<br />
- other types of mental illness 19<br />
2. DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS 25<br />
- gender differences 27<br />
- black and minority ethnic groups 28<br />
- children and young people 28<br />
- older people 29<br />
- the prison population 30<br />
- homeless people 31<br />
- other groups 32<br />
3. FACTORS RELATED TO MENTAL HEALTH PROBLEMS 35<br />
- mental health and material deprivation 37<br />
- family related and social factors 38<br />
- physical health 39<br />
- spirituality 39<br />
- other factors 40<br />
4. TREATMENT AND CARE 43<br />
- how many people seek help and use services? 45<br />
- what treatment and care is available for mental health problems? 46<br />
- treatment and coping 50<br />
5. THE COST OF MENTAL HEALTH PROBLEMS 63<br />
- hidden cost 65<br />
- overall cost 66<br />
- health and social care costs 67<br />
- economic and social factors 70<br />
- mental health promotion 73<br />
- violence and mental health 74
1.<br />
<strong>The</strong> extent of mental<br />
health problems
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
<strong>Mental</strong> <strong>Health</strong> Problems: 1 in 4 British adults 1<br />
How many people experience<br />
mental health problems?<br />
<strong>Mental</strong> health problems are among the most common<br />
health conditions, directly affecting about a quarter of<br />
the population in any one year. Depression and anxiety<br />
are the most widespread conditions, while only a small<br />
percentage of people experience more severe mental<br />
illnesses. However, estimates of exactly how many people<br />
experience which mental health problems vary, and it is<br />
not easy to compare different measures.<br />
For example, some calculations are based on how many<br />
people have a mental health problem at any point in<br />
time, while others measure the likelihood of someone<br />
developing mental health problems in their lifetime.<br />
Others measure rates per year. Figures may relate to<br />
different populations such as the adult population, a<br />
regional population or a nation within the UK (eg. the<br />
North West or England), or an international population.<br />
Some examples of how many people are affected are:<br />
• <strong>The</strong> Office for National Statistics Psychiatric Morbidity<br />
report found that in any one year 1 in 4 British adults<br />
experience at least one mental disorder 1 , and 1 in 6<br />
experiences this at any given time.<br />
• Although mental disorders are widespread, severe cases<br />
are concentrated among a relatively small proportion<br />
of people who often experience more than one mental<br />
health problem. 2<br />
• It is estimated that approximately 450 million people<br />
worldwide have a mental health problem. 3<br />
• 1 in 4 families worldwide is likely to have at least one<br />
member with a behavioural or mental disorder. 4<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
What are the main types of<br />
mental health problem?<br />
<strong>Mental</strong> health problems are usually defined and classified<br />
by medical professionals. But some mental health<br />
diagnoses are controversial, and there is much concern in<br />
the field that people are too often treated according to, or<br />
described by their label. This can have a profound effect on<br />
their quality of life. For this reason, diagnostic labels should<br />
be used with caution, and do not indicate the severity of<br />
illness. Nevertheless, diagnoses remain the most usual way<br />
of dividing and classifying symptoms into groups.<br />
Most mental health symptoms have traditionally been<br />
divided into groups called either ‘neurotic’ or ‘psychotic’<br />
symptoms.<br />
‘Neurotic’ covers those symptoms which can be regarded<br />
as extreme forms of ‘normal’ emotional experiences such as<br />
depression, anxiety or panic. Conditions formerly referred<br />
to as ‘neuroses’ are now more frequently called ‘common<br />
mental health problems,’ although this does not always<br />
mean they are less severe than conditions with psychotic<br />
symptoms.<br />
Less common are ‘psychotic’ symptoms which interfere<br />
with a person’s perception of reality and may include<br />
hallucinations, delusions or paranoia, with the person<br />
seeing, hearing, smelling, feeling or believing things that<br />
no one else does. Psychotic symptoms or ‘psychoses’ are<br />
often associated with ‘severe mental health problems.’<br />
However, there is no sharp distinction between the<br />
symptoms of common and severe mental health<br />
problems. It is important to remember that some illnesses<br />
feature both neurotic and psychotic symptoms.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007
250<br />
200<br />
250<br />
women THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
men<br />
all adults<br />
women<br />
men<br />
all adults<br />
150<br />
200<br />
100<br />
150<br />
50<br />
100<br />
0<br />
50<br />
16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74<br />
0<br />
Neurotic disorders: Prevalence by age per 1000 8<br />
16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64<br />
Common mental health<br />
problems<br />
• In a 2001 survey, 15% of British adults reported<br />
experiencing ‘neurotic symptoms’ in the previous week. 5<br />
• Mixed anxiety and depression is the most common<br />
mental disorder in Britain, with almost 9% of people<br />
meeting criteria for diagnosis. 6<br />
• About half of people with common mental health<br />
problems are no longer affected after 18 months, but<br />
poorer people, long-term sick and unemployed people<br />
are more likely to be still affected than the general<br />
population. 7<br />
• Overall, common mental health problems peak in<br />
middle age. 20-25% of people in the 45-54 years age<br />
group have a ‘neurotic disorder’. 8 As people age, neurotic<br />
disorders become less common, with the lowest level<br />
recorded in the 70-74 years age group.<br />
Depression<br />
<strong>The</strong> term ‘depression’ is used to describe a range of<br />
moods, ranging from low spirits to more severe mood<br />
problems that interfere with everyday life. Symptoms<br />
may include a loss of interest and pleasure, excessive<br />
feelings of worthlessness and guilt, hopelessness, morbid<br />
and suicidal thoughts, and weight loss or weight gain. A<br />
depressive episode is diagnosed if at least two out of three<br />
core symptoms have been experienced for most of the<br />
day, nearly every day, for at least two weeks. <strong>The</strong>se core<br />
symptoms are:<br />
• Low mood<br />
• Fatigue or lack of energy<br />
• Lack of interest or enjoyment in life<br />
A depressive episode may be classed as mild, moderate<br />
or severe, depending on the number and intensity of<br />
associated symptoms, such as sleep disturbance, appetite<br />
and weight change, anxiety, poor concentration, irritability<br />
and suicidal thoughts.<br />
• Between 8% and 12% of the population experience<br />
depression in any year. 9<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
England<br />
Northern Ireland<br />
Wales<br />
Scotland<br />
0 5 10 15 20<br />
Rates of suicide per 100,000 population 17<br />
• Only 2% of the population are experiencing a depressive<br />
episode without ‘co-morbid’ anxiety, 10 meaning<br />
‘occurring at the same time’.<br />
• Depression tends to recur in most people. More than<br />
half of people who have one episode of depression will<br />
have another, while those who have a second episode<br />
have a further relapse risk of 70%. After a third episode,<br />
the relapse risk is 90%. 11 For about 1 in 5 people, the<br />
condition is chronic. 12<br />
• Worldwide, 5.8% of men and 9.5% of women will<br />
experience a depressive episode in a 12 month period, a<br />
total of about 121 million people. 13<br />
• <strong>The</strong> World <strong>Health</strong> Organisation forecasts that by 2020<br />
depression will be the second leading contributor to the<br />
global burden of disease. 14<br />
Suicide and self-harm are not themselves mental illnesses,<br />
but they usually result from mental distress.<br />
Suicide<br />
<strong>The</strong> Government has set a target to reduce the death<br />
rate from suicide and undetermined injury by at least a<br />
fifth by the year 2010 (from a baseline rate of 9.2 deaths<br />
per 100,000 population in 1995/96/97 to 7.3 deaths per<br />
100,000 population in 2009/10/11). Data from the three<br />
years 2002/03/04 show a rate of 8.6 deaths per 100,000<br />
population – a reduction of 6.6% from the 1995/06/07<br />
baseline. 15<br />
• In 2004, more than 5,500 people in the UK died by<br />
suicide. 16<br />
• Scotland has the highest suicide rate in the UK at 20 in<br />
100,000, an increase of 1% over a decade and the only<br />
country in the UK to show a rise. In England the suicide<br />
rate is 10 per 100,000 people. In both Northern Ireland<br />
and Wales the suicide rate is 11 per 100,000. 17<br />
• <strong>The</strong> suicide rate in the EU is 17.5 people in 100,000 and<br />
15.1 in 100,000 worldwide. 18<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
10
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
1979<br />
2:3<br />
2002<br />
1:3<br />
2002<br />
1:3<br />
Female to male gender ratios for suicide 22<br />
• Although the rate of suicide among young men reduced<br />
by 30% in the period from 1998 to 2005, suicide remains<br />
the most common cause of death in men under the age<br />
of 35. 19<br />
• British men are three times more likely than British<br />
women to die by suicide. 20 This is true of younger men in<br />
particular – those aged 25-34 are four times as likely to<br />
kill themselves as women in this age group. 21<br />
• Since 1979, the gender gap for people dying by suicide<br />
has widened. In 1979 the female to male gender<br />
ratio for suicides was 2:3. In 2002, it was around 1:3. 22<br />
Nevertheless, women are more likely to attempt suicide<br />
than men. 23<br />
• Younger suicides more often had a history of<br />
schizophrenia, personality disorder, drug or alcohol<br />
misuse, or violence than older suicides. 24<br />
• 4% of people who took their lives were the lone carers of<br />
children. 25<br />
Suicide and history of using mental health services<br />
• An inquiry into suicides in the five years to 2001 found<br />
that approximately a quarter of people who died by<br />
suicide in England and Wales, Scotland and Northern<br />
Ireland had been in contact with mental health services<br />
in the year before death – this amounted to about 1,200<br />
people each year. At the time of their death, 16% of<br />
cases in England and Wales, 12% in Scotland and 10% in<br />
Northern Ireland were psychiatric in-patients. 26<br />
• <strong>The</strong> same inquiry reported that 42% of people who took<br />
their own lives in England and Wales were diagnosed<br />
with either a depressive illness or bi-polar disorder, and<br />
20% had schizophrenia or a related disorder. 27<br />
• In around a quarter of suicide inquiry cases in England,<br />
Wales and Scotland and nearly a third in Northern<br />
Ireland, the person died within three months of<br />
discharge from in-patient care, with a peak in the first<br />
one to two weeks after discharge. In England and Wales<br />
40% died before the first follow up appointment. In<br />
Scotland this was 35% and in Northern Ireland 66%. 28<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
11
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
75%<br />
Percentage of Black Caribbean suicides with a schizophrenia<br />
diagnosis 31<br />
Suicide and ethnicity<br />
• In the five years to 2001, 6% of people who took their<br />
own lives in England and Wales were from an ethnic<br />
minority group. In Scotland this was 2% and in Northern<br />
Ireland 1%. 29 <strong>The</strong> 2001 Census found that 9% of the<br />
population in England were from ethnic minorities.<br />
In Wales this was 2%, in Scotland 2% and in Northern<br />
Ireland 0.75%. 30<br />
• <strong>The</strong> National Confidential Inquiry into Suicide and<br />
Homicide by People with <strong>Mental</strong> Illness in the five years<br />
to 2001 found that people from ethnic minorities who<br />
died by suicide usually had severe mental illness. Three<br />
quarters of Black Caribbean people who took their own<br />
lives had a diagnosis of schizophrenia. 31<br />
Self-harm<br />
Deliberate self-harm ranges from destructive behaviours<br />
with no suicidal intent, but which relieve tension or<br />
communicate distress, through to attempted suicide.<br />
• <strong>The</strong> UK has one of the highest rates of self-harm in<br />
Europe, at 400 per 100,000 population. 32<br />
• <strong>The</strong>re is a high correlation between self-harming<br />
behaviour and mental health problems. Most of<br />
those who attend an emergency department after<br />
self-harming would meet the criteria for one or more<br />
psychiatric diagnoses. More than two thirds would meet<br />
the criteria for depression. 33<br />
• People with current mental health problems are 20<br />
times more likely than others to report having harmed<br />
themselves in the past. 34<br />
• People who have self-harmed are at significant risk of<br />
suicide. 35 A study found that the risk of a person dying<br />
by suicide within a year of being treated for self inflicted<br />
injury was 66 times the annual risk of suicide in England<br />
and Wales, and that there is a significant risk even many<br />
years later. 36<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
12
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Post-natal depression, also known<br />
as post partum depression, is<br />
believed to affect between<br />
8 and 15% of women. 39<br />
• Self-harming and suicide may be influenced by the<br />
depiction of similar behaviour in the media or taking<br />
place in peer groups. For example, one study showed a<br />
17% increase in presentations to hospital from selfpoisoning<br />
in the week after an overdose was depicted<br />
in a TV drama. 37 Similarly, a study of teenagers who selfharmed<br />
found that the strongest associated factor was<br />
awareness of friends who had also self-harmed. 38<br />
• Major public events may lead to amplification of existing<br />
distress. In the month following the death of Diana,<br />
Princess of Wales, the number of women dying by<br />
suicide increased by a third, with a 45% increase in the<br />
number of women aged 25-44 years taking their lives.<br />
Deliberate self-harm by women increased 65% and was<br />
up 44% overall.<br />
Postnatal depression<br />
<strong>The</strong>re are two main types of mental health problem that<br />
a woman may experience following the birth of a child:<br />
postnatal depression and puerperal psychosis. Puerperal<br />
psychosis is classed as a severe mental health problem<br />
(see page 18). Post-natal depression, also known as post<br />
partum depression, is believed to affect between 8 and<br />
15% of women. 39 Post-natal depression is not the same as<br />
the ‘baby blues’ which are very common, but last only a<br />
few days.<br />
Seasonal Affective Disorder<br />
Seasonal Affective Disorder (SAD) is a form of depression<br />
that affects approximately 0.8% of the population at some<br />
point in their lives. <strong>The</strong>re are two types of SAD: winter<br />
and summer depression. Winter depression occurs more<br />
frequently and is characterised by recurring episodes<br />
of depression that begin in Autumn/Winter as a result<br />
of inadequate bright light and go in Spring/Summer. 40<br />
SAD differs from other forms of depression in that those<br />
affected sleep more than normal, whereas people<br />
experiencing other forms of depression have difficulty<br />
sleeping.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
13
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
It often takes between 10 and 15 years<br />
for people to seek professional<br />
help for OCD. 44<br />
Anxiety<br />
Anxiety is a normal response to threat or danger and<br />
part of the usual human experience, but it can become<br />
a mental health problem if the response is exaggerated,<br />
