1. Mental ill health
Various different factors influence the development and course of mental illness, including
deprivation, homelessness, unemployment, poor educational attainment, being a member of a
Black and minority ethnic group and being a lone parent or teenage mother.
Table 1: Estimated number of adults in Barnet suffering from mental health problems in Barnet
shows the estimated prevalence, based on national prevalence data derived from the Office for
National Statistics Psychiatric Morbidity Survey. ‘Neuroses’ are mental health conditions of all
types that are less severe in as much as the person affected by them is aware of their problem
and, despite their disability, has a good ‘grasp’ of reality. People who are psychotic are much
more severely mentally ill and are unaware that they have a problem. They often have little or
no grasp of reality, as the rest of the population would understand it.
Table 1: Estimated number of adults in Barnet suffering from mental health problems in
Barnet Source: London Health Observatory
Mental health problem Prevalence (%) Number of adults
affected in
Barnet
Mixed anxiety and depressive disorder 8.4 16,573
Generalised anxiety disorder 5.3 10,457
Depressive episode 3.6 7,103
All phobias 2.1 4,143
Obsessive compulsive disorder 1.6 3,157
Panic disorder 0.9 1,776
Psychotic disorders 0.4 789
People aged 65 years and over experience the sort of mental health problems listed in Table 1
to a similar extent to that of younger people. However, dementia becomes a bigger issue as
people get older. It affects some 6% of people aged 65 years and over and 20% of people aged
over 80 years. Whilst it remains a significant problem, the proportion of people with dementia is
unlikely to increase much in Barnet because of the likely change in the age structure of the
population.
Figure 35 shows that the all-age death rate from mental and behavioural disorder in Barnet is
relatively low (the death rate from cardiovascular disease in people aged under 75 years in
Barnet in 2007 was 75.7/100,000, for example). This includes deaths from all causes including
suicide and dementia. shows deaths from suicides and injury of undetermined intent. The rates
of both all mental and behavioural disorders and suicide vary from year to year because the
overall numbers are small; small changes in numbers can lead to a relatively large change in
rate.

2. Figure 1: Age-standardised death rates from mental and behavioural disorders (all ages)
in Barnet
Source: Office for National Statistics annual mortality data population estimates
Figure 2: Age-standardised mortality from suicide and injury of undetermined intent in
people aged under 75 years in Barnet Source: Office for National Statistics annual mortality
data population estimates
What is probably more significant is the likely increase in the number of people suffering from
dementia in the future. Dementia covers a range of progressive, terminal brain diseases that
seriously affects a person’s ability to carry out daily activities. The most common form of
dementia among older people is Alzheimer’s disease and involves the parts of the brain that
control thoughts, memory, language and ability to carry out daily activities and loss of bodily
functions.i
dementia predominantly affects older people: about 5% of those aged 65 years and
over will have dementia and some 20% of those aged 80 and over will do so. Dementia also
affects younger people, but the main risk factor for dementia is age, with the prevalence rising
as people get older. Other risk factors include cardiovascular disease and learning disability
such as down’s syndrome. Dementia accounts for 3% of all deaths in England and Walesii
and
the average time from diagnosis to death is 11-12 years, but people can live with dementia for
as long as 20 years.
Table 10 shows approximately how many people we can expect to have in Barnet with
dementia in 2008 and in 2013. If we fail to address vascular disease risk factors in the
expanding middles-age population, then we can expect proportionately more people with
dementia in the years after 2013.
Table 2 The current and projected numbers of people in Barnet aged 65 years and older
6
7
8
9
10
11
12
13
14
15
2004 2005 2006 2007
Age-standardisedmortality
rateper100,000
6
7
8
9
10
11
12
13
14
15
2004 2005 2006 2007
Age-standardisedmortality
rateper100,000
0
2
4
6
8
10
12
14
Male Female Person
Age-standardiseddeathrateper100,000
0
2
4
6
8
10
12
14
Male Female Person
Age-standardiseddeathrateper100,000

