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The Fundamental Facts
The latest facts and figures
on mental health
The
Fundamental
Facts
Acknowledgements
The Mental Health Foundation would like to thank everyone who gave their time during the research and review phases
of this publication. Our special thanks to:
Andy Bell, Director of Public Affairs, Sainsbury Centre for Mental Health
Charlie Brooker, Professor of Mental Health and Criminal Justice, University of Lincoln
Alan Cohen, Director of Primary Care, Sainsbury Centre for Mental Health
David Crepaz-Keay, Senior Policy Advisor: Patient and Public Involvement, Mental Health Foundation
Catherine Jackson, Editor, Mental Health Today
Jeremy Laurance, Health Editor, The Independent
Dr Andrew McCulloch, Chief Executive, Mental Health Foundation
Dr Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent
Iain Ryrie, former Programme Director: Research, Mental Health Foundation
Dr Mike Shooter, immediate past President, Royal College of Psychiatrists
The Fundamental Facts
The latest facts and figures
on mental health
2007 edition
Mental Health Foundation
Researched and written by Ed Halliwell, Liz Main and Celia Richardson
With information on the cost of mental health problems based on
material provided by the Sainsbury Centre for Mental Health
Edited by Isobel Booth
Foreword
Mental health presents one of the greatest challenges that current and future generations will face. In health, economic
and social terms, the burden created by mental health problems and mental illness in the UK is immense and growing.
Mental health should be a concern for us all because it affects us all. On an individual level, mental health problems affect
our ability to function day to day and our overall quality of life. When you consider such problems collectively, the effect
on society is considerable. We need to find out how to turn the tide or future generations will be still further affected by
mental ill health.
Mental health and well-being are not nearly as well understood as other areas of health. We are not giving mental health
the attention demanded by its impact on society.
As a developed country, we could do better. We need to understand the balance of factors that both promote mental
health and support the recovery of people with mental health problems. We need to acknowledge that the way we live
and the decisions we make across all areas of policy have a profound impact on our collective mental health.
The Fundamental Facts will help contribute to that understanding.
David Brindle
Public Services Editor, The Guardian
Introduction
If we are to promote mental health and prevent and treat mental illness, better documentation, analysis and
comprehension are crucial.
Presenting the facts in a way that is accessible and useful to the many people who have a contribution to make is vital
to improving understanding. The Fundamental Facts is designed to do this. It is a quick reference tool, full of thoroughly
researched, fully referenced facts and figures. It is for anyone with an interest in mental health – from those who work
mainly in the field to those who have an interest in gaining speedy and usable insight or reference material.
A note on terminology and data:
In most of the facts and figures presented, referenced authors’ terms and definitions have been used for accuracy. Very
few mental health terms, or the diagnoses they describe, are uncontroversial. Where language has been used which
reflects a certain way of seeing mental health, this does not mean that any particular model of mental health is either
endorsed or rejected.
The terms ‘mental health problems, mental distress and mental ill health’ are used interchangeably here. The term ‘mental
illness’ is used specifically to refer to clinically recognised patterns or symptoms of behaviour that can be diagnosed as
mental illnesses.
The Mental Health Foundation has a holistic view of mental health which includes social, psychological and biological
factors. Some of the sources quoted here subscribe to other models of mental health.
A lot of studies have been carried out on mental health over recent years, some of them more scientifically robust than
others. The Fundamental Facts is a compendium, with no commentary made on the research findings.
The facts and figures are left to speak for themselves.
Contents
1. THE EXTENT OF MENTAL HEALTH PROBLEMS
5
- how many people experience mental health problems?
- what are the main types of mental health problem?
- common mental health problems
- severe mental illness
- other types of mental illness
7
8
9
17
19
2. DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
25
- gender differences
- black and minority ethnic groups
- children and young people
- older people
- the prison population
- homeless people
- other groups
27
28
28
29
30
31
32
3. FACTORS RELATED TO MENTAL HEALTH PROBLEMS
35
- mental health and material deprivation
- family related and social factors
- physical health
- spirituality
- other factors
37
38
39
39
40
4. TREATMENT AND CARE
43
- how many people seek help and use services?
- what treatment and care is available for mental health problems?
- treatment and coping
45
46
50
5. THE COST OF MENTAL HEALTH PROBLEMS
63
- hidden cost
- overall cost
- health and social care costs
- economic and social factors
- mental health promotion
- violence and mental health
65
66
67
70
73
74
1.
The extent of mental
health problems
THE EXTENT OF MENTAL HEALTH PROBLEMS
Mental Health Problems: 1 in 4 British adults1
How many people experience
mental health problems?
Mental health problems are among the most common
health conditions, directly affecting about a quarter of
the population in any one year. Depression and anxiety
are the most widespread conditions, while only a small
percentage of people experience more severe mental
illnesses. However, estimates of exactly how many people
experience which mental health problems vary, and it is
not easy to compare different measures.
For example, some calculations are based on how many
people have a mental health problem at any point in
time, while others measure the likelihood of someone
developing mental health problems in their lifetime.
Others measure rates per year. Figures may relate to
different populations such as the adult population, a
regional population or a nation within the UK (eg. the
North West or England), or an international population.
The Fundamental Facts 2007
Some examples of how many people are affected are:
• The Office for National Statistics Psychiatric Morbidity
report found that in any one year 1 in 4 British adults
experience at least one mental disorder1, and 1 in 6
experiences this at any given time.
• Although mental disorders are widespread, severe cases
are concentrated among a relatively small proportion
of people who often experience more than one mental
health problem.2
• It is estimated that approximately 450 million people
worldwide have a mental health problem.3
• 1 in 4 families worldwide is likely to have at least one
member with a behavioural or mental disorder.4
THE EXTENT OF MENTAL HEALTH PROBLEMS
What are the main types of
mental health problem?
Mental health problems are usually defined and classified
by medical professionals. But some mental health
diagnoses are controversial, and there is much concern in
the field that people are too often treated according to, or
described by their label. This can have a profound effect on
their quality of life. For this reason, diagnostic labels should
be used with caution, and do not indicate the severity of
illness. Nevertheless, diagnoses remain the most usual way
of dividing and classifying symptoms into groups.
Most mental health symptoms have traditionally been
divided into groups called either ‘neurotic’ or ‘psychotic’
symptoms.
Less common are ‘psychotic’ symptoms which interfere
with a person’s perception of reality and may include
hallucinations, delusions or paranoia, with the person
seeing, hearing, smelling, feeling or believing things that
no one else does. Psychotic symptoms or ‘psychoses’ are
often associated with ‘severe mental health problems.’
However, there is no sharp distinction between the
symptoms of common and severe mental health
problems. It is important to remember that some illnesses
feature both neurotic and psychotic symptoms.
‘Neurotic’ covers those symptoms which can be regarded
as extreme forms of ‘normal’ emotional experiences such as
depression, anxiety or panic. Conditions formerly referred
to as ‘neuroses’ are now more frequently called ‘common
mental health problems,’ although this does not always
mean they are less severe than conditions with psychotic
symptoms.
The Fundamental Facts 2007
THE EXTENT OF MENTAL HEALTH PROBLEMS
women
men
all adults
250
women
men
all adults
200
250
150
200
100
150
50
100
0
16-19
20-24
50
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
Neurotic disorders: Prevalence by age per 10008
0
16-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
Common mental health
problems
• In a 2001 survey, 15% of British adults reported
experiencing ‘neurotic symptoms’ in the previous week.5
• Mixed anxiety and depression is the most common
mental disorder in Britain, with almost 9% of people
meeting criteria for diagnosis.6
• About half of people with common mental health
problems are no longer affected after 18 months, but
poorer people, long-term sick and unemployed people
are more likely to be still affected than the general
population.7
• Overall, common mental health problems peak in
middle age. 20-25% of people in the 45-54 years age
group have a ‘neurotic disorder’.8 As people age, neurotic
disorders become less common, with the lowest level
recorded in the 70-74 years age group.
Depression
The term ‘depression’ is used to describe a range of
moods, ranging from low spirits to more severe mood
problems that interfere with everyday life. Symptoms
may include a loss of interest and pleasure, excessive
feelings of worthlessness and guilt, hopelessness, morbid
and suicidal thoughts, and weight loss or weight gain. A
depressive episode is diagnosed if at least two out of three
core symptoms have been experienced for most of the
day, nearly every day, for at least two weeks. These core
symptoms are:
• Low mood
• Fatigue or lack of energy
• Lack of interest or enjoyment in life
A depressive episode may be classed as mild, moderate
or severe, depending on the number and intensity of
associated symptoms, such as sleep disturbance, appetite
and weight change, anxiety, poor concentration, irritability
and suicidal thoughts.
• Between 8% and 12% of the population experience
depression in any year.9
The Fundamental Facts 2007
60-64
THE EXTENT OF MENTAL HEALTH PROBLEMS
England
Northern Ireland
Wales
Scotland
0
5
10
15
20
Rates of suicide per 100,000 population17
• Only 2% of the population are experiencing a depressive
episode without ‘co-morbid’ anxiety,10 meaning
‘occurring at the same time’.
• Depression tends to recur in most people. More than
half of people who have one episode of depression will
have another, while those who have a second episode
have a further relapse risk of 70%. After a third episode,
the relapse risk is 90%.11 For about 1 in 5 people, the
condition is chronic.12
• Worldwide, 5.8% of men and 9.5% of women will
experience a depressive episode in a 12 month period, a
total of about 121 million people.13
• The World Health Organisation forecasts that by 2020
depression will be the second leading contributor to the
global burden of disease.14
Suicide and self-harm are not themselves mental illnesses,
but they usually result from mental distress.
The Fundamental Facts 2007
Suicide
The Government has set a target to reduce the death
rate from suicide and undetermined injury by at least a
fifth by the year 2010 (from a baseline rate of 9.2 deaths
per 100,000 population in 1995/96/97 to 7.3 deaths per
100,000 population in 2009/10/11). Data from the three
years 2002/03/04 show a rate of 8.6 deaths per 100,000
population – a reduction of 6.6% from the 1995/06/07
baseline.15
• In 2004, more than 5,500 people in the UK died by
suicide.16
• Scotland has the highest suicide rate in the UK at 20 in
100,000, an increase of 1% over a decade and the only
country in the UK to show a rise. In England the suicide
rate is 10 per 100,000 people. In both Northern Ireland
and Wales the suicide rate is 11 per 100,000.17
• The suicide rate in the EU is 17.5 people in 100,000 and
15.1 in 100,000 worldwide.18
10
THE EXTENT OF MENTAL HEALTH PROBLEMS
1979
2002
2:3
1:3
2002
1:3
Female to male gender ratios for suicide22
• Although the rate of suicide among young men reduced
by 30% in the period from 1998 to 2005, suicide remains
the most common cause of death in men under the age
of 35.19
• British men are three times more likely than British
women to die by suicide.20 This is true of younger men in
particular – those aged 25-34 are four times as likely to
kill themselves as women in this age group.21
• Since 1979, the gender gap for people dying by suicide
has widened. In 1979 the female to male gender
ratio for suicides was 2:3. In 2002, it was around 1:3.22
Nevertheless, women are more likely to attempt suicide
than men.23
• Younger suicides more often had a history of
schizophrenia, personality disorder, drug or alcohol
misuse, or violence than older suicides.24
• 4% of people who took their lives were the lone carers of
children.25
The Fundamental Facts 2007
Suicide and history of using mental health services
• An inquiry into suicides in the five years to 2001 found
that approximately a quarter of people who died by
suicide in England and Wales, Scotland and Northern
Ireland had been in contact with mental health services
in the year before death – this amounted to about 1,200
people each year. At the time of their death, 16% of
cases in England and Wales, 12% in Scotland and 10% in
Northern Ireland were psychiatric in-patients.26
• The same inquiry reported that 42% of people who took
their own lives in England and Wales were diagnosed
with either a depressive illness or bi-polar disorder, and
20% had schizophrenia or a related disorder.27
• In around a quarter of suicide inquiry cases in England,
Wales and Scotland and nearly a third in Northern
Ireland, the person died within three months of
discharge from in-patient care, with a peak in the first
one to two weeks after discharge. In England and Wales
40% died before the first follow up appointment. In
Scotland this was 35% and in Northern Ireland 66%.28
11
THE EXTENT OF MENTAL HEALTH PROBLEMS
75%
Percentage of Black Caribbean suicides with a schizophrenia
diagnosis31
Suicide and ethnicity
Self-harm
• In the five years to 2001, 6% of people who took their
own lives in England and Wales were from an ethnic
minority group. In Scotland this was 2% and in Northern
Ireland 1%.29 The 2001 Census found that 9% of the
population in England were from ethnic minorities.
