Mental wellbeing

Last updated: 2019-02-28 13:02:41
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1. Summary

Last updated: 28/02/19

2. Introduction

The World Health Organisation define Mental Health as ‘a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’. Mental health may also be referred to as ‘emotional health’ or ‘mental wellbeing’.

Mental health is more than the absence of mental illness. Everyone has mental health and it should be considered as a continuum or spectrum. Mental health is a combination of an individual’s experience and their ability to function as both an individual and as a member of society. An individual’s mental health is linked to their emotional, physical and social wellbeing. It is influenced by an individual’s sense of control, resilience, self-efficacy/confidence and social connectedness. The wider social, economic, cultural and environmental conditions are also known to impact on an individual’s mental health.

Mental health is influenced by a wide range of factors across the life course. It is important to consider the impact of poor mental health in children and young people, as this will influence the way in which they cope with key life events as they journey through life. Children and adults with positive mental health are better able to deal with stressful events, recover more quickly from illness and be less likely to put their health at risk.

Mental health problems are the largest single burden of disease in the UK. It has an impact on every aspect of life, including physical health and risk taking behaviour. Table 1 below highlights the financial cost of a range of mental health conditions in 2007 and the projected cost for 2026 (Kingsfund, 2008).

The life expectancy for individuals with a SMI 15–20 years lower than the general population (NHS England, 2016).This is mostly from preventable physical health problems such as cardiovascular disease and cancer. The associated risks include:

  • Health-risk behaviours (such as poor diet, physical inactivity and smoking)
  • Wider determinants (unstable employment and housing)
  • Poor access to physical health care and health promotion services (PHE, February 2018).

The impact of mental health problems may include: underachievement in education; bullying; family disruption; disability; offending and anti-social behaviour; placing demands on the family, social services, health services; schools and the youth justice system (DoH, 2012). Mental health problems not only cause distress to the individual, but also to those who care about them.  Failure to access adequate or appropriate treatment/support can increase distress for the individual, their families and carers and the wider community. The impact on children is likely to continue into adult life and impact on the next generation.

CYP who are raised by a parent with a mental health problem are more likely to develop a mental health problem. There is some evidence to support a hereditary factor with regards to mental health problems. However, it is also important to understand the impact a mental health condition can have on emotional attachment, parenting style, access to support services, stability and consistency. Some behaviours associated with a mental health problem may have a direct impact on CYP, including self-medication with alcohol and increased risk taking behaviours. Children growing up with a parent with a mental health condition are more likely to repeat the behaviours they were exposed to as a child. This impacts on the cyclical nature of adverse childhood experiences and mental health problems.

Other JSNA topics this topic closely linked to:

Suicide and self-harm

Employment

Alcohol misuse

Poverty

Illicit drug use

Looked after children

Domestic abuse

Offenders

Migrants

Armed forces community

Housing

Education

The above JSNA topics are those most closely linked to mental health. It should be noted that there are strong links between physical health, the wider determinants of health and mental health. As a result mental health will be an influencing factor across most of the local authorities JSNA topics.

Last updated: 28/02/19

3. Data and Intelligence

Prevalence and Incidence:

Children and Young People

The infographic (PHE, 2016) above details the facts about mental health illness in Children and Young People across England.

The proportion school age children in Stockton-on-Tees who have social, emotional and mental health needs is significantly higher than the national average (as shown below).

The table below shows the Percentage of School Children with Social, Emotional and Mental Health Needs compared against statistically similar local authorities. Stockton-on-Tees has the 5th highest percentage of school pupils with social, emotional and mental health needs.

School pupils with social, emotional and mental health needs:% of schoolpupils with social, emotional and mental health needs (school age) 2018

The recent SHUE survey completed by year 8 (age 12/13) and year 10 (age 14/15) pupils across the borough, reflects the national data. The summary of the responses indicate:

  • A 4% reduction in determination to overcome adversity %)
  • A 3% reduction in high reported resilience
  • A 4% increase in low reported resilience
  • A 3% reduction in the number of pupils scoring highly on the Warwick and Edinburgh Mental Wellbeing Scale (high scores are indicative of positive mental health)
  • A 2% increase in number of pupils scoring a low score on the Warwick and Edinburgh Wellbeing Scale (low scores are indicative of poor mental health)
  • A 6% reduction in the ability to deal with feelings of worry

Depression and anxiety

(Mental Health and Wellbeing JSNA – area profiles, Fingertips 10/12/18)

The above profile shows that Stockton-on-Tees has a significantly higher incidence (the number of new cases within a given timescale) and prevalence (the total number of individuals that are suffering from depression) of depression than both the regional and national averages. This figure is also supported by the depression and anxiety prevalence from the GP Patient Survey.