lasts more than three weeks and interferes with daily<br />
life. Anxiety is characterised by worry and agitation,<br />
often accompanied by physical symptoms such as rapid<br />
breathing and a fast heartbeat or hot and cold sweats.<br />
‘Stress’ is not considered a mental health problem in its<br />
own right, but long-term stress may be associated with<br />
anxiety or depression.<br />
• Generalised anxiety disorder (GAD) is diagnosed after<br />
a person has on most days for at least six months<br />
experienced extreme tension (increased fatigue,<br />
trembling, restlessness, muscle tension), worry, and<br />
feelings of apprehension about everyday problems.<br />
<strong>The</strong> person is anxious in most situations, and there is no<br />
particular trigger for anxiety. 41<br />
• People who experience anxiety usually have symptoms<br />
that fit into more than one category of anxiety disorder,<br />
and are usually diagnosed with at least one other mental<br />
disorder, most commonly depression. 42<br />
• Social phobia, a persistent fear of being seen negatively<br />
or humiliated in social or performance situations, is the<br />
third most commonly diagnosed mental disorder in<br />
adults worldwide, with a lifetime prevalence of at least<br />
5%. 43<br />
Obsessive Compulsive Disorder (OCD)<br />
Obsessive compulsive disorder is a common form<br />
of anxiety characterised by obsessive thinking and<br />
compulsive behaviour. Obsessions are distressing,<br />
repetitive thoughts which may be seen as irrational, but<br />
cannot be ignored. Compulsions are ritual actions which<br />
people feel compelled to repeat in order to relieve anxiety<br />
or to stop obsessive thoughts. For example, someone may<br />
believe that their hands are constantly dirty so wash them<br />
over and over again.<br />
• 2-3% of people will experience Obsessive Compulsive<br />
Disorder during their lifetime. 44 It often takes between 10<br />
and 15 years for people to seek professional help.<br />
• 7% of British adults report ‘obsessions’ in any week, with<br />
4% reporting ‘compulsions’. 45<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
14
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Occurrences of phobias in men and women (per 1000) 46<br />
Phobias (including panic attacks)<br />
Phobias describe a group of disorders in which anxiety<br />
is experienced only, or predominantly, in certain welldefined<br />
situations that are not dangerous. As a result, these<br />
situations are avoided or endured with dread. <strong>The</strong> person’s<br />
concern may be focused on individual symptoms like<br />
palpitations or feeling faint and these are often associated<br />
with secondary fears of dying, losing control, or ‘going<br />
mad’.<br />
• Phobias are much more common in women than men,<br />
affecting about 22 in 1,000 women compared with 13 in<br />
1,000 men in Britain. 46<br />
• Agoraphobia is the term for a cluster of phobias that<br />
include fears of leaving home, entering shops, crowds<br />
and public places, or travelling alone in trains, buses or<br />
planes.<br />
• Social phobias are characterised by a fear of scrutiny by<br />
other people. Symptoms may include blushing, shaking<br />
hands, nausea or the urgent need to go to the toilet.<br />
• <strong>The</strong>re are numerous phobias restricted to highly specific<br />
situations such as proximity to particular animals,<br />
heights, thunder, darkness, flying, closed spaces, using<br />
public toilets, eating certain foods, dentistry, or the sight<br />
of blood or injury.<br />
• Panic disorder occurs when there are recurrent,<br />
unpredictable panic attacks followed by at least one<br />
month of persistent concern about having another<br />
attack.<br />
• Panic attacks are usually contained episodes<br />
characterised by a sudden and intense sensation of<br />
fear and accompanied by physical symptoms, and the<br />
person may feel that they are dying. 47<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
15
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
8.1% 8.1% 20.4% 20.4%<br />
Men<br />
Men<br />
Women Women<br />
Risk of developing PTSD after a traumatic event 48<br />
Post-traumatic stress disorder<br />
Post-traumatic stress disorder (PTSD) develops following<br />
a stressful event or a situation of an exceptionally<br />
threatening or catastrophic nature. Intentional acts of<br />
violence are more likely than natural events or accidents<br />
to result in PTSD. Common symptoms may include<br />
re-experiencing the event in nightmares or flashbacks,<br />
avoiding things or places associated with the event,<br />
panic attacks, sleep disturbance and poor concentration.<br />
Depression, emotional numbing, drug or alcohol misuse<br />
and anger are also common.<br />
In children, re-experiencing symptoms may take the form<br />
of re-enacting the experience, repetitive play or frightening<br />
dreams without recognisable content.<br />
• <strong>The</strong> risk of developing PTSD after a traumatic event is<br />
8.1% for men and 20.4% for women. 48<br />
• Symptoms of PTSD usually develop immediately after<br />
the traumatic event but for less than 15% of people<br />
affected, the onset of symptoms will be delayed. 49<br />
• PTSD sufferers may not seek treatment for months or<br />
years after the onset of symptoms.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
16
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Less than a quarter of people who have<br />
distressing psychotic experiences at some<br />
time in their lives remain permanently<br />
affected by them. 51<br />
Severe mental illness<br />
Psychosis<br />
‘Psychosis’ describes a loss of touch with reality, which<br />
may include hearing voices, seeing something that no<br />
one else sees, holding unusual personally derived beliefs,<br />
experiencing changes in perception or assigning personal<br />
meanings to everyday objects. Psychosis is associated<br />
with schizophrenia, schizoaffective disorder, puerperal<br />
psychosis, severe depression and is often experienced<br />
during the ‘highs’ of bipolar disorder. Other illnesses such<br />
as dementia can also feature psychotic symptoms.<br />
• About 1 in every 200 adults experiences a ‘probable<br />
psychotic disorder’ in the course of a year. 50<br />
• Less than a quarter of people who have distressing<br />
psychotic experiences at some time in their lives remain<br />
permanently affected by them. 51<br />
• <strong>The</strong> average age of onset of psychotic symptoms is 22. 52<br />
• 4.4% of people in the general population say they have<br />
experienced at least one symptom of psychosis such as<br />
delusions or hallucinations. Risk factors include smoking,<br />
living in the country, little social support, adverse life<br />
events, neurosis and excessive drug or alcohol use.<br />
Paranoid thoughts are the most commonly reported<br />
symptom. 53<br />
Bipolar disorder<br />
Bipolar disorder, also known as manic depression, is<br />
associated with severe mood changes that fluctuate from<br />
elation, overactivity and sometimes psychosis (together<br />
known as mania or hypomania) to a lowering of mood and<br />
decreased energy and activity (depression). It is diagnosed<br />
after at least two episodes in which a person’s mood<br />
and activity levels are significantly disturbed, including<br />
on some occasions mania or hypomania and, on others,<br />
depression. A person usually recovers completely between<br />
episodes.<br />
During a phase of ‘mania’, people may exhibit grandiose<br />
ideas (an inflated belief in their own power, knowledge<br />
or relationship to important people or deities), an inflated<br />
sense of self esteem, a reduced need for sleep and<br />
impaired concentration and judgment.<br />
Hypomania is a milder mania, in which abnormalities of<br />
mood and behaviour are persistent and marked, but are<br />
not accompanied by hallucinations or delusions and do<br />
not result in severe disruption to work or social rejection.<br />
• Between 0.9% and 2.1% of the adult population<br />
experience a bipolar disorder at some point in their<br />
lives. 54 <strong>The</strong>re is very little gender difference.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
17
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Approximately 25% of people with<br />
schizophrenia make a full recovery and<br />
experience no further episodes.<br />
Between 10 and 15% will experience<br />
severe long-term difficulties. 60<br />
• Symptoms of bipolar disorder usually begin between<br />
the ages of 15 and 24. 55 <strong>The</strong> age of onset of mania is<br />
earlier in men than in women, although women have<br />
a higher incidence throughout the rest of adult life. 56<br />
However the first episode may occur at any age from<br />
childhood to old age.<br />
Schizophrenia<br />
<strong>The</strong> diagnosis of schizophrenia refers to a group of<br />
symptoms, typically the presence of hallucinations,<br />
delusions, disordered thought, and problems with feelings,<br />
behaviour, motivation and speech. When they occur<br />
together they represent a severe mental illness.<br />
• Schizophrenia is the most common form of psychotic<br />
disorder, affecting between 1.1% and 2.4% of people at<br />
any one time. 57<br />
• <strong>The</strong> most frequent age of onset for schizophrenia is<br />
between 20 and 30 years. 58 On average, men have an<br />
earlier age of onset than women by about 5 years. 59<br />
• After a first episode, approximately 25% of people with<br />
schizophrenia make a full recovery and experience no<br />
further episodes. Between 10 and 15% will experience<br />
severe long-term difficulties and the remainder will<br />
experience recurrent acute episodes with periods of<br />
remission or with only residual symptoms in between. 60<br />
Schizoaffective disorder<br />
<strong>The</strong> diagnosis of schizoaffective disorder is given to<br />
someone who experiences both symptoms of a mood<br />
disorder (ie. depression) and symptoms of the type<br />
experienced with schizophrenia at the same time, or<br />
within days of each other.<br />
• Symptoms usually begin in early adult life, with men<br />
tending to show symptoms earlier than women.<br />
• About 1 in every 200 people is thought to develop<br />
the disorder at some point, and it tends to affect more<br />
women than men. 61<br />
Puerperal psychosis<br />
Puerperal psychosis is rare, following between about 1<br />
and 2 in 1000 births. 62 <strong>The</strong> onset is abrupt, usually within<br />
days of the birth. <strong>The</strong> mother often starts to behave<br />
strangely, seeming puzzled and perplexed, sleeping poorly<br />
and being restless and erratic in the day. She may have<br />
paranoid delusions that often centre around the child,<br />
for example a belief that the child is the devil, or that the<br />
world is too evil for the child to live in.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
18
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
0.2% 1.9%<br />
Percentage of men and women who experience anorexia 63<br />
Other types of<br />
mental illness<br />
Eating disorders<br />
Symptoms of eating disorders include severely reduced<br />
eating, intense fear of weight gain, and self perception that<br />
is overly influenced by weight or body shape. <strong>The</strong>y also<br />
include significant levels of self-induced vomiting, laxative<br />
abuse and strenuous exercise for weight control.<br />
• 1.9% of women and 0.2% of men experience anorexia in<br />
any year. 63 Anorexia is characterised by a failure to gain<br />
weight in relation to age, or excessive loss of weight,<br />
through avoiding food. In some cases death can occur<br />
because of the physical consequences of persistent<br />
starvation. Usually, the condition lasts for about 6 years.<br />
• Between 0.5% and 1% of young women experience<br />
bulimia at any one time. 64 <strong>The</strong> most common age of<br />
onset is in teenage years and early 30s. 65 Bulimia also<br />
involves a preoccupation with food but is characterised<br />
by episodes of intense binge eating, preceded and<br />
followed by periods of starvation and/or self-induced<br />
vomiting and purging.<br />
• About 40% of people referred to eating disorder clinics<br />
are classified ‘Eating Disorder Not Otherwise Specified’, 66<br />
with symptoms that don’t fit neatly into either the<br />
anorexia or bulimia classifications.<br />
Attention Deficit Hyperactivity Disorder<br />
Attention Deficit Hyperactivity Disorder (ADHD) is<br />
often used to describe children who display overactive<br />
(hyperactive) and impulsive behaviour and who have<br />
difficulty in paying attention.<br />
• A lack of consensus on the definition of, and criteria<br />
for, ADHD has produced widely divergent estimates<br />
of prevalence rate, varying between 0.5% and 26% of<br />
children. 67 This has been attributed in part to major<br />
differences in the way children from different cultures<br />
are rated for ADHD. 68<br />
Personality disorder<br />
This is a controversial diagnosis. Many people believe it is<br />
used in cases where symptoms do not obviously fit any<br />
other diagnosis. Personality disorder is used to diagnose<br />
a person who has difficulty coping with life and whose<br />
behaviour persistently causes distress to themselves or<br />
others. Personality disorders are characterised by longlasting<br />
rigid patterns of thought and behaviour. <strong>The</strong><br />
attitudes of people with a disorder usually exaggerate part<br />
of their personality and result in behaviour at odds with<br />
expectations of what is regarded as normal.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
19
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
38% 38% 15% 15%<br />
Men<br />
Men<br />
Women Women<br />
Percentage of adults assessed as being ‘hazardous drinkers’ 72<br />
• Between 4 and 5% of people living in Britain meet the<br />
criteria for a personality disorder. 69<br />
• Obsessive compulsive personality disorder is estimated<br />
to be the most common, affecting about 2% of the<br />
population (see page 14). Less than 1% fall into each<br />
of the other categories, with the highest being 0.8% in<br />
avoidant or schizoid personality disorder, followed by<br />
paranoid or borderline personality disorder and antisocial<br />
personality disorder. 70<br />
• Fewer people with a personality disorder make<br />
contact with psychiatric services than those with<br />
other conditions such as schizophrenia or depression.<br />
<strong>The</strong> probability of people with a personality disorder<br />
withdrawing from treatment is higher. 71<br />
Alcohol and other substance misuse<br />
Definitions of alcohol and substance misuse vary. However,<br />
dependence is usually defined by preoccupation with use<br />
of the substance, inability to control use, and failure to cut<br />
back despite life-damaging consequences.<br />
• In 2000, a quarter (26%) of adults in Britain, including<br />
38% of men and 15% of women, were assessed as<br />
being ‘hazardous drinkers’. Hazardous drinking refers<br />
to a pattern of drinking alcohol that brings the risk of<br />
physical or psychosocial harm. Prevalence of hazardous<br />
drinking decreased with age. For women prevalence<br />
was highest in the 16-19 year old group (32%), whereas<br />
for men it was highest in the 20-24 age group (62%). 72<br />
• Worldwide, 1.7% of adults are thought to have an<br />
alcohol-use disorder. 73<br />
• 3.7% of adults in Britain are considered to be drugdependent.<br />
74 <strong>The</strong> number of people who are drug<br />
dependent appears to have doubled between 1993 and<br />
2000. 75<br />
• 30% of people who are dependent on alcohol and<br />
45% of people dependent on drugs also have another<br />
psychiatric disorder. 76<br />
• In 2004/05, there were around 35,600 NHS hospital<br />
admissions with a primary diagnosis of mental and<br />
behavioural disorders due to alcohol. Around two thirds<br />
(68%) of those were men. 77<br />
• ‘Binge drinking’ is best defined as drinking twice the<br />
recommended daily limit of alcohol units. An NHS survey<br />
found that, using this measure, 23% of men reported<br />