In Wales this was 2%, in Scotland 2% and in Northern
Ireland 0.75%.30
Deliberate self-harm ranges from destructive behaviours
with no suicidal intent, but which relieve tension or
communicate distress, through to attempted suicide.
• The National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness in the five years
to 2001 found that people from ethnic minorities who
died by suicide usually had severe mental illness. Three
quarters of Black Caribbean people who took their own
lives had a diagnosis of schizophrenia.31
• The UK has one of the highest rates of self-harm in
Europe, at 400 per 100,000 population.32
• There is a high correlation between self-harming
behaviour and mental health problems. Most of
those who attend an emergency department after
self-harming would meet the criteria for one or more
psychiatric diagnoses. More than two thirds would meet
the criteria for depression.33
• People with current mental health problems are 20
times more likely than others to report having harmed
themselves in the past.34
• People who have self-harmed are at significant risk of
suicide.35 A study found that the risk of a person dying
by suicide within a year of being treated for self inflicted
injury was 66 times the annual risk of suicide in England
and Wales, and that there is a significant risk even many
years later.36
The Fundamental Facts 2007
12
THE EXTENT OF MENTAL HEALTH PROBLEMS
Post-natal depression, also known
as post partum depression, is
believed to affect between
8 and 15% of women.39
• Self-harming and suicide may be influenced by the
depiction of similar behaviour in the media or taking
place in peer groups. For example, one study showed a
17% increase in presentations to hospital from selfpoisoning in the week after an overdose was depicted
in a TV drama.37 Similarly, a study of teenagers who selfharmed found that the strongest associated factor was
awareness of friends who had also self-harmed.38
• Major public events may lead to amplification of existing
distress. In the month following the death of Diana,
Princess of Wales, the number of women dying by
suicide increased by a third, with a 45% increase in the
number of women aged 25-44 years taking their lives.
Deliberate self-harm by women increased 65% and was
up 44% overall.
The Fundamental Facts 2007
Postnatal depression
There are two main types of mental health problem that
a woman may experience following the birth of a child:
postnatal depression and puerperal psychosis. Puerperal
psychosis is classed as a severe mental health problem
(see page 18). Post-natal depression, also known as post
partum depression, is believed to affect between 8 and
15% of women.39 Post-natal depression is not the same as
the ‘baby blues’ which are very common, but last only a
few days.
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a form of depression
that affects approximately 0.8% of the population at some
point in their lives. There are two types of SAD: winter
and summer depression. Winter depression occurs more
frequently and is characterised by recurring episodes
of depression that begin in Autumn/Winter as a result
of inadequate bright light and go in Spring/Summer.40
SAD differs from other forms of depression in that those
affected sleep more than normal, whereas people
experiencing other forms of depression have difficulty
sleeping.
13
THE EXTENT OF MENTAL HEALTH PROBLEMS
It often takes between 10 and 15 years
for people to seek professional
help for OCD.44
Anxiety
Anxiety is a normal response to threat or danger and
part of the usual human experience, but it can become
a mental health problem if the response is exaggerated,
lasts more than three weeks and interferes with daily
life. Anxiety is characterised by worry and agitation,
often accompanied by physical symptoms such as rapid
breathing and a fast heartbeat or hot and cold sweats.
‘Stress’ is not considered a mental health problem in its
own right, but long-term stress may be associated with
anxiety or depression.
• Generalised anxiety disorder (GAD) is diagnosed after
a person has on most days for at least six months
experienced extreme tension (increased fatigue,
trembling, restlessness, muscle tension), worry, and
feelings of apprehension about everyday problems.
The person is anxious in most situations, and there is no
particular trigger for anxiety.41
• People who experience anxiety usually have symptoms
that fit into more than one category of anxiety disorder,
and are usually diagnosed with at least one other mental
disorder, most commonly depression.42
The Fundamental Facts 2007
• Social phobia, a persistent fear of being seen negatively
or humiliated in social or performance situations, is the
third most commonly diagnosed mental disorder in
adults worldwide, with a lifetime prevalence of at least
5%.43
Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder is a common form
of anxiety characterised by obsessive thinking and
compulsive behaviour. Obsessions are distressing,
repetitive thoughts which may be seen as irrational, but
cannot be ignored. Compulsions are ritual actions which
people feel compelled to repeat in order to relieve anxiety
or to stop obsessive thoughts. For example, someone may
believe that their hands are constantly dirty so wash them
over and over again.
• 2-3% of people will experience Obsessive Compulsive
Disorder during their lifetime.44 It often takes between 10
and 15 years for people to seek professional help.
• 7% of British adults report ‘obsessions’ in any week, with
4% reporting ‘compulsions’.45
14
THE EXTENT OF MENTAL HEALTH PROBLEMS
Occurrences of phobias in men and women (per 1000)46
Phobias (including panic attacks)
Phobias describe a group of disorders in which anxiety
is experienced only, or predominantly, in certain welldefined situations that are not dangerous. As a result, these
situations are avoided or endured with dread. The person’s
concern may be focused on individual symptoms like
palpitations or feeling faint and these are often associated
with secondary fears of dying, losing control, or ‘going
mad’.
• Phobias are much more common in women than men,
affecting about 22 in 1,000 women compared with 13 in
1,000 men in Britain.46
• Agoraphobia is the term for a cluster of phobias that
include fears of leaving home, entering shops, crowds
and public places, or travelling alone in trains, buses or
planes.
• There are numerous phobias restricted to highly specific
situations such as proximity to particular animals,
heights, thunder, darkness, flying, closed spaces, using
public toilets, eating certain foods, dentistry, or the sight
of blood or injury.
• Panic disorder occurs when there are recurrent,
unpredictable panic attacks followed by at least one
month of persistent concern about having another
attack.
• Panic attacks are usually contained episodes
characterised by a sudden and intense sensation of
fear and accompanied by physical symptoms, and the
person may feel that they are dying.47
• Social phobias are characterised by a fear of scrutiny by
other people. Symptoms may include blushing, shaking
hands, nausea or the urgent need to go to the toilet.
The Fundamental Facts 2007
15
THE EXTENT OF MENTAL HEALTH PROBLEMS
8.1%
Men
8.1%
Men
20.4%
20.4%
Women Women
Risk of developing PTSD after a traumatic event48
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) develops following
a stressful event or a situation of an exceptionally
threatening or catastrophic nature. Intentional acts of
violence are more likely than natural events or accidents
to result in PTSD. Common symptoms may include
re-experiencing the event in nightmares or flashbacks,
avoiding things or places associated with the event,
panic attacks, sleep disturbance and poor concentration.
Depression, emotional numbing, drug or alcohol misuse
and anger are also common.
In children, re-experiencing symptoms may take the form
of re-enacting the experience, repetitive play or frightening
dreams without recognisable content.
• The risk of developing PTSD after a traumatic event is
8.1% for men and 20.4% for women.48
• Symptoms of PTSD usually develop immediately after
the traumatic event but for less than 15% of people
affected, the onset of symptoms will be delayed.49
• PTSD sufferers may not seek treatment for months or
years after the onset of symptoms.
The Fundamental Facts 2007
16
THE EXTENT OF MENTAL HEALTH PROBLEMS
Less than a quarter of people who have
distressing psychotic experiences at some
time in their lives remain permanently
affected by them.51
Severe mental illness
Psychosis
Bipolar disorder
‘Psychosis’ describes a loss of touch with reality, which
may include hearing voices, seeing something that no
one else sees, holding unusual personally derived beliefs,
experiencing changes in perception or assigning personal
meanings to everyday objects. Psychosis is associated
with schizophrenia, schizoaffective disorder, puerperal
psychosis, severe depression and is often experienced
during the ‘highs’ of bipolar disorder. Other illnesses such
as dementia can also feature psychotic symptoms.
Bipolar disorder, also known as manic depression, is
associated with severe mood changes that fluctuate from
elation, overactivity and sometimes psychosis (together
known as mania or hypomania) to a lowering of mood and
decreased energy and activity (depression). It is diagnosed
after at least two episodes in which a person’s mood
and activity levels are significantly disturbed, including
on some occasions mania or hypomania and, on others,
depression. A person usually recovers completely between
episodes.
• About 1 in every 200 adults experiences a ‘probable
psychotic disorder’ in the course of a year.50
• Less than a quarter of people who have distressing
psychotic experiences at some time in their lives remain
permanently affected by them.51
• The average age of onset of psychotic symptoms is 22.52
• 4.4% of people in the general population say they have
experienced at least one symptom of psychosis such as
delusions or hallucinations. Risk factors include smoking,
living in the country, little social support, adverse life
events, neurosis and excessive drug or alcohol use.
Paranoid thoughts are the most commonly reported
symptom.53
The Fundamental Facts 2007
During a phase of ‘mania’, people may exhibit grandiose
ideas (an inflated belief in their own power, knowledge
or relationship to important people or deities), an inflated
sense of self esteem, a reduced need for sleep and
impaired concentration and judgment.
Hypomania is a milder mania, in which abnormalities of
mood and behaviour are persistent and marked, but are
not accompanied by hallucinations or delusions and do
not result in severe disruption to work or social rejection.
• Between 0.9% and 2.1% of the adult population
experience a bipolar disorder at some point in their
lives.54 There is very little gender difference.
17
THE EXTENT OF MENTAL HEALTH PROBLEMS
Approximately 25% of people with
schizophrenia make a full recovery and
experience no further episodes.
Between 10 and 15% will experience
severe long-term difficulties.60
• Symptoms of bipolar disorder usually begin between
the ages of 15 and 24.55 The age of onset of mania is
earlier in men than in women, although women have
a higher incidence throughout the rest of adult life.56
However the first episode may occur at any age from
childhood to old age.
Schizoaffective disorder
Schizophrenia
• Symptoms usually begin in early adult life, with men
tending to show symptoms earlier than women.
The diagnosis of schizophrenia refers to a group of
symptoms, typically the presence of hallucinations,
delusions, disordered thought, and problems with feelings,
behaviour, motivation and speech. When they occur
together they represent a severe mental illness.
• Schizophrenia is the most common form of psychotic
disorder, affecting between 1.1% and 2.4% of people at
any one time.57
• The most frequent age of onset for schizophrenia is
between 20 and 30 years.58 On average, men have an
earlier age of onset than women by about 5 years.59
• After a first episode, approximately 25% of people with
schizophrenia make a full recovery and experience no
further episodes. Between 10 and 15% will experience
severe long-term difficulties and the remainder will
experience recurrent acute episodes with periods of
remission or with only residual symptoms in between.60
The Fundamental Facts 2007
The diagnosis of schizoaffective disorder is given to
someone who experiences both symptoms of a mood
disorder (ie. depression) and symptoms of the type
experienced with schizophrenia at the same time, or
within days of each other.
• About 1 in every 200 people is thought to develop
the disorder at some point, and it tends to affect more
women than men.61
Puerperal psychosis
Puerperal psychosis is rare, following between about 1
and 2 in 1000 births.62 The onset is abrupt, usually within
days of the birth. The mother often starts to behave
strangely, seeming puzzled and perplexed, sleeping poorly
and being restless and erratic in the day. She may have
paranoid delusions that often centre around the child,
for example a belief that the child is the devil, or that the
world is too evil for the child to live in.
18
THE EXTENT OF MENTAL HEALTH PROBLEMS
0.2%
1.9%
Percentage of men and women who experience anorexia63
Other types of
mental illness
Eating disorders
Attention Deficit Hyperactivity Disorder
Symptoms of eating disorders include severely reduced
eating, intense fear of weight gain, and self perception that
is overly influenced by weight or body shape. They also
include significant levels of self-induced vomiting, laxative
abuse and strenuous exercise for weight control.