There are many factors that influence the prevalence of mental health problems such as depression and anxiety (as listed in section 4). Some of the factors are influenced by social determinants. Individuals who are affected by poverty are more likely to develop a mental health problem. This is then likely to be compounded by the impact of the mental health problem on employability and income, which entrenches poverty and increases the risk of mental health problems.

The graph above shows the percentage of individuals that have completed the IAPT treatment programme compared against the England average. The England average is continuing to improve and Stockton has moved from being above the national average to below the national average since quarter one of 2017/18.

Premature Mortality (including Suicide)

The chart below shows that there are more premature deaths in adults with a serious mental illness in Stockton-on-Tees than the England average.

The chart below shows the percentage of excess deaths in adults with a serious mental illness aged under 75’s. Stockton-on-Tees ranks third in England for excess under 75 mortality rate in adults with serious mental illness.

The graph below shows the suicide rate per 100,000 population for the borough of Stockton-on-Tees. The rate for 2013-15 and 2014-16 is higher than the national average. For the period 2014-16, Stockton-on-Tees had the 9th highest rate when compared against the England authorities.

The audit by the Tees Suicide Prevention Coordinator has identified three groups at higher risk of suicide:

Men aged between 35 and 44.

Main themes: a diagnosed mental health condition, recent involvement with the criminal justice system and substance misuse.

Men aged between 55 and 64

Main themes: Diagnosed mental health condition, financial issues and family issues or breakdown

Women aged between 45-54

Main themes: Bereavement & financial issues.

Further details on the audit can be found within the Suicide JSNA.

Dual diagnosis

Stockton-on-Tees has higher than the national average admission episodes for mental and behavioural disorders due to use of alcohol, as shown below:

However, the percentage of people in concurrent contact with mental health services and substance misuse services for alcohol is below both the regional and national average.

Last updated: 28/02/19

4. Which population groups are at risk and why?

Vulnerability to mental health problems:

Depending on the local context, certain groups in society may be particularly susceptible to experiencing mental health problems. The Adult Mental Health and Emotional Wellbeing Needs Assessment undertaken in 2017 identified at risk groups, risk factors and protective factors as:

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5. Consultation and engagement

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6. Strategic issues

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7. Evidence base

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8. What is being done and why?

Children and Young People

  • Children’s Services are currently reviewing smarter ways of working. Moving away from the current traditional approach to Children’s Services, toward a child centred whole system approach (family focused). With a view to offering a universal offer, a school offer and a personal offer to families and CYP.
  • HaST CCG commission TEWV to provide Child and Adolescent Mental Health Service (CAMHS), this service is open access and can support children up to the age of 18.
  • Review of CAMHS service to ensure it is meeting the needs of younger people. Mental Health - Crisis/Intensive Home Treatment Service provides a 24/7 service for Children, young People and families who are experiencing an acute mental health or emotional crisis which without the involvement of the Teesside CAMHS Crisis Team may increase immediate risk and result in an acute hospital or inpatient admission. The service provides a rapid response, offers prompt assessment within a maximum of 4 hours of a referral being received (with a 1 hour target), and where appropriate, intensive time limited interventions.
  • Future in Mind. The focus in has been on upskilling schools to identify needs and support children rather than to refer everyone to TEWV. The role of schools is of importance in the transformation of children’s mental health services.
  • Schools and colleges provide in-house support and may purchase additional support from providers such as Alliance.
  • The commissioning of the 0-19 service delivered by Harrogate and District NHS Trust including the provision of Family Hubs and school nurses.
  • Police Custody Appropriate Adult Service (Middlesbrough and Stockton MIND)

