8 Saving lives: mental health

Target:¹ to reduce the death rate from suicide and undetermined injury by at least a fifth by 2010 - saving up to 4,000 lives in total

8.1 Mental health is as important to an individual as good physical health. Mental health influences how we feel, perceive, think, communicate and understand. Without good mental health, people can be unable to fulfil their full potential or play an active part in everyday life.

8.2 Mental health problems are a major cause of ill-health, disability and mortality. They include:

¹ In the Green Paper we proposed suicide as a proxy target to cover the whole of the mental health priority area. A number of responses to the consultation suggested that a morbidity target would be better but none could offer solutions to the problems of measuring and monitoring such a target. A suicide target has the advantages of reliable data, while many mental health policies, including those to promote good mental health, will lead to reductions in suicides.

• depression and anxiety - extremely common in both urban and rural areas, often disabling and may last a long time if untreated

• schizophrenia - relatively rare but often extremely severe, disabling and long-term

• bipolar affective disorder (formerly known as manic depression)
  - relatively rare, episodic in nature and often very severe

• dementia - common in older people, involving progressive deterioration of intellectual and social functioning, with no recovery

8.4 More people who are worse off financially and socially, particularly in inner cities, have mental illness; more contemplate suicide and more actually commit suicide than people who are better off. For example:

• unemployed people are twice as likely to suffer from depression as people in work

• children in the poorest households are three times more likely to have mental ill-health than children in the best-off households

• people sleeping rough or using night shelters are four times more likely to have a mental disorder than the general population

• people in prisons are at least fifteen times more likely to have a psychotic disorder than the general population

• refugees have higher rates of mental disorder than the general population.

8.5 In England, on average, more than one person dies every two hours as a result of suicide. Suicidal thoughts are quite common but are seldom acted on. But if a quick and lethal method of suicide is readily at hand someone might act impulsively without allowing time for second thoughts or rescue. So there are more suicides among those who have easy access to the means of killing themselves such as guns, certain medicines or chemicals. That is one of the reasons why suicide figures are high for some professional groups such as doctors, nurses, farmers, vets and pharmacists.

'mental illness has a high economic cost'

8.6 Many people are mentally ill die prematurely from physical illness, especially respiratory illness, cancer or coronary heart disease. People with eating disorders and those involved in substance misuse are at highest risk, although the risks are almost as great for those with schizophrenia or major depression.

8.7 People with mental illness may suffer considerable fear, mental pain and distress, sometimes for many years, taking a considerable toll on themselves and their families. They may be socially excluded because of their mental illness. Besides the immense cost in personal suffering which mental illness carries, it has a high economic cost as well. A recent study estimated that the cost in England amounted to £32.1 billion.

How do we compare?

8.8 Suicide rates within the UK are reasonably similar in England, Wales and Northern Ireland but are higher in Scotland. Suicide rates in England are among the lowest in the European Union.

Fig 8.1 Death rates from suicide: England one of the best records in European Union

Causes

8.9 Detailed research on the causes of mental illness has shown that the major risk factors for mental illness include:

• poverty, poor education, unemployment

• social isolation stemming from discrimination against people with all types of physical disabilities

• major life events such as bereavement, redundancy, financial problems, being the victim of crime

• genetic predisposition

• drug and alcohol misuse

• developmental factors such as foetal damage and injury at birth

• poor parenting.

Action: promoting good mental health and reducing risk

8.10 Promoting good mental health is relevant to everyone. We can all enhance our mental well-being through some simple steps which make it easier for us to cope with the problems and pressures of daily life. These can be as straightforward as keeping in touch with our family and friends, and keeping involved with our local community. Making time for relaxation and for physical activity can reduce stress, while asking for help and talking problems over can also prevent mental health problems from building up.

8.11 We are promoting these simple steps through national public education campaigns, for use in a wide range of settings. Schools, workplaces, neighbourhoods and prisons should all play their part in improving mental health as well as improving health generally.

'it is possible to reduce the risk of various mental illnesses'

8.12 In addition it is possible to reduce the risk of various mental illnesses, such as depression by strengthening support systems; dementia by stopping smoking, adopting a healthy diet and being physically active; relapse in schizophrenia by specific family interventions; and suicide through a range of specific measures.

8.13 For example unemployed people are less likely to suffer depression and to have better success finding work if they are given social support and help in developing job-seeking skills; people caring for relatives with dementia are less likely to suffer from depression if they are given practical information about the disease. Similarly people caring for relatives with schizophrenia benefit from practical information and social support; support groups supplying a combination of practical help, social networking and advice on parenting have also been proven to have a dramatic impact on the mental health of young isolated mothers and on the cognitive and emotional development of their pre-school children. Rapid treatment for depressed mothers can prevent harm to the children who may otherwise experience cognitive and emotional damage. Self-help support groups have proved beneficial for widows where they can offer each other one-to-one support alongside other practical help and small group meetings. Children at school with unrecognised learning difficulties including dyslexia will benefit from appropriate school programmes for assessment and help.