Attention Deficit Hyperactivity Disorder (ADHD) is
often used to describe children who display overactive
(hyperactive) and impulsive behaviour and who have
difficulty in paying attention.
• 1.9% of women and 0.2% of men experience anorexia in
any year.63 Anorexia is characterised by a failure to gain
weight in relation to age, or excessive loss of weight,
through avoiding food. In some cases death can occur
because of the physical consequences of persistent
starvation. Usually, the condition lasts for about 6 years.
• Between 0.5% and 1% of young women experience
bulimia at any one time.64 The most common age of
onset is in teenage years and early 30s.65 Bulimia also
involves a preoccupation with food but is characterised
by episodes of intense binge eating, preceded and
followed by periods of starvation and/or self-induced
vomiting and purging.
• About 40% of people referred to eating disorder clinics
are classified ‘Eating Disorder Not Otherwise Specified’,66
with symptoms that don’t fit neatly into either the
anorexia or bulimia classifications.
The Fundamental Facts 2007
• A lack of consensus on the definition of, and criteria
for, ADHD has produced widely divergent estimates
of prevalence rate, varying between 0.5% and 26% of
children.67 This has been attributed in part to major
differences in the way children from different cultures
are rated for ADHD.68
Personality disorder
This is a controversial diagnosis. Many people believe it is
used in cases where symptoms do not obviously fit any
other diagnosis. Personality disorder is used to diagnose
a person who has difficulty coping with life and whose
behaviour persistently causes distress to themselves or
others. Personality disorders are characterised by longlasting rigid patterns of thought and behaviour. The
attitudes of people with a disorder usually exaggerate part
of their personality and result in behaviour at odds with
expectations of what is regarded as normal.
19
THE EXTENT OF MENTAL HEALTH PROBLEMS
38%
Men
38%
Men
15%
15%
Women Women
Percentage of adults assessed as being ‘hazardous drinkers’72
• Between 4 and 5% of people living in Britain meet the
criteria for a personality disorder.69
• Obsessive compulsive personality disorder is estimated
to be the most common, affecting about 2% of the
population (see page 14). Less than 1% fall into each
of the other categories, with the highest being 0.8% in
avoidant or schizoid personality disorder, followed by
paranoid or borderline personality disorder and antisocial personality disorder.70
• Fewer people with a personality disorder make
contact with psychiatric services than those with
other conditions such as schizophrenia or depression.
The probability of people with a personality disorder
withdrawing from treatment is higher.71
Alcohol and other substance misuse
Definitions of alcohol and substance misuse vary. However,
dependence is usually defined by preoccupation with use
of the substance, inability to control use, and failure to cut
back despite life-damaging consequences.
• In 2000, a quarter (26%) of adults in Britain, including
38% of men and 15% of women, were assessed as
being ‘hazardous drinkers’. Hazardous drinking refers
to a pattern of drinking alcohol that brings the risk of
physical or psychosocial harm. Prevalence of hazardous
The Fundamental Facts 2007
drinking decreased with age. For women prevalence
was highest in the 16-19 year old group (32%), whereas
for men it was highest in the 20-24 age group (62%).72
• Worldwide, 1.7% of adults are thought to have an
alcohol-use disorder.73
• 3.7% of adults in Britain are considered to be drugdependent.74 The number of people who are drug
dependent appears to have doubled between 1993 and
2000.75
• 30% of people who are dependent on alcohol and
45% of people dependent on drugs also have another
psychiatric disorder.76
• In 2004/05, there were around 35,600 NHS hospital
admissions with a primary diagnosis of mental and
behavioural disorders due to alcohol. Around two thirds
(68%) of those were men.77
• ‘Binge drinking’ is best defined as drinking twice the
recommended daily limit of alcohol units. An NHS survey
found that, using this measure, 23% of men reported
drinking more than 8 units on at least one day in a week.
The proportion ranged from 33% of men aged 16-24 to
6% of those aged 65 and over.78
20
THE EXTENT OF MENTAL HEALTH PROBLEMS
5%
5%
over 65 over 65
20%
20%
over 80 over 80
Percentage of people affected by dementia by age group82
Dual diagnosis
There is considerable overlap between substance
misuse problems and other mental health problems.
Such overlap affects many people with mental health
problems. However, dual diagnosis, when an individual
experiences a mental illness and a substance use problem
simultaneously, affects far fewer people.
• Between a third and half of people with severe mental
health problems consume alcohol or other substances
to levels that meet criteria for ‘problematic use’.79
• 51% of alcohol-dependent adults say they have a mental
health problem.80
• 44% of people using services of Community Mental
Health Teams in four urban centres reported problematic
drug or alcohol use in the preceding year.81
Dementia
Dementia is a progressive and largely irreversible condition
that involves widespread damage to mental functioning.
Someone with dementia may experience memory
loss, language impairment, disorientation, change in
personality, difficulties with daily living, self neglect,
and behaviour which is out of character (for example,
aggression, sleep disturbance or sexual disinhibition).
The Fundamental Facts 2007
• Dementia affects 5% of people over the age of 65
and 20% of those over 80. About 700,000 people in
the UK have dementia (1.2% of the population) at any
one time.82
• Dementia is uncommon before the age of 65, but does
affect 1 in 1,000 younger people.83
• About 60% of dementia cases are caused by Alzheimer’s
disease.
• About a fifth of cases of dementia are related to strokes
or insufficient blood flow to the brain, these cases being
known as vascular dementia.84
• In fronto-temporal dementia, which includes Pick’s
disease, damage is usually focused in the front part of
the brain. Personality and behaviour are initially more
affected than memory.
• People with multiple sclerosis, motor neurone disease,
Parkinson’s disease, Huntington’s disease and Down’s
syndrome are at increased risk of developing a type of
dementia linked to their condition.
21
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22. Mind Suicide Factsheet at www.
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31. Safety First: Five-Year Report of
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32. Horrocks, J, Self-poisoning
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2.2.
Differences in the
extent of mental health
problems
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
10% 10%
Men Men
25% 25%
Women
Women
Men and women requiring treatment for depression during
lifetime86
Difference in the extent of
mental health problems
Gender differences
• Women are more likely to have been treated for a
mental health problem than men (29% compared with
17%).85
• More than half of contacts with the Samaritans are made
by men – 53% compared with 43% by women. 4% were
unidentifiable.
• Depression is more common in women than men. 1 in
4 women will require treatment for depression at some
time, compared with 1 in 10 men.86 The reasons for this
are unclear, but are thought to be due to both social and
biological factors.
• Doctors are more likely to treat depression in women
than in men, even when they present with identical
symptoms.87
• Women are twice as likely to experience anxiety as men.
Of people with phobias or OCD, about 60% are female.88
The Fundamental Facts 2007
• Men are more likely than women to have an alcohol
or drug problem. 67% of British people who consume
alcohol at ‘hazardous’ levels, and 80% of those
dependent on alcohol are male. Almost three quarters
of people dependent on cannabis and 69% of those
dependent on other illegal drugs are male.89
• The prevalence of schizophrenia is about the same in
men and women, but the average age of onset is 18 in
men and 25 in women.90
• All personality disorder categories are more prevalent in
men, apart from the schizotypal category. Men are five
times more likely than women to be diagnosed with
anti-social personality disorder.91
• About 75% of people to die by suicide are men. This
proportion has been about the same for more than a
decade.92
27
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
Depression in ethnic minority groups has
been found to be up to 60% higher than in
the white population.95
Black and minority ethnic groups
In general, rates of mental health problems are thought to
be higher in minority ethnic groups in the UK than in the
white population,93 but they are less likely to have their
mental health problems detected by a GP.94
• Depression in ethnic minority groups has been found to
be up to 60% higher than in the white population.95
• Young Asian women are three times as likely to kill
themselves as young white women.96
• A higher prevalence of diagnosed mental illness,
particularly schizophrenia, has been found among Black
Caribbean people in the UK.97 They are twice as likely
as white people to be diagnosed as having a psychotic
disorder.98
• Mental health staff, including psychiatrists, are more
likely to perceive black patients as being potentially
dangerous, even though there is no evidence that
they are any more aggressive than other patient
populations.99
• Black African and Caribbean people are three times as
likely to be admitted to hospital and up to 44% more
likely to be detained under the Mental Health Act as
white people.100
The Fundamental Facts 2007
• Black people are more likely than white people to
be given physical treatments, such as medication
and ECT, and are likely to be prescribed higher doses
of medication. They are less likely to be offered
psychotherapy, counselling and other non-medical
interventions.101
• Compared with White British patients, both African–
Caribbean and Black African patients are less likely to be
referred to mental health services by a GP, and are more
commonly referred by a criminal justice agency.102
Children and young people
• Estimates vary, but research suggests that 20% of
children have a mental health problem in any given year,
and about 10% at any one time.103
• The British Medical Association estimates that at any
point in time up to 45,000 young people under the age
of 16 are experiencing a severe mental health disorder,
and approximately 1.1 million children under the age
of 18 would benefit from specialist mental health
services.104
28
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
aged 11-15
aged 11-15
aged 5-10aged 5-10
10.4%
10.4%
5.9%
5.9%
12.8%
12.8%
9.65%
9.65%
Rates of mental health problems among children
• Rates of mental health problems among children
increase as they reach adolescence. Disorders affect
10.4% of boys aged 5-10, rising to 12.8% of boys aged
11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls
aged 11-15.105
• In one study, 50-60% of adults with a diagnosed mental
disorder had received a mental health diagnosis of some
kind before the age of 15.106
• Among teenagers, rates of depression and anxiety have
increased by 70% in the past 25 years.107
• Children of single-parent families are twice as likely
to have a mental health problem as children of twoparent families (16%, compared with 8%). Also at higher
risk are children in large families, children of poor and
poorly-educated parents and those living in social sector
housing.108
Older people
• Older people are less likely to have a neurotic disorder
(or common mental health problem), other than
depression, than other sections of the British population.
10.2% of those aged 65-69 and 9.4% of those aged 70-74
have a neurotic disorder, compared with 16.4% of the
general population.110
• Depression affects 1 in 5 people over the age of 65 living
in the community and 2 in 5 living in care homes.111
However, it is likely that only a small proportion of older
people with depression are in contact with their GP or
mental health services.112
• An estimated 70% of new cases of depression in older
people are related to poor physical health.113,114
• 41% of British 11-15 year-olds who smoke regularly have
a mental disorder, as well as 24% of those who drink
alcohol at least once a week, and 49% of those who use
cannabis at least once a month.109
The Fundamental Facts 2007
29
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
72%
Men
72%
Men
70%
70%
Women Women
Mental disorders among sentenced prisoners117
The prison population
Prisoners have particularly high levels of mental illness.
Until 2003, prison health care was the responsibility of the
Home Office, but it now comes under the auspices of the
NHS.
