Mental and behavioural disorders

Mental wellbeing is the foundation for positive health and effective functioning for individuals and communities.  One in four people will experience mental health problems at some point during their life.

Mental ill-health is common with a significant impact on individuals, their families and the whole population. 22.8% of burden of disease in UK is due to mental disorder and self-reported injury compared to 15.9% for cancer and 16.2% for cardiovascular disease (WHO 2008).

The causes of mental illness are extremely complex – physical, social, environmental and psychological causes all play their part. The problems are unevenly distributed within the population and having mental ill-health further widens existing inequalities.  The impact of mental health problems has wide-ranging and long-lasting effects, including trans-generational impacts which occur more often in groups at higher risk.

Mental health conditions are strongly associated with socioeconomic deprivation.  The connection between rates of mental illness and other factors such as poverty, unemployment and social isolation is well established.

The cost of mental health problems to the economy in England is estimated to be £105 billion, and treatment costs are expected to double in the next 20 years (DH, 2011).
Employment opportunities for people with mental health problems in Middlesbrough are very limited and of those long term unemployed claiming incapacity benefit, two thirds have a mental health problem.

The mental illness needs index (MINI) for Middlesbrough, shows that there are significantly higher estimated needs than the national average with 11 out of 23 wards in the highest 20% of need and no wards in the lowest 20% of need.

Mental health needs in Middlesbrough are demonstrably higher than the national average.  The promotion and development of good mental health is essential to the human, social and economic development of Middlesbrough. The potential to promote good mental health lies with a number of agencies such as those responsible for housing, regeneration, social care, employment, leisure and health.

This topic is linked with:

Last updated: 2013-04-26 11:05:49
[+] Expand all

1. What are the key issues?

  • There is a high level of psychiatric illness.
  • There is a high level of social exclusion.
  • There are limited opportunities for people with mental health problems – thereby reducing social mobility and limiting life chances.
  • People with mental health problems are usually more deprived.
  • There are insufficient crisis beds and response services.
  • There are no personality disorder services.
  • There is low awareness and poor uptake of mental health promotion services.
  • There are limitations in the range of some specialist services locally.
  • Gaps exist in the range of rehabilitation and recovery elements including personalised specialist support.
  • There is limited access to services for high functioning autism in adults.
  • There are limited innovative creative lifelong support opportunities.
  • For people with challenging behaviour there is a lack of specialist complex dementia care.
  • There are limited opportunities to fulfil personal potential.
  • There are limited neuro-rehabilitation services for acquired brain injury (ABI).
  • In Middlesbrough, use of mental health beds varies widely depending on speciality. In both the 18-65 age group and the over 65 age group, bed usage is about half of the national average, whilst in child and adolescent mental health services (CAMHS) it is similar to the national picture.  For secure mental health bed usage, Middlesbrough is 33% higher than the national picture (NHS Comparators 2010/11).
  • Rates of prescribing of benzodiazepine-type medications are 40% higher in Middlesbrough than the national average (NHS Comparators 2010/11).


Last updated: 26/04/13

2. What commissioning priorities are recommended?

Increase access to talking therapies.

Implement “No Health Without Mental Health”.

Recognise mental health needs throughout the health and social care system, mental resilience, early intervention.

Improve physical health care for people with mental ill-health.

Improve awareness of safeguarding and risks.

Increase choice and control.

Implement personal health budgets in mental health.

Develop specialist autism services.

Improve comprehensive rehabilitation and recovery services based on the recovery model pathway.

Develop mental health promotion to combat stigma.

Encourage specific groups to come forward and access treatment and early intervention services, particularly men, black and minority ethnic communities and young people.

Commission specialist complex dementia care for people with challenging behaviour.

Implement the Multi-Agency Telecare Strategy for Middlesbrough.

Implement the National Dementia Strategy four priority areas:

  • Good quality early diagnosis and intervention for all.
  • Improved quality of care in general hospitals.
  • Living well with dementia in care homes.
  • Reduced use of antipsychotic medication.

Increase the proportion of people in contact with secondary mental health services who are in settled accommodation.

Improve meaningful employment opportunities for people in contact with secondary mental health services.



Last updated: 26/04/13

3. Who is at risk and why?

Mental health problems are more common in older people.  For older people it is estimated that 40% of GP attendees, 50% of Acute Hospital patients and 60% of care home residents have a mental health problem.

Depression affects 1 in 5 older people.  Dementia affects 5% of people aged over 65 and 20% of those aged over 80 (Mental Health Foundation, 2013)

About 10% of children have a mental health problem at any one time (Mental Health Foundation 2013b).

