Mental health equality in Great Britain

Today, the Equality and Human Rights Commission published a pre-publication draft of their report ‘Is Britain Fairer’ – a review on the state of equality and human rights in Britain. The current blog post will focus on the mental health sub-theme.

Key findings

Mental health and wellbeing

Across England, Wales and Scotland, women reported poorer mental health and wellbeing compared to men, disabled people reported poorer mental health wellbeing compared to non-disabled individuals, and those that identified as Lesbian, Gay, Bisexual, Trans (LGBT) reported poorer mental health and wellbeing compared to those that identified as heterosexual (for LGBT – England only).
People who experience homelessness are more likely to have mental health conditions, compared to the general population.
There are no official/robust figures for the number or prevalence of people in prison who have a mental health condition in England, Wales or Scotland.

Access and quality of services/therapies

Many people with mental health conditions do not have access to appropriate specialist care (e.g, access to perinatal services across Britain is poor – 40% have no access).
There is under-representation in the Improving Access to Psychological Therapies programme in England from ethnic minorities and older people.
The experience of individual inpatient care is currently not measured.

Immigration

Mental health provision for those in immigration detention is variable – from excellent in Scotland (e.g., Dungavel) to significant barriers reported in England and Wales.

Looked after children

In England, just under half (45%) of looked after children have a diagnosed mental health condition. Moreover, in Wales and Scotland, looked after children are at greater risk of experiencing poor mental health than children who have not been in care.

Deaths by suicide

28% of all deaths by suicide in the UK were of individuals who had been in contact with mental health services 12 months prior.

Restraint

In 2016/17 and in England, ethnic minorities (e.g., Black or Black British) were more likely (three times more) to have experienced restrictive interventions , compared with White British individuals.

Legislation

Black or Black British groups were four times more likely to be detained under mental health legislation, compared to those who identified as White (in 2016/17).

Conclusions

The Governments of England, Wales and Scotland have highlighted their commitment to establishing a parity of esteem between physical and mental health, and have implemented policies which represent steps towards this.

However, further work (including collection of reliable data collection and evaluation) needs to be conducted to ensure that all individuals, including those under protected characteristics (e.g., sexual orientation, ethnicity etc.) can access specialist treatment. Moreover, that the healthcare experiences of those under protected characteristics improves, as well as their mental health outcomes.

The full ‘Is Britain Fairer’ report can be accessed here, whilst the executive summary (shortened, concise version) can be accessed here. The report has been published in pre-publication form, and will be finalised following presentation to Parliament.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).

Access to mental health services for children and young people

Background

Improving access to and engagement with mental health services is a central tenant of the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme, which commenced in 2011. The Education Policy Institute (EPI) published their third report on mental health services for CYP on the 7^th October, with the current report focussing on access to services. The report is timely, as the CYP IAPT programme will become self-sustaining from 2019.

Which methods were used to obtain data for the report?

The EPI sent Freedom of Information requests to service providers (Child and Adolescent Mental Health Services; CAMHS) across England. In 2018, 90% of services and 73% of local authorities (e.g., county councils) returned information requested (Service: 54/60 providers contacted; Local authorities: 111/152). However, the data returned varied in terms of quality and extent (e.g., missing data points). The Institute also analysed data from the Mental Health Forward View Dashboard, which highlights performance against targets for Clinical Commissioning Groups (e.g., responsible for planning and funding health services for the local area that they look after).

What did the report find?

Access to mental health services for CYP

The number of referrals have increased in the last five years by 26%.
2% of referrals were rejected or were described as inappropriate – common reasons including the CYP did not meet the thresholds for treatment (i.e. the condition was not serious enough), or the condition was not suitable for intervention.
- Of the referrals rejected, most services signposted CYP to a more appropriate service.
- However, there was limited, or no follow-up after a referral was not accepted into CAMHS.
- 27/111 local authorities reported no longer providing services based on supporting early help (e.g., support for CYP with mild-moderate mental health problems), or support in schools.

Waiting times (2017-18)

The average median waiting time (maximum number of days in brackets) was 34 days (267) to assessment and 60 days (345) to treatment.

What were the limitations of the report?

The Education Policy Institute highlights that the quality of the data received, as well as official published data, should be treated with caution, due to the lack of standards for reporting data and missing data from CAMHS providers. The report also emphasised that it is also unclear how the Government is currently progressing on its commitment to increasing the CAMHS workforce, which is an important foundation to consider when analysing access to treatment for CYP.

In sum, the report highlights that CYP continue to experience difficulties in accessing treatment (e.g., referrals accepted, waiting times) and emphasise that greater attention needs to be paid to early intervention and prevention – to take ‘demand out of the system’ (p.30). To do so, policy makers could focus on a child poverty reduction strategy and ‘whole school’ (p. 31) approach.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).

Today is World Mental Health Day

History of the day

The 10th October each year marks World Mental Health Day, which has been observed since 1992. Each year, the day focusses on a particular issue surrounding mental health. In 2018, the theme for #worldmentalhealthday is Young People and Mental Health in a Changing World. It is hoped that the theme focus will demonstrate the importance of addressing the prevention, early intervention and adjusting the information and services available to support the mental health of young people (CYP; defined as those between 15-24 years old).

Why focus on Young People and Mental Health?

Worldwide, between 10-20% of CYP experience mental health disorders. Of those 10-20% of children, more than half of the disorders start before the age of 14, and up to three quarters by the mid-twenties. Within the UK, current efforts to further support the mental health of CYP are being addressed within a national programme to transform existing mental health services (the Children and Young People’s Improving Access to Psychological Therapies programme). Early intervention and prevention have also received an increased focus within the Green Paper for CYP mental health.

Resources to support your general wellbeing

A number of online resources are available to support your general wellbeing today, and beyond:

Action for Happiness – Ten keys to happier living
Charlie Waller Memorial Trust (resources)
NHS Choices Moodzone – tips for coping with stress, anxiety or depression
Mental Health First Aid (England) – toolkit to support young people’s wellbeing
Mental Health Foundation –Your mental health and Looking after your mental health
Mind – Tips for Everyday Living and Guide to Support and Services
Reading well – List of books for promoting the benefits of reading for health and wellbeing (endorsed by health professionals and supported by public libraries in England)
Rethink Mental Illness – Wellbeing and physical health
Students against depression
Student minds – Sources of support
Time to Change – About mental health

What to do in a crisis

If you or someone that you know is experiencing a life-threatening medical or mental health emergency:

Call 999 and ask for an ambulance (or ask someone else to call for you)
Go to A & E (or ask someone else to take you)

Urgent care, but not life-threatening

Call 111 (England)
Book an emergency GP appointment

Use the ‘I need urgent help’ tool offered by Mind.

Further information on what to do in a mental health crisis or emergency is provided by the NHS. Help for suicidal thoughts can also be found on the NHS website.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).