Staffordshire Joint Strategic Needs Assessment. Estimating current and future prevalence of mental health and learning disabilities in Staffordshire

Transcription

1 Staffordshire Joint Strategic Needs Assessment Estimating current and future prevalence of mental health and learning disabilities in Staffordshire Update: October 2011 Staffordshire Health Intelligence and Clinical Evidence Team

2 Contents Summary... 3 Mental health...3 Learning disabilities...5 Introduction Population projections Mental health Disease registers Support arrangements Mental health problems in adults aged Depression in older people Dementia Guardianship Suicide Drugs and alcohol Sexual abuse Learning disabilities Disease registers Support arrangements Estimates of children with learning disabilities Estimates of adults with learning disabilities Down s syndrome Autistic spectrum conditions (ASCs)

3 Summary People with mental ill health and learning disabilities face challenges and prejudice every day. They are more likely to be living in poverty, unemployed and are more likely to suffer from other ill health. The ageing population will have a significant impact on the number of people with mental ill health and learning disabilities. Therefore an understanding of the current and future profile of Staffordshire is important to allow for appropriate service planning and commissioning of health and social care services for populations with mental ill health and learning disabilities. Projections between 2010 and 2020 show there will be an overall 5% growth in the adult population for Staffordshire County. During this period there will be a 2% reduction in adults aged 18-64, but a significant growth in people aged 65 and over (29%), particularly in Tamworth (40.9%) and Lichfield (33.5%). Mental health Whilst most mental ill health is mild and self limiting and does not reach the level of diagnosis of a disorder, for a significant proportion of the population the effect of mental ill health is chronic and causes moderate disability and for some it can be a life long, severely disabling illness. At least one in four 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. Anxiety and depression affect the largest number of people and often occurs in conjunction with relationship and social problems, substance misuse or physical illness. In 2009/10 there were 4,700 people registered with a severe mental illness on GP registers across Staffordshire and 3,900 people with dementia. Levels of people with severe mental illness are lower than the England average. Levels of dementia recorded on GP registers in Newcastle are significantly higher than England. A comparison with the expected numbers of people with dementia shows that numbers on GP disease registers significantly under record the prevalence of dementia in the County. During 2008 there were 1,350 people aged with mental health problems who were helped to live at home. Around 120 were in supported residential and nursing care during the year. The number of people aged requiring support in future years will be similar. 3

4 In Staffordshire in 2010 it was estimated that: 13,000 people aged had depression, 83,800 people aged had a neurotic disorder, 22,500 people aged had a personality disorder and 2,000 people aged had a psychotic disorder with numbers in future years remaining similar. In 2010 it was estimated that 13,300 people aged 65 and over would have depression in Staffordshire. By 2020, these numbers are predicted to increase to 17,100. Around 4,200 people aged 65 and over were estimated to have had severe depression in 2010 rising in 2020 to around 5,500 people. In Staffordshire around 240 people aged are estimated to have early onset dementia with figures predicted to remain similar in future years. For people aged 65 and over in Staffordshire 3,600 men and 6,600 women were estimated to have dementia in By 2020 these numbers will have increased to 5,600 men and 8,800 women. In Staffordshire there were 14 people aged subject to guardianship as at 31 March Across Staffordshire there are around 40 suicides annually in people aged In Staffordshire around 11,500 men and 5,800 women aged are estimated to be dependent on illicit drugs with numbers predicted to fall slightly in future years. The number of drug misusers in effective treatment in 2010 was around 1,980. Numbers are predicted to remain similar in future years. In 2010 in Staffordshire, around 22,300 men and 8,400 women aged had an alcohol dependency disorder with numbers reducing slightly in future years. In Staffordshire in 2010, around 17,900 men and 40,600 women aged had been sexually abused during their childhood. By 2020 the number is predicted to reduce slightly to 17,600 men and 39,700 women. 4

5 Table 1 Current and projected numbers of selected mental health problems for people aged 18 and over in Staffordshire Common mental disorder (adults aged 18-64) 82,038 80,823 80,363 79,869 78,869 Borderline personality disorder (adults aged 18-64) 2,292 2,258 2,244 2,230 2,201 Antisocial personality disorder (adults aged 18-64) 1,790 1,767 1,760 1,753 1,739 Psychotic disorder (adults aged 18-64) 2,038 2,008 1,996 1,984 1,959 Depression (adults aged 65 and over) 13,297 15,559 17,118 18,812 20,788 Severe depression (adults aged 65 and over) 4,186 4,901 5,450 6,207 6,879 Early onset dementia (adults aged 45-64) Dementia (adults aged 65 and over) 10,196 12,099 14,413 17,365 20,625 Likely to commit suicide (adults aged 18-64) Dependent on illicit drugs (adults aged 18-64) 17,362 17,126 17,042 16,960 16,791 People aged 18 or over with a drug problem in effective treatment 1,976 2,033 2,080 2,129 2,180 Total population aged predicted to have alcohol 30,654 30,246 30,103 29,967 29,687 dependence Survivors of childhood sexual abuse (adults aged 18-64) 58,560 57,671 57,329 56,953 56,194 and Projecting Older People Population Information (POPPI) Learning disabilities Learning disability is one of the most common forms of disability and is a lifelong condition. It is acquired before, during or soon after birth and affects an individual s ability to learn. There is a joint commissioning strategy in Staffordshire for people with learning disabilities and a separate one specifically for autism. The all ages disability strategy is being written to cover people with learning disabilities of all ages and children with physical disabilities / sensory impairments up to the age of 18. The context for the development of this statement is move away from two distinct and separate approaches for children s & adults to ensure consistent outcomes for disabled people of all ages. These strategies are being used as the vehicles to deliver increased choice, control, rights and independence for all people with learning disabilities and on the autistic spectrum Staffordshire is continuing to undertake a significant modernisation programme for people with learning disabilities which includes re-provision of in-house residential services operated by Staffordshire County Council; a programme to 5