3. No. of people
aged 65-79
years
No. of people
aged 80 years
and over
No. of people aged
65-69 years with
dementia
(prevalence 5%)
No. of people aged
65-69 years with
dementia
(prevalence 20%)
2008 31,500 14,300 1,575 2,860
2013 34,600 15,400 1,730 3,080
Source of population data: Office for National Statistics
Another important risk that we face is that people with mental health problems tend to die
earlier than others, even taking suicide into account. People with mental health problems have
above-average rates of physical illnessiii
and death from natural causes in people with severe
mental health problems is 2.3 times higher than average – mainly due to disease of the
circulatory, digestive, endocrine, nervous and respiratory systems.iv
Higher death rates in
people with severe mental health problems reflect the greater prevalence of smoking and
people with severe mental health illness who also smoke are more likely to die of respiratory
disease (this risk is 10 times higher in people with schizophrenia.v
In addition to this, tobacco
smoke induces certain enzymes (i.e. makes them more active) and increases the metabolism
of a large number of drugs used in the treatment of mental health problems reducing their
benefit and – if this effect is recognised – requiring higher doses.vi
If we cannot enable people
with mental health problems to quit smoking then this particular health inequality will persist.
The relationship between diversity and deprivation and mental health problems
Disorders of mood (e.g. depression) and to a lesser extent thought disorders (e.g.
schizophrenia) are usually extremes of normal feelings and thoughts that are out of keeping
with the social norms of the sufferer’s society and culture. For example, most people
experience both anxiety and depression to some extent in certain circumstances, but when
such emotions significantly affect a person’s ability to function normally because of either or
both their intensity or duration, then this might become a clinical problem. It is particularly
noteworthy that schizophrenia is diagnosed more commonly in people of African Caribbean
origin than in people from other ethnic groups,vii
and that rates of suicide and of deliberate self-
harm are higher among young Asian women than in the White population.viii
It is not clear if this
is a genetic or a cultural issue. Some physical diseases are more common amongst people in
different ethnic groups, so it is not unreasonable to expect that this may apply to some mental
health issues. However, this may also be, in part, bound up in different cultural values and
beliefs, and whilst, say, diabetes is easy to diagnose with a blood test, the assessment of
someone’s mental health can be less clear-cut.
Local targets
There is currently a local target to reduce deaths from suicide in Barnet. However, as the
numbers of people killing themselves in an area as small as a London borough is quite small,
this local target is likely to become a London-wide one. However, there is still a need to
endeavour to reduce suicide and injury of undetermined intent, especially amongst people who
are currently receiving or who have recently received care from mental health services.
Key things that need to be done
The key activities required are:
 enabling more people with mental health problems to give up smoking;

4.  identifying and acting on any common factors that there may be in people who are currently
receiving or who have recently received care from mental health services and who attempt
or succeed in killing themselves;
 recognising that there will be an increased need for services to care for people with dementia
in the coming years.

5. i
National Audit Office (2007). Improving services and support for people with dementia. National Audit
Office.
ii
Office of National Statistics (2005) England and Wales – cause of death as sated on death certificates.
iii
Seymour L (2003) Not All in the Mind. The physical health of mental health service users. Radical
mentalities - briefing paper 2. London: Mentality
iv
Brown S, Inskip H and Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J
Psychiatry, 177: 212-217
v
Joukamaa, M, Heliovaara, M, Knekt, P et al. Mental disorders and cause-specific mortality. Br J Psychiatry
2001; 179: 498-502
vi
Bazire, S. Psychotropic Drug Directory 2003/04.Salisbury, UK: Fivepin Publishing
vii
Cochrane R & Sashidharan. Mental health and ethnic minorities: A review of literature and implications for
services in Ahmad W, Sheldon T, Stuart O; Ethnicity and Healht. NHS Centre for Review and
Dissemination, Social Policy Unit. Leeds, 1996
viii
Bahl, V. Mental illness: a national perspective. In Ethnicity: an Agenda for Mental Health. Bhugra, D and
Bahl, V. Gaskell, London, 1999.

6. i
National Audit Office (2007). Improving services and support for people with dementia. National Audit
Office.
ii
Office of National Statistics (2005) England and Wales – cause of death as sated on death certificates.
iii
Seymour L (2003) Not All in the Mind. The physical health of mental health service users. Radical
mentalities - briefing paper 2. London: Mentality
iv
Brown S, Inskip H and Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J
Psychiatry, 177: 212-217
v
Joukamaa, M, Heliovaara, M, Knekt, P et al. Mental disorders and cause-specific mortality. Br J Psychiatry
2001; 179: 498-502
vi
Bazire, S. Psychotropic Drug Directory 2003/04.Salisbury, UK: Fivepin Publishing
vii
Cochrane R & Sashidharan. Mental health and ethnic minorities: A review of literature and implications for
services in Ahmad W, Sheldon T, Stuart O; Ethnicity and Healht. NHS Centre for Review and
Dissemination, Social Policy Unit. Leeds, 1996
viii
Bahl, V. Mental illness: a national perspective. In Ethnicity: an Agenda for Mental Health. Bhugra, D and
Bahl, V. Gaskell, London, 1999.