Mental ill health
Various different factors influence the development and course of mental illness, including
deprivation,...
Figure 1: Age-standardised death rates from mental and behavioural disorders (all ages)
in Barnet
Source: Office for Natio...
No. of people
aged 65-79
years
No. of people
aged 80 years
and over
No. of people aged
65-69 years with
dementia
(prevalen...
 identifying and acting on any common factors that there may be in people who are currently
receiving or who have recentl...
i
National Audit Office (2007). Improving services and support for people with dementia. National Audit
Office.
ii
Office ...
i
National Audit Office (2007). Improving services and support for people with dementia. National Audit
Office.
ii
Office ...
Upcoming SlideShare
Loading in …5
×

Mental Ill Health

904 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
904
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
10
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Mental Ill Health

  1. 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. 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. 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. 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. 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. 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.

×