One in four people in the UK will suffer a mental health problem in the course of a year (The Mental Health Foundation). The cost of mental health problems to the economy in England have recently been estimated at £105 billion, and treatment costs are expected to double in the next 20 years (Department of Health).
Mental Health is high on the government’s agenda. The strategy, ‘No Health without Mental Health’ was published by the Department of Health in 2011. The strategy takes a cross government approach with a focus on outcomes for people with mental illness. In 2016, NHS England published the Five Year Forward View for Mental Health (Independent Mental Health Taskforce, 2016) which makes the case for transforming mental health care in England. Its ambition is to deliver rapid improvement outcomes by 2020/21 through ‘ensuring that 1 million more people with mental health problems are accessing high quality care’ including the investment of an additional £1 billion in 2020/21.
Sustainability and Transformation Plans (STPs) will provide the local vehicle for strategic planning, implementation at scale and collaboration between partners. Implementing the commitments of the five year forward view for mental health will improve access and outcomes, deliver seven-days services, reduce inequalities and realise efficiencies across the local health and care economy and wider society. Mental health should be an intrinsic element of every STP – threaded throughout and not an afterthought.
The Prevention Concordat for Better Mental Health (2017) is a prevention focused approach to improving public mental health through using evidence based planning and commissioning to increase the impact on reducing health inequalities. The concordat promotes better mental health and uses preventative measures to promote positive mental wellbeing and halt mental ill health before it has the chance to take hold. Derby City Council is one of only six local authorities in England, in the first wave of signatories, to sign up to the Prevention Concordat for Better Mental Health. In signing up, the Council has set out several proactive and preventative objectives for 2018/19 in order to continue promoting better mental health for Council employees and the people Derby.
The local report, ‘State of Mental Health in Derbyshire’, summarises information on the state of mental health and wellbeing in Derby and Derbyshire in 2015. Data is presented from a range of routinely available sources, including from local providers of mental health services.
Locally, profiles and assessments of need are available to download below, which should be used to support commissioners of health and social care services in their decision making, leading to the improvement of mental health and mental health services.
Headlines in Derby City
- The recorded prevalence of depression in general practice registered adults is 9.0% which is similar to the national average.
- The recorded prevalence of severe mental illness is 0.91% of the general practice registered population. This is comparable with the national average.
- The rate of ESA claimants for mental and behavioural disorders is 36.1 per 1,000 working age population.
- Hospital admissions for mental and behavioural disorders due to alcohol are significantly higher than average at a rate of 181.7 per 100,000 population.
- Hospital admissions for self-harm are significantly higher than average.
- The mortality rate from suicide is similar to the rate for England.
Admission to hospital for mental and behavioural disorders due to alcohol: rate per 100,000 population, 2016/17 (Fingertips Public Health England, 2018).
There are a wide range of risk factors which contribute to a person’s vulnerability to mental disorder. A number of these mental health risk factors are elevated in Derby compared to the national average:
- Smoking at time of delivery (14.5% of mothers)
- Child poverty (24.9% of children aged 0-15)
- Excess weight in Year 6 (36.8% of children aged 10-11)
- Looked after children (76.5 per 10,000 <18 population)
- Children in need due to abuse, neglect or family dysfunction (75.2% of children in need)
- 16-18 year olds not in education, employment or training (4.8% of 16-18 year olds)
- First time entrants to the youth justice system (424.6 per 100,000 population aged 10-17)
- Socioeconomic deprivation (27.8 overall IMD score 2015)
- Living in 20% most deprived areas (34.6% of population IMD 2015)
- First time offenders (239.3 per 100,000 population)
- Re-offending levels (29.4% in 12 month cohort)
- Homelessness applications – total decisions made (6.9 per 1,000 households)
- Estimated prevalence of opiate and/or crack cocaine use (14.2 per 1,000 population aged 15-64)
- Excess weight in adults (65.1% of population aged 18+)
- Long-term health problem or disability (18.7% of population)
- Older people living in poverty (18.6% of population aged 60+)
Protective factors reduce the likelihood of poor mental health by offering resilience in the face of adversity. These protective factors in Derby fall below the national average:
- GCSEs achieved 5A*-C including English & Maths (44.8% of pupils)
- Enough physical activity (62.6% of adult population)
- Sports club membership (20.8% of population aged 16+)
- Self-reported well-being – high happiness score (70.4% of respondents)
- Self-reported well-being – high satisfaction score (78.2% of respondents)
There are a number of mental health and wellbeing services available to adults in Derby, including:
- Primary care
- Improving Access to Psychological Therapy (IAPT) e.g. Talking Mental Health Derbyshire
- Social care
- Hospital treatment
- Specialist mental health services (community and hospital-based)
- Early Intervention and Assertive Outreach teams
- Derby City Neighbourhood team
- Crisis resolution and home treatment team based at Radbourne Unit
There are a number of charities and national resources which provide mental health and wellbeing services and support, for example:
- Derbyshire Mind
- Every Mind Matters
Dementia is a debilitating neurodegenerative syndrome that predominately affects older people through brain structural and chemical changes due to physical diseases. There are several symptoms of dementia but characteristics comprise of deterioration in memory, reasoning and communication abilities, and this impacts on a person’s capability to conduct daily activities independently (Alzheimer’s Society, 2007).