Women are more likely to have been treated for a mental health problem than men (29% compared to 17%) (Mental Health Foundation, 2013c).

Depression is more common in women than men. One in four women will require treatment for depression at some time, compared to 1 in 10 men (Mental Health Foundation, 2013c).

Women are twice as likely to experience anxiety as men. Of people with phobias or obsessive-compulsive disorder (OCD), about 60% are female (Mental Health Foundation, 2013c).

Boys are more likely to have a mental health problem than girls (Mental Health Foundation, 2013b).

Socioeconomic status
Unemployed people are twice as likely to have depression as those in work.  Only 24% of those with long-term mental health conditions are in work.

The Marmot Review (2010) shows the links between women who suffer from post-natal depression and those living in more deprived areas. Mothers who suffer from post-natal depression are one of the factors relating to children’s chances of doing well at school. The importance therefore of support in the early identification and support of post-natal depression and depressive illness is significant for both women and their children where deprivation is significant.

Rates of mental ill-health amongst some ethnic groups are estimated to be higher than the general population.

Other risks
People with drug and alcohol problems have higher rates of mental health problems.

Mixed anxiety and depression is the most common mental disorder in Britain (Mental Health Foundation, 2013e).

The UK has one of the highest self-harm rates in Europe: 400 per 100,000 population.  People with current mental health problems are 20 times more likely than others to report having harmed themselves in the past (Mental Health Foundation, 2013f).  See the suicide and self-harm topic for further details.

National statistics show that at least 1 in 4 people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time (DH, 2011).

Almost half of all adults will experience at least one episode of depression during their lifetime. DH 2011.

Nine out of ten prisoners have a mental disorder.

More than 70% of the prison population has two or more mental health disorders.  The suicide rate in prisons is almost 15 times higher than in the general population (Mental Health Foundation, 2013d).

Two-thirds of people with dementia never receive a diagnosis; the UK is in the bottom third of countries in Europe for diagnosis and treatment of people with dementia; only one-third of GPs feel they have adequate training in diagnosis of dementia.

Two-thirds of people in care homes have dementia; dependency is increasing; more than half are poorly occupied; behavioural disturbances are highly prevalent and are often treated with antipsychotic drugs.

About 180,000 people with dementia are on antipsychotic drugs in the UK.  In only about one-third of these cases are the drugs having a beneficial effect and there are 1,800 excess deaths per year as a result of their prescription.

Forty percent of people in acute hospitals have dementia; the excess cost is estimated to be £6m per annum in an average general hospital; co-morbidity with general medical conditions is high and people with dementia stay longer in hospital than those without.


Last updated: 26/04/13

4. What is the level of need in the population?

At any one time it is estimated that 19,900 people in Middlesbrough are suffering from a common mental health problem such as anxiety or depression.  Middlesbrough has significantly more adults with depression than England (14.3% and 11.7%, respectively) (NEPHO, 2013).

Prevalence of depression, Tees, 2010/11


A similar proportion of adults are diagnosed with dementia in Middlesbrough and England (0.5%).  However, this is only about 40% of the expected number of people with dementia in Middlesbrough (NEPHO, 2013).

Prevalence of dementia, Tees, 2010/11


There were 1,2000 people on mental health registers with serious mental illness in Middlesbrough in 2010/11.  The register includes all people with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses rather than all mental health problems.  The recorded prevalence in Middlesbrough is similar to the England and North East averages, and to a comparable area (Hull).

Prevalence of psychoses, Tees, 2010/11


The Community Mental Health Profiles (NEPHO, 2013) provide a comprehensive overview of mental health indicators at local authority level.  The spine charts below summarise the data for Middlesbrough.

Middlesbrough mental health spine char, part A

Middlesbrough mental health spine chart 2013 part B

Spine chart key

The Community Mental Health Profile for Middlesbrough can be found at the following


Clients receiving services
The number of clients with mental health problems receiving services in Middlesbrough has been increasing markedly in recent years (numbers are rounded to the nearest 5).

Number of clients aged 18-64 receiving services, Tees Valley, 2008/09 to 2010/11
Number of clients receiving service, Tees, 2008/09 to 2010/11

Source: NASCIS Information Centre - RAP P1

In Middlesbrough, about 60% of adults with mental health problems are living in settled accommodation, the lowest rate in Tees Valley and a decrease from 2009/10 (NASCIS).

Adults in contact with secondary mental health services in settled accommodation, Tees Valley, 2008/09 to 2010/11Adults in settled accommodation, Tees, 2008/09 to 2010/11

Source: NASCIS Information Centre

In Middlesbrough, a small proportion (4%) of adults in contact with secondary mental health services are in employment.  However, in Darlington and Redcar & Cleveland more than 10% are in employment.