• Prisoners with mental disorders are significantly overrepresented in the prison population. As many as
12-15% of all prisoners have four concurrent mental
disorders. 30% of all prisoners have a history of self-harm,
and the incidence of mental health disorder is higher for
women, older people and those from ethnic minority
groups.115
• Up to 90% of prisoners have a diagnosable mental
illness, substance abuse problem or, frequently, both.116
• 72% of male and 70% of female sentenced prisoners
have at least one mental disorder and 1 in 5 prisoners
has four major mental health disorders.117
• Male prisoners are 14 times more likely to have two
or more disorders than men in general, and female
prisoners 35 times more likely than women in general.118
The Fundamental Facts 2007
• In one UK study, 5.2% of prisoners had displayed
symptoms of psychosis in the past year compared
with 0.45% of the general population. Psychosis was
attributed to toxic or withdrawal effects of drugs and
alcohol in a quarter of the prison cases.119
• The suicide rate for men in prison is five times that for
men in the community. Boys aged 15-17 are 18 times
more likely to kill themselves in prison than in the
community.120
• National research found that 72% of people who died by
suicide in prison had a history of mental disorder. 57%
had symptoms suggestive of mental disorder at the time
they entered prison.121
• A fifth of perpetrators of homicide with schizophrenia
were sent to prison rather than hospital.122 Over 90% of
perpetrators with personality disorder had no symptoms
of mental illness at the time of the offence and received
a prison sentence.123
30
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
Less than 1 in 3 homeless people with mental health problems
receive treatment130
• Women make up just 6% of the prison population. In
2003 they accounted for 46% of all reported self-harm
incidents with 30% of women reported to have harmed
themselves, on average five times each, compared with
6% of men, who on average harmed themselves twice.124
• Behavioural and mental health problems are particularly
prevalent amongst children in prison. Of prisoners aged
16-20, around 85% show signs of a personality disorder
and 10% exhibit signs of psychotic illness.125
• More than half of all elderly prisoners suffer from a
mental disorder, most commonly depression, which
often emerges as a result of imprisonment.126
Homeless people
• In 2005/06 there were 7,340 homeless people
experiencing mental illness, more than double the
number 15 years earlier.127
• The percentage of homeless people judged to be
homeless and vulnerable due to mental illness or
disability rose from 3.25% in 1991 to 7.8% in 2006.128
• 1 in 4 homeless people will die by suicide.129
• Less than a third of homeless people with mental health
problems receive treatment.130
• 30-50% of homeless rough sleepers experience mental
health problems. About 70% misuse drugs.131
• Behavioural problems have been found to be higher
among homeless children living in temporary
accommodation, and mental health problems are
significantly higher among homeless mothers and
children.132
The Fundamental Facts 2007
31
DIFFERENCES IN THE EXTENT OF MENTAL HEALTH PROBLEMS
30%
Percentage of deaf people with mental health problems136
Other groups
• People who provide substantial amounts of care to
relatives are twice as likely to have a mental health
problem as the general population.133
• A survey of carers in England found that female carers
are 23% more likely to suffer from anxiety or depression
than women in the general population. (Most carers
are women.) People who spend 20 or more hours a
week caring are twice as likely to suffer from anxiety or
depression as those spending less time providing care.134
• Two thirds of refugees have experienced anxiety
and depression,135 which may often be linked to war,
imprisonment, torture or oppression in their home
countries, and/or social isolation, language difficulties
and discrimination in their new country.
• 30% of deaf people using British Sign Language
have mental health problems, primarily anxiety and
depression.136
• 25-40% of people with learning disabilities are estimated
to have a mental health problem.137
The Fundamental Facts 2007
32
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Adults In Great Britain London:
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95. National Health Service
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86. National Institute for
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Depression, NICE Guideline, Second
Consultation. London: NHS p19,
(2003)
96. Mind Suicide Factsheet, at
www.mind.org.uk, (2004)
87. World Health Organisation, Fact
sheet N°248, Women and Mental
Health, (2000), available at www.
who.int/mediacentre/factsheets
(accessed August 2006)
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110. Singleton N, Bumpstead
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Mental Illness
124. Safer Custody News, London:
Prison Service, (June 2004)
127. Answer to Parliamentary
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London: Hansard available at
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(accessed October 2006)
128. Answer to Parliamentary
Question by Yvette Cooper,
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(accessed October 2006)
129. Mental Health And Social
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Report London: Office Of The
Deputy Prime Minister, (2004)
130. National Health Service,
Mental Health: National Service
Frameworks London: NHS, (1999)
131. Research from Shelter,
available at http://england.shelter.
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132. Research from Shelter,
available at http://england.shelter.
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133. Mental Health and Social
Exclusion London: Office of the
Deputy Prime Minister, quoting
Singleton N et al (2002) Mental
Health Of Carers London: The
Stationery Office, (2004)
134. Office for National Statistics,
Mental Health of Carers London:
The Stationery Office, (2002)
135. Burnett A, Peel M, Health
Needs Of Asylum Seekers And
Refugees, British Medical Journal,
322 pp544-547, (2001)
136. Mental Health And Social
Exclusion: Social Exclusion Unit
Report London: Office Of The
Deputy Prime Minister, (2004)
The Fundamental Facts 2007
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137. Health Needs of People With
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www.learningdisabilities.org.uk
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References
116. Brooker C. et al, Mental health
services and prisoners: A review,
London: Department of Health,
(2003)
3.
Factors related to mental
health problems
FACTORS RELATED TO MENTAL HEALTH PROBLEMS
Factors related to mental
health problems
Mental health and material deprivation
• Having a low income, being unemployed, living in poor
housing, low levels of education and membership of
social classes IV (partly skilled people) and V (individuals
with no skills) are all associated with a greater risk of
experiencing a mental health problem.138
• The poorest fifth of adults are at double the risk of
experiencing a mental health problem as those on
average incomes.139
• In a study of British adults taking the GHQ questionnaire
(which measures psychological well-being), the
prevalence of high scores (indicative of a psychiatric
problem) increased as household income decreased.140
• Financial problems can be both a cause and a
consequence of mental health problems. People with
mental health problems are three times as likely to be in
debt as the general population and more than twice as
likely to have problems managing money.141
• Children in poor households are three times as likely
to have mental health problems as children in well-off
households.142
• People without a degree are almost twice as likely to
experience depression as those with a degree.143
The Fundamental Facts 2007
37
FACTORS RELATED TO MENTAL HEALTH PROBLEMS
1 in 4 people using mental health services has no
146
1 in 3 people using mental health services has no
contact with their family
contact with their friends146
Family-related and social factors
• Social isolation is a factor in mental health problems.
20% of people with common mental health problems
live alone, compared with 16% of the overall
population.144
• Between a third and two thirds of children whose
parents have mental health problems will develop
problems either in childhood or adult life.150 Children
of depressed parents have a 50% risk of developing
depression themselves before the age of 20.151
• A person with a severe mental health problem is
four times more likely than average to have no close
friends.145
• Almost half of children in care have a mental health
problem. Children in care are 4 to 5 times as likely to
have a mental health problem as other children.152
• 1 in 4 people using mental health services has no
contact with their family, and 1 in 3 has no contact with
friends.146
• Taking part in social activities, sport and exercise is
associated with higher levels of life satisfaction. For
example, 76% of those who play sport or exercise at least
once a week are satisfied, compared with 70% of those
who never or rarely play sport or exercise.153
• Low levels of social support can reduce the likelihood of
recovery – in one study 54% of women and 51% of men
with mental health problems and good social support
recovered over an 18 month period, compared with 35%
of women and 36% of men with a severe lack of social
support.147
• People with a common mental health problem are twice
as likely to be separated or divorced as their mentally
healthy counterparts (14%, compared with 7%),148 and
are more than twice as likely to be single parents as
those without a mental health problem (9%, compared
with 4%).149
The Fundamental Facts 2007
• Other social and economic risk factors for mental health
problems include: poor transport, neighbourhood
disorganisation and racial discrimination. Social and
economic protective factors for mental health include:
community empowerment and integration, provision
of social services, tolerance, and strong community
networks.154
38
FACTORS RELATED TO MENTAL HEALTH PROBLEMS
Diabetes 27%
Hypertension 29%
Stroke 31%
Cancer patients 33%
HIV/AIDS 44%
0
10
20
30
40
50
Percentage of people with poor physical health affected by depression156
Physical health
Spirituality
People with poor physical health are at higher risk of
experiencing common mental health problems, and
people with mental health problems are more likely to
have poor physical health.
Spirituality means different things for different people
at different times. Although for centuries spirituality has
been expressed through religion, art, nature and the
built environment, recent expressions of spirituality have
become more varied. Underlying this is an assumption that
trying to make sense of the world around us and our place
within it is an intrinsic part of what it means to be human.
• A person with schizophrenia will, on average, live for
10 years less than someone without a mental health
problem.155
• Depression affects 27% of people with diabetes, 29% of
people with hypertension, 31% of people who have had
a stroke, 33% of cancer patients and 44% of people with
HIV/AIDS.156
• People who experience persistent pain are four times
as likely to have an anxiety or depressive disorder as the
general population.157
• 61% of people with schizophrenia presenting at GP
surgeries and 46% of those with manic depression
smoke, compared with 33% of the remaining
population.158 In one study smoking cessation had been
offered to more of those with severe mental illness
than to other patients who smoke, and more had been
prescribed smoking cessation medication.159
The Fundamental Facts 2007
• Research literature has consistently reported that
aspects of religious and spiritual involvement are
associated with desirable mental health outcomes.160,161
The Royal College of Psychiatrists notes that people who
use mental health services identify the benefits of good
quality spiritual care as being: improved self-control, self
esteem and confidence; speedier and easier recovery;
and improved relationships.162
• In a study of people with severe mental health problems
across a range of diagnoses, 60% reported that religion/
spirituality had ‘a great deal’ of helpful impact on their
illness through the feelings it fostered of being cared for
and of not being alone.163
39
FACTORS RELATED TO MENTAL HEALTH PROBLEMS
66%
Percentage of people with mental health problems who believe
that workplace stress was a factor166
• Studies have found that religious people, those who
believe in a transcendent being or higher power, and
people who belong to a community with others who
share their values and offer support are more likely to
recover from depression.164
Other factors
• Overall, people with common mental health problems
are more likely to live in an urban area than in the
country. However, among rural areas, the most deprived
and remote areas have the highest overall levels of
mental health problems and suicide.165
• Workplace stress can frequently contribute to mental
health problems. About two thirds of people with
mental health problems believe that long hours,
unrealistic workloads or bad management at work
caused or exacerbated their condition.166
• Having a sense of control over one’s life is linked to good
mental health. In one survey, of those who said they had
‘complete control’ in their lives, only 14% said they had
ever been told by a doctor that they had a mental health
problem, compared with 56% of those who said they
had ‘little control’.168
• Women who have been abused in childhood are
four times more likely to develop major depression in
adulthood.169
• People who experienced childhood sexual abuse are
almost three and a half times as likely to be treated
for psychiatric disorders in adulthood as the general
population. They are five times as likely to have a
diagnosis of personality disorder.170
• Mental health is adversely affected by war, conflict,
extreme poverty, displacement and natural disasters.
Worldwide, it is estimated that between a third and
a half of those affected by such events suffer from
diagnosable mental distress, especially post-traumatic
stress disorder, depression and anxiety.167
The Fundamental Facts 2007
40
138. Based on Meltzer H, Singleton
N, Lee A, Bebbington P, Brugha T,
Jenkins R , The social and economic
circumstances of adults with mental
disorders Her Majesty’s Stationery
Office (HMSO): London, (2002)
149. Singleton N, Bumpstead
R, O’Brien M, Lee A, Meltzer H,
Psychiatric Morbidity Among Adults
Living In Private Households, 2000
London: The Stationery Office p78,
(2001)
139. Based on Meltzer H, Singleton
N, Lee A, Bebbington P, Brugha T,
Jenkins R , The social and economic
circumstances of adults with mental
disorders Her Majesty’s Stationery
Office (HMSO): London, (2002)
150. Mental Health and Social
Exclusion, Social Exclusion Unit,
London: Office of the Deputy Prime
Minister, p75, quoting Falkov A,
Crossing Bridge: Training Resources
for Working With Mentally Ill
Parents And Their Children London:
Department of Health/Pavilion,
(2004)
140. Department of Health,
Health Survey for England 2003:
Summary of Key Findings London:
Department Of Health p10, (2004)
141. Mental Health and Social
Exclusion, Social Exclusion Unit,
London: Office of the Deputy Prime
Minister, p88, quoting Meltzer 2002,
(2004)
References
142. National Health Service:
National Service Frameworks
London: NHS, (1999)
143. Singleton N, Bumpstead
R, O’Brien M, Lee A, Meltzer H,
Psychiatric Morbidity Among Adults
Living In Private Households, 2000
London: The Stationery Office p79,
(2001)
151. Prevention Of Mental Disorders
Geneva: World Health Organisation
p29, (2004)
152. Every Child Matters: Change
for Children – Facts And Figures,
Department for Education and
Skills (2003)
153. Donovan N, Halpern D,
Life Satisfaction: the State Of
Knowledge And Implications for
Government London: Strategy Unit
p26, (2002)
154. Prevention Of Mental Disorders
Geneva: World Health Organisation
pp22-24, (2004)
144. Singleton N, Bumpstead
R, O’Brien M, Lee A, Meltzer H,
Psychiatric Morbidity Among Adults
Living In Private Households, 2000
London: The Stationery Office p77,
(2001)
155. Healthy Body And Mind:
Promoting Healthy Living for
People Who Experience Mental
Distress, National Institute for
Mental Health In England, Leeds:
NIMHE p4, (2004)
145. Huxley P, Thornicroft G, Social
Inclusion, Social Quality And Mental
Illness, British Journal Of Psychiatry
182 pp289-90, (2003)
156. Investing In Mental Health,
Geneva: World Health Organisation,
p11, (2003)
146. National Health Service:
National Service Frameworks
London: NHS p46, (1999)
147. Singleton N, Lewis G. Better Or
Worse: A Longitudinal Study Of The
Mental Health Of Adults Living In
Private Households In Great Britain
London: The Stationery Office p33,
(2003)
157. The World Health Report 2001
Mental Health: New Understanding,
New Hope Geneva: World Health
Organisation p8, (2001)
158. Equal Treatment: Closing
the Gap Interim Report of a
Formal Investigation into Health
Inequalities, Disability Rights
Commission, (2005), available
at http://drc-gb.org/newsroom
(accessed August 2006)
148. Singleton N, Bumpstead
R, O’Brien M, Lee A, Meltzer H.