6 re-provide accommodation with support for individuals who have lived in NHS campus housing; a review of respite services in North Staffordshire and day opportunities across the County. We have adopted a person centred approach, based upon high quality person centred plans that are heavily geared towards promoting people to be in control of their lives by making their own choices about the way the want to live their life. The outcomes will ensure that people with learning disabilities are able to be in control and make decisions about how they live their life, and disabled children are able to develop in an environment which encourages personal growth and self determination. The key findings from the data show that: In 2009/10, around 2,600 people were recorded on a learning disability register across Staffordshire. The proportion of people recorded on learning disability registers in Staffordshire is similar to England with Cannock Chase having levels significantly higher than England. However comparison with expected numbers of people with learning disabilities show that numbers on GP disease registers significantly under record the prevalence of learning disabilities in the County. The number of people aged with a learning disability who have been helped to live at home during 2010 in Staffordshire was 1,860. A further 435 were estimated to be in supported residential and nursing care during the year. Numbers of people aged with a learning disability requiring support in future years will be similar. In 2010, between 2,400 and 5,700 children and younger people under 18 in Staffordshire were estimated to have a learning disability with numbers falling slightly to 2,200 and 5,200 by In 2010, 15,500 people aged 18 and over in Staffordshire were estimated to have some sort of learning disability, with numbers rising to 16,300 by In 2010, 3,200 people aged 18 and over in Staffordshire were estimated to have a moderate or severe learning disability and potentially in receipt of services. These numbers will increase slightly to 3,300 by In 2010, 732 people aged in Staffordshire were estimated to have severe learning disabilities, reducing slightly to 718 by In 2010, 990 people aged in Staffordshire were estimated to have a moderate or severe learning disability and living with a parent. 6

7 In 2010, 230 people aged in Staffordshire were estimated to have a learning disability and display challenging behaviour. This figure is predicted to be similar in future years. In 2010, 319 people aged in Staffordshire were estimated to have Down s syndrome, remaining similar in future. Around six people aged 65 and over will have Down s syndrome. Around 30 people aged 45 and over are predicted to have Down s syndrome and dementia in Staffordshire with numbers staying the same in future years. 7

8 The Staffordshire and Stoke on Trent Autism strategy document ( ) includes key priorities for action to address service gaps. It is about adults who fit the definitions of autistic spectrum conditions and young people over the age of 14. It includes specific services commissioned and mainstream services such as leisure, housing and education. The strategy and action plan reflect the four key themes of the national autism document Fulfilling and Rewarding Lives. 1. Training of staff who provide services for people with autism. 2. Identification and diagnosis of autism in adults 3. Planning in relation to the provision of services to people with autism as they move from children to adults 4. Local planning and leadership in relation to the provision of services for adults with autism. The key findings from the data show that: In 2010, 1,400 children aged 17 and under in Staffordshire were estimated to have autistic spectrum conditions. This number is predicted to remain similar in future years. In 2010, 6,600 adults aged 18 and over in Staffordshire were estimated to have autistic spectrum conditions. This number is predicted to remain similar in future years. In 2010, between 960 and 3,800 children aged 17 and under in Staffordshire were estimated to have learning disabilities and autistic spectrum conditions. In 2010, between 3,100 and 5,100 adults aged 18 and over in Staffordshire were estimated to have learning disabilities and autistic spectrum conditions. 8

9 Table 2 Current and projected numbers of selected learning disabilities for people aged 18 and over in Staffordshire Learning disability (adults aged 18 and over) 12,349 12,189 12,127 12,078 11,973 Moderate or severe learning disability (adults aged 18 and over) 2,773 2,746 2,751 2,775 2,787 Severe learning disability (adults aged 18-64) Moderate or severe learning disability and be living with a parent (adults aged 18-64) ,002 Learning disability, predicted to display challenging behaviour (adults aged 18-64) Down s syndrome (adults aged 18-64) Down s syndrome (adults aged 65 and over) Down s syndrome and dementia (adults aged 45-64) Autistic spectrum conditions (adults aged 18 and over) 6,600 6,700 6,900 7,000 7,200 Learning disabilities and 3,100 3,200 3,300 3,300 3,400 autistic spectrum conditions 5,100 5,300 5,400 5,500 5,600 (adults aged 18 and over) and Projecting Older People Population Information (POPPI) 9

10 Introduction Mental health is defined by the World Health Organisation as a state of wellbeing 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 his or her community. Most mental ill health is mild and self limiting and does not reach the level of diagnosis of a disorder. However, a significant proportion is chronic and causes moderate disability while a small number of people suffer life long severely disabling illness. Anxiety and depression affect the largest number of people and often occurs in conjunction with relationship and social problems, substance misuse or physical illness. At least one in four 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 Mental illness often carries a stigma and people with a mental illness are more likely to be living in poverty, unemployed and suffer from other ill health, for example: One in ten children aged between 5 and 16 years has a mental health problem and many continue to have mental health problems into adulthood. Half of those with lifetime mental health problems first experience symptoms by the age of 14 and three-quarters before their mid-20s. Self-harming in young people is not uncommon (10 13% of yearolds have self-harmed). Almost half of all adults will experience at least one episode of depression during their lifetime. One in ten new mothers experiences postnatal depression. About one in 100 people has a severe mental health problem. Some 60% of adults living in hostels have a personality disorder. Some 90% of all prisoners are estimated to have a diagnosable mental health problem (including personality disorder) and/or a substance misuse problem 1. Unemployed people are twice as likely to have depression as people in work. 1 No health without mental health - A cross-government mental health outcomes strategy for people of all ages. Department of Health