drinking more than 8 units on at least one day in a week.<br />
<strong>The</strong> proportion ranged from 33% of men aged 16-24 to<br />
6% of those aged 65 and over. 78<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
20
THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
5% 5% 20% 20%<br />
over 65 over 65 over 80 over 80<br />
Percentage of people affected by dementia by age group 82<br />
Dual diagnosis<br />
<strong>The</strong>re is considerable overlap between substance<br />
misuse problems and other mental health problems.<br />
Such overlap affects many people with mental health<br />
problems. However, dual diagnosis, when an individual<br />
experiences a mental illness and a substance use problem<br />
simultaneously, affects far fewer people.<br />
• Between a third and half of people with severe mental<br />
health problems consume alcohol or other substances<br />
to levels that meet criteria for ‘problematic use’. 79<br />
• 51% of alcohol-dependent adults say they have a mental<br />
health problem. 80<br />
• 44% of people using services of Community <strong>Mental</strong><br />
<strong>Health</strong> Teams in four urban centres reported problematic<br />
drug or alcohol use in the preceding year. 81<br />
Dementia<br />
Dementia is a progressive and largely irreversible condition<br />
that involves widespread damage to mental functioning.<br />
Someone with dementia may experience memory<br />
loss, language impairment, disorientation, change in<br />
personality, difficulties with daily living, self neglect,<br />
and behaviour which is out of character (for example,<br />
aggression, sleep disturbance or sexual disinhibition).<br />
• Dementia affects 5% of people over the age of 65<br />
and 20% of those over 80. About 700,000 people in<br />
the UK have dementia (1.2% of the population) at any<br />
one time. 82<br />
• Dementia is uncommon before the age of 65, but does<br />
affect 1 in 1,000 younger people. 83<br />
• About 60% of dementia cases are caused by Alzheimer’s<br />
disease.<br />
• About a fifth of cases of dementia are related to strokes<br />
or insufficient blood flow to the brain, these cases being<br />
known as vascular dementia. 84<br />
• In fronto-temporal dementia, which includes Pick’s<br />
disease, damage is usually focused in the front part of<br />
the brain. Personality and behaviour are initially more<br />
affected than memory.<br />
• People with multiple sclerosis, motor neurone disease,<br />
Parkinson’s disease, Huntington’s disease and Down’s<br />
syndrome are at increased risk of developing a type of<br />
dementia linked to their condition.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
21
1. Singleton N, Bumpstead R,<br />
O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households 2000<br />
London: <strong>The</strong> Stationery Office p32,<br />
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2. Mario M, Psychiatric comorbidity:<br />
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5. Singleton N, Bumpstead R,<br />
O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households 2000<br />
London: <strong>The</strong> Stationery Office,<br />
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6. Singleton N, Bumpstead R,<br />
O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households 2000<br />
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7. Singleton N, Lewis G. Better Or<br />
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8. Singleton N, Bumpstead R,<br />
O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households 2000<br />
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9. Singleton N, Bumpstead R,<br />
O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households 2000<br />
London: <strong>The</strong> Stationery Office,<br />
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10. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
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11. National Institute for <strong>Health</strong> and<br />
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13. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
<strong>Mental</strong> <strong>Health</strong>: New Understanding,<br />
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14. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
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15. National Suicide Prevention<br />
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16. Samaritans Suicide Statistics<br />
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at Onset of Mania and Bipolar<br />
Disorder Over a 35-year Period<br />
in Camberwell, England, Am J<br />
Psychiatry 162: 257-262, (February<br />
2005)<br />
60. Wing J and Marshall P, Protocol<br />
for Visiting Teams: Standards<br />
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Collaborating Centre for <strong>Mental</strong><br />
<strong>Health</strong>, (1994)<br />
61. Schizoaffective Disorder<br />
<strong>Facts</strong>heet at www.mentalheakth.<br />
org.uk, <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong>,<br />
(2003)<br />
62. Robertson E. et al, <strong>The</strong> British<br />
Journal of Psychiatry, 186: 258-259,<br />
(2005)<br />
63. Eating Disorders: Core<br />
Interventions In <strong>The</strong> Treatment And<br />
Management Of Anorexia Nervosa,<br />
Bulimia Nervosa And Other Eating<br />
Disorders, National Collaborating<br />
Centre for <strong>Mental</strong> <strong>Health</strong>, London:<br />
<strong>The</strong> British Psychological Society/<br />
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64. Eating Disorders: Core<br />
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bulimia nervosa and related eating<br />
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65. Uwaifo G. and Daly R, (2005),<br />
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66. Button E. et al (2005), Don’t<br />
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service use in an eating disorders<br />
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136, (2005)<br />
67. Timimi S. and Taylor E, In<br />
Debate: ADHD is best understood<br />
as a cultural construct, British<br />
Journal of Psychiatry, 184: 8-9,<br />
(2004)<br />
68. Timimi S. and Taylor E, In<br />
Debate: ADHD is best understood<br />
as a cultural construct, British<br />
Journal of Psychiatry, 184: 8-9,<br />
(2004)<br />
69. Singleton N, Coid J, Yang M,<br />
Tyrer P, Roberts A and Ullrich<br />
S, Prevalence and correlates of<br />
personality disorder in Great Britain.<br />
British Journal of Psychiatry, 188,<br />
423 - 431, (2006)<br />
70. Singleton N, Coid J, Yang M,<br />
Tyrer P, Roberts A and Ullrich<br />
S, Prevalence and correlates of<br />
personality disorder in Great Britain.<br />
British Journal of Psychiatry, 188,<br />
423 - 431, (2006)<br />
71. Coid J, Yang M, Tyrer P, Roberts<br />
A and Ullrich S, Prevalence and<br />
correlates of personality disorder<br />
in Great Britain. British Journal of<br />
Psychiatry, 188, 423 - 431, (2006)<br />
72. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office,<br />
(2001) cited in Statistics on Alcohol,<br />
England, Information Centre,<br />
Lifestyle Statistics, London: NHS,<br />
(2006)<br />
73. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
<strong>Mental</strong> <strong>Health</strong>: New Understanding,<br />
New Hope Geneva: World <strong>Health</strong><br />
Organisation, (2001)<br />
74. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office,<br />
(2001)<br />
75. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office,<br />
(2001)<br />
76. Coulthard, M. Farrell, M.<br />
Singleton, N. Meltzer, H. Tobacco,<br />
Alcohol and Drug Use and <strong>Mental</strong><br />
<strong>Health</strong> London: <strong>The</strong> Stationery<br />
Office at www.statistics.gov.uk,<br />
(2002)<br />
77. NHS Statistics on<br />
Alcohol: England, (2006). Available<br />
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78. NHS Statistics on Alcohol:<br />
England, (2006). Available at<br />
www.ic.nhs.uk (accessed August<br />
2006)<br />
79. Johnson S, Taylor R. Statistics<br />
of <strong>Mental</strong>ly-Disordered Offenders<br />
2001: England and Wales, London:<br />
Home Office, (2001)<br />
80. Waiting for Change: Treatment<br />
Delays And <strong>The</strong> Damage To Drinkers<br />
London: Turning Point p15, (2003)<br />
81. Living With Severe <strong>Mental</strong><br />
<strong>Health</strong> And Substance Abuse<br />
Problems London: Rethink p11,<br />
(2004)<br />
82. National Institute for <strong>Health</strong> and<br />
Clinical Excellence, Dementia: <strong>The</strong><br />
Treatment And Care Of People With<br />
Dementia In <strong>Health</strong> And Social Care<br />
London: NICE p3, (2004)<br />
83. Dementia <strong>Facts</strong>heet<br />
www.mentalhealth.org.uk, <strong>Mental</strong><br />
<strong>Health</strong> <strong>Foundation</strong>, (2000)<br />
84. National Institute for <strong>Health</strong> and<br />
Clinical Excellence, Dementia: <strong>The</strong><br />
Treatment And Care Of People With<br />
Dementia In <strong>Health</strong> And Social Care<br />
London: NICE p3, (2004)<br />
References<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
24
2.<br />
Differences in the<br />
extent of mental health<br />
problems
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
10% 10% 25% 25%<br />
Men Men<br />
Women Women<br />
Men and women requiring treatment for depression during<br />
Difference in the extent of<br />
mental health problems<br />
Gender differences<br />
• Women are more likely to have been treated for a<br />
mental health problem than men (29% compared with<br />
17%). 85<br />
• More than half of contacts with the Samaritans are made<br />
by men – 53% compared with 43% by women. 4% were<br />
unidentifiable.<br />
• Depression is more common in women than men. 1 in<br />
4 women will require treatment for depression at some<br />
time, compared with 1 in 10 men. 86 <strong>The</strong> reasons for this<br />
are unclear, but are thought to be due to both social and<br />
biological factors.<br />
• Doctors are more likely to treat depression in women<br />
than in men, even when they present with identical<br />
symptoms. 87<br />
• Women are twice as likely to experience anxiety as men.<br />
Of people with phobias or OCD, about 60% are female. 88<br />
• Men are more likely than women to have an alcohol<br />
or drug problem. 67% of British people who consume<br />
alcohol at ‘hazardous’ levels, and 80% of those<br />
dependent on alcohol are male. Almost three quarters<br />
of people dependent on cannabis and 69% of those<br />
dependent on other illegal drugs are male. 89<br />
• <strong>The</strong> prevalence of schizophrenia is about the same in<br />
men and women, but the average age of onset is 18 in<br />
men and 25 in women. 90<br />
• All personality disorder categories are more prevalent in<br />
men, apart from the schizotypal category. Men are five<br />
times more likely than women to be diagnosed with<br />
anti-social personality disorder. 91<br />
• About 75% of people to die by suicide are men. This<br />
proportion has been about the same for more than a<br />
decade. 92<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
27
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Depression in ethnic minority groups has<br />
been found to be up to 60% higher than in<br />
the white population. 95<br />
Black and minority ethnic groups<br />
In general, rates of mental health problems are thought to<br />
be higher in minority ethnic groups in the UK than in the<br />
white population, 93 but they are less likely to have their<br />
mental health problems detected by a GP. 94<br />
• Depression in ethnic minority groups has been found to<br />
be up to 60% higher than in the white population. 95<br />
• Young Asian women are three times as likely to kill<br />
themselves as young white women. 96<br />
• A higher prevalence of diagnosed mental illness,<br />
particularly schizophrenia, has been found among Black<br />
Caribbean people in the UK. 97 <strong>The</strong>y are twice as likely<br />
as white people to be diagnosed as having a psychotic<br />
disorder. 98<br />
• <strong>Mental</strong> health staff, including psychiatrists, are more<br />
likely to perceive black patients as being potentially<br />
dangerous, even though there is no evidence that<br />
they are any more aggressive than other patient<br />
populations. 99<br />
• Black African and Caribbean people are three times as<br />
likely to be admitted to hospital and up to 44% more<br />
likely to be detained under the <strong>Mental</strong> <strong>Health</strong> Act as<br />
white people. 100<br />
• Black people are more likely than white people to<br />
be given physical treatments, such as medication<br />
and ECT, and are likely to be prescribed higher doses<br />
of medication. <strong>The</strong>y are less likely to be offered<br />
psychotherapy, counselling and other non-medical<br />
interventions. 101<br />
• Compared with White British patients, both African–<br />
Caribbean and Black African patients are less likely to be<br />
referred to mental health services by a GP, and are more<br />
commonly referred by a criminal justice agency. 102<br />
Children and young people<br />
• Estimates vary, but research suggests that 20% of<br />
children have a mental health problem in any given year,<br />
and about 10% at any one time. 103<br />
• <strong>The</strong> British Medical Association estimates that at any<br />
point in time up to 45,000 young people under the age<br />
of 16 are experiencing a severe mental health disorder,<br />
and approximately 1.1 million children under the age<br />
of 18 would benefit from specialist mental health<br />
services. 104<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
28
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
aged 11-15 aged 11-15<br />
aged 5-10aged 5-10<br />
10.4% 10.4% 5.9% 5.9% 12.8% 12.8% 9.65% 9.65%<br />
Rates of mental health problems among children<br />
• Rates of mental health problems among children<br />
increase as they reach adolescence. Disorders affect<br />
10.4% of boys aged 5-10, rising to 12.8% of boys aged<br />
11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls<br />
aged 11-15. 105<br />
• In one study, 50-60% of adults with a diagnosed mental<br />
disorder had received a mental health diagnosis of some<br />
kind before the age of 15. 106<br />
• Among teenagers, rates of depression and anxiety have<br />
increased by 70% in the past 25 years. 107<br />
• Children of single-parent families are twice as likely<br />
to have a mental health problem as children of twoparent<br />
families (16%, compared with 8%). Also at higher<br />
risk are children in large families, children of poor and<br />
poorly-educated parents and those living in social sector<br />
housing. 108<br />
• 41% of British 11-15 year-olds who smoke regularly have<br />
a mental disorder, as well as 24% of those who drink<br />
alcohol at least once a week, and 49% of those who use<br />
cannabis at least once a month. 109<br />
Older people<br />
• Older people are less likely to have a neurotic disorder<br />
(or common mental health problem), other than<br />
depression, than other sections of the British population.<br />
10.2% of those aged 65-69 and 9.4% of those aged 70-74<br />
have a neurotic disorder, compared with 16.4% of the<br />
general population. 110<br />
• Depression affects 1 in 5 people over the age of 65 living<br />
in the community and 2 in 5 living in care homes. 111<br />
However, it is likely that only a small proportion of older<br />
people with depression are in contact with their GP or<br />
mental health services. 112<br />
• An estimated 70% of new cases of depression in older<br />
people are related to poor physical health. 113,114<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
29
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
72% 72% 70% 70%<br />
Men<br />
Men<br />
Women Women<br />
<strong>Mental</strong> disorders among sentenced prisoners 117<br />
<strong>The</strong> prison population<br />
Prisoners have particularly high levels of mental illness.<br />
Until 2003, prison health care was the responsibility of the<br />
Home Office, but it now comes under the auspices of the<br />
