Download Equalities in mental health - Lancashire Care NHS Foundation Trust

Factfile 5
Equalities in
mental health
‘Inequalities are a matter of life and
death, of health and sickness, of
wellbeing and misery. Creating a fairer
society is fundamental to improving
the health of the whole population
and ensuring a fairer distribution of
good health’
EQUALITIES
THE EQUALITY ACT 2010
The Government Equalities Office states that the Equality Act
2010 is intended to provide a new cross-cutting legislative
framework to protect the rights of individuals and advance equality
of opportunity for all; to update, simplify and strengthen the
previous legislation; and to deliver a simple, modern and accessible
framework of discrimination law which protects individuals from
unfair treatment and promotes a fair and more equal society.
The Equality Act 2010:
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bans discrimination against adults in the provision of services
and exercise of public functions
creates a public sector duty to have due regard to the need to
eliminate discrimination and to advance equality of opportunity
and foster good relations between people who share a
protected characteristic and people who do not share it.
The duty applies to eight protected characteristics:
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age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation.
By law, the public sector must ensure it provides an equitable level
of service to all users, giving specific regard to the particular needs
of these groups.
This factfile outlines some relevant facts and figures relating to
inequality in mental health.
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N M H D U FA C T F I L E 5
RACE
Severe mental illness
Rates of psychosis are up to nine times higher for people from African Caribbean communities
living in the UK than for the White British population, six times higher for people from African
communities and also higher, but to a smaller degree, for other Black and minority ethnic
(BME) groups in England. Rates in the Caribbean and Africa are comparable to the overall rate
in England.1
Immigrants to the UK are typically at two to eight times greater risk of psychoses than nativeborn groups. This higher risk extends into the second generations.2
Factors that explain raised rates in immigrants and their descendants include: stressful life
events, discrimination, urban living and socio-economic deprivation.2
Rates of psychiatric hospital admission are around three times higher than average for Black
ethnic groups in England. These rates are disproportionate to the population of the country,
but may not be disproportionate to the numbers of people experiencing severe mental illness.3
Indian and Chinese groups have admission rates consistently below average.3
Psychiatric inpatients from Black groups are more likely to enter the mental health system via
the criminal justice system or social services, rather than primary care or specialist community
teams. They are also more likely to be detained under the Mental Health Act.3
There is no consistent evidence that people from BME communities are subject to greater use
of seclusion or physical restraint, although people from the Other Black ethnic group are more
likely to be subject to seclusion.4
BME inpatients are no more likely than White patients to report feeling coerced during their
treatment, but patients in the hospitals with higher number of patients from BME communities
do generally report feeling more coerced.4
Asian groups report less favourably than White groups in satisfaction scores.5
BME groups are more likely than White patients to be prescribed more than one drug, but are
not more likely to receive higher doses of drugs.4
Early indications are that the proportions of patients from BME communities subject to
supervised community treatment in the community match the proportions detained in
hospital.6
Common mental disorders
Rates of common mental disorders are comparable between White, Black and South Asian
men.