Children whose parents are divorcing can benefit from school-based help and parents can be taught parenting skills.

8.14 We can reduce suicide through the following steps:

• reduce access to methods of suicide, such as controlling the pack sizes for paracetamol available off the shelf

• develop NHS Direct, networked to specialist mental health helplines, as a source of advice for those in mental distress

• good assessment and follow-up of people who attempt to kill themselves

• use good practice guidelines on looking after suicidal people in primary and specialist care

• continue professional training about prompt detection, assessment, diagnosis and treatment of depression and assessment of suicidal risk

• support people who are at high risk of suicide, particularly people with severe mental illness and those in high risk occupations

• develop mental health promotion strategies in schools, workplaces and prisons which enhance social support and coping strategies and which tackle bullying

• work with the media to ensure responsible reporting of suicides which neither glamorises the event nor publishes the method used

• audit suicides in order to learn the lessons for prevention.
  We support the National Confidential Inquiry into Suicide and Homicide which audits suicides across the country.

Action: early recognition

8.15 There are far more people with a mental health problem than the specialist services see. Some of them will seek help from families and friends. Many will be seen by their family doctor but mental health problems can be difficult to diagnose, especially when the patient has physical symptoms or learning difficulties or if there is a language or other cultural barrier. On average, family doctors identify only about half of the people who come to them with depression and anxiety, and not all of those receive the right treatment. Some patients first come into contact with the police or social services rather than a hospital or a family doctor. For all these reasons it is important that people in the relevant agencies, especially those in the health service, have the skills to recognise the symptoms of mental illness.

'the National Service Framework will set national standards
and define service models for mental health'

8.16 Mental health is the subject of one of the first two new National Service Frameworks. The Framework will set national standards and define service models for mental health promotion, suicide prevention, assessment, diagnosis, treatment, rehabilitation and care. We shall use the Framework to ensure that these professional staff have the skills to detect early signs of mental illness and to assess suicidal risk; and we are ensuring that mental health teams have the necessary skills for relapse prevention, including for those with concomitant substance misuse.

Action: effective treatment

8.17 We can achieve a great deal by promoting good mental health, preventing illness and by prompt and effective treatment in primary care. Our Healthy Citizens initiative will help individuals to take control of their own mental health, through making use of NHS Direct, through developing their health skills and through our Expert Patients programme. But there will always be a need for effective specialist mental health services. Access to specialist treatment and care varies across the country as well as by age, ethnic group, gender, and social class. We therefore need to ensure that people suffering from mental ill-health have access to consistently high quality treatment and care services suited to their needs. To achieve this, in December 1998 we published Modernising Mental Health Services - safe, sound and supportive, setting out in detail our strategy for ensuring effective mental health services. That strategy made mental health a national priority across both health and social care services.

8.18 Secondly we have launched a fundamental review of the law on mental health to ensure that it is brought up-to-date to reflect modern practice. It will report in the summer.

8.19 Thirdly the National Service Framework for Mental Health, to be implemented from April 2000, will ensure the development of consistent high quality services which cross professional and agency boundaries, and which are equally accessible to all.

Integrated action

8.20 If we are to promote mental health and reduce not only mental illness but also its adverse impact on individuals and families we need to:

• ensure that mental health is regarded as a key outcome of each strand of the Government's agenda to promote social inclusion - from Sure Start to Better Government for Older People; from the Rough Sleepers Initiative to the Welfare to Work programme, and across the range of local initiatives

• put in place the range of action to reduce suicide - within the NHS and partner agencies, the media and those who can help to reduce access to the methods of suicide

• strengthen the capacity of primary care services to identify, assess and treat those with mental health problems

• ensure effective care for those with severe mental illness; and better support for those who care for them.

8.21 The National Service Framework for Mental Health will cover these areas - setting out standards and service models with a clear drive towards implementation and delivery. It will be a key element in meeting our target for reducing suicides. It will address the whole range of mental health service provision, from primary care, where the majority of mental health problems can be managed, through to specialist mental health services. This will help to ensure that people with mental health problems receive the service they need, regardless of who they are or where they live.

8.22 We shall bring together the implementation of this contract for mental health with the delivery of the National Service Framework for Mental Health by setting up a high-level Task Force, accountable to the Chief Medical Officer. The Task Force will ensure that the essential ground work is laid to set us on course for achieving our target for saving lives which would otherwise be lost to suicide. We will identify someone of national prominence to act as its champion, whose function will be to build and maintain momentum for action, to communicate the purpose of the contract and to encourage individuals to commit themselves to it.

8.23 We will use the Public Health Development Fund to support the achievement of our target for mental health.

Fig 8.2 Ways of beating mental health problems: examples of how everyone can play their part

We welcome your comments on this site. Prepared 5 July 1999