Mental health and wellbeing
Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with mental health and wellbeing, 2016.
Mental health is a state of wellbeing in which individual potential can be realised. People with good mental health can cope with normal life stresses, work and contribute to the community. In contrast, mental illness refers to morbidity due to mental, neurological and substance misuse disorders and it affects more than 25% of people at any one time.
No other health condition matches mental illness in terms of prevalence, persistence and breadth of impact.
Who’s at risk and why?
There are a number of groups within the population that are at particularly higher risk of developing mental health problems, including:
- those who are unemployed
- homeless people
- people with a long term condition
- people from minority ethnic backgrounds and other minorities, such as people of a lesbian, gay, bisexual and transgender sexual orientation
- people who misuse substances
- asylum seekers and refugees
- victims and perpetrators of abuse and crime.
Risk factors for poor mental health are high in Leicester. Significantly higher than average numbers of people with depression are recorded in some of the most deprived areas in Leicester, such as Aylestone, Braunstone, Eyres Monsell, Freemen and Humberstone. However, recorded depression is lower than average in Belgrave, Rushey Mead, Spinney Hills, and Stoneygate.
Whilst these areas have similar rates of deprivation, they are characterised by a higher proportion of residents from Black and Minority Ethnic (BME) backgrounds than those areas where rates of recorded depression is higher.
Prevalence rates from national surveys show 16-18% of working age adults may experience a common mental health problem at any time. As people live longer, so protecting the mental health and wellbeing of older people will become more problematic.
The level of need in the population
Mental illness can affect people of all ages. It is estimated to affect between 3,500 and 5,250 children and 3,000 to 5,000 older people in Leicester. Locally, 34,000 -38,000 working age adults have a common mental health problem and a further 3,400 have a serious mental illness.
However, this level of prevalence does not fully describe the level of need in Leicester. This is because mental illness has a significant impact on many outcomes, increasing the level of need in the population.
In the case of children and young people, this includes poor educational achievement, a greater risk of suicide and substance misuse, antisocial behaviour, offending and early pregnancy. Poor mental health in childhood and adolescence can result in poor health outcomes in adulthood, including mental illness, unemployment, low earnings, marital problems and conduct disorder. The high level of factors associated with mental illness in Leicester can have a wide impact on the population.
Current services in relation to need
Leicester addresses perinatal maternal mental health through universal services such as GPs, midwives, health visitors and through specialist services. Child and adolescent mental health is addressed locally through a network of services, in the form of a tiered model of Child and Adolescent Mental Health Services (CAMHS), which saw 1,350 children in 2012-13. This is supplemented with other services.
To support student mental health, our universities offer student counselling and support. There are also various local services such as general practices (GPs), Open Mind Improving Access to Psychological Therapies (IAPT) and the Crisis Team, providing additional support.
For working age adults, there is a stepped care model of service provision, with Leicester showing a significantly higher number of total contacts with mental health services, but a significantly lower number of contacts with a Community Psychiatric Nurse and a significantly worse recovery rate for Improving Access to Psychological Therapies in 2011/12, than achieved in England as a whole.
There are also a number of specialist services and treatments, which support the stepped care approach to mental health. Some of these are:
- IAPT, which provides treatments for people with mild to moderate mental health problems at Steps 2 and 3 of the Stepped Care model.
- Mental Health Facilitators, offering a primary care based service to patients with more severe and enduring mental illness, such as schizophrenia or bi-polar disorder.
- The Crisis Resolution and Home Treatment team (CRHT), which cares for acutely ill people at home who would otherwise require hospital admission.
- Community Mental Health Teams.
There are a number of mental health services which are oriented to older people. Some of these are:
- local authority social services care
- meals on wheels
- day and respite care and funding for residential or nursing home care; primary care intervention
- old age psychiatry services.
Projected services use and outcomes in 3-5 years and 5-10 years
By 2020, the number of people aged 18-64 years, projected to have a common mental health disorder in Leicester is 35,207, rising to 35,292 by 2025. An 8% increase is anticipated by 2020 and a 10.8% increase by 2025. Other mental illnesses, such as personality disorder and psychoses, are also projected to increase over the next 10 years, but at a lower rate.
The population aged 65 years and over is projected by POPPI (Projecting Older People Population Information System), to increase from 40,200 in 2015 to 44,700 by 2020. Rates for the prevalence of depression and severe depression, applied to these population figures, suggest there are currently an estimated 3,455 people aged 65 and over with depression in Leicester and that this is projected to increase to 3,831 by 2020 and to 4,336 by 2025. So by 2020, there is a projected 12.7% rise in the number of older people with depression in Leicester, and a 27.5% rise in that group by 2025.
Currently, there are an estimated 1,091 older people with severe depression in Leicester, and it is estimated that this too will increase to 1,214 by 2020 and 1,392 by 2025; an increase of 11.3% and 27.5% respectively, on the 2014 figure.
Unmet needs and service gaps
In Leicester, there are fewer cases of diagnosed depression in working age adults than expected, higher rates of hospital admission for mental illness and worse than average outcomes. Commissioners should work to improve diagnosis of mental health problems in this group, tackling issues such as stigma and according parity of esteem between mental and physical health.
Commissioners should focus on prevention and early access to appropriate care. This means improving the capacity and capability of resources in primary care. Commissioners should also work with service providers, users and carers to develop resilience and recovery.
There needs to be more capacity for women with perinatal mental health issues to have timely access to specialised therapy. There is also a need to enable those professionals who regularly see women during and after pregnancy, to build therapeutic relationships with women as part of their preventative work.
There is a need to develop specialist care for transgender people. Commissioners should work with statutory and voluntary sector providers to address issues of access and outcome for people from minority communities.
Secondary mental health care for students is problematic. University counselling services aim to support students in their studies, however, there is some evidence, to suggest that they are used for more generic mental health support. Therefore there is probably a hidden mental health need amongst the student population.
There is a requirement for services to be flexible in response to student needs. This should be based on a strategic overview of the services which includes the main general practices consideration of how student counselling services fit into an integrated student mental health care framework.
In Leicester there is a need to ensure that mental health services for older people are commissioned on the basis of need, rather than focusing specifically on age or disease. The integrated approach between health, social care and voluntary and community sector services needs to be improved, to ensure that the mental health needs of older people are addressed as early and effectively as possible, including access to crisis care, psychiatric liaison in the Emergency Department and routes for safe discharge into the community.
There are different mental health needs across the diverse population of Leicester. Cultural perceptions about mental health can affect access to, and experience of, services. There is no single 'BME mental health problem'.
Recommendations for consideration by commissioners
Recommendations for commissioners include following the joint commissioning strategy on mental health in Leicester; and the recommendations of the Joint Specific Needs Assessment on Mental Health in Leicester.
- Mental Health Joint Specific Needs Assessment
- Leicester Health and Wellbeing Survey 2015
- POPPI: Projecting Older People Population Information
- PANSI: Projecting Adult Needs and Service Information