11 Children in the poorest households are three times more likely to have mental health problems than children in well off households. People who have been abused or been victims of domestic violence have higher rates of mental health problems. Between a quarter and a half of people using night shelters or sleeping rough may have a serious mental disorder, and up to half may be alcohol dependent. People with drug and alcohol problems have higher rates of other mental health problems. People with physical illnesses have higher rates of mental health problems. 2 Learning disability is one of the most common forms of disability and is a lifelong condition. It is acquired before, during or soon after birth and affects an individual s ability to learn. Similar to people suffering from mental ill health, people with learning disabilities also face challenges and prejudice every day, for example: Half of all families with children with a learning disability live in poverty. Less than one in five people with a learning disability work, although at least 65% of people with a learning disability want to work. Of those people with a learning disability that do work, most only work part time and are low paid. Just one in three people with a learning disability take part in some form of education or training. At least half of all adults with a learning disability live in the family home - meaning that many don't get the same chances as other people to gain independence, learn key skills and make choices about their own lives. People with a learning disability are 58 times more likely to die aged under 50 than other people. Less than a third of people with a learning disability have some choice of who they live with, and less than half have some choice over where they live. 3 A range of factors will influence the prevalence of future mental health and learning disabilities both locally and nationally including the ageing population and advances in science and medicine. 2 Department of Health, The National Service Framework for Mental Health: Modern Standards and Service Models. London: Department of Health, MENCAP, Facts about learning disability, Accessed 02 August

12 Understanding the current and future profile of Staffordshire is important to allow for appropriate service planning and commissioning of health and social care services for people with learning disabilities. This can be done by looking at several sources of intelligence including national prevalence and epidemiological data, primary care data and activity against existing service provision as a proxy measure of need. This report estimates the number of adults with mental health and learning disabilities from two main sources of data: General practice disease registers of people with mental illness and learning disabilities. The Projecting Older People Population Information (POPPI) and Projecting Adult Needs and Service Information (PANSI) systems, developed by the Institute of Public Care (IPC) for the Care Services Efficiency Delivery Programme (CSED) which estimate a range of current and future health problems in adult populations. This report is part of a series of reports that estimate the future prevalence of health conditions in the adult population of Staffordshire. Other reports look at health conditions in older people, long term conditions and physical and sensory disabilities. 1 Population projections Population projections for , based on revised 2008 mid year population estimates for Staffordshire, are shown in Table 3. Projections between 2010 and 2020 show that Staffordshire County will see: a growth in the overall adult population (5% compared with 7% for England); a small decline in adults aged (2% reduction compared with a 3% increase for England); a significant growth in people aged 65 and over (29% compared with 23% nationally); a significant growth in numbers of older people in Tamworth and Lichfield (Table 4 12

13 Table 3 Population projections for adults in Staffordshire by age group (percentage population change from 2010) ,300 66,500 61,100 60,500 65,300 (-5%) (-13%) (-14%) (-7%) ,100 99, ,000 97,200 92,100 (12%) (16%) (10%) (5%) , ,000 98, , ,700 (-15%) (-17%) (-6%) (-3%) , , , , ,000 (6%) (-1%) (-15%) (-16%) , , , , ,400 (-4%) (5%) (12%) (5%) ,900 56,600 50,300 53,400 60,600 (18%) (5%) (11%) (27%) ,900 44,600 53,000 47,400 50,500 (18%) (40%) (25%) (33%) ,100 33,700 40,100 48,100 43,300 (16%) (38%) (65%) (49%) ,000 23,600 28,300 34,200 41,300 (12%) (35%) (63%) (97%) ,800 14,500 17,300 21,800 26,700 (13%) (35%) (70%) (109%) 90 and over 6,000 8,200 10,700 14,200 19,500 (37%) (78%) (137%) (225%) , , , , ,500 (-1%) (-2%) (-3%) (-4%) 65 and over 154, , , , ,900 (17%) (29%) (42%) (56%) 18 and over 664, , , , ,400 (3%) (5%) (8%) (10%), Projecting Older People Population Information (POPPI) and 2008-based sub-national population projections , National Statistics, Crown copyright 13

14 Table 4 Population projections in people aged 65 and over by local authority (percentage population change from 2010) Cannock Chase 15,200 17,600 19,400 21,200 23,700 (16%) (28%) (39%) (56%) East Staffordshire 19,000 22,100 24,500 27,400 31,100 (16%) (29%) (44%) (64%) Lichfield 19,700 23,700 26,300 28,800 31,600 (20%) (34%) (46%) (60%) Newcastle-under-Lyme 22,600 25,500 27,300 29,400 32,300 (13%) (21%) (30%) (43%) South Staffordshire 22,300 26,000 28,700 31,300 34,500 (17%) (29%) (40%) (55%) Stafford 24,800 29,000 32,200 35,300 39,000 (17%) (30%) (42%) (57%) Staffordshire Moorlands 20,000 23,800 26,000 28,200 31,000 (19%) (30%) (41%) (55%) Tamworth 11,000 13,400 15,500 17,200 18,900 (22%) (41%) (56%) (72%) Staffordshire 154, , , , ,100 (17%) (29%) (42%) (57%) England 9,722,600 10,576,700 11,613,900 12,938,300 8,585,000 (13%) (23%) (35%) (51%) Source: Projecting Older People Population Information (POPPI) and 2008-based sub-national population projections , National Statistics, Crown copyright 2 Mental health 2.1 Disease registers Levels of people with severe mental illness (people with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses) and dementia are recorded on GP disease registers for Staffordshire practices. In 2009/10 there were 4,700 people registered with a severe mental illness on GP registers across Staffordshire and 3,900 people with dementia (Table 5 and Table 6). The number of people with severe mental illness is lower than the England average. Levels of dementia overall in Staffordshire are similar to England. However recorded levels in Newcastle-under-Lyme are significantly higher than England. This may be due to a combination of differences in case finding and recording on GP disease registers. Comparison with expected numbers of people with dementia show that GP disease registers significantly under record the prevalence of dementia in the County (section 2.5). 14