Depression and anxiety

  • Bereavement services – Cruse Bereavement Services is a charity dedicated to supporting bereaved people through one to one, groups or telephone support funded by Public Health.
  • Stockton Service Navigator Project - handholding support to access social prescribing services or Public Health commissioned services. The Navigator can help find an activity such as a walking group, creative arts group, exercise class or social group to support health and wellbeing. We can also signpost and support you to access other services such as the Citizens Advice Bureau, education providers, volunteering and job clubs.
  • Stigma and discrimination – pilot with Middlesbrough and Stockton Mind currently being undertaken working with employers, schools and members of the public.
  • IAPT (recent review and retender for service across the North East)
  • Recovery college – Hartlepool and East Durham Mind
  • Out patients – TEWV
  • Intensive Home Treatment team – TEWV
  • Social isolation and loneliness scoping document produced and being developed.
  • Integrated Mental Health Steering Group – with dedicated action plan to address many of the issues identified within the needs assessment and raised by the parties involved across the borough.
  • Crisis and prevention concordat Crisis and prevention concordat:
    • Police Force Control Room Mental Health Advisors
    • Mental Health Ambulance Service (regionally commissioned for 2019)
    • Street Triage Team
    • Custody-Court Liaison and Diversion
  • Voluntary and community sector organisations that support a range of individuals to improve their emotional wellbeing and mental health.

Premature Mortality (including Suicide)

  • Tees have a Suicide taskforce including the funded post of Tees Suicide Prevention Coordinator. The Tees Suicide Prevention Coordinator has been responsible for undertaking an audit of all recorded suicides over the last three years. The finding from this audit have identified three high risk groups.
  • Development of 6 stage Teesside Suicide Prevention Plan:
    • Reduce the risk of suicide in key high-risk group
    • Tailor approaches to improve mental health in specific groups
    • Reduce access to the means of suicide
    • Provide better information and support to those bereaved or affected by suicide
    • Support the media in delivering sensitive approaches to suicide and suicidal behaviour
    • Support research, data collection and monitoring.
  • STP Funding allocation. To be used to build upon the work already being undertaken including increased capacity for the Tees Training Hub. Also a community fund for local groups to bid for between £500 & £5000 to work with groups identified a high risk. Some funding to be spent on developing an algorithm to focus on early warning identification particularly considering the self-harm A&E pathway.

Dual diagnosis

  • Substance misuse – CGL commissioned service
  • IAPT services for mental health
  • More specific services for mental health conditions (Recovery College, Out Patients, Intensive home Treatment Team)
  • No single service for individuals with a mental health condition and an alcohol or substance misuse issue.
  • Mental Health Liaison (collocated with Arrest Referral drug and alcohol team in police custody)
  • In and out reach at Holme House Prison – Integrated Offender Management.
  • CGL (Change Grow Live) are the commissioned provider for working with adults, aged 18 years and over, who need support around with alcohol and substance misuse within the borough. They offer advice, information, assessments, treatment options, care and support.
  • TEWV and CGL are starting to work collaboratively. The early signs are promises with regards to patient engagement and progress.

Services impacting on all or multiples above

  • Tees Training Hub delivering free mental health training courses for frontline practitioners and line managers working in public, private and voluntary sector. A range of training is offered, including: Mental Health First Aid (adult and youth); Mental Health First Aid Lite; a Life Worth Living; and Applied Suicide Intervention Skills Training.
  • IAPT
  • Recovery College
  • Teesside Samaritans
  • Job Centre Plus
  • Citizens Advice
  • Stockton Information Directory
  • Stockton Welfare Advice Network
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9. What needs are unmet?

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10. What needs to be done and why?

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11. What additional needs assessment is required?

Children and Young People

Further work is required to identify the role of all agencies in the promotion of emotional wellbeing of CYP. It is not only the role, but the level of engagement with service that is difficult to establish. The services are currently fragmented across the 0-19 service, early year, the education system, CAMHS, GP’s and TEWV.

There is a lack of information and data relating to the overall engagement of children and young people with the range of services offered in relation to emotional wellbeing. Further work is needed to identify all of the agencies involved in the promotion of the emotional wellbeing within CYP.

Depression/ Anxiety

We need to establish why we have a high prevalence and incidence of depression within the borough. We should consider a range of factors including: diagnosis, treatment options, support, awareness of symptoms and access to services.

