People Living with Mental Health Problems

• Depression is the number one cause of disability worldwide. Anxiety disorders follow closely, at number six
• Mental ill health conditions affect around one in four people in any given year
• Estimated prevalence of common mental health disorders in SNEE (2017) was 15% (nearly 120,000)
• 1 in 6 people report experiencing a common mental health problem (like anxiety and depression) in any given week
• People with long-term conditions, including diabetes and heart disease, are two to three times more likely to have depression.
• People with more than four physical health conditions are nearly seven times more likely to experience mental ill health than people in good physical health.

• Mixed anxiety and depression have been estimated to cause one-fifth of days lost from work in Britain.

• SMI patients are more likely (1.3 x for female and 1.2 x for male) to have one or more of the physical health conditions –
• Patients aged 15 to 34 are 5 times more likely to have 3 or more physical health conditions and this health inequality reduces with age
• Research looking at the first recording of SMI diagnosis in primary care in the UK showed:
• Schizophrenia recording is more common in men than women
• Bipolar disorder recording is more common in women than men
• Other psychosis recording is more common in men than women

Most people who experience mental ill health as adults had a first episode before the age of 24.

Mental ill health in childhood can affect educational attainment and socialisation, further impacting adult life.

Children and young people with a mental disorder are more likely to be bullied and to bully others

Prevalence of emotional disorders increased with age and are more common in girls than boys

Behavioural disorders are the most common reason for referral of children and young people to child and adolescent mental health services – behavioural disorders were more common in boys and young men

Suffolk rates of self harm are increasing in 15-19 year olds, Essex rates are static

Young men are more likely to die by suicide than young women. There are no clear trends of suicide numbers in people aged under 25 and numbers are too small to be published

Healthwatch Suffolk research found

nearly a quarter (24%) of students with a mental health diagnosis said they self-harm

one in five students indicated that they had felt loved rarely or none of the time

• Survey data suggests that over the course of someone’s lifetime:
• 1 in 5 people have suicidal thoughts
• 1 in 14 people self-harm
• 1 in 15 people attempt suicide.

the true numbers are probably higher

• The number of people who self-harm or have suicidal thoughts is rising faster than the number of people experiencing mental health problems overall
• People reporting self-harm went up by 62% between the years 2000–2014 (that means it more than doubled)
• People reporting having had suicidal thoughts within the past year went up by 30% between the years 2000–2014
• Risk factors tend to relate to circumstances where people feel hopeless or trapped, or difficult life events, such as:
• a traumatic childhood or experiencing physical or emotional abuse,
• something upsetting or life changing such as a relationship ending or a loved one dying,
• misusing drugs or alcohol,
• living alone or having little social contact with other people,
• having a mental health condition such as depression
• self-harming,
• having a physical health condition, especially if this causes pain or
• serious disability,
• problems with work or money

• people living in financial hardship are at increased risk of mental health problems and lower mental wellbeing
• more deprived areas have a higher prevalence of SMI
• demonstrate the health inequality between the SMI and all patients is almost double for multi-morbid (2 or more) of the physical health conditions
• People who identify as LGBTIQ+ are between 2–3 times more likely than heterosexual people to report having a mental health problem in England
• 23% of Black or Black British people will experience a common mental health problem in any given week. This compares to 17% of White British people
• Over a quarter (26%) of young women aged between 16–24 years old report having a common mental health problem in any given week. This compares to 17% of adults. And this number has been going up
• Around 40% of people in England who face multiple disadvantage – problems including homelessness, substance misuse and contact with the criminal justice system in any given year also have a mental health problem

There is also a relationship between suicide rates and multiple disadvantage

 

“I want no wrong door to access services

I want as a mental health service user my voice to be listened to and respected

I want to be treated with dignity

I want professionals to remember I have my own feelings

I want to be given time

I want two-way communication

I want to be given options and choices about my own care

I want services to be delivered in a trauma informed way

I want to be involved in my care plan

I want to be involved in my discharge

I want no wrong door to access services

I want as a mental health service user my voice to be listened to and respected

I want to be treated with dignity

I want professionals to remember I have my own feelings

I want to be given time

I want two-way communication

I want to be given options and choices about my own care

I want services to be delivered in a trauma informed way

I want to be involved in my care plan

I want to be involved in my discharge

I want you to know that not everyone fits in a box

I want you to involve my family/parent carer

I want referrals from my GP to be taken as I need help

I want professionals to remember that I am behind that letter or email they are sending

I want professionals to keep me informed

I want the mental health service user voice to be listened to and respected

I want you to know that not everyone fits in a box

I want you to involve my family/parent carer

I want referrals from my GP to be taken as I need help

I want professionals to remember that I am behind that letter or email they are sending

I want professionals to keep me informed

I want the mental health service user voice to be listened to and respected

I want A&E staff to have training on mental health

I want a safe place in A&E when I am in crisis

I want the professional on the end of the telephone to be human

I want to be treated as you would like to be treated

I want mental health and wellbeing services to improve

I want you to remember I am an individual and have my own experiences.