NHS.<br />
• Prisoners with mental disorders are significantly overrepresented<br />
in the prison population. As many as<br />
12-15% of all prisoners have four concurrent mental<br />
disorders. 30% of all prisoners have a history of self-harm,<br />
and the incidence of mental health disorder is higher for<br />
women, older people and those from ethnic minority<br />
groups. 115<br />
• Up to 90% of prisoners have a diagnosable mental<br />
illness, substance abuse problem or, frequently, both. 116<br />
• 72% of male and 70% of female sentenced prisoners<br />
have at least one mental disorder and 1 in 5 prisoners<br />
has four major mental health disorders. 117<br />
• Male prisoners are 14 times more likely to have two<br />
or more disorders than men in general, and female<br />
prisoners 35 times more likely than women in general. 118<br />
• In one UK study, 5.2% of prisoners had displayed<br />
symptoms of psychosis in the past year compared<br />
with 0.45% of the general population. Psychosis was<br />
attributed to toxic or withdrawal effects of drugs and<br />
alcohol in a quarter of the prison cases. 119<br />
• <strong>The</strong> suicide rate for men in prison is five times that for<br />
men in the community. Boys aged 15-17 are 18 times<br />
more likely to kill themselves in prison than in the<br />
community. 120<br />
• National research found that 72% of people who died by<br />
suicide in prison had a history of mental disorder. 57%<br />
had symptoms suggestive of mental disorder at the time<br />
they entered prison. 121<br />
• A fifth of perpetrators of homicide with schizophrenia<br />
were sent to prison rather than hospital. 122 Over 90% of<br />
perpetrators with personality disorder had no symptoms<br />
of mental illness at the time of the offence and received<br />
a prison sentence. 123<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
30
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
Less than 1 in 3 homeless people with mental health problems<br />
receive treatment 130<br />
• Women make up just 6% of the prison population. In<br />
2003 they accounted for 46% of all reported self-harm<br />
incidents with 30% of women reported to have harmed<br />
themselves, on average five times each, compared with<br />
6% of men, who on average harmed themselves twice. 124<br />
• Behavioural and mental health problems are particularly<br />
prevalent amongst children in prison. Of prisoners aged<br />
16-20, around 85% show signs of a personality disorder<br />
and 10% exhibit signs of psychotic illness. 125<br />
• More than half of all elderly prisoners suffer from a<br />
mental disorder, most commonly depression, which<br />
often emerges as a result of imprisonment. 126<br />
Homeless people<br />
• In 2005/06 there were 7,340 homeless people<br />
experiencing mental illness, more than double the<br />
number 15 years earlier. 127<br />
• <strong>The</strong> percentage of homeless people judged to be<br />
homeless and vulnerable due to mental illness or<br />
disability rose from 3.25% in 1991 to 7.8% in 2006. 128<br />
• 1 in 4 homeless people will die by suicide. 129<br />
• Less than a third of homeless people with mental health<br />
problems receive treatment. 130<br />
• 30-50% of homeless rough sleepers experience mental<br />
health problems. About 70% misuse drugs. 131<br />
• Behavioural problems have been found to be higher<br />
among homeless children living in temporary<br />
accommodation, and mental health problems are<br />
significantly higher among homeless mothers and<br />
children. 132<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
31
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS<br />
30%<br />
Percentage of deaf people with mental health problems 136<br />
Other groups<br />
• People who provide substantial amounts of care to<br />
relatives are twice as likely to have a mental health<br />
problem as the general population. 133<br />
• A survey of carers in England found that female carers<br />
are 23% more likely to suffer from anxiety or depression<br />
than women in the general population. (Most carers<br />
are women.) People who spend 20 or more hours a<br />
week caring are twice as likely to suffer from anxiety or<br />
depression as those spending less time providing care. 134<br />
• Two thirds of refugees have experienced anxiety<br />
and depression, 135 which may often be linked to war,<br />
imprisonment, torture or oppression in their home<br />
countries, and/or social isolation, language difficulties<br />
and discrimination in their new country.<br />
• 30% of deaf people using British Sign Language<br />
have mental health problems, primarily anxiety and<br />
depression. 136<br />
• 25-40% of people with learning disabilities are estimated<br />
to have a mental health problem. 137<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
32
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116. Brooker C. et al, <strong>Mental</strong> health<br />
services and prisoners: A review,<br />
London: Department of <strong>Health</strong>,<br />
(2003)<br />
117. Paul Goggins, minister for<br />
prisons and probation speaking<br />
in a debate on prisons and mental<br />
health, Hansard, 17th March 2004,<br />
cited in Bromley Briefings Prison<br />
Factfile, London: Prison Reform<br />
Trust, (2006)<br />
118. <strong>Mental</strong> <strong>Health</strong> And Social<br />
Exclusion: Social Exclusion Unit<br />
Report London: Office Of <strong>The</strong><br />
Deputy Prime Minister p18, quoting<br />
Singleton N, Meltzer H, Gatward R,<br />
Coid J, Deasy D (1998), Psychiatric<br />
Morbidity Among Prisoners In<br />
England And Wales, London: ONS,<br />
(2004)<br />
119. Brugha T, Singleton N,<br />
Meltzer H, Bebbington P, Farrell M,<br />
Jenkins R, Coid J, Fryers T, Melzer<br />
D, and Lewis G, Psychosis in the<br />
Community and in Prisons: A<br />
Report From the British National<br />
Survey of Psychiatric Morbidity, Am<br />
J Psychiatry 162: 774-780, (2005)<br />
120. Fazel S et al, Suicides in male<br />
prisoners in England and Wales,<br />
1978-2003, <strong>The</strong> Lancet, Vol 366,<br />
(2005)<br />
121. Shaw J, Appleby L and Baker<br />
D, Safer Prisons, A National Study<br />
of Prison Suicides 1999-2000 by<br />
the National Confidential Inquiry<br />
into Suicide and Homicide by<br />
People with <strong>Mental</strong> Illness. London:<br />
Stationery Office, (2003)<br />
122. Shaw J. et al, Rates of mental<br />
disorder in people convicted of<br />
homicide: National Clinical Survey.<br />
British Journal of Psychiatry, 188,<br />
143-147, (2006). This study was<br />
carried out as part of the National<br />
Confidential Inquiry into Suicide<br />
and Homicide among People with<br />
<strong>Mental</strong> Illness.<br />
123. Shaw J. et al, Rates of mental<br />
disorder in people convicted of<br />
homicide: National Clinical Survey.<br />
British Journal of Psychiatry, 188,<br />
143-147, (2006). This study was<br />
carried out as part of the National<br />
Confidential Inquiry into Suicide<br />
and Homicide among People with<br />
<strong>Mental</strong> Illness<br />
124. Safer Custody News, London:<br />
Prison Service, (June 2004)<br />
125. Singleton et al, Psychiatric<br />
Morbidity among young offenders<br />
in England and Wales, London:<br />
Office for National Statistics, (2000)<br />
126. Prison Reform Trust, Growing<br />
Old in Prison, London: Prison<br />
Reform Trust, (2003)<br />
127. Answer to Parliamentary<br />
Question by Yvette Cooper,<br />
(Minister of State (Housing<br />
and Planning), Department<br />
for Communities and Local<br />
Government), 17th July 2006<br />
London: Hansard available at<br />
www.publications.parliament.uk,<br />
(accessed October 2006)<br />
128. Answer to Parliamentary<br />
Question by Yvette Cooper,<br />
(Minister of State (Housing<br />
and Planning), Department<br />
for Communities and Local<br />
Government), 17th July 2006<br />
London: Hansard available at<br />
www.publications.parliament.uk,<br />
(accessed October 2006)<br />
129. <strong>Mental</strong> <strong>Health</strong> And Social<br />
Exclusion: Social Exclusion Unit<br />
Report London: Office Of <strong>The</strong><br />
Deputy Prime Minister, (2004)<br />
130. National <strong>Health</strong> Service,<br />
<strong>Mental</strong> <strong>Health</strong>: National Service<br />
Frameworks London: NHS, (1999)<br />
131. Research from Shelter,<br />
available at http://england.shelter.<br />
org.uk (accessed June 2006)<br />
132. Research from Shelter,<br />
available at http://england.shelter.<br />
org.uk (accessed June 2006)<br />
133. <strong>Mental</strong> <strong>Health</strong> and Social<br />
Exclusion London: Office of the<br />
Deputy Prime Minister, quoting<br />
Singleton N et al (2002) <strong>Mental</strong><br />
<strong>Health</strong> Of Carers London: <strong>The</strong><br />
Stationery Office, (2004)<br />
134. Office for National Statistics,<br />
<strong>Mental</strong> <strong>Health</strong> of Carers London:<br />
<strong>The</strong> Stationery Office, (2002)<br />
135. Burnett A, Peel M, <strong>Health</strong><br />
Needs Of Asylum Seekers And<br />
Refugees, British Medical Journal,<br />
322 pp544-547, (2001)<br />
136. <strong>Mental</strong> <strong>Health</strong> And Social<br />
Exclusion: Social Exclusion Unit<br />
Report London: Office Of <strong>The</strong><br />
Deputy Prime Minister, (2004)<br />
137. <strong>Health</strong> Needs of People With<br />
Learning Disabilities, <strong>Foundation</strong> for<br />
People with Learning Difficulties,<br />
www.learningdisabilities.org.uk<br />
(accessed August 2006)<br />
References<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
34
3.<br />
Factors related to mental<br />
health problems
FACTORS RELATED TO MENTAL HEALTH PROBLEMS<br />
Factors related to mental<br />
health problems<br />
<strong>Mental</strong> health and material deprivation<br />
• Having a low income, being unemployed, living in poor<br />
housing, low levels of education and membership of<br />
social classes IV (partly skilled people) and V (individuals<br />
with no skills) are all associated with a greater risk of<br />
experiencing a mental health problem. 138<br />
• <strong>The</strong> poorest fifth of adults are at double the risk of<br />
experiencing a mental health problem as those on<br />
average incomes. 139<br />
• In a study of British adults taking the GHQ questionnaire<br />
(which measures psychological well-being), the<br />
prevalence of high scores (indicative of a psychiatric<br />
problem) increased as household income decreased. 140<br />
• Financial problems can be both a cause and a<br />
consequence of mental health problems. People with<br />
mental health problems are three times as likely to be in<br />
debt as the general population and more than twice as<br />
likely to have problems managing money. 141<br />
• Children in poor households are three times as likely<br />
to have mental health problems as children in well-off<br />
households. 142<br />
• People without a degree are almost twice as likely to<br />
experience depression as those with a degree. 143<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
37
FACTORS RELATED TO MENTAL HEALTH PROBLEMS<br />
1 in 4 people using mental health services has no<br />
contact with their family 146<br />
1 in 3 people using mental health services has no<br />
contact with their friends 146<br />
Family-related and social factors<br />
• Social isolation is a factor in mental health problems.<br />
20% of people with common mental health problems<br />
live alone, compared with 16% of the overall<br />
population. 144<br />
• A person with a severe mental health problem is<br />
four times more likely than average to have no close<br />
friends. 145<br />
• 1 in 4 people using mental health services has no<br />
contact with their family, and 1 in 3 has no contact with<br />
friends. 146<br />
• Low levels of social support can reduce the likelihood of<br />
recovery – in one study 54% of women and 51% of men<br />
with mental health problems and good social support<br />
recovered over an 18 month period, compared with 35%<br />
of women and 36% of men with a severe lack of social<br />
support. 147<br />
• People with a common mental health problem are twice<br />
as likely to be separated or divorced as their mentally<br />
healthy counterparts (14%, compared with 7%), 148 and<br />
are more than twice as likely to be single parents as<br />
those without a mental health problem (9%, compared<br />
with 4%). 149<br />
• Between a third and two thirds of children whose<br />
parents have mental health problems will develop<br />
problems either in childhood or adult life. 150 Children<br />
of depressed parents have a 50% risk of developing<br />
depression themselves before the age of 20. 151<br />
• Almost half of children in care have a mental health<br />
problem. Children in care are 4 to 5 times as likely to<br />
have a mental health problem as other children. 152<br />
• Taking part in social activities, sport and exercise is<br />
associated with higher levels of life satisfaction. For<br />
example, 76% of those who play sport or exercise at least<br />
once a week are satisfied, compared with 70% of those<br />
who never or rarely play sport or exercise. 153<br />
• Other social and economic risk factors for mental health<br />
problems include: poor transport, neighbourhood<br />
disorganisation and racial discrimination. Social and<br />
economic protective factors for mental health include:<br />
community empowerment and integration, provision<br />
of social services, tolerance, and strong community<br />
networks. 154<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
38
FACTORS RELATED TO MENTAL HEALTH PROBLEMS<br />
Diabetes 27%<br />
Hypertension 29%<br />
Stroke 31%<br />
Cancer patients 33%<br />
HIV/AIDS 44%<br />
0 10 20 30 40 50<br />
Percentage of people with poor physical health affected by depression 156<br />
Physical health<br />
People with poor physical health are at higher risk of<br />
experiencing common mental health problems, and<br />
people with mental health problems are more likely to<br />
have poor physical health.<br />
• A person with schizophrenia will, on average, live for<br />
10 years less than someone without a mental health<br />
problem. 155<br />
• Depression affects 27% of people with diabetes, 29% of<br />
people with hypertension, 31% of people who have had<br />
a stroke, 33% of cancer patients and 44% of people with<br />
HIV/AIDS. 156<br />
• People who experience persistent pain are four times<br />
as likely to have an anxiety or depressive disorder as the<br />
general population. 157<br />
• 61% of people with schizophrenia presenting at GP<br />
surgeries and 46% of those with manic depression<br />
smoke, compared with 33% of the remaining<br />
population. 158 In one study smoking cessation had been<br />
offered to more of those with severe mental illness<br />
than to other patients who smoke, and more had been<br />
prescribed smoking cessation medication. 159<br />
Spirituality<br />
Spirituality means different things for different people<br />
at different times. Although for centuries spirituality has<br />
been expressed through religion, art, nature and the<br />
built environment, recent expressions of spirituality have<br />
become more varied. Underlying this is an assumption that<br />
trying to make sense of the world around us and our place<br />
within it is an intrinsic part of what it means to be human.<br />
• Research literature has consistently reported that<br />
aspects of religious and spiritual involvement are<br />
associated with desirable mental health outcomes. 160,161<br />
<strong>The</strong> Royal College of Psychiatrists notes that people who<br />
use mental health services identify the benefits of good<br />
quality spiritual care as being: improved self-control, self<br />
esteem and confidence; speedier and easier recovery;<br />
and improved relationships. 162<br />
• In a study of people with severe mental health problems<br />
across a range of diagnoses, 60% reported that religion/<br />
spirituality had ‘a great deal’ of helpful impact on their<br />
illness through the feelings it fostered of being cared for<br />