15 Table 5 Number and proportion with severe mental health illness, 2009/10 Number on 95% confidence interval Percentage GP registers Lower limit Upper limit Cannock Chase % 0.46% 0.55% East Staffordshire % 0.50% 0.58% Lichfield % 0.53% 0.63% Newcastle-under-Lyme % 0.63% 0.72% South Staffordshire % 0.38% 0.47% Stafford % 0.52% 0.60% Staffordshire Moorlands % 0.65% 0.77% Tamworth % 0.51% 0.61% Staffordshire 4, % 0.55% 0.58% England 424, % 0.77% 0.78% Source: Quality and Outcomes Framework (QOF) for April 2009 to March 2010, Quality Management and Analysis System (QMAS) database /10 data as at end of July 2010, Copyright The Information Centre for health and social care, Prescribing Support Unit. All rights reserved Table 6 Number and proportion of people with dementia, 2009/10 Number on 95% confidence interval Percentage GP registers Lower limit Upper limit Cannock Chase % 0.36% 0.45% East Staffordshire % 0.46% 0.53% Lichfield % 0.37% 0.46% Newcastle-under-Lyme % 0.47% 0.55% South Staffordshire % 0.46% 0.56% Stafford % 0.44% 0.52% Staffordshire Moorlands % 0.42% 0.51% Tamworth % 0.39% 0.49% Staffordshire 3, % 0.45% 0.48% England 249, % 0.45% 0.46% Source: Quality and Outcomes Framework (QOF) for April 2009 to March 2010, Quality Management and Analysis System (QMAS) database /10 data as at end of July 2010, Copyright The Information Centre for health and social care, Prescribing Support Unit. All rights reserved 2.2 Support arrangements Estimates of the number of people aged with a mental health problem helped to live independently and those in supported residential and nursing care during the year is taken from two sources: 'People aged with mental health problems helped to live independently' is taken from Social Care Indicators from the National Indicator Set final, reference NI136. National Indicator NI136 gives information on the number of adults that are assisted directly through social services assessed/care planned, funded support to live independently, plus those supported through organisations that receive social services grant funded services. The information is broken down by primary client type (adults with a learning disability, a physical disability, a mental health problem, a substance misuse problem and vulnerable people) and by age group (adults aged and older people aged 65 and over). 15

16 'Helped to live independently' is taken from Social Care Indicators from the National Indicator Set final, reference NI136. National Indicator NI136 gives information on the number of adults that are assisted directly through social services assessed/care planned, funded support to live independently, plus those supported through organisations that receive social services grant funded services. 'Supported by social care in care homes' is taken from National Adult Social Care Intelligence Service (NASCIS), Referrals, Assessments and Packages of Care data, final 2008/09 The 2008/09 rates have been applied to ONS population projections to estimate the number of people with mental health problems who are helped to live independently and those in supported residential and nursing care during the year. Using these rates in 2010 in Staffordshire: 1,350 were helped to live independently reducing slightly to 1,320 by were in supported residential and nursing care during the year, similar to the number expected in future years (Table 7). Table 7 People aged with mental health problems either helped to live at home, residential or nursing care in Staffordshire Helped to live at home 1,348 1,328 1,321 1,314 1,299 Living in residential and nursing care during the year, purchased or provided by the CSSR Mental health problems in adults aged Estimates of mental health problems have been calculated based on an Office for National Statistics survey looking into psychiatric morbidity in adults. 4 The report found that one in six adults showed symptoms sufficient to warrant a diagnosis of a common but significant mental health problem. The survey reported on prevalence rates for selected conditions: Depression Depression is among the highest cost mental health conditions in terms of service costs and loss of earnings. 5 The overall rate was found to be 23 per 1,000 men, 28 per 1,000 women and 26 per 1,000 people. 4 Singleton N, Bumpstead R, O'Brien M, Lee A and Meltzer H, Psychiatric morbidity among adults living in private households, Office for National Statistics Paying the price: The cost of mental health care in England to 2026, King's Fund,

