Today is World Mental Health Day, an opportunity to raise awareness of mental health issues and mobilise efforts to support it. To mark the occasion, we look at what the data tell us about the current landscape of mental ill health and care in England.
What’s the current picture of mental health?
Common mental disorders (CMD) are, as the name suggests, quite common, with one in six adults suffering from depression or anxiety. Since 2000, overall rates of CMD in England have steadily increased in women (now 1 in 5 women) and remained largely stable in men (1 in 8). Serious mental illness is much less prevalent (e.g. less than one in 100 adults had a psychotic disorder in 2014), but health outcomes are appalling: in 2013/14, under-75 mortality in people with a serious mental illness was 3.5 times that of the general population in England and this has been increasing year-on-year since 2009/10 (NHS Outcomes Framework, 1.5i).
There are a number of factors driving this excess premature mortality, including lifestyle behaviours, medication side effects and poorer access to physical healthcare. People with mental ill health use more emergency hospital care than those without mental ill health: in 2013/14, this was 3.2 times the A&E attendance and 4.9 times the emergency inpatient admissions, suggesting their physical health needs are less well managed (Dorning, Davies, & Blunt, 2015).
Furthermore, in the NHS Adult Inpatient Survey 2015, people with a mental health condition reported a less positive experience of inpatient care (19% rated their overall care experience 10 out of 10) than those without a mental health condition (27%). People with a mental health condition were less frequently involved in decisions about care or treatment (43% said they were definitely involved, versus 60% with no mental health condition) and a smaller proportion received an answer from the doctor that they could understand when they asked an important question (52% compared to 71% for people without a mental health condition).
Employment is also a driver of social gradients in mortality. In Q4 2015/16, there was a 34.2 percentage point difference in employment rate between people with and without a mental illness. This was a large improvement on the 44.8 percentage point gap in Q4 2006/07 but there is still a huge amount of progress to make.
According to the NHS Benchmarking Network, approximately 98% of users of mental health services receive care in specialist mental health community teams. In 2014 and 2015, roughly three-quarters of people asked about their use of community mental health services rated their overall care as at least 6 out of 10. Three-quarters also reported they been treated with respect and dignity by NHS mental health staff.
Crisis resolution and home treatment teams (CRHT) were mandated by the NHS in 2000, to offer an alternative to acute hospital admission. A recent report raises concerns about the appropriateness of such frequent use of CRHT, which saw three times as many suicides as in-patient settings. Many people who died by suicide had a history of drug or alcohol misuse, but few were in contact with specialist substance misuse services, highlighting that people are falling through the cracks in an over-burdened system.
What does the future hold?
There has been some progress this year, with the Five Year Forward View for Mental Health and accompanying guidelines on implementation. These set out plans for increased staffing and improved access to mental health services across crisis care, acute care and IAPT services and across children, teenage, expectant mother, and adult mental health. Evidently there is still a very long way to go in terms of improving outcomes for people with mental illness, but having a road map for this is the first step on the journey.
Reported rates of self-harming have increased across men and women and across age groups, but much of this increase is said to be due to greater awareness about the behaviour and improved reporting. Over time, stigma around mental illness is slowly being eroded. Each and every one of us has a role in continuing to break down these taboos, to raise awareness of the issues and push for more support for mental health, not just on 10th October each year, but every day.