Among women, rates of all common mental disorders (except phobias) are higher in the
South Asian group.7
Higher rates of suicide, self-harm and eating disorders are found among Asian adolescent
girls.8
Women refugees and asylum seekers have higher rates of post-traumatic stress disorder and
other mental illness.8
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EQUALITIES
AGE
Incidence of mental health problems is higher in older people in the UK:
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40% of older people who attend their GP
50% of older adult inpatients in general hospitals
60% of residents in care homes have some form of mental health problem.9
For every 10,000 people aged 65 or over, there are:
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2500 people with a diagnosable mental illness
1350 people with depression (1135 receiving no treatment)
500 people with dementia (333 not diagnosed)
650 people with other mental illness.8
Over a quarter of admissions to mental health inpatient services are people over the age
of 65.9
Mental health problems in older people often accompany long-term illness − depression and
dementia are common and have a worse outcome in the 60% of older people who suffer
from a long-term illness.9
Approximately 700,000 people in the UK have dementia, and this is predicted to rise to over
one million people by 2025.9
The financial cost of dementia to the UK each year is currently over £17 billion.9
Over the next 15 years, more than one in 15 of the population will be an older person
experiencing a mental health problem.10
One in four older people living in the community have symptoms of depression that are severe
enough to warrant help, but only half of these are diagnosed and treated.10
There is evidence of ageism in relation to:
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exclusion of older people from mental health services that are available to younger
adults
very low levels of referrals from GPs to specialist units for older mental health sufferers,
and
a general lack of age appropriate service provision.11
Older people do not have the same access as working age adults to assertive outreach, crisis
home treatment and early intervention services, or to rehabilitation, psychotherapy and
general hospital liaison services.12
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N M H D U FA C T F I L E 5
WOMEN
Recorded rates of anxiety and depression are between 1.5 and two times higher in women
than in men.8
Rates of self-harm (including cutting, burning and overdose) are two to three times higher in
women than in men.8
At least one new mother in ten will experience post-natal depression.13
Two thirds of women in prison have mental health problems and over half have been
diagnosed with a personality disorder.14
Nine out of ten of the 1.15 million people in the UK who have an eating disorder are female.15
Women also more vulnerable than men to risk factors linked with poor mental health:
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poverty − nearly twice as many women (30%) than men (16%) of working age are
economically inactive, and nearly twice as many men than women are in full-time paid
employment
social isolation
violence and abuse
child sexual abuse – an estimated 7%–30% of girls and 3%–13% of boys have
experienced sexual abuse in childhood
domestic violence – between 18% and 30% of women experience domestic violence
during their lifetime
sexual violence and rape – around one in 10 women have experienced some form of
sexual victimisation, including rape.8
Older women in particular are more vulnerable to social isolation, poverty and other factors
linked with mental ill health. Women’s greater life expectancy means they are:
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more likely to experience bereavement in old age
more likely to experience institutional care, with its accompanying loss of independence
and role
more likely than men to suffer from physical ill health and long-term disability, resulting
in restriction in mobility and inability to care for themselves.8
Women offenders have much higher rates of mental distress than male offenders. They are:
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twice as likely as men to have received help for a mental health-related or emotional
problem in the 12 months before entering prison (40% v 20%)
more likely to have severe mental illness
twice as likely as men to have symptoms associated with post-traumatic stress disorder
more likely than men to have a history of self-harm, particularly if they have a mental
disorder.8
EQUALITIES
MEN
One in eight men (12.5%) has a common mental health problem.16
Three quarters of suicides are male.16
5.4% of men have a personality disorder diagnosis.16
Men are three times more likely than women to be alcohol dependent.16
Men are twice as likely as women to use class A drugs.16
72% of male prisoners have two or more mental health problems.16
More than twice as many male psychiatric inpatients are compulsorily detained.16
Men are twice as likely as women to be victims of violent crime.16
Poor educational attainment is linked with poor mental health in adulthood. In recent decades
boys have tended to do less well at school than girls:
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There are now fewer young men than young women in further education
Boys are also significantly more likely to be identified as having either a special
educational need or a behavioural, emotional or social difficulty
Boys are performing less well than girls at all levels of education. For example in 2008
only 60.9 per cent of boys achieved 5 or more grade A*-C GCSEs compared to 69.9
per cent of girls
80% of pupils permanently excluded from school and 75% of those on fixed term
exclusions are male.