and of not being alone. 163<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
39
FACTORS RELATED TO MENTAL HEALTH PROBLEMS<br />
66%<br />
Percentage of people with mental health problems who believe<br />
that workplace stress was a factor 166<br />
• Studies have found that religious people, those who<br />
believe in a transcendent being or higher power, and<br />
people who belong to a community with others who<br />
share their values and offer support are more likely to<br />
recover from depression. 164<br />
Other factors<br />
• Overall, people with common mental health problems<br />
are more likely to live in an urban area than in the<br />
country. However, among rural areas, the most deprived<br />
and remote areas have the highest overall levels of<br />
mental health problems and suicide. 165<br />
• Workplace stress can frequently contribute to mental<br />
health problems. About two thirds of people with<br />
mental health problems believe that long hours,<br />
unrealistic workloads or bad management at work<br />
caused or exacerbated their condition. 166<br />
• Having a sense of control over one’s life is linked to good<br />
mental health. In one survey, of those who said they had<br />
‘complete control’ in their lives, only 14% said they had<br />
ever been told by a doctor that they had a mental health<br />
problem, compared with 56% of those who said they<br />
had ‘little control’. 168<br />
• Women who have been abused in childhood are<br />
four times more likely to develop major depression in<br />
adulthood. 169<br />
• People who experienced childhood sexual abuse are<br />
almost three and a half times as likely to be treated<br />
for psychiatric disorders in adulthood as the general<br />
population. <strong>The</strong>y are five times as likely to have a<br />
diagnosis of personality disorder. 170<br />
• <strong>Mental</strong> health is adversely affected by war, conflict,<br />
extreme poverty, displacement and natural disasters.<br />
Worldwide, it is estimated that between a third and<br />
a half of those affected by such events suffer from<br />
diagnosable mental distress, especially post-traumatic<br />
stress disorder, depression and anxiety. 167<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
40
References<br />
138. Based on Meltzer H, Singleton<br />
N, Lee A, Bebbington P, Brugha T,<br />
Jenkins R , <strong>The</strong> social and economic<br />
circumstances of adults with mental<br />
disorders Her Majesty’s Stationery<br />
Office (HMSO): London, (2002)<br />
139. Based on Meltzer H, Singleton<br />
N, Lee A, Bebbington P, Brugha T,<br />
Jenkins R , <strong>The</strong> social and economic<br />
circumstances of adults with mental<br />
disorders Her Majesty’s Stationery<br />
Office (HMSO): London, (2002)<br />
140. Department of <strong>Health</strong>,<br />
<strong>Health</strong> Survey for England 2003:<br />
Summary of Key Findings London:<br />
Department Of <strong>Health</strong> p10, (2004)<br />
141. <strong>Mental</strong> <strong>Health</strong> and Social<br />
Exclusion, Social Exclusion Unit,<br />
London: Office of the Deputy Prime<br />
Minister, p88, quoting Meltzer 2002,<br />
(2004)<br />
142. National <strong>Health</strong> Service:<br />
National Service Frameworks<br />
London: NHS, (1999)<br />
143. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H,<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office p79,<br />
(2001)<br />
144. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H,<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office p77,<br />
(2001)<br />
145. Huxley P, Thornicroft G, Social<br />
Inclusion, Social Quality And <strong>Mental</strong><br />
Illness, British Journal Of Psychiatry<br />
182 pp289-90, (2003)<br />
146. National <strong>Health</strong> Service:<br />
National Service Frameworks<br />
London: NHS p46, (1999)<br />
147. Singleton N, Lewis G. Better Or<br />
Worse: A Longitudinal Study Of <strong>The</strong><br />
<strong>Mental</strong> <strong>Health</strong> Of Adults Living In<br />
Private Households In Great Britain<br />
London: <strong>The</strong> Stationery Office p33,<br />
(2003)<br />
148. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H.<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office p77,<br />
(2001)<br />
149. Singleton N, Bumpstead<br />
R, O’Brien M, Lee A, Meltzer H,<br />
Psychiatric Morbidity Among Adults<br />
Living In Private Households, 2000<br />
London: <strong>The</strong> Stationery Office p78,<br />
(2001)<br />
150. <strong>Mental</strong> <strong>Health</strong> and Social<br />
Exclusion, Social Exclusion Unit,<br />
London: Office of the Deputy Prime<br />
Minister, p75, quoting Falkov A,<br />
Crossing Bridge: Training Resources<br />
for Working With <strong>Mental</strong>ly Ill<br />
Parents And <strong>The</strong>ir Children London:<br />
Department of <strong>Health</strong>/Pavilion,<br />
(2004)<br />
151. Prevention Of <strong>Mental</strong> Disorders<br />
Geneva: World <strong>Health</strong> Organisation<br />
p29, (2004)<br />
152. Every Child Matters: Change<br />
for Children – <strong>Facts</strong> And Figures,<br />
Department for Education and<br />
Skills (2003)<br />
153. Donovan N, Halpern D,<br />
Life Satisfaction: the State Of<br />
Knowledge And Implications for<br />
Government London: Strategy Unit<br />
p26, (2002)<br />
154. Prevention Of <strong>Mental</strong> Disorders<br />
Geneva: World <strong>Health</strong> Organisation<br />
pp22-24, (2004)<br />
155. <strong>Health</strong>y Body And Mind:<br />
Promoting <strong>Health</strong>y Living for<br />
People Who Experience <strong>Mental</strong><br />
Distress, National Institute for<br />
<strong>Mental</strong> <strong>Health</strong> In England, Leeds:<br />
NIMHE p4, (2004)<br />
156. Investing In <strong>Mental</strong> <strong>Health</strong>,<br />
Geneva: World <strong>Health</strong> Organisation,<br />
p11, (2003)<br />
157. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
<strong>Mental</strong> <strong>Health</strong>: New Understanding,<br />
New Hope Geneva: World <strong>Health</strong><br />
Organisation p8, (2001)<br />
158. Equal Treatment: Closing<br />
the Gap Interim Report of a<br />
Formal Investigation into <strong>Health</strong><br />
Inequalities, Disability Rights<br />
Commission, (2005), available<br />
at http://drc-gb.org/newsroom<br />
(accessed August 2006)<br />
159. Equal Treatment: Closing<br />
the Gap Interim Report of a<br />
Formal Investigation into <strong>Health</strong><br />
Inequalities, Disability Rights<br />
Commission, (2005), available<br />
at http://drc-gb.org/newsroom<br />
(accessed August 2006)<br />
160. Swinton, J. (2001) Spirituality<br />
and <strong>Mental</strong> <strong>Health</strong> Care:<br />
Rediscovering a Forgotten<br />
Dimension. London: Jessica<br />
Kingsley, cited in Culliford L,<br />
Spiritual care and psychiatric<br />
treatment: an introduction,<br />
Advances in Psychiatric Treatment<br />
8: 249-258, (2002)<br />
161. <strong>Mental</strong>ity – Adulthood (2004)<br />
available at www.library.nhs.uk/<br />
mentalhealth (accessed June 2006)<br />
162. Culliford L. and Powell A,<br />
Spirituality and <strong>Mental</strong> <strong>Health</strong>,<br />
Royal College of Psychiatrists,<br />
(2005), available at www.rcpsych.<br />
ac.uk (accessed June 2006)<br />
163. Foskett J, Marriott J, and<br />
Wilson-Rudd F, <strong>Mental</strong> health,<br />
religion and spirituality: Attitudes,<br />
experience and expertise among<br />
mental health professionals and<br />
religious leaders in Somerset:<br />
<strong>Mental</strong> <strong>Health</strong>, Religion and<br />
Culture, 2004, v. 7, no. 1, p. 5-22 in<br />
Cornah D. <strong>The</strong> impact of spirituality<br />
on mental health: a review of the<br />
literature, London: <strong>Mental</strong> <strong>Health</strong><br />
<strong>Foundation</strong>, (2006)<br />
164. Cornah D, <strong>The</strong> impact of<br />
spirituality on mental health: a<br />
review of the literature, London:<br />
<strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong>, (2006)<br />
165. Melzer D, Geographic<br />
variations in <strong>Health</strong> London: <strong>The</strong><br />
Stationery Office, (2002)<br />
166. Out At Work: Updates vol 3<br />
issue 16 London: <strong>Mental</strong> <strong>Health</strong><br />
<strong>Foundation</strong>, (2002)<br />
167. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
<strong>Mental</strong> <strong>Health</strong>: New Understanding,<br />
New Hope Geneva: World <strong>Health</strong><br />
Organisation, p43, (2001)<br />
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168. Well What Do You Think: <strong>The</strong><br />
Second National Scottish Survey Of<br />
Public Attitudes To <strong>Mental</strong> <strong>Health</strong>,<br />
<strong>Mental</strong> Well-Being And <strong>Mental</strong><br />
<strong>Health</strong> Problems, Scottish Executive<br />
(2004), available at www.scotland.<br />
gov.uk<br />
169. <strong>The</strong> World <strong>Health</strong> Report 2001<br />
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British Journal Of Psychiatry 184<br />
pp416-21, (2004)<br />
References<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
42
4.<br />
Treatment and care
TREATMENT AND CARE<br />
27%<br />
Percentage of people with a mental health problem who receive<br />
ongoing treatment 172<br />
How many people seek<br />
help and use services?<br />
• Over an 18 month period, 23% of people in Britain said<br />
they received some treatment or service, not necessarily<br />
provided by the NHS, for a mental health problem. 171<br />
• It is estimated that only about a quarter of people in<br />
Britain with a mental health problem receive ongoing<br />
treatment, either because they have not gone to the<br />
doctor at all, have been misdiagnosed by a GP, or have<br />
refused treatment. 172 In a 12 month period, 3% of all<br />
people with mental illness (whether treated or not) saw<br />
a psychiatrist and 2% a psychologist. 173<br />
• 85% of people with a psychotic disorder receive<br />
treatment. 174<br />
• Only 2 in every 5 people experiencing anxiety or a<br />
substance misuse problem seek help in the year of the<br />
onset of the disorder. 175<br />
• Almost 40% of drug users with a psychiatric disorder<br />
receive no treatment for their mental health problem. 176<br />
• Around three quarters of 5-15 year-olds with mental<br />
health problems are not in contact with child and<br />
adolescent mental health services. 177<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
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TREATMENT AND CARE<br />
30%<br />
Percentage of GP consultations related to mental health 178<br />
What treatment and care is available for<br />
mental health problems?<br />
Primary care<br />
• At the end of March 2006, around 19,000 people<br />
• Approximately 30% of all GP consultations are related to were receiving care from assertive outreach teams in<br />
a mental health problem. 178<br />
the community, usually because these people were<br />
reluctant to engage with other mental health services.<br />
• About 90% of people with mental health problems This represents an increase of 7% on the previous year. 184<br />
receive all their treatment from primary care services<br />
(as opposed to specialist mental health services), as do • 8,000 people received early intervention in psychosis<br />
at least a quarter of those with severe problems. 179 On treatment in 2005/06 (up from 4,600 in 2004/05) from<br />
average, a person with severe mental health problems 128 early intervention teams (compared with 109 in<br />
has 13 to 14 consultations per year with their GP. 180<br />
2004/05). 185<br />
Community care<br />
Community mental health teams now provide most local<br />
specialist mental health services.<br />
• <strong>Mental</strong> health nursing care is provided for 540,000<br />
people living in the community, and there are 2.1 million<br />
attendances a year at NHS day care facilities as well as 2<br />
million consultant outpatient attendances. 181<br />
• During 2005/06, crisis and home treatment teams<br />
provided 84,000 episodes of home treatment for people<br />
who would otherwise have been admitted to hospital. 182<br />
This was an increase from 69,000 in 2004/05, although<br />
the number of crisis resolution teams reduced to 266 in<br />
2006 from 343 in 2005. 183<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007 46
TREATMENT AND CARE<br />
1983<br />
82,000<br />
1999/00<br />
34,173<br />
2004/05<br />
31,667<br />
0 20 40 60 80 100<br />
Number of NHS hospital beds for mental health problems in England 186<br />
Hospital provision<br />
• <strong>The</strong> number of NHS beds for mental health problems in<br />
England was 31,667 in 2004/05. In 1999/2000 there were<br />
34,173 beds. 186 In 1983, there were 82,000 beds. 187<br />
• <strong>The</strong> NHS spent about £575 million on acute psychiatric<br />
in-patient hospital care in 2005/06, 188 about 68% of its<br />
budget for clinical mental health services.<br />
• In 2003/04, the average cost of a hospital bed was £225<br />
a day for an acute bed and £440 for intensive care. Costs<br />
of secure hospital care were £351 a day in low-secure<br />
units and £400 a day in medium-secure units. <strong>The</strong><br />
weekly cost of local authority residential and nursing<br />
care for adults with mental health problems was £496<br />
per person in England in 2004/05. 189<br />
• While the number of NHS adult mental health<br />
admissions fell by about 10% over four years to 122,260<br />
in 2002/03, the average length of stay per admission was<br />
stable at roughly 18-19 days. 190<br />
• Child and adolescent psychiatric units are unevenly<br />
distributed across England and Wales, with a<br />
concentration in London and the South East. More than<br />
a quarter of child and adolescent beds are now provided<br />
by the independent sector. 191 In 2002, 124 NHS Trusts<br />
were identified as providers of specialised child and<br />
adolescent mental health services – between them they<br />
had 732 teams and 7,340 staff. 192<br />
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TREATMENT AND CARE<br />
46% 46% 29% 29%<br />
Men<br />
Men<br />
Women Women<br />
Percentage of people detained in mental health units under the<br />
<strong>Mental</strong> <strong>Health</strong> Act 194<br />
<strong>The</strong> <strong>Mental</strong> <strong>Health</strong> Act (1983)<br />
<strong>The</strong> <strong>Mental</strong> <strong>Health</strong> Act (1983) is the principal Act governing<br />
the treatment of people with mental health problems in<br />
England, Wales and Northern Ireland. It covers all aspects<br />
of compulsory admission and subsequent treatment.<br />
• <strong>The</strong>re were 46,700 detentions under the <strong>Mental</strong> <strong>Health</strong><br />
Act (1983) in 2004/05. On 26,752 occasions the <strong>Mental</strong><br />
<strong>Health</strong> Act was used to admit a person to hospital (an<br />
increase from 25,642 in 1994/95). On almost 20,000<br />
occasions in 2004/05 the <strong>Mental</strong> <strong>Health</strong> Act was used to<br />
detain a person already admitted voluntarily to hospital<br />
in order to prevent them leaving, down very slightly<br />
from a decade earlier. 193<br />
• A mental health census in 2005 found that 46% of<br />
men and 29% of women in mental health units were<br />
detained under the <strong>Mental</strong> <strong>Health</strong> Act. 194<br />
• In 2005, 53% of compulsory admissions under the<br />
<strong>Mental</strong> <strong>Health</strong> Act to NHS hospitals were male, but at<br />
a given point in time there were almost twice as many<br />
men as women detained. <strong>The</strong> Office of National Statistics<br />
speculates that this could be due to a longer average<br />
period of detention for men or to more men being<br />
detained to prevent them leaving hospital following<br />
a voluntary admission, but notes these data are not<br />
collected. 195<br />
• <strong>The</strong> highest rate of detentions in 2005 was in London<br />
(134 people per 100,000) followed by the North West (93<br />
per 100,000). <strong>The</strong> East of England had the lowest rate (69<br />