Adults in contact with secondary mental health services in employment, Tees Valley, 2008/09 to 2010/11Adults in employment, Tees, 2008/09 to 2010/11

Source: NASCIS Information Centre

Residential and nursing homes
The number of people with mental health problems who are supported in residential and nursing homes has increased in Middlesbrough from 50 in 2008/09 to 60 in 2010/11 (numbers rounded to nearest 5).

Adults with mental health problems who are supported in residential and nursing homes, Tees Valley, 2008/9 to 2010/11Adults supported in residential homes, Tees, 2008/09 to 2010/11


Self-directed support and direct payments
In Middlesbrough, fewer clients receive self-directed support but more receive direct payment (not self-directed support) than the North East average.

Self-directed support and direct payments, Tees, 2009/10 to 2010/11

Number of clients receiving self-directed support and / or direct payments, Tees Valley, 2009/10 to 2010/11


Incapacity benefit
Incapacity benefit levels for mental illness in Middlesbrough are above both the England and North East averages.

Incapacity benefit for mental illness, Tees, 2009/10


Last updated: 26/04/13

5. What services are currently provided?

  • Increasing access to psychological therapies (IAPT)
  • Inpatient and community services for children and young people, adults and older people.
  • Crisis services
  • Rehabilitation and recovery services
  • Specialist secure services
  • Forwards team and employment support services
  • Living life recovery service
  • Early intervention in psychosis team
  • Psychiatric liaison services for Child and Adolescent Mental Health Services (CAMHS), Adult Mental Health (AMH) and Older People’s Mental Health (OPMH).
  • Care home liaison services
  • Memory clinics
  • Young onset dementia services
  • Carers support services
  • Dementia advisory service
  • Primary care mental health service
  • Assertive outreach service
  • Criminal justice liaison service (CJLS)
  • Supported housing services
  • Nursing and care home registered services


Last updated: 26/04/13

6. What is the projected level of need?

The North East Public Health Observatory has estimated future numbers of people with dementia (NEPHO, 2008).  In Middlesbrough, the number is expected to increase from 1,500 in 2010 to 1,800 in 2020.

Projecting Adult Needs and Service Information (PANSI, 2013) provides forecasts of numbers of people aged 18-64 years with mental health problems and early onset dementia.  In 2012, the forecast numbers were:

  • Common mental disorder – 13,900
  • Borderline personality disorder – 390
  • Antisocial personality disorder – 300
  • Psychotic disorder – 350
  • Early onset dementia – 35

In Middlesbrough, these numbers are broadly stable to 2020.

Projecting Older People Population Information System (POPPI, 2013) provides forecasts of numbers of people aged over 65 years with depression, severe depression and dementia.  In Middlesbrough, the following forecasts are made:

Forecast number of older people with mental health problems, Middlesbrough, 2012 to 2020





Change 2012 to 2020 (%)

People aged 65 and over predicted to have depression





People aged 65 and over predicted to have severe depression





People aged 65 and over predicted to have dementia








Last updated: 26/04/13

7. What needs might be unmet?

  • There is no comprehensive rehabilitation and recovery support pathway.
  • There are limited long-term innovative support opportunities.
  • Access to diagnosis and support for autism in adults is restricted.
  • There is an unmet need for specialist support for complex dementia care.
  • There are limited resources at tiers 1 and 2 in Child and Adolescent Mental Health Services.
  • There is a limited range of crisis provision.
  • There is a need for specialist inpatient and rehabilitation personality disorder services.
  • Access to all NICE accredited talking therapies across all tiers of mental health is required.
  • Some communities are poorly served by mental health support services.
  • There is a need for early detection and intervention for people with mental health problems accessing acute hospital services.


Last updated: 26/04/13

8. What evidence is there for effective intervention?

National Institute for Health and Clinical Excellence

Public Health Guidance

Social and emotional wellbeing in primary education (PH12)

Mental wellbeing and older people (PH16)

Social and emotional wellbeing in secondary education (PH20)

Promoting mental wellbeing at work (PH22)

Social and emotional wellbeing: early years (PH40)


Clinical Guidance

Eating disorders (CG9)

Self-harm (CG16)

Violence (CG25)

Post-traumatic stress disorder (PTSD) (CG26)

Depression in children and young people (CG28)

Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) (CG31)

Bipolar disorder (CG38)

Dementia (CG42)

Antenatal and postnatal mental health (CG45)

Attention deficit hyperactivity disorder (ADHD) (CG72)

Antisocial personality disorder (CG77)

Borderline personality disorder (BPD) (CG78)