Men have measurably lower access to the social support of friends, relatives and community.16
Men are less likely than women to seek help for emotional health problems, and more likely to
express emotional distress in behavioural and conduct disorders.16
Nine in ten rough sleepers are men.16 76% of rough sleepers have mental health problems.17
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N M H D U FA C T F I L E 5
L E S B I A N , G AY, B I S E X U A L A N D T R A N S G E N D E R M E N TA L H E A LT H
Gay men and lesbians report more psychological distress than heterosexuals, despite similar
levels of social support and physical health as heterosexual men and women.18
Anxiety, depression, self-harm and suicidal feelings are more common among lesbian, gay and
bisexual people than among heterosexual people. Rates of drug and alcohol misuse are also
higher among lesbian, gay and bisexual people. In all studies, bisexual men and women are
usually found to have the highest levels of mental distress.19,20
Lesbian, gay and bisexual people are at significantly higher risk than heterosexual people of
suicidal feelings, self-harm, drug or alcohol misuse and having a mental health problem.21
Lesbian and bisexual women are at particular risk of suicidal feelings and drug or alcohol
dependence.21
Gay and bisexual men are over four times more likely than heterosexual men to attempt
suicide.21
More than a quarter of gay men and almost a third of lesbians have self-harmed themselves
deliberately, compared with one in seven heterosexual peoples. Of those who self-harm, 65%
of gay men and 48% of lesbians attribute this wholly or partially to difficulties associated with
their sexual orientation.20
There is a strong association between homophobic bullying and mental ill health, including
low self-esteem, fear, stress and self-harm.21
Young people who identify themselves as lesbian, gay or bisexual face a higher risk of being
bullied at school. Half of all lesbian, gay and bisexual adults who have been bullied at school
have contemplated suicide or self-harm.22
Transgender people
An estimated one in 10,000–12,000 biological men have gender identity disorder and one in
40,000– 50,000 women. Transsexual women and men experience stigma and discrimination
that may contribute to poorer mental health.8
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EQUALITIES
L E A R N I N G D I S A B I L I T I E S A N D M E N TA L H E A LT H
An estimated 25-40% of people with learning disabilities also have mental health problems.23
Approximately a quarter of people with learning disabilities who live in the community, and
four in ten of those in hospitals have some form of mental health problem.24
People with learning disabilities are more vulnerable to more of the risk factors associated with
mental ill health, such as adverse life events and lack of social support, and are much less likely
than the general population to be able easily to access psychiatric services.25
Mental health problems such as depression tend to be under-diagnosed in people with
learning disabilities. Many symptoms of mental illness are wrongly regarded as challenging
behaviour and so do not receive appropriate treatment.26
Every working day at least one person on average appears in court charged with a crime against
a disabled person, nearly half of which involve violence. There is evidence that many more
incidents of targeted violence or hostility go unreported or are not dealt with effectively.27
P H Y S I C A L H E A LT H I N E Q U A L I T I E S
Serious mental illness and physical health
People with schizophrenia and bipolar disorder die an average 25 years earlier than the
general population, largely due to physical health problems.28
People with serious mental illness have much higher mortality rates from all causes, respiratory
disease, cardiovascular disease and infectious disease.28
People with schizophrenia have higher rates of obesity (1.5–2 times), diabetes (2 times),
dyslipidaemia (5 times), and smoking (2–3 times).30
Physical illness and mental health
Physical illness increases the risks of poor mental health:
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there is a higher risk of depressive disorder for a wide range of physical illnesses
including hypertension, asthma, arthritis and rheumatism, back pain, diabetes, heart
disease and chronic bronchitis31
physical illness and two or more recent adverse life events increases risk of mental illness
six-fold compared with those without physical illness32
there is a 20% rate of new onset of depression or anxiety within one year of diagnosis
of cancer or first hospitalisation with a heart attack.33,34
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N M H D U FA C T F I L E 5
Children and young people
Children and young people with conduct disorder are 17 times more likely to be excluded
from school; six times more likely to smoke regularly; four times more likely to be two or
more years behind in intellectual development, and four times more likely to report that they
regularly drink alcohol.35,36
Children and young people with emotional disorders are almost five times more likely to report
self-harm or suicide attempts; four and half times more likely to rate themselves or be rated by
their parents as having ‘fair/bad health’, and over four times more likely to have long periods
of time off school.35,36
Comorbidity of disorders is common – children and young people frequently have both
emotional and conduct disorders and mental illness and physical health problems.35,36
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EQUALITIES
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