per 100,000).<br />
• Research suggests that use of crisis plans, also known<br />
as advance statements or advance directives, drawn up<br />
jointly between professionals and patients can reduce<br />
the number of compulsory admissions under the <strong>Mental</strong><br />
<strong>Health</strong> Act by more than 50%. 196<br />
• <strong>The</strong> 2005 mental health ethnicity census found that<br />
people from ethnic minorities are more likely to be<br />
detained under the <strong>Mental</strong> <strong>Health</strong> Act. Inpatients from<br />
the Black Caribbean, Black African, and Other Black<br />
groups were more likely (by between 33% and 44%)<br />
to be detained when compared with the average for<br />
all inpatients. <strong>The</strong> rate of detention for inpatients from<br />
the Other White group was also slightly higher than<br />
average. 197<br />
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TREATMENT AND CARE<br />
27%<br />
Percentage of carers turned away when trying to access help 206<br />
Users’ experience of staff<br />
• Most service users are positive about the way they<br />
are treated by mental health staff. In one study three<br />
quarters rated their care as good, very good or excellent,<br />
compared with 9% who said it was poor or very poor. 198<br />
• 15% of people using mental health services say they do<br />
not have enough say in decisions about their treatment,<br />
while 44% say they only have a say to some extent. 18%<br />
say their diagnosis has not been discussed with them. 199<br />
Informal care<br />
• In the UK adults with mental health problems receive<br />
about 21 million hours a week of informal (unpaid) care<br />
from family and friends. 200<br />
• Up to 420,000 people in the UK care for someone with a<br />
mental health problem, 201 including between 6,000 and<br />
17,000 children and young people. 202 Including carers<br />
of people with dementia, estimates rise to around 1.5<br />
million. 31% of these are involved in caring for more<br />
than 50 hours a week. 203<br />
• A 2003 survey found that 75% of people who care for a<br />
person with a mental health problem are women, and<br />
the average age of carers was 62 years. <strong>The</strong> average age<br />
of recipients of care was 39 years, and 68% were male.<br />
44% cared for a person with schizophrenia and 9% for a<br />
person with bipolar disorder. 204<br />
• 29% of the 175,000 young carers in the UK are looking<br />
after people with mental health problems. 82% of young<br />
carers provide emotional support to the person they<br />
care for. 205<br />
• 27% of carers said they had been turned away when<br />
trying to access help for the person they care for. 206 56%<br />
cited an access related issue as the most frustrating<br />
aspect of dealing with mental health services. 207<br />
A quarter of carers felt they do not have sufficient<br />
information available. 208<br />
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TREATMENT AND CARE<br />
Counselling 82%<br />
Antidepressants 60%<br />
Exercise 76%<br />
Counselling 42%<br />
Alternative therapies 60%<br />
Exercise therapy 2%<br />
Antidepressants 52%<br />
0 20 40 60 80 100<br />
0 20 40 60 80 100<br />
Percentage of people prepared to try various treatments 210 Treatments prescribed by GPs for depression 210<br />
Treatment<br />
and coping<br />
• People with mental health problems report a variety<br />
of treatments and coping mechanisms as helpful, but<br />
one survey found that more than half weren’t given any<br />
choice of treatment. 209<br />
• According to an online survey by the <strong>Mental</strong> <strong>Health</strong><br />
<strong>Foundation</strong>, of those visiting their GP with depression,<br />
60% were prescribed anti-depressants, 42% were offered<br />
counselling and 2% were offered exercise therapy.<br />
<strong>The</strong> same survey found that 82% of people would be<br />
prepared to try counselling, 76% would be prepared to<br />
try exercise, 60% would be prepared to try alternative<br />
therapies, and 52% would be prepared to try antidepressants.<br />
210<br />
• Two surveys 211,212 of people with mental health problems<br />
found that useful techniques and coping strategies<br />
include:<br />
- Support from family and friends<br />
- Medication<br />
- Counselling or psychotherapy<br />
- Something worthwhile to do during the day<br />
- Peer support<br />
- Alternative therapies<br />
- Volunteering and working<br />
- Hobbies<br />
- Physical exercise<br />
- Advice from their GP<br />
- Spirituality and religion<br />
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TREATMENT AND CARE<br />
9.3%<br />
Percentage of prescriptions written for mental health problems 218<br />
• About half of people with mental health problems<br />
pay privately for treatments that are not prescribed,<br />
spending on average £61 a month. <strong>The</strong> most commonly<br />
paid for treatments are complementary therapies<br />
(63%), followed by counselling or psychotherapy (31%)<br />
and exercise (30%). 58% of people with mental health<br />
problems feel they miss out on treatment that would<br />
be helpful, the majority because they cannot afford<br />
it. <strong>The</strong> treatments most often cited as missed out on<br />
are counselling, psychotherapy and complementary<br />
therapies. 213<br />
Medication<br />
• A combination of therapies has been shown to be<br />
most effective in treating some common mental health<br />
problems. Guidance from the National Institute for<br />
<strong>Health</strong> and Clinical Excellence (NICE) states that a variety<br />
of psychological therapies, in addition to or instead of<br />
medication, can be helpful for managing anxiety 214 and<br />
depression, 215 and in some cases bipolar disorder 216 and<br />
schizophrenia. 217<br />
• In 2004, GPs wrote a total of 63.9 million drug<br />
prescriptions for mental health problems in England,<br />
representing 9.3% of the total prescriptions by volume. 218<br />
• Another survey found that 87% of people prescribed<br />
medication said they had not received enough<br />
information about the drugs they were given, and 86%<br />
said they were not warned of possible side effects. 219<br />
• Approximately 2 million people of working age in Britain<br />
are currently taking psychiatric drugs, most prescribed<br />
by their GPs. 220<br />
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TREATMENT AND CARE<br />
35% 55% 35% 55%<br />
Percentage of GPs who believe anti-depressants to be the most<br />
effective intervention for mild to moderate depression 225<br />
Percentage of GPs who believe counselling and psychotherapy to be<br />
the most effective intervention for mild to moderate depression 225<br />
Anti-depressants<br />
• In 2005, doctors wrote 29.4 million prescriptions for antidepressants,<br />
4 million more than in 2004. 221 <strong>The</strong> number<br />
of prescriptions written for anti-depressants has tripled<br />
since the early 1990s, after a newer class of drug called<br />
selective serotonin reuptake inhibitors (SSRIs) such as<br />
Prozac became available in the late 1980s. 222<br />
• NICE guidelines state that anti-depressants are<br />
not recommended for the initial treatment of mild<br />
depression because the risks may outweigh the benefits.<br />
Instead it recommends self-guided cognitive therapy<br />
or short courses of cognitive therapy with a therapist. 223<br />
NICE recommends that for severe depression a<br />
combination of anti-depressants and individual CBT<br />
should be considered as the combination is more costeffective<br />
than either treatment on its own. 224<br />
• Although 57% of GPs say that anti-depressants are<br />
over-prescribed, 55% use them as their first treatment<br />
response to mild or moderate depression. Only 35%<br />
believe they are the most effective intervention for mild<br />
or moderate depression, with 55% believing counselling<br />
and psychotherapy is the most effective intervention.<br />
More than three quarters (78%) have prescribed an<br />
anti-depressant in the last three years despite believing<br />
that an alternative treatment might have been more<br />
appropriate, most commonly because the alternative<br />
was not available or there was a long waiting list for it. 225<br />
• Female GPs and those with more years of GP experience<br />
are less likely to prescribe anti-depressants. 226<br />
• Unpleasant symptoms associated with anti-depressants<br />
often result in patients not continuing with medication.<br />
In one study, only 33% of patients completed ‘an<br />
adequate period of treatment.’ 227<br />
Anti-psychotics<br />
Anti-psychotics are used to treat symptoms of acute<br />
psychosis and to prevent further episodes. Anti-psychotics<br />
are generally divided into two classes: the older ‘typical’<br />
agents (neuroleptics) and the newer ‘atypical’ agents,<br />
mostly developed since the early 1990s. Atypicals usually<br />
have less distressing side effects, and the National Institute<br />
for <strong>Health</strong> and Clinical Excellence recommends they be<br />
prescribed for all new cases of schizophrenia. 228<br />
• 5.7 million prescriptions for anti-psychotic medications<br />
were written in 2005 at a cost of £210.9 million. 229 A<br />
further 163,600 long-acting anti-psychotic injections<br />
were prescribed, costing £5.2 million.<br />
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TREATMENT AND CARE<br />
20%<br />
Percentage of patients prescribed a dose of anti-psychotic medication<br />
above that recommended by the British National Formulary 235<br />
• Side effects of typical anti-psychotics may include<br />
shuffling and involuntary muscle twitches, jerks and<br />
spasms.<br />
• <strong>The</strong> side effects of atypical medication can include<br />
sedation, diarrhoea, constipation, muscle spasms, weight<br />
gain and heart problems, 230 and these frequently lead to<br />
people discontinuing treatment. 231<br />
• An audit study of prescription of anti-psychotic<br />
medication found that 20% of patients were prescribed<br />
a total dose of anti-psychotic medication above that<br />
recommended by the British National Formulary, a<br />
biannual manual that provides healthcare providers with<br />
information on choosing and prescribing medication. 232 .<br />
Sleeping and anxiety medication<br />
Minor tranquillisers and hypnotics, primarily<br />
benzodiazepines, are used to treat anxiety and sleep<br />
problems. <strong>The</strong>y are usually prescribed on a short-term<br />
basis due to their addictive nature. <strong>The</strong>se include<br />
benzodiazepines such as diazepam and hypnotics<br />
(sleeping pills).<br />
Mood stabilisers<br />
Mood stabilising medications are used to treat bipolar<br />
disorder. <strong>The</strong>y are usually taken long-term, even when<br />
a person is not experiencing an episode of mania/<br />
hypomania or depression.<br />
• <strong>The</strong> oldest mood stabiliser is lithium.<br />
• Anti-convulsant drugs developed to treat epilepsy are<br />
often used as mood stabilisers. <strong>The</strong>se include sodium<br />
valproate, carbamazapine, and lamotrigine.<br />
• Some anti-psychotic medications appear to be effective<br />
as mood stabilisers.<br />
• In 2005, 786,300 prescriptions for lithium were written at<br />
a cost of £1.6 million. 234<br />
• <strong>The</strong> Department of <strong>Health</strong> does not quantify the overall<br />
number of mood stabilisers prescribed, because most<br />
individual drugs are also used for other conditions. 235<br />
• 16 million prescriptions for hypnotics and anxiolytics<br />
(drugs for anxiety) were written in 2005, costing £38<br />
million. 233<br />
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TREATMENT AND CARE<br />
88% 88% 88% 67% 67% 67% 30%<br />
30% 30%<br />
Percentage of people who found<br />
talking treatments helpful 241<br />
Percentage of people who found<br />
anti-depressants helpful 241<br />
Percentage of people who<br />
found ECT helpful 241<br />
Talking <strong>The</strong>rapies<br />
Talking therapies or psychological therapies are based on<br />
the idea that talking to a trained therapist can help people<br />
better understand their thoughts and feelings and how<br />
they relate to their behaviour, mood and psychological<br />
wellbeing. Talking therapies can help people find ways<br />
to change their lives by acting and thinking in a more<br />
constructive or positive manner.<br />
• Clinical trials show that cognitive behavioural therapy,<br />
a form of psychotherapy, is as effective as medication<br />
in treating anxiety and depression. 236 <strong>The</strong> relapse rate is<br />
also lower once the treatment has ended. 237,238<br />
• When asked, people with mental health problems are<br />
most likely to cite access to psychological therapies,<br />
such as psychotherapy and counselling, as their highest<br />
treatment priority, 239 and the lack of it their biggest<br />
complaint. 240<br />
• <strong>The</strong> vast majority of those with experience of talking<br />
treatments rate them as helpful or helpful at times<br />
(88%), compared with 67% of those who had used antidepressants<br />
and 30% of those who had received ECT. 241<br />
• <strong>The</strong> National Institute for <strong>Health</strong> and Clinical Excellence’s<br />
guidelines on treatment of depression state that<br />
‘cognitive-behavioural therapy should be offered, as it is<br />
of equal effectiveness to anti-depressants’.<br />
• A majority (55%) of GPs believe that counselling<br />
and psychotherapy are the most effective strategies<br />
for treating depression. However, only 32% refer to<br />
them as their first treatment response. 242 This is often<br />
because they are not available, despite the government<br />
recommending that talking treatments ought to be<br />
made available for the treatment of most mental health<br />
problems. 243<br />
• Waiting times for psychological therapies are on<br />
average six to nine months, and can be as long as two<br />
years. <strong>The</strong>re is no target for reducing waiting times for<br />
psychological treatments. 244<br />
• Early psychological treatment can significantly reduce<br />
hospital admissions, GP visits and drug prescriptions. 245<br />
• Adding family therapy to medication for those with<br />
schizophrenia can reduce relapse rates by a half over<br />
both one year and two years. 246<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007 54
TREATMENT AND CARE<br />
Electroconvulsive <strong>The</strong>rapy<br />
• <strong>The</strong> National Institute for <strong>Health</strong> and Clinical Excellence<br />
recommends that electroconvulsive therapy (ECT)<br />
should only be used for the treatment of severe<br />
depressive illness or a prolonged or severe episode<br />
of mania or catatonia, to gain fast and short-term<br />
improvement of severe symptoms after all other<br />
treatment options have failed, or when the situation is<br />
thought to be life threatening. 247<br />
• Around 11,000 people a year receive ECT in England. 248<br />
• A 2002 Department of <strong>Health</strong> survey found that use of<br />
ECT had fallen since 1999. 249 More than twice as many<br />
women as men were given ECT, and that nearly half of<br />
people given ECT were aged over 65. 250<br />
• Nearly three quarters of people who were given ECT<br />
were informal patients (not detained under the <strong>Mental</strong><br />
<strong>Health</strong> Act). Of those patients that were detained, 60%<br />
did not consent to treatment. 251<br />
• A systemic review of patients’ experience of ECT found<br />
that at least one third of patients reported persistent<br />
memory loss. 252<br />
Psychosurgery<br />
• Neurosurgery for mental illness is occasionally carried<br />
out in the UK. <strong>The</strong> <strong>Mental</strong> <strong>Health</strong> Act Commission panel<br />
authorised seven operations in England and Wales in<br />
1999/2000, and two in 2000/01. 253 This compares to 23<br />
operations carried out in England, Scotland and Wales in<br />
1993. 254<br />
• Of 74 patients receiving psychosurgery, 12 were<br />