The links between socially isolation and loneliness are well documented. Further work is needed to identify the level of need within the borough, the impact this has on mental health, what services are currently available to support or are needed and identify appropriate interventions for prevention. This should be undertaken as a priority to minimise the impact of social isolation and loneliness across the life course.

Further work should be undertaken within the borough to reduce the stigma and discrimination associated with the proactive accessing of support services and to understand the impact of stigma and discrimination on physical and mental health.

Establishing the most appropriate offer for Social Prescribing in relation to prevention of mental health problems. Explore the possibility of social prescribing prior to prescriptions for depression and anxiety in conjunction with IAPT support services.

Individuals exposed to an ACE are more likely to develop a mental health problem. Work should be undertaken to unpick the issues with a view to treating the cause of any mental health condition, as opposed treating the symptoms. This is particularly important for parents in order to end the cyclical nature of ACE and mental health problems

Premature mortality

Further engagement and consultation with individuals with a serious mental health condition and interested stakeholders to gather views on the issues relating to accessing physical and mental health services, with a view to identifying appropriate intervention to minimise early mortality.

Considerations should be given to how services can be designed to maximise engagement of individuals with serious mental health illnesses to enable preventative interventions to take place. Some of the services that need to work as a whole system may include mental health, alcohol and substance misuse, smoking cessation, welfare support.

Dual diagnosis

Further engagement and consultation with individuals with a dual diagnosis and carers of individuals with a dual diagnosis. This should be undertaken to establish the current issues with the service provision and to establish the best course of action to address this issue in order to maximise the treatment options.

A gap has also been identified with regards to training of professionals in relation to understanding the long term impact of trauma and adverse childhood experiences.

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12. References

References

Department of Health/ NHS England, Future in mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing (2012) https://www.gov.uk/government/publications/improving-mental-health-services-for-young-people

Kingsfund ‘Paying the Price: The cost of mental health care in England to 2026’, https://www.kingsfund.org.uk/sites/default/files/field/field_publication_summary/executive-summary-paying-the-price-mental-health-may08.pdf.

Public Health England, Guidance- Wellbeing and mental health: Appling All Our Health (Updated February 2018) https://www.gov.uk/government/publications/wellbeing-in-mental-health-applying-all-our-health/wellbeing-in-mental-health-applying-all-our-health

Public Health England, The mental health of children and young people in England (2016) https://assetts.publishing.service.gov.uk/government/uploads/system/uploads/attachment-data/file/575632/Mental_health_of_children_in_England.pdf

https://www.thersa.org/action-and-research/rsa-projects/public-services-and-communities-folder/mental-health/long-life.html

NHS England. The Five Year Forward View for Mental Health – report from the Mental Health Taskforce. Leeds: NHS England Mental Health Taskforce; 2016.  https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

World Health Organisation: Information sheet Premature death among people with severe mental disorders http://www.who.int/mental_health/management/info_sheet.pdf

Glossary

Depression is a mental health problem characterised by persistent low mood and a loss of interest and enjoyment in ordinary things. A range of emotional, physical and behavioural symptoms are likely such as sleep disturbance, change in appetite, loss of energy, poor concentration, low feelings of self-worth and thoughts of suicide. Depressive episodes can range from mild to severe.Glossary

Generalised anxiety disorder (GAD) is an anxiety disorder characterised by excessive worry about many different things and difficulty controlling that worry. This is often accompanied by restlessness, difficulties with concentration, irritability, muscular tension and disturbed sleep.

Mental health problems – a wide spectrum, from distress to depression and loss of touch with reality, which may interfere with the ability to cope on a day to day basis.

Self-efficacy – an individual’s belief that they can be successful in undertaking a specific task.

Serious mental health illness – are the clinically diagnosed illnesses of schizophrenia, bipolar disorder and other psychosis. These may also be referred to as a significant mental health illness, significant mental health problem or severe mental health problem.

Social Capital - the network of social connections that exist between people, and their shared values and norms. 

Last updated: 28/02/19

13. Key contact

Name: Katie Slack

Job title: Health Improvement Specialist

Organisation: Public Health, Stockton-on-Tees Borough Council

Phone number: 01642 528802

Contributor/s: Daniel Maddison, Commissioning Lead, HAST CCG.

 

Last updated: 28/02/19

Email: katie.slack@stockton.gov.uk