17 Neurotic disorders Neurotic disorders are characterised by a variety of symptoms such as fatigue and sleep problems, forgetfulness and concentration difficulties, irritability, worry, panic, hopelessness, and obsessions and compulsions, which are present to such a degree that they cause problems with daily activities and distress. The survey found a prevalence rate of 135 per 1,000 men, 194 per 1,000 women and 164 per 1,000 people. People from an Asian background have a higher prevalence of neurotic disorder: 156 per 1,000 Asian men, 229 per 1,000 Asian women and 192 per 1,000 Asian people. Personality disorders The report defined personality disorders as obsessive-compulsive, avoidant, schizoid, paranoid, borderline, antisocial, dependent and schizotypal disorders. The prevalence rate for any personality disorder was reported as 54 per 1,000 men, 34 per 1,000 women and 44 per 1,000 people. Psychotic disorders Psychotic disorders were defined as one of a number of disorders under the categories of schizophrenia, schizotypal and delusional disorders and affective disorders such as manic episodes and bipolar affective disorder. These disorders produce disturbances in thinking and perception that are severe enough to distort the person's perception of the world and the relationship of events within it. Psychoses are normally divided into two groups: organic psychoses, such as dementia and Alzheimer's disease, and functional psychoses, which mainly cover schizophrenia and manic depression. To obtain an estimate of the prevalence of psychotic disorder an assessment of probable psychotic disorder was applied. The prevalence rate for probable psychotic disorder in people aged is six per 1,000 men, five per 1,000 women and five per 1,000 people. In Staffordshire in 2010 it was estimated that: 13,000 people aged had depression; 83,800 people aged had a neurotic disorder; 22,500 people aged had a personality disorder. These numbers are expected to fall slightly in future years (Table 8 to Table 11and Table 16). 17

18 Table 8 People aged predicted to have mental health problems in Staffordshire Depression Men 5,888 5,817 5,794 5,775 5,736 Women 7,112 6,994 6,947 6,891 6,779 People 13,000 12,811 12,741 12,666 12,515 Neurotic disorders Men 34,560 34,142 34,007 33,899 33,669 Women 49,276 48,461 48,131 47,743 46,967 People 83,836 82,603 82,138 81,642 80,636 Personality disorders Men 13,824 13,657 13,603 13,559 13,468 Women 8,636 8,493 8,435 8,367 8,231 People 22,460 22,150 22,038 21,927 21,699 population projections and former prevalence rates Table 9 People aged predicted to have depression by local authority Cannock Chase 1,513 1,504 1,499 1,486 1,461 East Staffordshire 1,691 1,693 1,712 1,711 1,698 Lichfield 1,518 1,510 1,528 1,543 1,539 Newcastle-under-Lyme 2,008 1,976 1,962 1,952 1,939 South Staffordshire 1,622 1,563 1,528 1,479 1,441 Stafford 1,983 1,962 1,962 1,954 1,943 Staffordshire Moorlands 1,461 1,407 1,391 1,366 1,334 Tamworth 1,226 1,195 1,174 1,161 1,150 Staffordshire 13,000 12,811 12,741 12,666 12,515 England 831, , , , ,114 population projections and former prevalence rates Table 10 People aged predicted to have neurotic disorders by local authority Cannock Chase 9,770 9,710 9,677 9,592 9,433 East Staffordshire 10,893 10,901 11,021 11,015 10,930 Lichfield 9,791 9,744 9,857 9,955 9,924 Newcastle-under-Lyme 12,951 12,730 12,633 12,563 12,472 South Staffordshire 10,468 10,081 9,862 9,541 9,297 Stafford 12,776 12,639 12,639 12,586 12,509 Staffordshire Moorlands 9,423 9,069 8,964 8,805 8,590 Tamworth 7,914 7,716 7,579 7,488 7,416 Staffordshire 83,836 82,603 82,138 81,642 80,636 England 5,363,343 5,450,059 5,543,730 5,625,007 5,679,579 population projections and former prevalence rates 18

19 Table 11 People aged predicted to have personality disorders by local authority Cannock Chase 2,604 2,585 2,576 2,555 2,509 East Staffordshire 2,932 2,939 2,978 2,980 2,959 Lichfield 2,617 2,603 2,635 2,661 2,662 Newcastle-under-Lyme 3,471 3,426 3,409 3,403 3,384 South Staffordshire 2,796 2,698 2,633 2,552 2,485 Stafford 3,441 3,407 3,407 3,395 3,382 Staffordshire Moorlands 2,522 2,433 2,408 2,362 2,316 Tamworth 2,106 2,053 2,020 2,001 1,985 Staffordshire 22,460 22,150 22,038 21,927 21,699 England 1,434,491 1,459,098 1,485,387 1,508,554 1,525,142 population projections and former prevalence rates The latest groupings used within PANSI and POPPI differ from those used when this document was first written. Mental health problems are now categorised into the following groups: Common mental disorders Borderline personality disorders Antisocial personality disorders Psychotic disorders Depression, neurotic disorders and certain personality disorders are now grouped into common mental disorders, while the remaining personality disorders are now split into two categories. There has been no change to the psychotic disorders group. In Staffordshire in 2010 it was estimated that: 82,000 people aged had a common mental disorder; 2,300 people aged had a borderline personality disorder; 1,800 people aged had an antisocial personality disorder; 2,040 people aged had a psychotic disorder. 19

20 Table 12 People aged predicted to have mental health problems in Staffordshire Common mental disorder (adults aged 18-64) Men 32,000 31,613 31,488 31,388 31,175 Women 50,038 49,211 48,876 48,482 47,694 People 82,038 80,823 80,363 79,869 78,869 Borderline personality disorder (adults aged 18-64) Men Women 1,524 1,499 1,489 1,477 1,453 People 2,292 2,258 2,244 2,230 2,201 Antisocial personality disorder (adults aged 18-64) Men 1,536 1,517 1,511 1,507 1,496 Women People 1,790 1,767 1,760 1,753 1,739 Psychotic disorders Men Women 1,270 1,249 1,241 1,231 1,211 People 2,038 2,008 1,996 1,984 1,959 Table 13 People aged predicted to have a common mental disorder by local authority Cannock Chase 9,565 9,508 9,476 9,392 9,238 East Staffordshire 10,654 10,660 10,774 10,767 10,683 Lichfield 9,583 9,538 9,648 9,744 9,710 Newcastle-under-Lyme 12,672 12,450 12,352 12,278 12,187 South Staffordshire 10,247 9,866 9,655 9,338 9,100 Stafford 12,495 12,359 12,359 12,307 12,228 Staffordshire Moorlands 9,222 8,873 8,769 8,615 8,400 Tamworth 7,750 7,556 7,420 7,329 7,258 Staffordshire 82,038 80,823 80,363 79,869 78,869 England 5,249,261 5,333,570 5,424,756 5,503,735 5,556,352 20

