Mental Health (original new page draft)

The World Health Organization (2005) defines mental health as “a state of wellbeing in which the individual realises his or her own abilities, 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”.

As in the WHO’s definition of health (“a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”), mental health is not just the absence of illness, but requires an additional positive ‘something’ to be present in the individual. Thus, the concept of an individual’s mental health state is increasingly being uncoupled from mental illness. 

Mental health and wellbeing consists of emotional wellbeing or happiness, psychological wellbeing and social wellbeing. 

Psychological wellbeing is sometimes defined as consisting of six dimensions: positive evaluation of oneself and one’s past life (self-acceptance); a sense of continued growth and development as a person; the belief that one’s life is purposeful and meaningful; the possession of quality relations with others; the capacity to manage effectively one’s life and surrounding world (environmental mastery); and a sense of self-determination (autonomy). 

Social wellbeing has been defined as “individuals’ perceptions of the quality of their relationships with other people, their neighbourhoods, and their communities” with social wellbeing being made up of various dimensions including social integration, social acceptance, social contribution, social actualization and social coherence.

Life affects us all differently. We all go through difficult times, and negative emotions can be a healthy reaction to the challenges we face. But for many of us, things can become more serious, and each year as many as 1 in 4 of us experiences a mental health problem.

Being aware of what can affect our mental health can make it easier to understand when we, or someone we care about, are struggling, and helps us think about what we can do to improve things or where to get support.

Some things that affect our mental health include our:

• upbringing and environment, which shapes our brain development when young and opportunities throughout life
• experiences, like our relationships, how we are treated, our financial situation, work, where we live, physical health, life events and the changes we go through
• genes and temperament, which may make some of us more likely to develop certain kinds of mental health problems when combined with our life experiences

All of these influence how we think about, make sense of and respond to challenges and opportunities in life.

How we think about ourselves, the people and the world around us and the future, is a result of the things that happen to us. But it also has profound implications for our mental health.

There are many situations or life events that can affect us and make us feel distressed or less able to cope. We all respond to life's challenges differently – there's no single "right way" to react.

It may be everyday events, one-off experiences or several things building up. Even experiences that are positive can be difficult to cope with sometimes.

How we feel is often a completely natural reaction to challenges. But for some of us, these feelings can become more difficult to manage, especially if they do not go away – after a while, what we're experiencing affects our daily life.

Some things that affect our mental wellbeing include:

• personal life and relationships
• money, work or housing
• life changes
• health issues
• traumatic life events
• smoking, alcohol, gambling and drug misuse

There is now accepted understanding and recognition that mental health is more than the absence of mental illness and that good mental health underpins everything we do, how we think, feel, act and behave. It is an essential and precious individual, family, community and business resource that needs to be protected and enhanced.

People with higher levels of good mental health and wellbeing have better general health use health services less, live longer, have better educational outcomes, are more likely to undertake healthier lifestyles including reduced smoking and harmful
levels of drinking, are more productive at work, take less time off sick, have higher
income, have stronger social relationships and are more social.

Higher levels of mental wellbeing are also associated with reduced levels of mental
ill-health in adulthood. 

Mental health problems are extremely common. They are wide ranging in nature from common mental health problems such as depression and anxiety to rarer problems such as schizophrenia and other psychoses (mental health problems that stop the person from thinking clearly, telling the difference between reality and their imagination-NHS Choices). Mental health problems can be surrounded by prejudice, ignorance and fear. This can result
in stigma and discrimination that makes it harder for those with mental health problems to live a normal life. It is widely reported that one in four people will experience mental health problems each year (McManus 2009) and up to one in two people at some point in their lives
(Kessler 2007). Mental health is influenced by a wide range of biological and social risk factors, including fixed factors such as age and sex, and modifiable factors such as:

• Family and socio-economic characteristics such as marital status, family composition
  and employment;
• Individual circumstances such as life events, social supports, immigration status, and debt;
• Household characteristics such as accommodation type and housing tenure;
• Geography such as urban/rural and region;
• And societal factors such as crime and deprivation index

(Foresight Mental Capital and Wellbeing Project 2008)

There are a number of groups within the population that are at higher risk of experiencing mental health problems. The Department of Health (2010) described the increased risks for some of these groups as follows:

• Unemployed adults have a 5.6-fold increased risk of developing a mental health problem;
• Homeless people have a 5.3-fold increased risk of developing a mental health problem; 
• Citizens living in a cold home or experiencing fuel poverty have a 4-fold increased risk of having depression or anxiety; 
• Adults with two or more physical illnesses have a 6.4-fold increased risk of having mental health problems; 
• Black men are 3 times more likely to be represented on a psychiatric ward and up to six times more likely to be detained under the Mental Health Act; 
• Young people who start using cannabis before they’re 15 are 6.7 times more likely to develop schizophrenia; 
• Offenders have a 5-fold increased risk of suicide. There is an 18-fold increased risk amongst young offenders, a 35.8-fold increased risk amongst female offenders and
  an 8.3-fold increased risk for recently released offenders; 
• Lesbian, gay, bisexual or transgender adults have a 4-fold increased risk of suicide; 
• Children who experience abuse have a 7-fold increased risk of recurrent depression and a 9.9-fold increased risk of developing post-traumatic stress disorder as an adult;
• Children experiencing 4 or more adverse childhood experiences1 have a 12.2-fold increased risk of attempted suicide as an adult; 
• Looked after children have a 4.5-fold increased risk of suicide attempt.
  Local research highlighted the increased risk of mental health issues, including  posttraumatic stress disorder in asylum seekers and refugees (Bunting 2009).