Psychiatric Morbidity Among Adults
Living In Private Households, 2000
London: The Stationery Office p77,
(2001)
The Fundamental Facts 2007
41
159. Equal Treatment: Closing
the Gap Interim Report of a
Formal Investigation into Health
Inequalities, Disability Rights
Commission, (2005), available
at http://drc-gb.org/newsroom
(accessed August 2006)
160. Swinton, J. (2001) Spirituality
and Mental Health Care:
Rediscovering a Forgotten
Dimension. London: Jessica
Kingsley, cited in Culliford L,
Spiritual care and psychiatric
treatment: an introduction,
Advances in Psychiatric Treatment
8: 249-258, (2002)
161. Mentality – Adulthood (2004)
available at www.library.nhs.uk/
mentalhealth (accessed June 2006)
162. Culliford L. and Powell A,
Spirituality and Mental Health,
Royal College of Psychiatrists,
(2005), available at www.rcpsych.
ac.uk (accessed June 2006)
163. Foskett J, Marriott J, and
Wilson-Rudd F, Mental health,
religion and spirituality: Attitudes,
experience and expertise among
mental health professionals and
religious leaders in Somerset:
Mental Health, Religion and
Culture, 2004, v. 7, no. 1, p. 5-22 in
Cornah D. The impact of spirituality
on mental health: a review of the
literature, London: Mental Health
Foundation, (2006)
164. Cornah D, The impact of
spirituality on mental health: a
review of the literature, London:
Mental Health Foundation, (2006)
165. Melzer D, Geographic
variations in Health London: The
Stationery Office, (2002)
166. Out At Work: Updates vol 3
issue 16 London: Mental Health
Foundation, (2002)
167. The World Health Report 2001
Mental Health: New Understanding,
New Hope Geneva: World Health
Organisation, p43, (2001)
References
168. Well What Do You Think: The
Second National Scottish Survey Of
Public Attitudes To Mental Health,
Mental Well-Being And Mental
Health Problems, Scottish Executive
(2004), available at www.scotland.
gov.uk
169. The World Health Report 2001
Mental Health: New Understanding,
New Hope Geneva: World Health
Organisation p10, (2001)
170. Spataro J et al, Impact Of Child
Sexual Abuse On Mental Health
British Journal Of Psychiatry 184
pp416-21, (2004)
The Fundamental Facts 2007
42
4.
Treatment and care
TREATMENT AND CARE
27%
Percentage of people with a mental health problem who receive
ongoing treatment172
How many people seek
help and use services?
• Over an 18 month period, 23% of people in Britain said
they received some treatment or service, not necessarily
provided by the NHS, for a mental health problem.171
• It is estimated that only about a quarter of people in
Britain with a mental health problem receive ongoing
treatment, either because they have not gone to the
doctor at all, have been misdiagnosed by a GP, or have
refused treatment.172 In a 12 month period, 3% of all
people with mental illness (whether treated or not) saw
a psychiatrist and 2% a psychologist.173
• 85% of people with a psychotic disorder receive
treatment.174
• Only 2 in every 5 people experiencing anxiety or a
substance misuse problem seek help in the year of the
onset of the disorder.175
• Almost 40% of drug users with a psychiatric disorder
receive no treatment for their mental health problem.176
• Around three quarters of 5-15 year-olds with mental
health problems are not in contact with child and
adolescent mental health services.177
The Fundamental Facts 2007
45
TREATMENT AND CARE
30%
Percentage of GP consultations related to mental health178
What treatment and care is available for
mental health problems?
Primary care
• Approximately 30% of all GP consultations are related to
a mental health problem.178
• About 90% of people with mental health problems
receive all their treatment from primary care services
(as opposed to specialist mental health services), as do
at least a quarter of those with severe problems.179 On
average, a person with severe mental health problems
has 13 to 14 consultations per year with their GP.180
• At the end of March 2006, around 19,000 people
were receiving care from assertive outreach teams in
the community, usually because these people were
reluctant to engage with other mental health services.
This represents an increase of 7% on the previous year.184
• 8,000 people received early intervention in psychosis
treatment in 2005/06 (up from 4,600 in 2004/05) from
128 early intervention teams (compared with 109 in
2004/05).185
Community care
Community mental health teams now provide most local
specialist mental health services.
• Mental health nursing care is provided for 540,000
people living in the community, and there are 2.1 million
attendances a year at NHS day care facilities as well as 2
million consultant outpatient attendances.181
• During 2005/06, crisis and home treatment teams
provided 84,000 episodes of home treatment for people
who would otherwise have been admitted to hospital.182
This was an increase from 69,000 in 2004/05, although
the number of crisis resolution teams reduced to 266 in
2006 from 343 in 2005.183
The Fundamental Facts 2007
46
TREATMENT AND CARE
82,000
1983
34,173
1999/00
31,667
2004/05
0
20
40
60
80
100
Number of NHS hospital beds for mental health problems in England186
Hospital provision
• The number of NHS beds for mental health problems in
England was 31,667 in 2004/05. In 1999/2000 there were
34,173 beds.186 In 1983, there were 82,000 beds.187
• The NHS spent about £575 million on acute psychiatric
in-patient hospital care in 2005/06,188 about 68% of its
budget for clinical mental health services.
• Child and adolescent psychiatric units are unevenly
distributed across England and Wales, with a
concentration in London and the South East. More than
a quarter of child and adolescent beds are now provided
by the independent sector.191 In 2002, 124 NHS Trusts
were identified as providers of specialised child and
adolescent mental health services – between them they
had 732 teams and 7,340 staff.192
• In 2003/04, the average cost of a hospital bed was £225
a day for an acute bed and £440 for intensive care. Costs
of secure hospital care were £351 a day in low-secure
units and £400 a day in medium-secure units. The
weekly cost of local authority residential and nursing
care for adults with mental health problems was £496
per person in England in 2004/05.189
• While the number of NHS adult mental health
admissions fell by about 10% over four years to 122,260
in 2002/03, the average length of stay per admission was
stable at roughly 18-19 days.190
The Fundamental Facts 2007
47
TREATMENT AND CARE
46%
Men
46%
Men
29%
29%
Women Women
Percentage of people detained in mental health units under the
Mental Health Act194
The Mental Health Act (1983)
The Mental Health Act (1983) is the principal Act governing
the treatment of people with mental health problems in
England, Wales and Northern Ireland. It covers all aspects
of compulsory admission and subsequent treatment.
• There were 46,700 detentions under the Mental Health
Act (1983) in 2004/05. On 26,752 occasions the Mental
Health Act was used to admit a person to hospital (an
increase from 25,642 in 1994/95). On almost 20,000
occasions in 2004/05 the Mental Health Act was used to
detain a person already admitted voluntarily to hospital
in order to prevent them leaving, down very slightly
from a decade earlier.193
• A mental health census in 2005 found that 46% of
men and 29% of women in mental health units were
detained under the Mental Health Act.194
• In 2005, 53% of compulsory admissions under the
Mental Health Act to NHS hospitals were male, but at
a given point in time there were almost twice as many
men as women detained. The Office of National Statistics
speculates that this could be due to a longer average
period of detention for men or to more men being
detained to prevent them leaving hospital following
a voluntary admission, but notes these data are not
collected.195
The Fundamental Facts 2007
• The highest rate of detentions in 2005 was in London
(134 people per 100,000) followed by the North West (93
per 100,000). The East of England had the lowest rate (69
per 100,000).
• Research suggests that use of crisis plans, also known
as advance statements or advance directives, drawn up
jointly between professionals and patients can reduce
the number of compulsory admissions under the Mental
Health Act by more than 50%.196
• The 2005 mental health ethnicity census found that
people from ethnic minorities are more likely to be
detained under the Mental Health Act. Inpatients from
the Black Caribbean, Black African, and Other Black
groups were more likely (by between 33% and 44%)
to be detained when compared with the average for
all inpatients. The rate of detention for inpatients from
the Other White group was also slightly higher than
average.197
48
TREATMENT AND CARE
27%
Percentage of carers turned away when trying to access help206
Users’ experience of staff
• Most service users are positive about the way they
are treated by mental health staff. In one study three
quarters rated their care as good, very good or excellent,
compared with 9% who said it was poor or very poor.198
• 15% of people using mental health services say they do
not have enough say in decisions about their treatment,
while 44% say they only have a say to some extent. 18%
say their diagnosis has not been discussed with them.199
Informal care
• In the UK adults with mental health problems receive
about 21 million hours a week of informal (unpaid) care
from family and friends.200
• Up to 420,000 people in the UK care for someone with a
mental health problem,201 including between 6,000 and
17,000 children and young people.202 Including carers
of people with dementia, estimates rise to around 1.5
million. 31% of these are involved in caring for more
than 50 hours a week.203
The Fundamental Facts 2007
• A 2003 survey found that 75% of people who care for a
person with a mental health problem are women, and
the average age of carers was 62 years. The average age
of recipients of care was 39 years, and 68% were male.
44% cared for a person with schizophrenia and 9% for a
person with bipolar disorder.204
• 29% of the 175,000 young carers in the UK are looking
after people with mental health problems. 82% of young
carers provide emotional support to the person they
care for.205
• 27% of carers said they had been turned away when
trying to access help for the person they care for.206 56%
cited an access related issue as the most frustrating
aspect of dealing with mental health services.207
A quarter of carers felt they do not have sufficient
information available.208
49
TREATMENT AND CARE
Counselling 82%
Antidepressants 60%
Exercise 76%
Counselling 42%
Alternative therapies 60%
Exercise therapy 2%
Antidepressants 52%
0
0
20
40
60
80
100
20
40
60
80
100
Treatments prescribed by GPs for depression210
Percentage of people prepared to try various treatments210
Treatment
and coping
• People with mental health problems report a variety
of treatments and coping mechanisms as helpful, but
one survey found that more than half weren’t given any
choice of treatment.209
• According to an online survey by the Mental Health
Foundation, of those visiting their GP with depression,
60% were prescribed anti-depressants, 42% were offered
counselling and 2% were offered exercise therapy.