I do not want to be prejudged by my diagnosis

I do not want to be rushed

I do not want to feel pressured to accepting something I am not happy with

I do not want to be discharged from services if I miss one meeting

I do not want to have services ‘Done’ to me

I do not want to have to reach crisis point before I am offered support

I do not want to keep telling my story over and over again

I do not want to be ignored as a family/parent carer

I do not want to wait hours in A&E when I am in crisis

I do not want to be told that I have capacity to end my own life

I do not want my support worker turning up late or not at all

I do not want to wait on hold for 111-2 for an hour or more when I am in crisis

I do not want to be picked up by the police if I am in crisis

I do not want to be told to stop raising my voice or swearing if I am in crisis (Unless it is directed at the

professional direct)

I do not want to have to jump through hoops for years until I receive the service I need

I do not want to have to ‘play the game’ to access services I need

I do not want to be classed as ‘Hard to reach/engage'”

The Race Equality Foundation’s literature review showed inequality and discrimination impacts across mental health services:

Access:

• Less likely to access mental health support in primary care and more likely to end up crisis care.
• Barriers: lack of knowledge of mental health care, different cultural attitudes or ideas about mental health, relationships with local healthcare practitioners, and institutional attitudes towards those with complex lives or needs.

Assessment:

• Poor physical health can lead doctors to focus on them even though some conditions are complicated by mental ill-health.
• Ethnic bias includes greater uncertainty by some clinicians in diagnosis of emotional problems and depression.

Treatment:

• Less likely to be referred to talking therapies and more likely to be medicated for ill mental health.
• The impact of racism and wider inequalities on their mental health is not sufficiently addressed.

Recovery:

• Traumatic, inappropriate and discriminatory experiences of services impact on chances for recovery.
• Eurocentric approach to recovery does not take a race equality perspective and external factors.

Gaps in evidence:

• More evidence is needed on the inequalities for Gypsy, Roma and Traveller communities; the Chinese community; and Eastern European ethnic groups including Slovak, Czech and Romanian.

The Centre for Mental Health is developing A coproduced approach to tracking young Black men’s experiences of community wellbeing and mental health programmes living in a predominantly white society:

• Feeling pressure to change your identity to fit into white-centric society.
• Feeling undervalued and unappreciated.
• Blackness: “As a Black man you have to protect your identity, otherwise no-one else will.”
• Constantly being a minority in every space being a negative feeling, which creates a constant state of “uncomfortability”.
• Always being expected to be strong, tough and to not talk about vulnerabilities or mental health.
• Always being watched and feeling unable to make any mistakes. “Failures [by Black men] are screamed out and accomplishments are whispered.”
• Feeling disappointed and disheartened by the lack of change. “I see the fanfare of equality and diversity, but at the end of the day nothing changes [at work].”
• Feeling sceptical and triggered by disingenuous support of Black Lives Matter by white people.
• Feeling hypervigilant and “paranoid of each other, which in itself is a mental health issue”.

Young Black men said they valued support which is empowering, embraces positive Black identity, strengthens strategies for dealing with racial trauma. improves connection and relationships, promotes personal ‘growth and evolving’, incorporates spirituality, improves awareness of mental health, and enables better access to resources, education and employment.

The Health Foundation highlights that for people with depression and/or anxiety:

• Almost three quarters have at least one other physical or mental health-related long-term condition; almost a third have 3 or more other long-term conditions.
• Chronic pain, hypertension and irritable bowel syndrome are particularly prevalent.

 

For people with anxiety and/or depression living in areas of higher deprivation:

• Additional long-term conditions are more likely.
• A&E visits and emergency hospital admissions are higher.
• Use secondary health care for mental health needs is relatively rare, but use of unplanned (emergency) mental health secondary health care is more likely
• This group has potentially higher levels of need but we do not see
  more primary care consultations or planned care (elective hospital
  admissions and outpatients appointments) as might be expected.

Recently published research by the Alzheimer’s Society found that approximately 40% of people with dementia have depression, but of referrals to IAPT only 0.2% are people with dementia – a lack of expertise in dementia may mean primary care is not referring everyone who could benefit from therapy, or lead to referrals being rejected by some IAPT services.

Recent research by Queen Mary University of London (reported in The Guardian) analysed data from almost 600,000 people over 19 years and found that of the 5,000 with dementia, the suicide
rate was similar to the general population – 2%. But:

• An increased risk of suicide was also seen among those who had a psychiatric condition.
• Those who were diagnosed with dementia before the age of 65 were at 2.82 times
  increased risk of suicide compared with those without the condition.
• In the first 3 months of younger people’s diagnosis, the risk was almost 7 times greater than those without dementia, though this did later reduce.

