Mental health inequalities in Northamptonshire. Dr Jonathan Campion

Transcription

1 Mental health inequalities in Northamptonshire Dr Jonathan Campion Visiting Professor of Population Mental Health, University College London Director of Public Mental Health, South London and Maudsley NHS FT 18 th June 2013

2 Mental health and inequalities Inequality gradient associated with risk factors for mental disorder and poor wellbeing Higher levels of inequality associated with proportionately: Increased level of risk factors Reduced level of protective factors Increased numbers from higher risk groups Addressing and preventing inequality can prevent mental disorder and poor wellbeing

3 Addressing mental health associated inequalities by Prevention of mental disorder and promotion of mental health Addressing inequalities arising from mental disorder including poor education, physical health, health risk behaviour, unemployment rates (particularly smoking) Increasing availability of early intervention for mental disorder, which improves outcomes and reduces associated inequalities. Addressing inequalities in access to services and outcomes for treatment for mental disorder, prevention and promotion

4 Policy context of mental health and wellbeing Current mental health strategy (HMG, 2011) adopts a twin track approach to: Offer early treatment to people with mental disorder Population approach to promote mental wellbeing and prevent mental disorder Highlights inequalities associated with mental disorder Public Health White Paper signals new approach which places mental health and wellbeing 'at the heart' of the new system and highlights key role of DsPH in public mental health

5 JCPMH PMH guidance - estimation of local Recent work to apply JCPMH public mental health commissioning guidance to 700,000 population of Northamptonshire to give: Level of risk and protective factors Numbers from higher risk groups Numbers with mental disorder and poor wellbeing including from higher risk groups Proportion receiving treatment, prevention or mental health promotion Impacts/ outcomes of treatment/ prevention/ promotion Associated economic savings in range of areas Size, impact and cost of unmet need

6 Impact of mental disorder 23% of burden of disease in UK compared to 16% for cancer and 16% for cardiovascular disease Costs England at least 105 billion each year Size of impact due to Arising early in the life course Broad range of inequalities Mental disorder being common Only a minority receiving any intervention

7 Early onset of mental disorder Key reason for size of burden 50% of lifetime mental illness (excluding dementia) starts by age 14 (Kim-Cohen et al. 2003; Kessler et al, 2005) 75% by mid twenties (Kessler et al, 2007)

8 Impacts of mental disorder on broad range of inequalities

9 During childhood and adolescence health outcomes self-harm and suicide educational outcomes antisocial behaviour and offending social skills outcomes health risk behaviour - smoking, alcohol and drug misuse, sexual risk, nutrition, physical activity teenage parenthood

10 Impacts of emotional and conduct disorder in children and young people in UK (Green et al, 2005) Risk Behaviour Emotional Conduct No Disorder Disorder (6%) Disorder (4%) Smoke Regularly (age 11-16) Drink at least twice a week (age 11-16) Ever Used Hard Drugs (age Have ever self harmed (self report) 19% 30% 5% 5% 12% 3% 6% 12% 1% 21% 19% 4% Have no friends 6% 8% 1% Have ever been excluded from school 12% 34% 4%

11 Increased risk of poor adult outcomes Poor mental health in childhood and adolescence also associated with inequalities during adulthood including higher rates of: adult mental disorder health risk behaviour physical illness suicide unemployment and lower earnings marital problems crime and violence

12 Numbers with mental disorder Proportionately increase with level of deprivation 10% of children and young people (Green et al, 2005) 17.6% adults at least one CMD (McManus et al, 2009) 0.4% adults have psychosis 6% alcohol dependent, 3% dependent on illegal drugs, 21% dependent on tobacco 5.4% of men and 3.4% of women have diagnosable personality disorder (Singleton et al, 2001) Dementia: 5% of people aged over 65 20% of those aged over 80

13 Numbers of children and adolescents with mental disorder in Northamptonshire 3351 emotional disorder 5299 conduct disorder 2049 hyperkinetic disorder year olds report self harm year olds reported drinking alcohol in the previous week year olds used illegal drugs in past year 2100 of year olds regular smokers

14 Numbers of adults with mental disorder in Northamptonshire Common mental disorder 86,888 Psychosis: each year 2145 experience a psychotic disorder with 171 new cases Alcohol dependence: 31,645 Drug misuse in 2011/12: 39,876 used an illegal drug 13,441 used class A drugs 15,073 taken an illicit drug Tobacco smokers 107,270 Personality disorder: 23,475 Dementia: 5302 people

15 Examples of local variation of substance misuse across Northamptonshire % binge drinking in people aged 16 and over: Wellingborough 19.1% Northampton 21.7% England 20.1% Rate of opiate or crack use per 1000 Corby 12.8 South Northamptonshire 2.0 England 8.9 Tobacco dependence: South Northamptonshire 11.2%, Corby 25.5% and England 20.0%