21 Table 14 People aged predicted to have a borderline personality disorder by local authority Cannock Chase East Staffordshire Lichfield Newcastle-under-Lyme South Staffordshire Stafford Staffordshire Moorlands Tamworth Staffordshire 2,292 2,258 2,244 2,230 2,201 England 146, , , , ,137 Table 15 People aged predicted to have an antisocial personality disorder by local authority Cannock Chase East Staffordshire Lichfield Newcastle-under-Lyme South Staffordshire Stafford Staffordshire Moorlands Tamworth Staffordshire 1,790 1,767 1,760 1,753 1,739 England 114, , , , ,888 Table 16 People aged predicted to have psychotic disorders by local authority Cannock Chase East Staffordshire Lichfield Newcastle-under-Lyme South Staffordshire Stafford Staffordshire Moorlands Tamworth Staffordshire 2,038 2,008 1,996 1,984 1,959 England 130, , , , ,011 21

22 2.4 Depression in older people Between five and eleven per cent of the people aged 65 and over are estimated to have depression based on a study looking into the prevalence of depression in older population. The same study found that two to four per cent of older people are estimated to have severe depression. 6 In Staffordshire, in 2010, it was estimated that 13,300 people aged 65 and over had depression. By 2020, these numbers are predicted to increase with 17,100 people aged 65 and over having depression (Table 17). These represent much more modest increases when compared with the previous estimates. Around 4,200 people aged 65 and over were estimated to have severe depression in 2010 rising in 2020 to around 5,500 people aged 65 and over (Table 18). Once again, these estimates are at the lower end of the range previously predicted. Table 17 People aged 65 and over predicted to have depression by local authority Cannock Chase 1,319 1,510 1,655 1,824 2,036 East Staffordshire 1,655 1,891 2,079 2,347 2,656 Lichfield 1,701 2,038 2,247 2,479 2,728 Newcastle-under-Lyme 1,941 2,189 2,347 2,567 2,767 South Staffordshire 1,910 2,233 2,480 2,693 2,971 Stafford 2,132 2,482 2,773 3,020 3,352 Staffordshire Moorlands 1,718 2,030 2,240 2,436 2,650 Tamworth 944 1,141 1,310 1,482 1,624 Staffordshire 13,297 15,559 17,118 18,812 20,788 England 743, , , ,873 1,113,160 Source: Projecting Older People Population Information (POPPI) Table 18 People aged 65 and over predicted to have severe depression by local authority Cannock Chase East Staffordshire Lichfield Newcastle-under-Lyme South Staffordshire Stafford ,004 1,116 Staffordshire Moorlands Tamworth Staffordshire 4,186 4,901 5,450 6,207 6,879 England 235, , , , ,845 Source: Projecting Older People Population Information (POPPI) 6 McDougall et al, Prevalence of depression in older people in England and Wales: the MRC CFA Study in Psychological Medicine, 2007, 37,

23 2.5 Dementia Early onset dementia rates are based on an Alzheimer's Society report which looked into the prevalence and cost of dementia. The study found that the rates for men aged were higher than women (Table 19). Table 19 Early onset dementia rates per 100,000 population in UK Men Women Source: Personal Social Services Research Unit (PSSRU), London School of Economics and the Institute of Psychiatry, King's College London, Dementia UK: the full report. Alzheimer's Society In Staffordshire, around 240 people aged are estimated to have early onset dementia, with numbers in this age group predicted to remain similar in future years (Table 20 and Table 21). Table 20 People aged predicted to have early onset dementia in Staffordshire Males Females Persons Table 21 People aged predicted to have early onset dementia by local authority Cannock Chase East Staffordshire Lichfield Newcastle-under-Lyme South Staffordshire Stafford Staffordshire Moorlands Tamworth Staffordshire England 13,179 13,324 14,291 14,875 14,547 The same study also reports on dementia prevalence rates in people aged 65 and over (Table 22). This shows that in Staffordshire 3,600 men and 6,600 women aged 65 and over were estimated to have dementia in By 2020 these numbers will have increased to 4,600 men and 7,500 women (Table 23 and Table 24). 23

24 Comparison with expected numbers of people with dementia show that numbers on GP disease registers significantly under record the prevalence of dementia in the County (section 2.1). Table 22 Dementia rates in older populations in the UK Age band Men Women % 1.0% % 2.4% % 6.5% % 13.3% % 22.2% % 30.7% Source: Personal Social Services Research Unit (PSSRU), London School of Economics and the Institute of Psychiatry, King's College London, Dementia UK: A report into the prevalence and cost of dementia. Alzheimer's Society Table 23 People aged 65 and over predicted to have dementia in Staffordshire Men , ,316 1,591 1, ,186 1,570 1, and over ,032 1,507 2, and over 3,627 4,571 5,646 6,911 8,267 Women ,034 1,164 1,385 1,658 1, ,636 1,769 2,048 2,474 2, ,865 1,998 2,264 2,753 3, and over 1,320 1,750 2,149 2,702 3, and over 6,570 7,528 8,767 10,455 12,358 People ,220 1,450 1,297 1, ,702 1,974 2,343 2,810 2, ,513 2,809 3,364 4,065 4, ,583 2,917 3,450 4,323 5, and over 1,767 2,475 3,181 4,208 5, and over 10,196 12,099 14,413 17,365 20,625 Source: Projecting Older People Population Information (POPPI) 24