Deprivation

Overall Wirral has significantly higher deprivation than England, both for overall IMD score XX vs XX (2019)(X) and for the population living in areas defined as being in the 20% most deprived areas in England XX.% vs XX.X%(X) (2019). Wirral ranks highest among and significantly worse than its XX CIPFA group (CIPFA range: X.X% – XX.X%).

However there are pockets of deprivation with the following lower super output areas having statistically significantly higher Index of Multiple Deprivation summary scores than the XXX for Wirral overall(X) , ranging from XX.X-XX.X in descending order: * XXXXXXXXXX, see POWER BI visulaisations 

Unemployment

Wirral has a significantly lower percentage of people in long term unemployment than England xxxxxxxxxxxx (x). and ranks xnd lowest among the 15 CIPFA group – significantly better than most in the group (CIPFA range: 0.07 – 0.31).

There was a larger increase in unemployment in Surrey than England in the years 2001-2011 – a 71% rise compared to a rise of 43% in unemployment across England. However, as Surrey has a low rate of unemployment, the increase in the actual number of people unemployed was broadly similar to the increase across other parts of England over the same time period (Surreyi). Spelthorne, Woking and Reigate & Banstead have the highest rates of unemployment in Surrey (in descending order). See Surreyi dataset

Mental Health Benefit Claimants

Incapacity benefit is a measure of the level of severity of mental illness in the community and a direct measure of socio-economic disadvantage in those ‘not in work’ because of mental illness. Severe mental illness restricts a person’s capacity to fully participate in society, in particular the employment market. Unemployment rates are higher amongst people with severe mental illness.

The highest proportion of incapacity benefit and Employment Support Allowance claim in both Surrey and nationally is for mental health diagnosis (49.6% and 48.5% respectively). See Surreyi dataset

Surrey has a slightly higher percentage of mental health incapacity benefit claimants than England. Surrey wards with the highest proportion of Employment Support Allowance claimants for mental health reasons are (in descending order): Maybury and Sheerwater, Merstham and Westborough.

Homelessness

Surrey has a significantly lower level of statutory homelessness acceptances per 1,000 households than England (2015/6) 1.3 vs 2.5 and 5th lowest in its 15 CIPFA group. Surrey has a significantly lower level of statutory homelessness households in temporary accommodation per 1,000 households than England (3.1) with Surrey’s data too low to report.(9) Surrey ranks: lowest among the 15 CIPFA group. Statistical significance: Significantly better than almost all of the group (CIPFA range: 0.2 – 2.4).

Among all the Surrey boroughs, Spelthorne ( 2.8 per 1,000 households) had the highest statutory homelessness, higher than 7 of the Surrey boroughs but similar to the compared to the England average. Runneymede, Woking and Reigate and Banstead are also in the top three compared to other Surrey boroughs. See data visualisation.

Most councils in Surrey have seen a rise in homeless applications. There were 983 homeless applications in Surrey in 2013-14, which increased by 11% (to 1088) in 2014 -15. An increase of 12% is projected by the end of March 2016. The highest number of applications were received in Reigate & Banstead, Spelthorne, then Epsom & Ewell. The sharp rise in homelessness has also led to a shortage of temporary accommodation within the County and some homeless people are now being placed in bed and breakfast accommodation outside of Surrey, which means they can become disconnected from their health, care and support services. The housing JSNA chapter shows that mental health issues are overtaking substance and alcohol issues in this group.

Research has shown that the impact of homelessness is the most profound amongst rough sleepers. A report issued by CRISIS and Sheffield University(10) has shown that rough sleepers have a significantly lower life expectancy (average age at death of just 47 years for men and 43 years for women), and are nine times more likely to die by suicide.

Housing

The percentage of adults in Surrey in contact with secondary mental health services who live in stable and appropriate accommodation – independently, is lower than for England 45.3% vs 59.7% (2014/15) (statistical significance is not calculated), and (11)ranks 6th lowest among the 15 CIPFA group (CIPFA range: 24.8 – 81.8). Surrey has a significantly lower percentage of houses that are overcrowded than England 3.4 vs 4.8 (2011, although the fourth highest among its 15 CIFA nearest neighbours). Housing support data suggests a large variation in capacity compared to population. Spelthorne appears to have high occupancy compared to other boroughs, but this data is difficult to interpret as it includes both short term support and more stable tenancies (Mental Health PVR 2012)(12) .

The percentage of households experiencing fuel poverty in Surrey is lower than England 9.7% vs 14.6% (Census 2011)(13) . Surrey ranks: 3rd lowest among and significantly better than the 15 (CIPFA group. CIPFA range: 8.6 – 19.6).

Crime

Surrey has a significantly lower rate of violent crime per 1000 population than England 13.9 vs 17.2 (2015/6) (14) and ranks: mid-way among the 15 CIPFA group. Statistical significance: Significantly better than half in the group (CIPFA range: 8.6 – 18.6).

Surrey has a lower rate of violent offences (including sexual violence) per 1000 than England 1.3 vs 1.7 (15) (2015/16). Surrey has a significantly lower rate of emergency hospital admissions per 100,000 population for violent crime (including sexual violence) than England 25.1 vs 47.5 and ranks 4th lowest among the 15 CIPFA group (2012/13 – 2014/15) – significantly better than half of the group CIPFA range: 14.1 – 39.4.

Social Isolation

The percentage (%) of adult social care users in Surrey that have as much social contact as they would like ( 2015/16) is similar to England 45.5 vs 46.4 and Surrey ranks 6th lowest among the 15 CIPFA group – not statistically different from most of the group (CIPFA range: 39.9 – 51.4)(16) . However, Surrey has a significantly lower percentage of adult carers who have as much social contact as they would like than England 35.8 vs 38.5 (17) (2014-5) and ranks. 6th lowest among the 15 CIPFA group – not statistically different from most of the group (CIPFA range: 26.8 to 46.8).