16 Inequality underpins many of the risk factors for mental disorder and poor wellbeing

17 Inequality as a key risk factor for mental disorder and poor wellbeing Index Multiple Deprivation: Range from 1 to 326 Northamptonshire overall 102 Corby 57 Northampton 119 Wellingborough 133 Kettering 164 East Northamptonshire 225 Daventry 248 South Northamptonshire 323

18 Protective factors for wellbeing reduced as IMD rises Reduced educational outcomes Reduced physical activity Healthy life expectancy

19 Risk factors for mental disorder and poor wellbeing Increase as deprivation increases Parental factors School factors e.g. exclusion Household factors e.g Excess Winter Deaths:

20 Risk factors for mental disorder and poor wellbeing : Violence and abuse In Northamptonshire 15,020 of year olds experience severe maltreatment during childhood 4206 of year olds and 6725 of year olds experience physical violence by an adult Sexual abuse in under 18s, 12,300 experience sexual touching and 3100 experience sexual intercourse Rates of referral to social care for abuse of vulnerable persons with learning disability: England and Northamptonshire 222.2

21 Certain groups at much higher risk of mental disorder and low wellbeing Higher risk groups benefit proportionately more from intervention to promote wellbeing, prevent mental disorder and treat mental disorder if it arises Proportionate universalism Need for information about numbers from higher risk groups (Campion & Fitch, 2012)

22 Interventions to promote wellbeing, prevent mental disorder and treat mental disorder Good evidence exists for a range of public mental health interventions across the life course which reduce associated inequalities (RCPsych, 2010; Campion & Fitch, 2012) Intervention for mental disorder and associated inequalities Prevention of mental disorder Promotion of mental health BUT only a minority receive intervention

23 Size and impact of intervention gap Results in broad range of associated inequalities and costs Since majority of life time mental disorder arises by mid 20's, these impacts continue over a large part of life course

24 Proportion of children and adolescents receiving intervention for mental disorder in Northamptonshire 776 referrals to CAMHS 16 families received parenting skills

25 Numbers of children and adolescents with mental disorder in Northamptonshire 3351 have emotional disorder 5299 have conduct disorder 2049 have hyperkinetic disorder year olds report self harm 5040 of year olds reported drinking alcohol in the previous week 5040 of year olds used illegal drugs in the past year and 2540 in the previous month 2100 of year olds were regular smokers 3360 of year olds smoked in previous week

26 Proportion of adults with mental disorder in Northamptonshire receiving intervention 4.3% of people with common mental disorder were referred for psychological therapies 49% of first episode psychoses seen by in Early Intervention Psychosis services. No intervention at stage which precedes psychosis (at risk mental state) 27.9% of smokers received NRT with no information on intervention for those with mental disorder

27 Savings per invested (Knapp et al, 2011) Early detection and treatment of depression at work 5 Early intervention for the stage which precedes psychosis (Clinical High Risk State) 10 First episode psychosis 18

28 No local provision of cost effective interventions to promote wellbeing School based social emotional learning programmes result in net savings of 84 for each spent (DH, 2011) Work based mental health promotion programmes result in net savings of 10 for each spent (DH, 2011) Other cost effective interventions include debt advice services, physical activity, befriending services, timebanks and community navigators Cost effective targeted promotion interventions for those recovering from mental disorder include supported employment and supported housing.

29 Prevention of mental disorder Occurs through addressing risk factors particularly violence and abuse during childhood and adolescence: In Northamptonshire 15,020 of year olds experience severe maltreatment during childhood 4206 of year olds and 6725 of year olds experience physical violence by an adult Sexual abuse in under 18s, 12,300 experience sexual touching and 3100 experience sexual intercourse

30 Prevention interventions Cost effective approaches include school based bullying prevention ( 14) prevention and addressing child abuse prevention of conduct disorder through school based social emotional programmes ( 84) school based violence prevention programmes suicide prevention Smoking cessation prevents premature mortality in people

31 Coverage of mental health in local JSNA Highlights Lack of provision Lack of information for higher risk groups Impacts and costs of unmet need Enables transparency about level of coverage of interventions which commissioners decide is acceptable

32 Summary Inequalities result in increased risk of mental disorder and poor wellbeing Risk of mental disorder and poor wellbeing is several fold times higher in particular groups Mental disorder then results in a range of further inequalities across the life course Lack of mental health coverage in JSNA

33 Summary Only a minority with mental disorder receive treatment which further compounds associated inequalities Almost no local spend on interventions to prevent mental disorder or promote mental wellbeing which prevent inequalities Lack of data on provision of services including to higher risk groups Inequality focused commissioning can prevent inequalities and trans-generational transmission

34 References and contact Campion J, Bhui K, Bhugra D (2012). European Psychiatric Association guidance on prevention of mental disorder. European Psychiatry 27: Campion J, Fitch C (2012) Guidance for the commissioning of public mental health services. Joint Commissioning Panel for Mental Health. jonathan_campion@yahoo.co.uk