The same survey found that 82% of people would be
prepared to try counselling, 76% would be prepared to
try exercise, 60% would be prepared to try alternative
therapies, and 52% would be prepared to try antidepressants.210
The Fundamental Facts 2007
• Two surveys211,212 of people with mental health problems
found that useful techniques and coping strategies
include:
- Support from family and friends
- Medication
- Counselling or psychotherapy
- Something worthwhile to do during the day
- Peer support
- Alternative therapies
- Volunteering and working
- Hobbies
- Physical exercise
- Advice from their GP
- Spirituality and religion
50
TREATMENT AND CARE
9.3%
Percentage of prescriptions written for mental health problems218
• About half of people with mental health problems
pay privately for treatments that are not prescribed,
spending on average £61 a month. The most commonly
paid for treatments are complementary therapies
(63%), followed by counselling or psychotherapy (31%)
and exercise (30%). 58% of people with mental health
problems feel they miss out on treatment that would
be helpful, the majority because they cannot afford
it. The treatments most often cited as missed out on
are counselling, psychotherapy and complementary
therapies.213
Medication
• A combination of therapies has been shown to be
most effective in treating some common mental health
problems. Guidance from the National Institute for
Health and Clinical Excellence (NICE) states that a variety
of psychological therapies, in addition to or instead of
medication, can be helpful for managing anxiety214 and
depression,215 and in some cases bipolar disorder216 and
schizophrenia.217
• In 2004, GPs wrote a total of 63.9 million drug
prescriptions for mental health problems in England,
representing 9.3% of the total prescriptions by volume.218
• Another survey found that 87% of people prescribed
medication said they had not received enough
information about the drugs they were given, and 86%
said they were not warned of possible side effects.219
• Approximately 2 million people of working age in Britain
are currently taking psychiatric drugs, most prescribed
by their GPs.220
The Fundamental Facts 2007
51
TREATMENT AND CARE
35%
55%
35%
Percentage of GPs who believe anti-depressants to be the most
225
effective intervention for mild to moderate depression
55%
Percentage of GPs who believe counselling and psychotherapy to be
the most effective intervention for mild to moderate depression225
Anti-depressants
• In 2005, doctors wrote 29.4 million prescriptions for antidepressants, 4 million more than in 2004.221 The number
of prescriptions written for anti-depressants has tripled
since the early 1990s, after a newer class of drug called
selective serotonin reuptake inhibitors (SSRIs) such as
Prozac became available in the late 1980s.222
• NICE guidelines state that anti-depressants are
not recommended for the initial treatment of mild
depression because the risks may outweigh the benefits.
Instead it recommends self-guided cognitive therapy
or short courses of cognitive therapy with a therapist.223
NICE recommends that for severe depression a
combination of anti-depressants and individual CBT
should be considered as the combination is more costeffective than either treatment on its own.224
• Although 57% of GPs say that anti-depressants are
over-prescribed, 55% use them as their first treatment
response to mild or moderate depression. Only 35%
believe they are the most effective intervention for mild
or moderate depression, with 55% believing counselling
and psychotherapy is the most effective intervention.
More than three quarters (78%) have prescribed an
anti-depressant in the last three years despite believing
The Fundamental Facts 2007
that an alternative treatment might have been more
appropriate, most commonly because the alternative
was not available or there was a long waiting list for it.225
• Female GPs and those with more years of GP experience
are less likely to prescribe anti-depressants.226
• Unpleasant symptoms associated with anti-depressants
often result in patients not continuing with medication.
In one study, only 33% of patients completed ‘an
adequate period of treatment.’ 227
Anti-psychotics
Anti-psychotics are used to treat symptoms of acute
psychosis and to prevent further episodes. Anti-psychotics
are generally divided into two classes: the older ‘typical’
agents (neuroleptics) and the newer ‘atypical’ agents,
mostly developed since the early 1990s. Atypicals usually
have less distressing side effects, and the National Institute
for Health and Clinical Excellence recommends they be
prescribed for all new cases of schizophrenia.228
• 5.7 million prescriptions for anti-psychotic medications
were written in 2005 at a cost of £210.9 million.229 A
further 163,600 long-acting anti-psychotic injections
were prescribed, costing £5.2 million.
52
TREATMENT AND CARE
20%
Percentage of patients prescribed a dose of anti-psychotic medication
above that recommended by the British National Formulary235
• Side effects of typical anti-psychotics may include
shuffling and involuntary muscle twitches, jerks and
spasms.
• The side effects of atypical medication can include
sedation, diarrhoea, constipation, muscle spasms, weight
gain and heart problems,230 and these frequently lead to
people discontinuing treatment.231
• An audit study of prescription of anti-psychotic
medication found that 20% of patients were prescribed
a total dose of anti-psychotic medication above that
recommended by the British National Formulary, a
biannual manual that provides healthcare providers with
information on choosing and prescribing medication.232 .
Sleeping and anxiety medication
Minor tranquillisers and hypnotics, primarily
benzodiazepines, are used to treat anxiety and sleep
problems. They are usually prescribed on a short-term
basis due to their addictive nature. These include
benzodiazepines such as diazepam and hypnotics
(sleeping pills).
Mood stabilisers
Mood stabilising medications are used to treat bipolar
disorder. They are usually taken long-term, even when
a person is not experiencing an episode of mania/
hypomania or depression.
• The oldest mood stabiliser is lithium.
• Anti-convulsant drugs developed to treat epilepsy are
often used as mood stabilisers. These include sodium
valproate, carbamazapine, and lamotrigine.
• Some anti-psychotic medications appear to be effective
as mood stabilisers.
• In 2005, 786,300 prescriptions for lithium were written at
a cost of £1.6 million.234
• The Department of Health does not quantify the overall
number of mood stabilisers prescribed, because most
individual drugs are also used for other conditions.235
• 16 million prescriptions for hypnotics and anxiolytics
(drugs for anxiety) were written in 2005, costing £38
million.233
The Fundamental Facts 2007
53
TREATMENT AND CARE
88%
88%
Percentage of people who found
241
talking treatments helpful
88%
67%
67%
67%
Percentage of people who found
241
anti-depressants helpful
Talking Therapies
Talking therapies or psychological therapies are based on
the idea that talking to a trained therapist can help people
better understand their thoughts and feelings and how
they relate to their behaviour, mood and psychological
wellbeing. Talking therapies can help people find ways
to change their lives by acting and thinking in a more
constructive or positive manner.
• Clinical trials show that cognitive behavioural therapy,
a form of psychotherapy, is as effective as medication
in treating anxiety and depression.236 The relapse rate is
also lower once the treatment has ended.237,238
• When asked, people with mental health problems are
most likely to cite access to psychological therapies,
such as psychotherapy and counselling, as their highest
treatment priority,239 and the lack of it their biggest
complaint.240
• The vast majority of those with experience of talking
treatments rate them as helpful or helpful at times
(88%), compared with 67% of those who had used antidepressants and 30% of those who had received ECT.241
The Fundamental Facts 2007
30%
30%
30%
Percentage of people who
found ECT helpful241
• The National Institute for Health and Clinical Excellence’s
guidelines on treatment of depression state that
‘cognitive-behavioural therapy should be offered, as it is
of equal effectiveness to anti-depressants’.
• A majority (55%) of GPs believe that counselling
and psychotherapy are the most effective strategies
for treating depression. However, only 32% refer to
them as their first treatment response.242 This is often
because they are not available, despite the government
recommending that talking treatments ought to be
made available for the treatment of most mental health
problems.243
• Waiting times for psychological therapies are on
average six to nine months, and can be as long as two
years. There is no target for reducing waiting times for
psychological treatments.244
• Early psychological treatment can significantly reduce
hospital admissions, GP visits and drug prescriptions.245
• Adding family therapy to medication for those with
schizophrenia can reduce relapse rates by a half over
both one year and two years.246
54
TREATMENT AND CARE
Electroconvulsive Therapy
Psychosurgery
• The National Institute for Health and Clinical Excellence
recommends that electroconvulsive therapy (ECT)
should only be used for the treatment of severe
depressive illness or a prolonged or severe episode
of mania or catatonia, to gain fast and short-term
improvement of severe symptoms after all other
treatment options have failed, or when the situation is
thought to be life threatening.247
• Neurosurgery for mental illness is occasionally carried
out in the UK. The Mental Health Act Commission panel
authorised seven operations in England and Wales in
1999/2000, and two in 2000/01.253 This compares to 23
operations carried out in England, Scotland and Wales in
1993.254
• Around 11,000 people a year receive ECT in England.248
• A 2002 Department of Health survey found that use of
ECT had fallen since 1999.249 More than twice as many
women as men were given ECT, and that nearly half of
people given ECT were aged over 65.250
• Of 74 patients receiving psychosurgery, 12 were
experiencing manic depression, 41 depression, 18
obsessions, and 3 anxiety. Of 42 patients on whom data
was available, doctors reported significant improvement
in 12, some improvement in 22, no change in 6 and
deterioration in 2.255
• Nearly three quarters of people who were given ECT
were informal patients (not detained under the Mental
Health Act). Of those patients that were detained, 60%
did not consent to treatment.251
• A systemic review of patients’ experience of ECT found
that at least one third of patients reported persistent
memory loss.252
The Fundamental Facts 2007
55
TREATMENT AND CARE
81%
Percentage of patients who found exercise effective as a treatment
for depression261
Exercise
Alternative and complementary therapies
• Exercise has been shown to improve both physical and
mental health for people with a range of mental health
problems, including psychotic disorders, depression and
anxiety256 It can also help people with alcohol misuse
problems and schizophrenia.257
The term ‘alternative therapy’ is used for therapies that
offer alternatives to orthodox Western medicine. The term
‘complementary therapy’ is generally used to indicate
therapies that differ from orthodox Western medicine,
and which may be used to complement, support, or
sometimes, to replace it.
• Studies have shown that exercise can be as successful at
treating mild or moderate depression as psychotherapy
or as medication.258
• The National Institute for Health and Clinical
Excellence recommends that patients of all ages with
mild depression should be advised of the benefits
of following a structured and supervised exercise
programme, typically up to 3 sessions per week of 45
minutes to an hour for between 10 and 12 weeks.259
• Only 5% of GPs prescribe exercise therapy as one of
their top three treatment responses to mild or moderate
depression.260
• A Mental Health Foundation survey found that a greater
proportion of people who had tried exercise as a
treatment for depression found it very or quite effective
(81%) than found anti-depressants very or quite effective
(70%).261
The Fundamental Facts 2007
• A survey found that of those who had tried alternative
treatments, more than a third had to take the initiative
and ask for it, and many had to pay for it themselves.262
• Herbal medicines, for example St. John’s Wort
(hypericum), have been linked to the relief of mild to
moderate depression.263 There is some evidence that
traditional Chinese medicine may be a useful adjunct to
orthodox medicine for the treatment of schizophrenia,
particularly in alleviating distress and the side effects of
traditional medication.264
• Acupuncture can have a positive effect for some people
diagnosed with schizophrenia.
• Reflexology has been shown to aid relaxation, relieve
stress and restore energy. It can help to reduce the side
effects of psychotropic medication and can moderate
the highs and lows of mood swings.265
56
TREATMENT AND CARE
• Transcendental meditation, hypnotherapy, yoga,
exercise, relaxation, massage and aromatherapy have
all been shown to have some effect in reducing stress,
tension and anxiety and in alleviating mental distress.266
• Massage has been shown to reduce levels of anxiety,
stress and depression in some people.267
• Aromatherapy has been successfully used to reduce
disturbed behaviour, to promote sleep and to stimulate
motivational behaviour of people with dementia.268
• Artistic pursuits can help people with mental health
problems feel better about themselves, fostering
creativity, self esteem and social networks. One survey
found that half of people with mental health problems
felt better after becoming involved in the arts.269
• Bright light treatment and dawn simulation is effective
in treating Seasonal Affective Disorder, and there are
indications that it may be as effective as anti-depressants
for treating non-seasonal depression.270
• Bibliotherapy based on cognitive behavioural therapy
principles has shown results comparable to medication
or psychotherapy for people with depression. In
bibliotherapy, a therapist ‘prescribes’ a self-help book for
a patient to either read between sessions or as a stand-
The Fundamental Facts 2007
alone therapy. Some studies show that recovery is faster,
and that patients who have used bibliotherapy have a
lower relapse rate.271
• Animal-assisted therapy involves the use of trained
animals to help patients’ recovery. Also known as pet
therapy, it has been shown to reduce short-term anxiety
levels of psychiatric inpatients with a range of disorders.