experiencing manic depression, 41 depression, 18<br />
obsessions, and 3 anxiety. Of 42 patients on whom data<br />
was available, doctors reported significant improvement<br />
in 12, some improvement in 22, no change in 6 and<br />
deterioration in 2. 255<br />
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TREATMENT AND CARE<br />
81%<br />
Percentage of patients who found exercise effective as a treatment<br />
for depression 261<br />
Exercise<br />
• Exercise has been shown to improve both physical and<br />
mental health for people with a range of mental health<br />
problems, including psychotic disorders, depression and<br />
anxiety 256 It can also help people with alcohol misuse<br />
problems and schizophrenia. 257<br />
• Studies have shown that exercise can be as successful at<br />
treating mild or moderate depression as psychotherapy<br />
or as medication. 258<br />
• <strong>The</strong> National Institute for <strong>Health</strong> and Clinical<br />
Excellence recommends that patients of all ages with<br />
mild depression should be advised of the benefits<br />
of following a structured and supervised exercise<br />
programme, typically up to 3 sessions per week of 45<br />
minutes to an hour for between 10 and 12 weeks. 259<br />
• Only 5% of GPs prescribe exercise therapy as one of<br />
their top three treatment responses to mild or moderate<br />
depression. 260<br />
• A <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong> survey found that a greater<br />
proportion of people who had tried exercise as a<br />
treatment for depression found it very or quite effective<br />
(81%) than found anti-depressants very or quite effective<br />
(70%). 261<br />
Alternative and complementary therapies<br />
<strong>The</strong> term ‘alternative therapy’ is used for therapies that<br />
offer alternatives to orthodox Western medicine. <strong>The</strong> term<br />
‘complementary therapy’ is generally used to indicate<br />
therapies that differ from orthodox Western medicine,<br />
and which may be used to complement, support, or<br />
sometimes, to replace it.<br />
• A survey found that of those who had tried alternative<br />
treatments, more than a third had to take the initiative<br />
and ask for it, and many had to pay for it themselves. 262<br />
• Herbal medicines, for example St. John’s Wort<br />
(hypericum), have been linked to the relief of mild to<br />
moderate depression. 263 <strong>The</strong>re is some evidence that<br />
traditional Chinese medicine may be a useful adjunct to<br />
orthodox medicine for the treatment of schizophrenia,<br />
particularly in alleviating distress and the side effects of<br />
traditional medication. 264<br />
• Acupuncture can have a positive effect for some people<br />
diagnosed with schizophrenia.<br />
• Reflexology has been shown to aid relaxation, relieve<br />
stress and restore energy. It can help to reduce the side<br />
effects of psychotropic medication and can moderate<br />
the highs and lows of mood swings. 265<br />
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TREATMENT AND CARE<br />
• Transcendental meditation, hypnotherapy, yoga,<br />
exercise, relaxation, massage and aromatherapy have<br />
all been shown to have some effect in reducing stress,<br />
tension and anxiety and in alleviating mental distress. 266<br />
• Massage has been shown to reduce levels of anxiety,<br />
stress and depression in some people. 267<br />
• Aromatherapy has been successfully used to reduce<br />
disturbed behaviour, to promote sleep and to stimulate<br />
motivational behaviour of people with dementia. 268<br />
• Artistic pursuits can help people with mental health<br />
problems feel better about themselves, fostering<br />
creativity, self esteem and social networks. One survey<br />
found that half of people with mental health problems<br />
felt better after becoming involved in the arts. 269<br />
• Bright light treatment and dawn simulation is effective<br />
in treating Seasonal Affective Disorder, and there are<br />
indications that it may be as effective as anti-depressants<br />
for treating non-seasonal depression. 270<br />
• Bibliotherapy based on cognitive behavioural therapy<br />
principles has shown results comparable to medication<br />
or psychotherapy for people with depression. In<br />
bibliotherapy, a therapist ‘prescribes’ a self-help book for<br />
a patient to either read between sessions or as a standalone<br />
therapy. Some studies show that recovery is faster,<br />
and that patients who have used bibliotherapy have a<br />
lower relapse rate. 271<br />
• Animal-assisted therapy involves the use of trained<br />
animals to help patients’ recovery. Also known as pet<br />
therapy, it has been shown to reduce short-term anxiety<br />
levels of psychiatric inpatients with a range of disorders.<br />
<strong>The</strong> calming influence of dogs has also been useful<br />
in psychotherapy, because of the ability to alert the<br />
therapist early to clients’ distress and the facilitation of<br />
communication and interaction. 272<br />
Nutrition<br />
<strong>The</strong>re is growing evidence that diet plays an important<br />
role in specific mental health problems including Attention<br />
Deficit Hyperactivity Disorder (ADHD), depression,<br />
schizophrenia and Alzheimer’s disease. A balanced mood<br />
and feelings of well-being can be protected by a diet that<br />
provides adequate amounts of complex carbohydrates,<br />
essential fats, amino acids, vitamins and minerals and<br />
water. 273<br />
• Research into nutritional and dietary medicine has<br />
demonstrated that food sensitivities may cause<br />
psychiatric symptoms, whilst a lack of folic acid has been<br />
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TREATMENT AND CARE<br />
Unequal intakes of Omega-3 and Omega-6<br />
fats are implicated in a number of mental<br />
health problems. 273<br />
associated with depression and schizophrenia and the<br />
supplementation of certain amino acids may relieve<br />
depression. 274<br />
• Among some young offenders, diets supplemented with<br />
vitamins, minerals and essential fatty acids have resulted<br />
in significant reductions in anti-social behaviour. 275<br />
Food and depression<br />
• A number of studies have linked the intake of certain<br />
nutrients with the reported prevalence of different types<br />
of depression. For example, correlations between low<br />
intakes of fish by country and high levels of depression<br />
among its citizens – and the reverse – have been shown<br />
for many types of depression. 276<br />
• Complex carbohydrates as well as certain food<br />
components such as folic acid, omega-3 fatty acids,<br />
selenium and tryptophan may help to decrease the<br />
symptoms of depression. Those with low intakes of<br />
folate, or folic acid, have been found to be significantly<br />
more likely to be diagnosed with depression than those<br />
with higher intakes.<br />
• Similar conclusions have been drawn from studies<br />
looking at the association of depression with low<br />
levels of zinc and vitamins B1, B2 and C. In other<br />
studies standard treatments have been supplemented<br />
with these micronutrients resulting in greater relief<br />
of symptoms in people with depression and bi-polar<br />
affective disorder, in some cases by as much as 50%. 277<br />
Other interventions<br />
• Studies show that there are benefits to involving<br />
families in the treatment of people with schizophrenia,<br />
depression, alcohol problems and childhood behaviour<br />
disorders. Helping to change the nature of family<br />
interaction in the home is associated with a reduced risk<br />
of relapse. 278<br />
• School-based interventions and parent training<br />
programmes for parents of children with behavioural<br />
problems can improve these children’s conduct and<br />
mental well-being. 279 Long-term, universal school mental<br />
health programmes, involving changes to the school<br />
culture, can also be effective, probably more than brief<br />
class-based programmes. 280<br />
• Home-based social support for pregnant women at high<br />
risk of depression improves the mental health of both<br />
mothers and children. 281<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007 58
171. Singleton N, Lewis G, Better Or<br />
Worse: A Longitudinal Study Of <strong>The</strong><br />
<strong>Mental</strong> <strong>Health</strong> Of Adults Living In<br />
Private Households In Great Britain<br />
London: <strong>The</strong> Stationery Office<br />
pxviii, (2003)<br />
172. Layard R, <strong>Mental</strong> <strong>Health</strong>:<br />
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5.<br />
<strong>The</strong> costs of mental<br />
health problems
THE COST OF MENTAL HEALTH PROBLEMS<br />
1 in 4 unemployed people has a common mental health<br />
problem 283<br />
Hidden cost<br />
• <strong>The</strong> ‘hidden’ costs of mental illness have a significant<br />
impact on public finances: it has been estimated that<br />
the costs of depression through lost working days are 23<br />
times higher than the costs to the health service. 282<br />
• 1 in 4 unemployed people has a common mental health<br />
problem. 283<br />
• Childhood mental health problems can have a<br />
significant economic effect on society. It is estimated<br />
that a child with a conduct disorder will, by the age<br />
of 28, have generated costs (such as to the health,<br />
education, benefits and criminal justice systems) ten<br />
times as high as a child without conduct problems. 284<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
65
THE COST OF MENTAL HEALTH PROBLEMS<br />
<strong>The</strong> economic and social cost of mental<br />
health problems is greater than that<br />
of crime. 286<br />
Overall cost<br />
• In 2002/03, the economic and social cost of mental<br />
health problems in England was £77 billion. 285 Updating<br />
these figures and incorporating estimates for Scotland,<br />
Wales and Northern Ireland, it is calculated that in the<br />
UK, the economic and social costs of mental health<br />
problems in 2003/04 was £98 billion (£17 billion on<br />
health and social care, £28.3 billion in costs to the<br />
economy and £53.1 billion in human costs).<br />
• <strong>The</strong> economic and social cost of mental health problems<br />
is therefore greater than that of crime (estimated at<br />
£60 billion for England and Wales in 1999/2000), 286 and<br />
larger than the total amount spent on all NHS and social<br />
services (£95.2 billion in the UK in 2003/04). 287<br />
• <strong>The</strong> World <strong>Health</strong> Organisation estimates that the cost<br />
of mental health problems in developed countries is<br />
between 3 and 4% of Gross National Product. 288 In the<br />
UK this is estimated to be 2% of GDP, 289 comprising the<br />
costs of public spending on health and social care and<br />
loss of paid work.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
66
THE COST OF MENTAL HEALTH PROBLEMS<br />
Support<br />
<strong>Mental</strong>ly disordered offenders<br />
Secure and high dependency<br />
Psychological therapies<br />
Personality disorder services<br />
Other professionals<br />
<strong>Mental</strong> health promotion<br />
Home support<br />
Direct payments<br />
Day services<br />
Continuing care<br />
Community <strong>Mental</strong> <strong>Health</strong> Teams<br />
Clinical services<br />
Carers’ services<br />
Accommodation<br />
Access and Crisis<br />
£43m<br />
£38m<br />
£142m<br />
£10.5m<br />
£86m<br />
£3m<br />
£91.5m<br />
£2.5m<br />
£150.5m<br />
£19m<br />
£384m<br />
£362m<br />
£369m<br />
£549m<br />
£660m<br />
£840m<br />
<strong>Health</strong> and social<br />
care costs<br />
0 200 400 600 800 1000<br />
Planned investment in services in England 2005/2006 292<br />
• £4.9 billion was spent on mental health services for<br />
adults of working age by the NHS and local authorities<br />
combined in England in 2005/06. This was the<br />
equivalent of £150 per head. 290 After taking account<br />
of estimated pay and price inflation, investment in<br />
these mental health services increased 3% in 2005/06<br />
compared to 9% in 2004/05. 291<br />
• <strong>The</strong> biggest increases in spending for 2005/06 reflect the<br />
Department of <strong>Health</strong> priorities for mental healthcare,<br />
and reinforce the trend over the past four years.<br />
<strong>The</strong>se are:<br />
• Assertive outreach – more than £100 million in 2005/06<br />
(less than £50 million in 2001/02)<br />
• Crisis resolution/home treatment – more than £155<br />
million in 2005/06 (£26 million in 2001/02)<br />
• Early intervention in psychosis – £42 million in 2005/06<br />
(less than £4 million in 2001/02.)<br />
• <strong>Mental</strong> health priorities have changed over the past five<br />
years. While there has been a 25% overall real growth<br />
in total investment over the period, actual increases in<br />
specific service areas vary widely. 293<br />
• In 2002/03, spending on mental health accounted for<br />
11.8% of all public expenditure on health and social<br />
services in England. 294 Using a comparable ratio for the<br />
UK, this implies total public spending on mental health<br />
care in 2003/04 of £11.2 billion, equivalent to £190 per<br />
head of the population. 82% was spent by the NHS and<br />
18% by local authorities.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
67
THE COST OF MENTAL HEALTH PROBLEMS<br />
Access and crisis services 117%<br />
Secure and high dependency services 100%<br />
Home support 54%<br />
Accommodation 20%<br />
Psychological therapies 14%<br />
Community <strong>Mental</strong> <strong>Health</strong> Teams 14%<br />
Continuing care 10%<br />
Clinical services 10%<br />
0 20 40 60 80 100 120<br />
Increases in investment between 2001/02 and 2005/06 295<br />
Staff costs<br />
• <strong>The</strong> cost of a consultant psychiatrist is estimated at £71<br />
per hour, or £216 per hour of direct patient contact.<br />
<strong>The</strong> cost of a community mental health nurse is £26<br />
per hour, or £71 per hour of direct patient contact. Each<br />
attendance at NHS day care facilities costs £29. 296 An<br />
average GP consultation costs £24. 297<br />
Private care<br />
• One study estimated that in England in 1996/97 private<br />
spending on counselling and related services was<br />
£108 million. Spending by mental health charities and<br />
voluntary organisations that was financed from private<br />
sources amounted to £12 million. This total of £120<br />
million corresponded to 2.1% of public spending on<br />
mental health care in the year concerned. 298<br />
Informal care costs<br />
• If the 21 million hours a week of informal (unpaid) care<br />
from family and friends of people with mental health<br />
problems was provided as paid work by nursing or care<br />
staff, it would cost £4.9 billion a year. This is equivalent to<br />
nearly half the cost of all mental health services provided<br />
by the NHS and local authorities. 299<br />
Voluntary sector<br />
• It is estimated that, in total, around 10% of all public<br />
spending on mental health services is now in the<br />
voluntary sector. 300<br />
• Residential care and supported housing accounts for<br />
about two thirds of this total, but the voluntary sector<br />
also supplies a wide range of other services. <strong>The</strong>se<br />
include: day care; home and community support<br />
services; employment, education and training; services<br />
for carers; and information, advice and advocacy.<br />
• <strong>The</strong> largest purchasers of mental health services from<br />
the voluntary sector are social services departments,<br />
accounting for almost two thirds of all contracts.<br />
• Independent and voluntary sector agencies also play<br />
a major role in the Supporting People programme,<br />
introduced in 2003 by the Office of the Deputy Prime<br />
Minister to support vulnerable people in their own<br />
homes. In 2003/04, around 40,000 people with mental<br />
health problems in England received assistance through<br />
this programme at a cost of £250 million and, of this<br />
total, over 80% was spent on support services provided<br />
by private and voluntary organisations. 301<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