The Women’s Mental health Taskforce (2018) found:

Women’s roles: Role as parent not fully recognised. Childcare responsibilities impacted on women’s ability to attend appointments or services Reluctance to seek support – fear of not being seen as a fit parent and having child taken away.

Within mental health services: Lack of staff continuity impacted on developing trusted, supportive relationships. Inpatient services could be re-traumatising – disempowerment, restraint, observations, often by male staff. Lack of voice or control might echo previous experiences of abuse and coercive control.

In secure care settings: Services are primarily based on the needs of men. Women are often detained in higher security settings than necessary and often do not receive the right type of care.

Aftercare: Lack of ongoing support or aftercare, being “left to get on with it”  Struggles adapting after hospital discharge, including vulnerable women with limited support networks.

Minority ethnic women experiences: Imbalance of power between service users and providers, cultural naivety, insensitivity, discrimination, and language barriers. Additional barriers to accessing mental health support and services: recognising and accepting mental health problems, reluctance to discuss psychological distress and seek help, negative perception of mental health and social stigma, financial factors. These factors can impact on the relationship between service user and service provider.

The Mental Health Foundation highlights:

• Three times as many men as women die by suicide
• Men aged 40 to 49 have the highest suicide rates in the UK
• Higher rates of suicide are found in minority communities, including gay men, war veterans, men from ethnic minority backgrounds, and those with low incomes including middle-aged men with low incomes.
• Men report lower levels of life satisfaction than women, according to the Government’s national well-being survey.
• Men are less likely to access psychological therapies than women: only 36% of referrals to NHS talking therapies.
• Men are far more likely than women to go missing, sleep rough, become dependent on alcohol and use drugs frequently.

The All Party Parliamentary Group on issues affecting men and boys points out that men tend to talk about mental health less due to societal expectations and traditional gender roles – to be strong, in control, the breadwinner. Research suggests men who can’t speak openly about emotions are less able to recognise mental health symptoms, talk to friends and family, and seek help.

Rethink Mental Illness reported in 2021 the results of a survey of people severely affected by mental illness including schizophrenia, bipolar disorder and borderline personality disorder, finding:

• Eight in ten people reported that the fear of being stigmatised or discriminated against stopped them from doing things they wanted to do, including seeking help for a mental health problem (61%), disclosing their mental health condition to friends or family (69%) or applying for a job or promotion at work (61%).
• 88% agreed that discrimination towards people severely affected by mental illness is widespread in England.
• 67% of people agreed that levels of stigma towards more common health problems, which can be managed with the right treatment and support, had improved in the last ten years,
  but this had not extended to people severely affected by mental illness.

The report of the Care Quality Commission’s mental health survey 2022 states that people’s experiences of mental health services remain poor:

Positive results

Organising care

• 96% said that they knew how to contact the person that was in charge of organising their care
• 88% said that this person organised their care ‘quite well’ or ‘very well’.

Key areas for improvement

Communication

• 31% had not been told who is in charge of their care.
• 40% did not have a care review meeting with community mental health services in the last 12 months.

Accessing care

• 40% had ‘definitely’ seen services enough for their needs.
• 45% were not always given enough time to discuss their needs.

Key areas for improvement cont.

Crisis care

• 28% would not know who to contact out of office hours in the NHS if they had a crisis.
• 47%‘definitely’ got the help they needed

Involvement

• 44% ‘definitely’ agreed what care they would receive with NHS community mental health services.
• 51% were involved as much as they wanted to be in deciding which NHS talking therapies to use.

Support and wellbeing

• 40% did not receive support for their physical health needs, but would have liked it.
• 50% said that the person they saw understood how their mental health affected other areas of their lives.

Variations in experiences

• Younger people (18-35) reported worse than average experiences of care.
• People with challenging and chaotic non-psychotic disorders reported worse than average experiences.
• In contrast, those with a diagnosis of first episode psychosis consistently reported better than average experiences.
• People who received care via telephone reported worse than average experiences.

When we get ill: mental ill health 2022 – Healthy Suffolk

Mental Health, Dementia and Neurology – OHID (phe.org.uk)

How common are mental health problems? – Mind

Suicides in England 2021 (samaritans.org)

https://www.mentalhealth.org.uk/explore-mental-health/publications/tackling-social-inequalities-reduce-mental-health-problems

Suicide – Mental Health UK (mentalhealth-uk.org)

MHF-Prevention-report-2019.pdf (mentalhealth.org.uk)

Severe mental illness (SMI) and physical health inequalities: briefing – GOV.UK (www.gov.uk)

Suffolk User Forum – Keeping your teeth in mind – A guide for people experiencing psychosis and those who care for them