Introduction

Mental health is defined by the World Health Organisation (WHO) as a “state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”[i] Mental health is fundamental to our physical health, our relationships, our education and our work. There is no health without mental health.

This chapter considers the needs, evidence of effective interventions and treatment, and the current service provision for mental health problems in the adult and older people’s population and includes;

• Mental health risk factors
• Self-reported wellbeing
• Common Mental Disorders
• Serious Mental Illness
• Physical health inequalities and mental health problems

Mental health problems± impact on individuals, families, communities and society as a whole, with immense associated social and financial costs and is a contributing factor to the perpetuating cycles of inequality through generations. Mental illness is an important cause and consequence of social inequality. Mental health problems contribute a higher percentage of total disability adjusted life years (DALY)× in the UK than any other chronic illness[ii]. Recent estimates put the full cost of mental health problems in England at £105.2 billion[iii], and mental illness accounts for about 13% of total National Health Service (NHS) spend[iv].

The causes and influences of mental health problems are wide ranging and interacting. They are often associated with adverse events in our lives and other circumstances, such as poverty, unemployment, levels of supportive networks, levels of education and the broader social environment. These factors interact and affect how resilient we are in coping with these challenges.

Often mental health problems result in stigma and discrimination that makes it harder for those with mental health problems to live a normal life.

Mental health problems are classified as either Common Mental Disorders (CMD) or Serious Mental Illness (SMI).

For CMD the term covers a technical classification of six neurotic disorders and includes the following:

• Mixed Anxiety and Depression
• Generalised Anxiety Disorder
• Depression
• Phobias
• Obsessive Compulsive Disorder
• Panic Disorder

The majority of CMD is either anxiety or depression.

SMI disrupts a person’s perception of reality, their thoughts and judgement and affects their ability to think clearly. People affected may see, hear, smell or feel things that nobody else can. SMI sometimes referred to as a psychosis and includes conditions such as schizophrenia and bipolar disorder (formerly known as manic depression), paranoia and hallucinations[v].

There were approximately 510,000 people in Nottinghamshire aged 16 to 74 in 2014/15, of whom;

• 4.3 % experienced high levels of anxiety
• 7.9% experience both anxiety and depression
• 0.7% are known to GPs with a SMI.

In 2013/14 people known to mental health services in Nottinghamshire were over 3.7 times more likely to die before the age of 75 than the general population⁴⁶.

In 2014, Nottinghamshire County Health and Wellbeing Board approved the No Health without Mental Health Nottinghamshire Mental Health Framework for Action (FfA) 2014-2017. This FfA brings together the vision for improved mental health across the life course under the following five priorities;

1. Promoting mental resilience and preventing mental health problems
2. Identifying problems early and supporting effective interventions
3. Improving outcomes through effective treatment and relapse prevention
4. Ensuring effective support for those with mental health problems
5. Improving the wellbeing and physical health of those with mental health problems

Unmet needs and gaps

Unmet needs and service gaps where identified by applying the Public Mental Health conceptual model (Mental Health Promotion, Mental Illness Prevention and Treatment, Recovery and Rehabilitation against unmet needs and service delivery. This JSNA has identified that Nottinghamshire service delivery focuses on the mental health treatment, with very little emphasis on mental health promotion, prevention, recovery as well as addressing the needs of those with mental health problems and co-existing physical conditions.

The following unmet needs and service gaps have been identified and are aligned to the Nottinghamshire No Health without Mental Health Framework for Action – 2014/2017

• Accessing of mental health services is confusing and difficult to navigate and it is not always clear where to first turn for support. Signposting service information needs to be clearer and easy accessible.
• There is inequity in the offer of Social Prescribing being delivered in Bassetlaw District for +65 years only. Consideration is needed to expand the service across the County and to include adults and older people to offer social support to those at risk of mental or recovering from mental health problems
• Broader understanding of mental health needs and the relationship with physical health needs to be improved at all levels within commissioning and provision including in physical health JSNA chapters
• The gap in life expectancy between people with mental health problems and the general population needs to be reduced. This is an important priority for Nottinghamshire County Public Health and CCGs, and particularly with a focus on reducing smoking and improving identification of physical health problems early and improving access to LTC treatment to prevent emergency hospital admissions
• Care for people in mental health crisis is a partnership priority under the HM Crisis Care Concordat. More needs to done in preventing mental health problems and intervening early to prevent a mental health crisis
• As part of mental health recovery interventions access to employment is required to improve the employment rate for those in mental health services
• Assessing for mental health problems is not routinely undertaken by health and social care professionals. Make Every Contact Count (MECC) needs to be utilised to raise awareness of mental health problems and sign posting to mental health services when required
• Access to Mental Health First Aid training is not routinely offered to employers as a means to support those with mental health problems to remain in work or to support people in getting back to work.

Recommendations for consideration by commissioners

± The phrase ‘mental health problem’ mirrors the terminology used in the National Strategy. Therefore it is also used in this chapter as an umbrella term to describe the full range of diagnosable mental illnesses and disorders, including personality disorder.

× DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences:

[i] World Health Organisation (2005) Mental Health Action plan for Europe: Facing the challenges, building solutions. Copenhagen: WHO

[ii] World Health Organisation. The Global Burden of Disease: 2004. Update

[iii] Centre for Mental Health. The economic and social costs of mental health problems in 2009/10 Available online: http://www.centreformentalhealth.org.uk/pdfs/Economic_and_social_costs_2010.pdf

[iv] Parsonage, Naylor. Mental health and physical health: a comparative analysis of costs, quality and service cost effectiveness: London School of Economics, 2012

[v] NHS Choices. Psychosis. http://www.nhs.uk/conditions/Psychosis/Pages/Introduction.aspx