25 Table 24 People aged 65 and over predicted to have dementia by local authority Cannock Chase 981 1,120 1,318 1,579 1,884 East Staffordshire 1,296 1,525 1,797 2,184 2,626 Lichfield 1,240 1,537 1,886 2,320 2,785 Newcastle-under-Lyme 1,575 1,771 2,020 2,379 2,698 South Staffordshire 1,436 1,772 2,185 2,610 3,090 Stafford 1,675 1,934 2,357 2,854 3,406 Staffordshire Moorlands 1,314 1,551 1,853 2,227 2,605 Tamworth ,546 Staffordshire 10,196 12,099 14,413 17,365 20,625 England 614, , , ,664 1,084,369 Source: Projecting Older People Population Information (POPPI) 2.6 Guardianship Section 7 of the Mental Health Act 1983 provides for guardianship under the auspices of a local social services authority (or a named individual) on the recommendation of two doctors and an application by an approved social worker or nearest relative. Under Section 37, a court can also make a guardianship order. Section 8 of the Act sets out the three powers conferred on the guardian. These are; the power to require the patient to reside at a specified place, the power to require the patient to attend specified places for medical treatment, occupation, education or training and the power to require access to be given to the patient by a doctor, approved social worker or other specified person. The purpose of guardianship is to enable patients to receive care in the community where it cannot be provided without the use of compulsory powers. It provides a framework, as part of the overall care and treatment plan, for working with a patient to achieve as independent a life as possible. Guardianship applies to patients who are at least 16 years old and who are suffering from mental illness, psychopathic disorder, severe mental impairment or mental impairment of a nature or degree which warrants reception into guardianship, and where it is also necessary in the interests of the welfare of the patient or for the protection of others. Based on information collated by the Information Centre for health and social care, in Staffordshire there were 14 people aged subject to guardianship as at 31 March

26 2.7 Suicide Predictions of suicide are based on trends from Office for National Statistics mortality data from the National Centre for Health Outcomes Development (NCHOD). The data shows death rates from suicide as 5.8 per 100,000 population in England, 9.2 per 100,000 men and 2.5 per 100,000 women. Annually, in Staffordshire, there are around 40 suicides in people aged (Table 25). Table 25 People aged predicted to commit suicide Staffordshire England 2,368 2,397 2,450 2,502 2, Drugs and alcohol The information about drug and alcohol misuse is based on a household survey published by the Health and Social Care Information Centre. Drug misuse has been defined as the use of a substance for purposes not consistent with legal or medical guidelines. The prevalence of drug dependence was 3.4% (4.5% of men, 2.3% of women). Most dependence was on cannabis only (2.5%), rather than other drugs (0.9%). Symptoms of dependence were most commonly reported by adults aged between 16 and 24 (13.3% of men, 7.0% of women in this age group). The prevalence of drug dependence varied with ethnicity and income. In Staffordshire around 11,500 men and 5,800 women aged are estimated to be dependent on illicit drugs with numbers predicted to remain very similar across future years (Table 26 and Table 27). Table 26 People aged predicted to be dependent on illicit drugs in Staffordshire Males 11,520 11,381 11,336 11,300 11,223 Females 5,842 5,745 5,706 5,660 5,568 Persons 17,362 17,126 17,042 16,960 16,791 26

27 Table 27 People aged predicted to be dependent on illicit drugs by local authority Cannock Chase 2,011 1,995 1,988 1,972 1,936 East Staffordshire 2,269 2,275 2,307 2,309 2,293 Lichfield 2,022 2,011 2,035 2,056 2,058 Newcastle-under-Lyme 2,684 2,652 2,640 2,638 2,624 South Staffordshire 2,160 2,085 2,033 1,972 1,920 Stafford 2,663 2,638 2,638 2,629 2,620 Staffordshire Moorlands 1,949 1,881 1,863 1,827 1,793 Tamworth 1,625 1,585 1,560 1,546 1,534 Staffordshire 17,362 17,126 17,042 16,960 16,791 England 1,108,456 1,127,728 1,148,268 1,166,432 1,179,614 'People aged 18 or over with a drug problem in effective treatment' was published by the National Treatment Agency for Substance Misuse. The number in effective treatment in 2010 was around 1,976. Numbers are expected to rise slightly in Staffordshire in future years (Table 28). The figures include any problem drug user aged 18 or over (drug use includes opiates, crack-cocaine, cannabis and amphetamines; figures do not include alcohol misuse). Effective treatment means clients who were engaged for more than 12 weeks, or if exiting treatment before 12 weeks, were free of dependency on exit. Table 28 People aged 18 or over with a drug problem in effective treatment Staffordshire 1,976 2,033 2,080 2,129 2,180 England 197, , , , ,391 Harmful drinking denotes the most hazardous use of alcohol, at which damage to health is likely. One possible outcome of harmful drinking is alcohol dependence. Alcohol dependence can be described as a cluster of behavioural, cognitive, and physiological phenomena that typically include a strong desire to consume alcohol, and difficulties in controlling drinking. The prevalence of alcohol dependence was 5.9% (8.7% of men, 3.3% of women). For men, the highest levels of dependence were identified in those between the ages of 25 and 34 (16.8%), for women in those between the ages of 16 and 24 (9.8%).& Most recorded dependence was categorised as mild (5.4%), with relatively few adults reporting symptoms of moderate or severe dependence (0.4% and 0.1% respectively). 7 In 2010 in Staffordshire, around 22,300 men and 8,400 women aged are estimated to have an alcohol dependency disorder (Table 29 and Table 30). 7 Adult psychiatric morbidity in England, 2007: Results of a household survey, published by the Health and Social Care Information Centre in