68
THE COST OF MENTAL HEALTH PROBLEMS<br />
Hypnotics<br />
£38.3m<br />
Anti-psychotics<br />
£223.6m<br />
Anti-depressants<br />
£338.5m<br />
Dementia drugs<br />
£49.3m<br />
Substance dependence<br />
£83.3m<br />
0 50 100 150 200 250 300 350<br />
Cost of drug treatments in 2005 302<br />
Drug and talking therapy costs<br />
• <strong>The</strong> cost of drug prescriptions for mental health<br />
problems in England has risen rapidly over recent<br />
years, from £159 million in 1992/93, 303 to £540 million in<br />
2002, 304 and £854 million in 2004. Relative to the drugs<br />
bill as a whole, prescriptions for mental health problems<br />
represented 10% by cost. Anti-depressants accounted<br />
for 47% of total spending on drugs for mental health<br />
problems and anti-psychotics for 26%, with other<br />
formulations accounting for the remaining 27%. 305<br />
• In 1992, the cost of anti-depressant prescriptions<br />
dispensed in the community in England was<br />
£18.1million. By 2003, this had risen to £395.2million.<br />
This rise is linked to the introduction of SSRI (selective<br />
serotonin reuptake inhibitor) anti-depressants, such<br />
as Prozac, in the 1990s. <strong>The</strong>se drugs were both more<br />
expensive and more widely prescribed than other<br />
classes of anti-depressants. 306 <strong>The</strong> cost of prescribing<br />
SSRIs has fallen in recent years as branded drugs have<br />
become available as generic compounds.<br />
• NICE recommends short talking therapies such as<br />
cognitive behavioural therapy as an alternative or<br />
adjunct to anti-depressants. <strong>The</strong> cost of this is about<br />
£750 for 16 sessions of CBT. 307<br />
• In 2002 in England, expenditure on anti-psychotics<br />
was £165.3million. 308 In 2005, it was £223.6million. 309<br />
This increase reflects the impact of guidance from the<br />
National Institute for <strong>Health</strong> and Clinical Excellence on<br />
the new atypical anti-psychotic drugs for schizophrenia,<br />
which are much more costly than the drugs they<br />
replace. However, evidence from cost-effectiveness<br />
studies shows that these higher costs are more than<br />
offset by reductions in hospital inpatient stays, with<br />
savings estimated to average £1,000 per patient year. 310<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
69
THE COST OF MENTAL HEALTH PROBLEMS<br />
2001/02 £3.254bn<br />
2002/03 £3.709bn<br />
2003/04 £3.943bn<br />
2004/05 £4.52bn<br />
2005/06<br />
£4.904bn<br />
0 1 2 3 4 5<br />
Investment in <strong>Mental</strong> <strong>Health</strong> Services in England for working age adults 311<br />
Economic and<br />
social factors<br />
<strong>Mental</strong> health and employment<br />
• People with a common mental health problem<br />
aged between 16 and 74 years are more likely to be<br />
economically inactive (39%, compared with 28% of<br />
those with no mental health problem), and less likely to<br />
be employed (58%, compared with 69%). 312<br />
• Less than a quarter of people with a long-term mental<br />
health problem are employed, the lowest rate for any<br />
group of disabled people. 313 However, this group of<br />
people form a relatively small proportion of all the<br />
people who experience a mental health problem.<br />
(About three quarters of the overall working age<br />
population are in employment.)<br />
• Unemployment is even more prevalent among people<br />
receiving secondary mental health care. About one in<br />
ten people in psychiatric care has a job, and, typically,<br />
they earn two thirds of the average national hourly<br />
rate. 314<br />
• 35% of adults with long-term mental health conditions<br />
say they want to work (compared with 28% of those<br />
with other health problems). 315<br />
• People with mental health problems are at more than<br />
twice the risk of losing their jobs compared with the<br />
general population. 316<br />
• Of those people with mental health problems who<br />
have lost their jobs, 55% make unsuccessful attempts<br />
to return to work, and of those that do return, 68% have<br />
less responsibility, work fewer hours and are paid less<br />
than before. 317<br />
• Fewer than 4 in 10 employers would consider hiring a<br />
person with a mental health problem, compared with<br />
more than 6 in 10 who would hire a person with a<br />
physical disability. 318<br />
• Most employers who have employed people with<br />
mental health problems in a supported work placement<br />
would do so again, but few other employers would. 319<br />
• 7 in 10 managers have had experience of managing a<br />
staff member with a diagnosed mental health problem<br />
(50%) or a suspected mental health problem (20%). Less<br />
than a quarter felt they knew enough about managing<br />
someone with a mental health problem to handle it and<br />
deal with it ‘OK’. 320<br />
• A survey of people with mental health problems<br />
found that 67% had disclosed their condition to close<br />
colleagues, 61% had told their manager and 1 in 10<br />
had told everyone. 321 About 1 in 10 of those who had<br />
disclosed said colleagues made snide remarks, and 1 in<br />
10 reported that colleagues had avoided them.<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
70
THE COST OF MENTAL HEALTH PROBLEMS<br />
Service categories 2001/02<br />
(£m)<br />
2002/03<br />
(£m)<br />
2003/04<br />
(£m)<br />
2004/05<br />
(£m)<br />
2005/06<br />
(£m)<br />
Community <strong>Mental</strong> <strong>Health</strong> Teams 483 526 530 570 549<br />
Access and crisis services 170 203 254 316 369<br />
Clinical services 764 754 811 878 838<br />
Secure and high dependency 330 376 474 621 661<br />
Continuing care 349 372 380 404 384<br />
<strong>Mental</strong>ly disordered offenders 35 33 53 43 58<br />
Other community and hospital professionals 52 50 47 67 86<br />
Psychological therapies 125 142 143 149 142<br />
Home support services 59 63 70 108 91<br />
Day services 178 163 172 156 151<br />
Support services 37 47 43 43 43<br />
Carer’s services 10 11 15 18 19<br />
Accommodation 301 315 369 366 362<br />
<strong>Mental</strong> health promotion 6 3 3 2 3<br />
Direct payments 6 3 6 3 2<br />
Personality disorder services 0 0 1 4 10<br />
Investment in <strong>Mental</strong> <strong>Health</strong> Services in England for working age adults by category 322<br />
<strong>The</strong> cost of mental health problems at work<br />
• Stress, anxiety and depression accounted for a third of<br />
the 168 million working days lost in the UK for health<br />
and related reasons in 2004, translating to a cost of<br />
sickness absence of about £4.1 billion. 323<br />
• Each case of stress-related ill health leads to an average<br />
of 30.9 working days lost. 324 In a typical year, about 30<br />
times as many working days are lost through mental ill<br />
health as from industrial disputes. 325<br />
• Over 900,000 people in England are in receipt of sickness<br />
and disability benefits for mental health problems, more<br />
than the total number of unemployed people claiming<br />
Jobseekers’ Allowance. 326 <strong>The</strong> number of people claiming<br />
Incapacity Benefit because of mental health problems<br />
has almost doubled since 1995, 327 and makes up more<br />
than 40% of the total number of claimants. 328 However,<br />
almost half the people in contact with community<br />
mental health teams do not receive the full amount of<br />
welfare benefits to which they are entitled. 329<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
71
THE COST OF MENTAL HEALTH PROBLEMS<br />
Psychotic<br />
disorder<br />
%<br />
Any psychiatric<br />
disorder %<br />
No<br />
disorder<br />
%<br />
Living alone 43 21 15<br />
In rented accommodation 62 38 24<br />
With accommodation problems 49 48 33<br />
No educational qualifications 40 28 27<br />
Social class IV (partly skilled people) or V (individuals with no skills) 40 25 21<br />
Economically inactive 70 32 29<br />
Household income less than £200 a week 25 17 13<br />
Receiving Income Support 30 11 4<br />
With debt problems 33 24 9<br />
Any difficulty with activities of daily living 60 37 16<br />
Experience of violence within the home 37 16 4<br />
Experience of sexual abuse 31 9 2<br />
Severe lack of perceived social support 30 12 6<br />
Social isolation (two or fewer friends seen in last week) 55 30 22<br />
<strong>Mental</strong> health problems and personal and social factors among adults in England, Scotland and Wales 330<br />
Human costs<br />
• <strong>The</strong> human costs of mental health problems are<br />
estimated to be nearly five times as large as the costs of<br />
all mental health services provided by the NHS and local<br />
authorities, amounting to around £53 billion in the UK<br />
in 2003/04. 331 This includes the adverse effects of mental<br />
health problems on health-related quality of life and – as<br />
a major risk factor for suicide – on length of life.<br />
About half of people with common mental health<br />
problems are limited by their condition, and around a<br />
fifth are disabled by it. 332<br />
• In total, more than 40% of the World <strong>Health</strong><br />
Organisation’s ‘years lived with disability’ are caused by<br />
mental health problems or alcohol abuse. 333<br />
• <strong>Mental</strong> health problems are associated with a wide<br />
range of adverse personal and social problems. People<br />
with mental health problems are more likely than the<br />
rest of the population to live alone, have no educational<br />
qualifications, be economically inactive, and have a<br />
household income of less than £200 a week. <strong>The</strong>y are<br />
almost three times as likely to have debt problems, more<br />
than twice as likely to be receiving income support,<br />
more than four times as likely to have experienced<br />
sexual abuse, and twice as likely to report a lack of social<br />
support. <strong>The</strong> differences are even more stark among<br />
those with a psychotic disorder (for example, they are<br />
almost three times as likely to be living alone, five times<br />
as likely to report a lack of social support and more<br />
than fifteen times as likely to have experienced sexual<br />
abuse). 334<br />
• One in four tenants with mental health problems is in<br />
serious rent arrears and is at risk of losing their home. 335<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
72
THE COST OF MENTAL HEALTH PROBLEMS<br />
<br />
Less than 1% of the £4.9 billion spent by<br />
the NHS and local authorities in 2005/06<br />
on mental health for adults of working<br />
ages was earmarked for mental<br />
health promotion. 341<br />
<strong>Mental</strong> health promotion<br />
<strong>Mental</strong> health promotion involves any action to enhance<br />
the mental well-being of individuals, families, organisations<br />
and communities, recognising that everyone has mental<br />
health needs, whether or not they have a diagnosis of<br />
mental illness. <strong>Mental</strong> health promotion programmes that<br />
target the whole community will also include and benefit<br />
people with mental health problems. 336 <strong>The</strong> emotional<br />
and cognitive skills and attributes associated with positive<br />
mental well-being include feeling satisfied, optimistic,<br />
hopeful, confident, understood, relaxed, enthusiastic,<br />
interested in other people and in control. 337<br />
Examples of factors that promote well-being include:<br />
eating well, keeping physically active, drinking in<br />
moderation, valuing yourself and others, talking about<br />
your feelings, keeping in touch with friends and loved<br />
ones, caring for others, getting involved and making a<br />
contribution, learning new skills, doing something creative,<br />
taking a break, and asking for help. 338<br />
• Evidence shows that mental health promotion can<br />
contribute to the prevention of common mental<br />
health problems, for example anxiety, depression and<br />
substance abuse. 339 It can also contribute to health<br />
improvement for people whether or not they are at risk<br />
of mental illness, as well as for people living with mental<br />
health problems. 3340<br />
• Interventions to reduce stress in the workplace, to<br />
tackle bullying in schools, to increase access to green,<br />
open spaces and to reduce fear of crime all contribute<br />
to health gain through improving mental well-being,<br />
in addition to any impact they may have on preventing<br />
mental disorders. 341<br />
• Less than 1% of the £4.9 billion spent by the NHS and<br />
local authorities in 2005/06 on mental health for adults<br />
of working age was earmarked for mental health<br />
promotion. 342<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
73
THE COST OF MENTAL HEALTH PROBLEMS<br />
People with severe mental illness are<br />
more likely to be the victims than<br />
the perpetrators of violence. 344<br />
Violence and<br />
mental health<br />
<strong>The</strong>re is widespread public fear that people with mental<br />
disorder pose a significant risk of interpersonal violence,<br />
but research has shown that the degree of association<br />
between violence and mental disorder is small 343 and is<br />
accounted for by a small minority of patients. 344<br />
• People with severe mental illness are more likely to<br />
be the victims than the perpetrators of violence. 345 In<br />
one study 16% of people with psychosis living in the<br />
community had been violently victimised. 346<br />
• A third of people who committed homicide had a<br />
lifetime history of mental disorder, but in most cases this<br />
was not a severe mental illness. Most had not attended<br />
psychiatric services, and only 10% had symptoms of<br />
mental illness at the time of the offence. <strong>The</strong> most<br />
common diagnoses were personality disorder, and<br />
alcohol and drug dependence. 90% of the perpetrators<br />
were male. 347<br />
• 5% of all perpetrators of homicide in England and Wales,<br />
and 2% in Scotland, had a diagnosis of schizophrenia.<br />
9% of people convicted of homicide had a diagnosis of<br />
personality disorder. 348<br />
• 7% of people convicted of homicide in England and<br />
Wales, and 6% in Scotland, were committed to a<br />
psychiatric hospital. 349<br />
• <strong>Mental</strong>ly ill perpetrators were less likely to kill a stranger<br />
than those without mental illness. 350<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007<br />
74
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77
NOTES<br />
<strong>The</strong> <strong>Fundamental</strong> <strong>Facts</strong> 2007 78
About the <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
Founded in 1949, the <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong> is the leading UK charity working in<br />
mental health and learning disabilities.<br />
We are unique in the way we work. We bring together teams that undertake research,<br />
develop services, design training, influence policy and raise public awareness within one<br />
organisation. We are keen to tackle difficult issues and try different approaches, many of<br />
them led by service users themselves. We use our findings to promote survival, recovery<br />
and prevention. We do this by working with statutory and voluntary organisations, from<br />
GP practices to primary schools. We enable them to provide better help for people with<br />
mental health problems or learning disabilities, and promote mental well-being.<br />
We also work to influence policy, including Government at the highest levels. We use our<br />
knowledge to raise awareness and to help tackle stigma attached to mental illness and<br />
learning disabilities. We reach millions of people every year through our media work,<br />
information booklets and online services. We can only continue our work with the<br />
support of many individuals, charitable trusts and companies.<br />
To support our work, please visit www.mentalhealth.org.uk<br />
<strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong><br />
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© <strong>Mental</strong> <strong>Health</strong> <strong>Foundation</strong> 2007<br />
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