It is calculated that one in every 79 people in the UK population has dementia, and this is represented as one in 14 people aged over 65 years old. As dementia advances, the symptoms will become more severe. There are many forms of dementia which adds to the complexity of understanding the disease however many factors, such as age, lifestyle, medical history and genetics, are believed to contribute together to the onset of dementia (Alzheimer’s Society, 2014).
The importance of further developments in the field, in terms of funding, research, care and services, have been highlighted by the growing aging population both in England and globally. The number of UK dementia cases is expected to increase by 40% to over one million by 2025 and by 156% to over two million by 2051. These increasing number of cases projected for the future may be altered by adult’s efforts to prevent and treat lifestyle conditions, such as obesity, hypertension, diabetes and high cholesterol, in order to preserve brain and body health and reduce dementia risk in later years of life. The aforementioned lifestyle related conditions are modifiable risk factors for dementia (Alzheimer’s Society, 2014).
Recent emphasis on dementia
The National Dementia Strategy for England was launched in 2009 by The Department of Health. The government outlined the five year Dementia Strategy spanning 2010 to 2015 and this Strategy focused on the quality of life for people with dementia and their carers. The Strategy key recommendations for improving dementia care services covered three broad themes: Raising awareness and understanding; Early diagnosis and support; Living well with dementia. The delivery of the Strategy was supported by an additional £150 million funding (Alzheimer’s Society, 2009).
In 2012, during the National Dementia Strategy delivery timeframe, the Prime Minister created the challenge of major dementia care and research developments by 2015. This was followed, and built upon, by the Prime Minister’s Challenge on Dementia 2020. This second challenge aimed to make England the world leading country of dementia care and support, and research (Department of Health, 2016). England has the Living Well With Dementia: a national dementia strategy which outlines improvements for dementia services and includes a focus on health inequalities.
In 2013, the world’s first G8 dementia summit was held in London and brought together ministers, researchers, pharmaceutical companies and charities. This event resulted in the ambition for a cure or a disease-modifying therapy for dementia by 2025 (Department of Health, 2014). The World Health Organization hosted the first Ministerial Conference on Global Action Against Dementia in 2015, which was partially supported by the UK, to bring together Ministers and dementia experts to discuss the worldwide problems of dementia (WHO, 2015). Dementia is a public health priority not only in England and localities but is a priority shared by many countries globally.
Dementia health indicators
Indicators associated with dementia that commissioners should be aware of, include an aging population, and lifestyle factors, including smoking, physical activity and healthy eating. Public Health England’s Dementia Profiles offer health intelligence with which to inform the provision of care of people who have dementia. Headlines for Derby include:
- More than 2,100 residents have been diagnosed with dementia
- 20.5% of eligible residents have received an NHS Health Check – promoting opportunities in mid-life to reduce the behavioural risk factors for dementia
- 33.5% of adult carers have as much social contact as they would like
- The directly age-standardised rate of admission to hospital in those aged 65 years and over with dementia, was 1,648 per 100,000 population in 2014/15
- 8.1% of residents with dementia died in their own home in 2014.