Schizophrenia (CG82)

Depression in adults (CG90)

Depression with a chronic physical health problem (CG91)

Anxiety (CG113)

Psychosis with coexisting substance misuse (CG120)

Common mental health disorders (CG123)

Self-harm (longer term management) (CG133)

Service user experience in adult mental health (CG136)

Psychosis and schizophrenia in children and young people (CG155)


Quality Standards

Service user experience in adult mental health (QS14)


The Centre for Evidence-Based Health Care ( promotes the teaching and practice of evidence based health care (with emphasis on mental health) both in the UK and internationally.  The principal research groups are concerned with mood disorders, cognitive therapy, eating disorders, evidence-based medication, schizophrenia, suicide and deliberate self-harm.

The Cochrane Collaboration at ( provides a wealth of information on evidence-based interventions for mental health.

The Social Care Institute for Excellence ( shares knowledge about best practice and has a range of evidence-based guides on working with people who have mental ill-health.

In Control ( has published research to show that personal budgets and direct payments improve the lives of people with mental ill health by giving them choice and control over the services they receive.

The Commissioning Friend for Mental Health Services (NMHDU, 2009) outlines the challenges that commissioners of mental health services need to note:

  • Personalisation and personal budgets;
  • Improving quality;
  • Reduced budgets;
  • Commissioning in partnership (Health and Social Care);
  • Engagement of service users, carers and their families.

In summary, to improve mental health, there is a strong evidence base for:

  • Recovery-based interventions;
  • Early interventions using talking therapies;
  • Promoting employment and good quality housing; and
  • Personal budgets.



Last updated: 26/04/13

9. What do people say?

The Attitudes to Mental Illness 2011, Survey report (NHSIC, 2011) found:

  • Service users, carers and referrers report difficulties in accessing mental health services.
  • There is a lack of clarity of information from services.
  • Service users report feeling stigmatised by attitudes towards mental health conditions.
  • Carers and service users express concern about having to travel out-of-area for very specialist services.
  • The percentage of people agreeing that ‘mental illness is an illness like any other’ increased from 71% in 1994 to 77% in 2011, although this figure is little changed in recent years.
  • The percentage of people saying they would be comfortable talking to a friend or family member about their mental health rose from 66% in 2009 to 70% in 2011.
  • The percentage saying they would feel uncomfortable talking to their employer about their mental health was 43% in 2011, compared to 50% in 2010.
  • In 2010, participants reported significantly less discrimination from friends, neighbours, dating, education, family, finding a job, public transport, religious activities.
  • Concern has been expressed regarding the impact of changes to the benefits system.
  • People expressed desire for greater recovery-based optimism.
  • There should be greater comprehensive mental health awareness training for all front line staff.

NICE patient experience Service user experience in adult mental health (QS14)


Last updated: 26/04/13

10. What additional needs assessment is required?

Work is required to understand the range and capacity required of step down options from rehabilitation and recovery services to encourage people with a personal budget to live independently.


Last updated: 26/04/13

Key contact

Name: John Stamp

Job title: Mental Health and Learning Disability Lead


Phone: 01642 745091




Local strategies and plans



Crisis service review - 2010

Older persons mental health implementation plan - 2011


National strategies and plans


Department of Health (2011) No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages.

Time To Change national mental health anti stigma campaign. Commencing phase 2 of the campaign following the last 4 years which have shown a decrease in discriminatory attitudes and behaviour.

National Dementia Strategy – living well with dementia 2009

National autism strategy – working together for change 2010


Other references

Anxiety UK

Department of Health (2012). Dementia: News, information and conversations.

Marmot Review (2010). Fair Society, Healthy Lives.

Mental Health Foundation (2007). Fundamental Facts.

Mental Health Foundation (2013). Mental Health Statistics: Older People.

Mental Health Foundation (2013b). Mental Health Statistics: Children and Young People.

Mental Health Foundation (2013c). Mental Health Statistics: Men & Women.

Mental Health Foundation (2013d). Mental Health Statistics: Prisons.

Mental Health Foundation (2013e). Mental Health Statistics: The Most Common Mental Health Problems.

Mental Health Foundation (2013f). Mental Health Statistics: Self-Harm.


NHS Health and Social Care Information Centre (NHSIC, 2011). Attitudes to Mental Illness - 2011, Survey report.

North East Public Health Observatory (NEPHO, 2008). Mental Health Observatory Brief 3 - Estimating the Future Numbers of Dementia.

North East Public Health Observatory (NEPHO, 2013). Community mental health profile.

PANSI (2013). Projecting Adult Needs and Service Information.

POPPI (2013). Projecting Older People Population Information System.