The calming influence of dogs has also been useful
in psychotherapy, because of the ability to alert the
therapist early to clients’ distress and the facilitation of
communication and interaction.272
Nutrition
There is growing evidence that diet plays an important
role in specific mental health problems including Attention
Deficit Hyperactivity Disorder (ADHD), depression,
schizophrenia and Alzheimer’s disease. A balanced mood
and feelings of well-being can be protected by a diet that
provides adequate amounts of complex carbohydrates,
essential fats, amino acids, vitamins and minerals and
water.273
• Research into nutritional and dietary medicine has
demonstrated that food sensitivities may cause
psychiatric symptoms, whilst a lack of folic acid has been
57
TREATMENT AND CARE
Unequal intakes of Omega-3 and Omega-6
fats are implicated in a number of mental
health problems.273
associated with depression and schizophrenia and the
supplementation of certain amino acids may relieve
depression.274
• Among some young offenders, diets supplemented with
vitamins, minerals and essential fatty acids have resulted
in significant reductions in anti-social behaviour.275
Food and depression
• A number of studies have linked the intake of certain
nutrients with the reported prevalence of different types
of depression. For example, correlations between low
intakes of fish by country and high levels of depression
among its citizens – and the reverse – have been shown
for many types of depression.276
• Complex carbohydrates as well as certain food
components such as folic acid, omega-3 fatty acids,
selenium and tryptophan may help to decrease the
symptoms of depression. Those with low intakes of
folate, or folic acid, have been found to be significantly
more likely to be diagnosed with depression than those
with higher intakes.
• Similar conclusions have been drawn from studies
looking at the association of depression with low
The Fundamental Facts 2007
levels of zinc and vitamins B1, B2 and C. In other
studies standard treatments have been supplemented
with these micronutrients resulting in greater relief
of symptoms in people with depression and bi-polar
affective disorder, in some cases by as much as 50%.277
Other interventions
• Studies show that there are benefits to involving
families in the treatment of people with schizophrenia,
depression, alcohol problems and childhood behaviour
disorders. Helping to change the nature of family
interaction in the home is associated with a reduced risk
of relapse.278
• School-based interventions and parent training
programmes for parents of children with behavioural
problems can improve these children’s conduct and
mental well-being.279 Long-term, universal school mental
health programmes, involving changes to the school
culture, can also be effective, probably more than brief
class-based programmes.280
• Home-based social support for pregnant women at high
risk of depression improves the mental health of both
mothers and children.281
58
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perspective on electroconvulsive
therapy: systematic review, British
Medical Journal 326;1363, (2003)
249. Electroconvulsive Therapy:
Survey covering the period from
January 2002 to March 2002,
England, Department of Health,
(2003) available at www.dh.gov.uk
250. Electroconvulsive Therapy:
Survey covering the period from
January 2002 to March 2002,
England, Department of Health,
(2003), available at www.dh.gov.uk/
(accessed June 2006)
251. Electroconvulsive Therapy:
Survey covering the period from
January 2002 to March 2002,
England, Department of Health,
(2003), available at www.dh.gov.uk/
(accessed June 2006)
252. Rose D. et al, Patients’
perspective on electroconvulsive
therapy: systematic review, British
Medical Journal 326;1363, (2003)
253. Mind Statistics 7: Treatments
And Services for People With
Mental Health Problems (2003), at
www.mind.org.uk, quoting The
Mental Health Act Commission
Ninth Biennial report 1999-2001
The Stationery Office, (2003)
254. Mind Statistics 7: Treatments
And Services for People With
Mental Health Problems, (2003), at
www.mind.org.uk
255. Mind Statistics 7: Treatments
And Services for People With
Mental Health Problems, at
www.mind.org.uk, quoting The
Mental Health Act Commission
Ninth Biennial report 1999-2001
The Stationery Office, (2003)
256. Complementary Therapies
for Mental Health Problems,
Mental Health Foundation, (2000)
www.mentalhealth.org.uk
257. Daley A, Exercise and mental
health in clinical populations: Is
exercise therapy a worthwhile
intervention? Advances in
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(2002)
258. Up And Running? Exercise
Therapy And The Treatment Of Mild
or Moderate Depression In Primary
Care London: Mental Health
Foundation p25, (2005)
The Fundamental Facts 2007
61
259. National Institute for Health
and Clinical Excellence (2004)
Depression: Management of
depression in primary and
secondary care, NICE, London;
available at www.nice.org.uk
(accessed August 2006)
260. Up and Running? Exercise
Therapy And The Treatment Of Mild
or Moderate Depressison In Primary
Care London: Mental Health
Foundation p8, (2005)
261. Exercise and depression
– online survey results, Mental
Health Foundation, (2005)
262. Mind Press release: Mind says
mental health patients survey
findings are just ‘tip of the iceberg’,
at www.mind.org.uk, (2004)
263. Complementary Therapies
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Mental Health Foundation, (2000)
www.mentalhealth.org.uk
264. Rathbone A et al, Chinese
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The Cochrane Database of
Systematic Reviews: Reviews 2005
Issue 4, John Wiley and Sons, Ltd:
Chichester, (2005)
265. Complementary Therapies
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Mental Health Foundation, (2000)
www.mentalhealth.org.uk
266. Complementary Therapies
for Mental Health Problems,
Mental Health Foundation, (2000)
www.mentalhealth.org.uk
267. Complementary Therapies
for Mental Health Problems,
Mental Health Foundation, (2000)
www.mentalhealth.org.uk
268. Thorgrimsen L. et al,
Aromatherapy for dementia. The
Cochrane Database of systematic
reviews: Review 2003 Issue 3, John
Wiley & Sons, Ltd. Chichester, (2003)
269. Mental Health and Social
Exclusion, Social Exclusion Unit
London: Office of the Deputy Prime
Minister, (2004) p43, quoting
Matatasso F, Use or Ornament? The
Social Impact Of The Arts: Comedia,
(1997)
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270. Golden R N et al, The Efficacy
of Light Therapy in the Treatment
of Mood Disorders: A Review and
Meta-Analysis of the Evidence, Am J
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271. Smith M. et al, Three year
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272. Barker S and Dawson K, The
Effects of Animal-Assisted Therapy
on Anxiety Ratings of Hospitalized
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273. Cornah D, Feeding Minds: The
impact of food on mental health,
Mental Health Foundation: London,
(2006)
274. Complementary Therapies
for Mental Health Problems,
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www.mentalhealth.org.uk
275. Cornah D, Feeding Minds: The
impact of food on mental health,
Mental Health Foundation: London,
(2006)
276. Cornah D, Feeding Minds: The
impact of food on mental health,
Mental Health Foundation: London,
(2006)
277. Cornah D, Feeding Minds: The
impact of food on mental health,
Mental Health Foundation: London,
(2006)
278. World Health Report: Mental
Health: New Understanding,
New Hope Geneva: World Health
Organisation, (2001)
279. Centre for Reviews And
Dissemination, A National Contract
On Mental Health York: Centre for
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280. Choosing Mental Health
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281. Centre for Reviews And
Dissemination, A National Contract
On Mental Health York: Centre for
Reviews And Dissemination, (2000)
The Fundamental Facts 2007
62
5.
The costs of mental
health problems
THE COST OF MENTAL HEALTH PROBLEMS
1 in 4 unemployed people has a common mental health
problem283
Hidden cost
• The ‘hidden’ costs of mental illness have a significant
impact on public finances: it has been estimated that
the costs of depression through lost working days are 23
times higher than the costs to the health service.282
• 1 in 4 unemployed people has a common mental health
problem.283
• Childhood mental health problems can have a
significant economic effect on society. It is estimated
that a child with a conduct disorder will, by the age
of 28, have generated costs (such as to the health,
education, benefits and criminal justice systems) ten
times as high as a child without conduct problems.284
The Fundamental Facts 2007
65
THE COST OF MENTAL HEALTH PROBLEMS
The economic and social cost of mental
health problems is greater than that
of crime.286
Overall cost
• In 2002/03, the economic and social cost of mental
health problems in England was £77 billion.285 Updating
these figures and incorporating estimates for Scotland,
Wales and Northern Ireland, it is calculated that in the
UK, the economic and social costs of mental health
problems in 2003/04 was £98 billion (£17 billion on
health and social care, £28.3 billion in costs to the
economy and £53.1 billion in human costs).
• The economic and social cost of mental health problems
is therefore greater than that of crime (estimated at
£60 billion for England and Wales in 1999/2000),286 and
larger than the total amount spent on all NHS and social
services (£95.2 billion in the UK in 2003/04).287
• The World Health Organisation estimates that the cost
of mental health problems in developed countries is
between 3 and 4% of Gross National Product.288 In the
UK this is estimated to be 2% of GDP,289 comprising the
costs of public spending on health and social care and
loss of paid work.
The Fundamental Facts 2007
66
THE COST OF MENTAL HEALTH PROBLEMS
Support
£43m
Mentally disordered offenders
£38m
£660m
Secure and high dependency
£142m
Psychological therapies
£10.5m
Personality disorder services
£86m
Other professionals
£3m
Mental health promotion
£91.5m
Home support
£2.5m
Direct payments
£150.5m
Day services
£384m
Continuing care
£549m
Community Mental Health Teams
£840m
Clinical services
£19m
Carers’ services
Accommodation
£362m
Access and Crisis
£369m
Health and social
care costs
0
200
400
600
800
Planned investment in services in England 2005/2006292
• £4.9 billion was spent on mental health services for
adults of working age by the NHS and local authorities
combined in England in 2005/06. This was the
equivalent of £150 per head.290 After taking account
of estimated pay and price inflation, investment in
these mental health services increased 3% in 2005/06
compared to 9% in 2004/05.291
• The biggest increases in spending for 2005/06 reflect the
Department of Health priorities for mental healthcare,
and reinforce the trend over the past four years.
These are:
• Mental health priorities have changed over the past five
years. While there has been a 25% overall real growth
in total investment over the period, actual increases in
specific service areas vary widely.293
• In 2002/03, spending on mental health accounted for
11.8% of all public expenditure on health and social
services in England.294 Using a comparable ratio for the
UK, this implies total public spending on mental health
care in 2003/04 of £11.2 billion, equivalent to £190 per
head of the population. 82% was spent by the NHS and
18% by local authorities.
• Assertive outreach – more than £100 million in 2005/06
(less than £50 million in 2001/02)
• Crisis resolution/home treatment – more than £155
million in 2005/06 (£26 million in 2001/02)
• Early intervention in psychosis – £42 million in 2005/06
(less than £4 million in 2001/02.)
The Fundamental Facts 2007
67
1000
THE COST OF MENTAL HEALTH PROBLEMS
117%
Access and crisis services
100%
Secure and high dependency services
54%
Home support
20%
Accommodation
Psychological therapies
14%
Community Mental Health Teams
14%
Continuing care
10%
Clinical services
10%
0
20
40
60
80
100
120
Increases in investment between 2001/02 and 2005/06295
Staff costs
Voluntary sector
• The cost of a consultant psychiatrist is estimated at £71
per hour, or £216 per hour of direct patient contact.
The cost of a community mental health nurse is £26
per hour, or £71 per hour of direct patient contact. Each
attendance at NHS day care facilities costs £29.296 An
average GP consultation costs £24.297
• It is estimated that, in total, around 10% of all public
spending on mental health services is now in the
voluntary sector.300
Private care
• One study estimated that in England in 1996/97 private
spending on counselling and related services was
£108 million. Spending by mental health charities and
voluntary organisations that was financed from private
sources amounted to £12 million. This total of £120
million corresponded to 2.1% of public spending on
mental health care in the year concerned.298
Informal care costs
• If the 21 million hours a week of informal (unpaid) care
from family and friends of people with mental health
problems was provided as paid work by nursing or care
staff, it would cost £4.9 billion a year. This is equivalent to
nearly half the cost of all mental health services provided
by the NHS and local authorities.299
The Fundamental Facts 2007
• Residential care and supported housing accounts for
about two thirds of this total, but the voluntary sector
also supplies a wide range of other services. These
include: day care; home and community support
services; employment, education and training; services
for carers; and information, advice and advocacy.
• The largest purchasers of mental health services from
the voluntary sector are social services departments,
accounting for almost two thirds of all contracts.