28 Table 29 People aged predicted to have alcohol dependence in Staffordshire Males 22,272 22,002 21,915 21,846 21,698 Females 8,382 8,243 8,187 8,121 7,989 Persons 30,654 30,246 30,103 29,967 29,687 Table 30 People aged predicted to have alcohol dependence by local authority Cannock Chase 3,544 3,515 3,503 3,476 3,410 East Staffordshire 4,011 4,025 4,084 4,089 4,062 Lichfield 3,567 3,547 3,591 3,627 3,635 Newcastle-under-Lyme 4,739 4,688 4,672 4,673 4,651 South Staffordshire 3,811 3,681 3,586 3,480 3,387 Stafford 4,709 4,666 4,666 4,651 4,638 Staffordshire Moorlands 3,441 3,323 3,292 3,227 3,171 Tamworth 2,864 2,792 2,749 2,727 2,709 Staffordshire 30,654 30,246 30,103 29,967 29,687 England 1,956,064 1,990,673 2,027,444 2,060,102 2,084, Sexual abuse Research shows that victims of abuse have significantly higher rates of psychiatric problems than the general population. Studies demonstrate an association between child sexual abuse and a subsequent increase in rates of childhood and adult mental disorders. 8 A study of 1,235 men and 1,634 women aged found that eleven percent of respondents (7% for males and 16% for females) had been abused in childhood against their wishes or when they were 12 years old or younger. 9 Using these prevalence rates this equated to 18,000 men and 41,000 women aged who had been abused during their childhood in By 2020 the number will have reduced slightly to 17,600 men and 39,700 women (Table 31 and Table 32). 8 Spataro J and Mullen PE, Impact of child sexual abuse on mental health, The British Journal of Psychiatry, Cawson P, Wattam C, Brooker S and Kelly G, Child maltreatment in the United Kingdom, NSPCC,

29 Table 31 People aged predicted to be survivors of childhood sexual abuse in Staffordshire Males 17,920 17,703 17,633 17,577 17,458 Females 40,640 39,968 39,696 39,376 38,736 Persons 58,560 57,671 57,329 56,953 56,194 Table 32 People aged predicted to be survivors of childhood sexual abuse by local authority Cannock Chase 6,842 6,805 6,782 6,720 6,614 East Staffordshire 7,591 7,589 7,663 7,654 7,592 Lichfield 6,847 6,817 6,893 6,962 6,928 Newcastle-under-Lyme 9,044 8,870 8,790 8,724 8,653 South Staffordshire 7,323 7,045 6,902 6,670 6,502 Stafford 8,900 8,799 8,799 8,760 8,696 Staffordshire Moorlands 6,585 6,330 6,252 6,146 5,981 Tamworth 5,547 5,409 5,308 5,237 5,182 Staffordshire 58,560 57,671 57,329 56,953 56,194 England 3,749,559 3,808,258 3,872,060 3,926,935 3,962,372 3 Learning disabilities 3.1 Disease registers The number of people with learning disabilities is recorded on GP disease registers for Staffordshire practices. In 2009/10, around 2,600 people were recorded on a learning disability register across Staffordshire. The proportion of people recorded on learning disability registers in Staffordshire is similar to England, with Cannock Chase having levels significantly higher than England. This may be due to a combination of differences in case finding and recording on GP disease registers as well as real differences in prevalence due to variations in demographic and risk factors between areas. 29

30 Table 33 Number and proportion with learning disabilities, 2009/10 Number on 95% confidence interval Percentage register Lower limit Upper limit Cannock Chase % 0.43% 0.53% East Staffordshire % 0.42% 0.51% Lichfield % 0.33% 0.42% Newcastle-under-Lyme % 0.37% 0.45% South Staffordshire % 0.25% 0.33% Stafford % 0.29% 0.36% Staffordshire Moorlands % 0.42% 0.53% Tamworth % 0.37% 0.47% Staffordshire 2, % 0.39% 0.42% England 179, % 0.42% 0.42% Source: Quality and Outcomes Framework (QOF) for April 2009 to March 2010, Quality Management and Analysis System (QMAS) database /10 data as at end of July 2010, Copyright The Information Centre for health and social care, Prescribing Support Unit. All rights reserved 3.2 Support arrangements Estimates of the number of people aged with a learning disability helped to live independently and those in supported residential and nursing care during the year is taken from two sources: 'People aged with a learning disability helped to live independently' is taken from Social Care Indicators from the National Indicator Set final, reference NI136. This indicator gives information on the number of adults that are assisted directly through social services to live independently, plus those supported through organisations that receive social services grant funded services. 'People aged with a learning disability in residential and nursing care during the year, purchased or provided by the CSSR' is taken from the National Adult Social Care Intelligence Service (NASCIS), Referrals, Assessments and Packages of Care data, final 2008/09. This indicator gives the estimated number of clients receiving services during the period by client type, service type, and age group The 2008/09 rates have been applied to ONS population projections to estimate the number of people with a learning disability helped to live independently and those in supported residential and nursing care during the year. Using these rates, in 2010 in Staffordshire: 1,860 were helped to live at home, predicted to reduce slightly to 1,823 by were in supported residential and nursing care during the year with numbers predicted to remain similar in future years (Table 34). 30