• Independent and voluntary sector agencies also play
a major role in the Supporting People programme,
introduced in 2003 by the Office of the Deputy Prime
Minister to support vulnerable people in their own
homes. In 2003/04, around 40,000 people with mental
health problems in England received assistance through
this programme at a cost of £250 million and, of this
total, over 80% was spent on support services provided
by private and voluntary organisations.301
68
THE COST OF MENTAL HEALTH PROBLEMS
£38.3m
Hypnotics
£223.6m
Anti-psychotics
£338.5m
Anti-depressants
£49.3m
Dementia drugs
£83.3m
Substance dependence
0
50
100
150
200
250
300
350
Cost of drug treatments in 2005302
Drug and talking therapy costs
• The cost of drug prescriptions for mental health
problems in England has risen rapidly over recent
years, from £159 million in 1992/93,303 to £540 million in
2002,304 and £854 million in 2004. Relative to the drugs
bill as a whole, prescriptions for mental health problems
represented 10% by cost. Anti-depressants accounted
for 47% of total spending on drugs for mental health
problems and anti-psychotics for 26%, with other
formulations accounting for the remaining 27%.305
• In 1992, the cost of anti-depressant prescriptions
dispensed in the community in England was
£18.1million. By 2003, this had risen to £395.2million.
This rise is linked to the introduction of SSRI (selective
serotonin reuptake inhibitor) anti-depressants, such
as Prozac, in the 1990s. These drugs were both more
expensive and more widely prescribed than other
classes of anti-depressants.306 The cost of prescribing
SSRIs has fallen in recent years as branded drugs have
become available as generic compounds.
The Fundamental Facts 2007
• NICE recommends short talking therapies such as
cognitive behavioural therapy as an alternative or
adjunct to anti-depressants. The cost of this is about
£750 for 16 sessions of CBT.307
• In 2002 in England, expenditure on anti-psychotics
was £165.3million.308 In 2005, it was £223.6million.309
This increase reflects the impact of guidance from the
National Institute for Health and Clinical Excellence on
the new atypical anti-psychotic drugs for schizophrenia,
which are much more costly than the drugs they
replace. However, evidence from cost-effectiveness
studies shows that these higher costs are more than
offset by reductions in hospital inpatient stays, with
savings estimated to average £1,000 per patient year.310
69
THE COST OF MENTAL HEALTH PROBLEMS
£3.254bn
2001/02
£3.709bn
2002/03
£3.943bn
2003/04
£4.52bn
2004/05
£4.904bn
2005/06
0
1
2
3
4
5
Investment in Mental Health Services in England for working age adults311
Economic and
social factors
Mental health and employment
• People with a common mental health problem
aged between 16 and 74 years are more likely to be
economically inactive (39%, compared with 28% of
those with no mental health problem), and less likely to
be employed (58%, compared with 69%).312
• Less than a quarter of people with a long-term mental
health problem are employed, the lowest rate for any
group of disabled people.313 However, this group of
people form a relatively small proportion of all the
people who experience a mental health problem.
(About three quarters of the overall working age
population are in employment.)
• Unemployment is even more prevalent among people
receiving secondary mental health care. About one in
ten people in psychiatric care has a job, and, typically,
they earn two thirds of the average national hourly
rate.314
• 35% of adults with long-term mental health conditions
say they want to work (compared with 28% of those
with other health problems).315
• People with mental health problems are at more than
twice the risk of losing their jobs compared with the
general population.316
The Fundamental Facts 2007
• Of those people with mental health problems who
have lost their jobs, 55% make unsuccessful attempts
to return to work, and of those that do return, 68% have
less responsibility, work fewer hours and are paid less
than before.317
• Fewer than 4 in 10 employers would consider hiring a
person with a mental health problem, compared with
more than 6 in 10 who would hire a person with a
physical disability.318
• Most employers who have employed people with
mental health problems in a supported work placement
would do so again, but few other employers would.319
• 7 in 10 managers have had experience of managing a
staff member with a diagnosed mental health problem
(50%) or a suspected mental health problem (20%). Less
than a quarter felt they knew enough about managing
someone with a mental health problem to handle it and
deal with it ‘OK’.320
• A survey of people with mental health problems
found that 67% had disclosed their condition to close
colleagues, 61% had told their manager and 1 in 10
had told everyone.321 About 1 in 10 of those who had
disclosed said colleagues made snide remarks, and 1 in
10 reported that colleagues had avoided them.
70
THE COST OF MENTAL HEALTH PROBLEMS
Service categories
2001/02
(£m)
2002/03
(£m)
2003/04
(£m)
2004/05
(£m)
2005/06
(£m)
Community Mental Health Teams
483
526
530
570
549
Access and crisis services
170
203
254
316
369
Clinical services
764
754
811
878
838
Secure and high dependency
330
376
474
621
661
Continuing care
349
372
380
404
384
Mentally disordered offenders
35
33
53
43
58
Other community and hospital professionals
52
50
47
67
86
Psychological therapies
125
142
143
149
142
Home support services
59
63
70
108
91
178
163
172
156
151
37
47
43
43
43
Day services
Support services
Carer’s services
10
11
15
18
19
301
315
369
366
362
Mental health promotion
6
3
3
2
3
Direct payments
6
3
6
3
2
Personality disorder services
0
0
1
4
10
Accommodation
Investment in Mental Health Services in England for working age adults by category322
The cost of mental health problems at work
• Stress, anxiety and depression accounted for a third of
the 168 million working days lost in the UK for health
and related reasons in 2004, translating to a cost of
sickness absence of about £4.1 billion.323
• Each case of stress-related ill health leads to an average
of 30.9 working days lost.324 In a typical year, about 30
times as many working days are lost through mental ill
health as from industrial disputes.325
• Over 900,000 people in England are in receipt of sickness
and disability benefits for mental health problems, more
than the total number of unemployed people claiming
Jobseekers’ Allowance.326 The number of people claiming
Incapacity Benefit because of mental health problems
has almost doubled since 1995,327 and makes up more
than 40% of the total number of claimants.328 However,
almost half the people in contact with community
mental health teams do not receive the full amount of
welfare benefits to which they are entitled.329
The Fundamental Facts 2007
71
THE COST OF MENTAL HEALTH PROBLEMS
Psychotic Any psychiatric
disorder
disorder %
%
No
disorder
%
Living alone
43
21
15
In rented accommodation
62
38
24
With accommodation problems
49
48
33
No educational qualifications
40
28
27
Social class IV (partly skilled people) or V (individuals with no skills)
40
25
21
Economically inactive
70
32
29
Household income less than £200 a week
25
17
13
Receiving Income Support
30
11
4
With debt problems
33
24
9
Any difficulty with activities of daily living
60
37
16
Experience of violence within the home
37
16
4
Experience of sexual abuse
31
9
2
Severe lack of perceived social support
30
12
6
Social isolation (two or fewer friends seen in last week)
55
30
22
Mental health problems and personal and social factors among adults in England, Scotland and Wales330
Human costs
• The human costs of mental health problems are
estimated to be nearly five times as large as the costs of
all mental health services provided by the NHS and local
authorities, amounting to around £53 billion in the UK
in 2003/04.331 This includes the adverse effects of mental
health problems on health-related quality of life and – as
a major risk factor for suicide – on length of life.
About half of people with common mental health
problems are limited by their condition, and around a
fifth are disabled by it.332
• In total, more than 40% of the World Health
Organisation’s ‘years lived with disability’ are caused by
mental health problems or alcohol abuse.333
• Mental health problems are associated with a wide
range of adverse personal and social problems. People
with mental health problems are more likely than the
rest of the population to live alone, have no educational
qualifications, be economically inactive, and have a
household income of less than £200 a week. They are
almost three times as likely to have debt problems, more
than twice as likely to be receiving income support,
more than four times as likely to have experienced
sexual abuse, and twice as likely to report a lack of social
support. The differences are even more stark among
those with a psychotic disorder (for example, they are
almost three times as likely to be living alone, five times
as likely to report a lack of social support and more
than fifteen times as likely to have experienced sexual
abuse).334
• One in four tenants with mental health problems is in
serious rent arrears and is at risk of losing their home.335
The Fundamental Facts 2007
72
THE COST OF MENTAL HEALTH PROBLEMS
Less than 1% of the £4.9 billion spent by
the NHS and local authorities in 2005/06
on mental health for adults of working
ages was earmarked for mental
health promotion.341
Mental health promotion
Mental health promotion involves any action to enhance
the mental well-being of individuals, families, organisations
and communities, recognising that everyone has mental
health needs, whether or not they have a diagnosis of
mental illness. Mental health promotion programmes that
target the whole community will also include and benefit
people with mental health problems.336 The emotional
and cognitive skills and attributes associated with positive
mental well-being include feeling satisfied, optimistic,
hopeful, confident, understood, relaxed, enthusiastic,
interested in other people and in control.337
Examples of factors that promote well-being include:
eating well, keeping physically active, drinking in
moderation, valuing yourself and others, talking about
your feelings, keeping in touch with friends and loved
ones, caring for others, getting involved and making a
contribution, learning new skills, doing something creative,
taking a break, and asking for help.338
The Fundamental Facts 2007
• Evidence shows that mental health promotion can
contribute to the prevention of common mental
health problems, for example anxiety, depression and
substance abuse.339 It can also contribute to health
improvement for people whether or not they are at risk
of mental illness, as well as for people living with mental
health problems.3340
• Interventions to reduce stress in the workplace, to
tackle bullying in schools, to increase access to green,
open spaces and to reduce fear of crime all contribute
to health gain through improving mental well-being,
in addition to any impact they may have on preventing
mental disorders.341
• Less than 1% of the £4.9 billion spent by the NHS and
local authorities in 2005/06 on mental health for adults
of working age was earmarked for mental health
promotion.342
73
THE COST OF MENTAL HEALTH PROBLEMS
People with severe mental illness are
more likely to be the victims than
the perpetrators of violence.344
Violence and
mental health
There is widespread public fear that people with mental
disorder pose a significant risk of interpersonal violence,
but research has shown that the degree of association
between violence and mental disorder is small343 and is
accounted for by a small minority of patients.344
• People with severe mental illness are more likely to
be the victims than the perpetrators of violence.345 In
one study 16% of people with psychosis living in the
community had been violently victimised.346
• 5% of all perpetrators of homicide in England and Wales,
and 2% in Scotland, had a diagnosis of schizophrenia.
9% of people convicted of homicide had a diagnosis of
personality disorder.348
• 7% of people convicted of homicide in England and
Wales, and 6% in Scotland, were committed to a
psychiatric hospital.349
• Mentally ill perpetrators were less likely to kill a stranger
than those without mental illness.350
• A third of people who committed homicide had a
lifetime history of mental disorder, but in most cases this
was not a severe mental illness. Most had not attended
psychiatric services, and only 10% had symptoms of
mental illness at the time of the offence. The most
common diagnoses were personality disorder, and
alcohol and drug dependence. 90% of the perpetrators
were male.347
The Fundamental Facts 2007
74
282. Knapp M Hidden costs of
mental illness, British Journal of
Psychiatry 182, (2003)
283. Mental Health and Social
Exclusion, Social Exclusion Unit,
London: Office of the Deputy
Prime Minister, (2004) p13, quoting
Singleton N, Bumpstead R, O’Brien
M, Lee A, Meltzer H. Psychiatric
Morbidity Among Adults Living In
Private Households, (2000) London:
The Stationery Office, (2001)
284. Scott S et al Financial Cost
Of Social Exclusion: Follow-Up
Study Of Anti-social Children In
Adulthood British Medical Journal
323 p191, (2001)
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The Fundamental Facts 2007
77
NOTES
The Fundamental Facts 2007
78
About the Mental Health Foundation
Founded in 1949, the Mental Health Foundation is the leading UK charity working in
mental health and learning disabilities.
We are unique in the way we work. We bring together teams that undertake research,
develop services, design training, influence policy and raise public awareness within one
organisation. We are keen to tackle difficult issues and try different approaches, many of
them led by service users themselves. We use our findings to promote survival, recovery
and prevention. We do this by working with statutory and voluntary organisations, from
GP practices to primary schools. We enable them to provide better help for people with
mental health problems or learning disabilities, and promote mental well-being.
We also work to influence policy, including Government at the highest levels. We use our
knowledge to raise awareness and to help tackle stigma attached to mental illness and
learning disabilities. We reach millions of people every year through our media work,
information booklets and online services. We can only continue our work with the
support of many individuals, charitable trusts and companies.
To support our work, please visit www.mentalhealth.org.uk
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© Mental Health Foundation 2007
ISBN 978-1-903645-93-2