Mental health and wellbeing
Why is it important?
Good mental health and wellbeing is fundamental to our physical health, our relationships, our education, our
training, our work and to achieving our potential.
The benefits of positive mental health and well-being are wide ranging and significant both for individuals and
for society as a whole. Positive mental health is associated with an increase in life expectancy, improved
quality of life, improved physical outcomes, improved education attainment, increased economic
participation, and positive social relationships.
Mental ill health represents up to 23% of the total burden of ill health, and is the single largest cause of
disability in the UK. [1] It covers a wide range of conditions such as depression, anxiety disorders and
obsessive compulsive disorders, through to more severe conditions like schizophrenia.
The cost of mental ill health to the economy in England have been estimated at £105 billion (of which 30
billion is work related), and is the single largest area of spend in the NHS, accounting for 11 per cent of the
NHS secondary health care budget. It is predicted that treatment costs will double in the next 20 years. [2]
Impact of Economic Downturn on Mental health
The strongest negative effect of an economic downturn is on mental health. People suffering from financial
strain and job insecurity are at risk of mental health problems. The table below summaries the economic
downturn effects on mental health.
The effects of the economic downturn on mental health [3]
Factor
Cause
Health Impacts
Population Most At Risk
Rising
Unemployment
Financial strain; loss of:
social status; identity;
self esteem, physical and
mental activity
Psychological distress,
alcohol abuse, depression
and suicides
Young aged 15-24
Job Insecurity
Narrowing of options
and choices; loss of
control; fear of job loss;
financial difficulties;
workload increase
Common mental health
problems; job stress
Low skilled; public sector
workers and others in
sectors having to reduce
personnel
Households in High
Debt Increase
Financial strain; worry;
housing payment
problems; consumer
debt
Poorer mental health, risk
factor for mental disorder;
increased occurrence of
major depression
Low income workers; those
with little experience of
coping with hardship; single,
females/mothers
Increased Poverty
Social exclusion;
Mental health problems;
Poor or living near the
Middle aged and unmarried
men/single women
inequality
depression and suicide;
developmental deficit
(emotional, cognitive,
physical)
poverty line; children
growing up in extreme
poverty: low educational
levels
Adverse Lifestyle
Changes
Increased alcohol intake;
binge drinking
Rise in suicide; alcohol
related deaths
Lower educational group
Families Under
Pressure
Strain on parental
mental health; marital
interaction
Poor mental health;
feelings of helplessness;
young - confusion, anger
and insecurity
Mothers, children and
adolescents
Cuts in Health
Systems and Social
Protection
Loss of state support to
mitigate against the
impact of economic
downturn
Poor mental health;
feelings of helplessness;
young - confusion, anger
and insecurity
Mothers, children and
adolescents, families
[1] Who (2008) The Global Burden of Disease: 2004 update, available at: www.who.int/healthinfo/
global_burden_disease
[2] Department of Health (2011) No health without mental health: A Cross-Government Mental Health
Outcomes Strategy for People of All Ages
[3] The impact of economic crises on the risk of depression and suicide: A literature review, Wahlbeck K,
Awolin M, 2009
Gateshead data
See Topic sections: Mental and Behavioural Disorders ; Self Harm and Suicide
Summary
Common Mental Illness
The majority of common mental health problems are concerned with depression and anxiety, with a smaller
proportion of people experiencing phobias, obsessive compulsive disorder and panic disorder. Whilst major
psychiatric disorders such as schizophrenia, Bipolar disorder and psychotic illnesses (which have a community
prevalence of less than 1%) are certainly more disabling to individual sufferers and more distressing for their
families and carers, their rarity means that these conditions place less of a burden on the public health than
common mental health problems.
In Gateshead more than 11,000 people are diagnosed with depression and a further 22,000 are estimated to
have a generalised anxiety or mixed depression and anxiety disorder.
Severe Mental Illness
Severe mental illness is made up of conditions which generally need high levels of care, have the greatest
impact on the individual and often relapse. These include several forms of psychosis and personality
disorders. Although relatively small numbers of people are affected, these conditions need a high level of
resource to support the individuals and their families. GP records indicate that over 1,900 people have been
diagnosed with a severe mental illness (schizophrenia, bipolar affective disorder and other psychoses).
Both the rate of emergency psychiatric admissions and the rate of admissions for self-harm are significantly
higher in Gateshead than in England overall.
Dual diagnosis
Dual diagnosis is the term usually used to describe patients with both severe mental illness (mainly psychotic
disorders) and problematic drug and/or alcohol use. Personality disorder may also coexist with psychiatric
illness and/or substance misuse. People with dual diagnosis of drug and alcohol misuse and/or mental health
problems are frequently the most in need of treatment services.
Self harm
Self harm is when somebody intentionally damages or injures their body. It is a way of coping with or
expressing overwhelming emotional distress. Sometimes when people self-harm they intend to die but often
the intention is more to punish themselves, express their distress or relieve unbearable tension. Self-harm can
also be a cry for help.
Self harm can take many forms including

Cutting, burning, biting

Substance abuse

Head banging and hitting

Taking personal risks

Picking and scratching

Neglecting oneself

Pulling out hair

Eating disorders

Over dosing and self-poisoning
In 2012/13 there were 535 emergency hospital admissions in Gateshead for intentional self harm.
Self-harming in young people is not uncommon, but only a fraction of cases are seen in hospital settings;
therefore, all those in contact with young people should be aware of how, and when, to refer somebody on
for further assessment and support.
Suicide
About 3 out of 4 suicides are men and in almost all cultures, the suicide rate rises with age. The highest rates
of suicide in the UK are among people aged over 75 and it remains a common cause of death in men under
the age of 35
Some groups of people are known to be at higher risk of suicide than the general population. These groups
include:

young and middle-aged men (the highest rate aged 35-54)

people in the care of mental health services, including inpatients

people with a history of self-harm

people in contact with the criminal justice system

specific occupational groups, such as doctors, nurses, veterinary workers

farmers and agricultural workers

lesbian, gay, bisexual, transgender and questioning (LGBTQ)
People with a diagnosed mental health condition are at particular risk. Around 90% of suicide victims suffer from a
psychiatric disorder at the time of their death.
In Gateshead there were 38 deaths from suicide and injuries of undetermined intent between 2011 and
2013, the majority of deaths were men between the ages of 31 and 60.
Physical health
Physical health and mental health are inextricably linked. Poor mental health is associated with an increased
risk of diseases such as cardiovascular disease, cancer and diabetes, while good mental health is a known
protective factor. Poor physical health also increases the risk of people developing mental health problems.
According to the British Journal of Psychiatry (Levels of anxiety and depression as predictors of mortality: the
HUNT study, 2009), people with a mental illness have higher rates of physical illness and tend to die 10 – 20
years earlier than the general population, largely from treatable conditions associated with modifiable risk
factors such as smoking, obesity, substance abuse, and inadequate medical care.
The Royal College of Physicians and the Royal College of Psychiatry report (Smoking and Mental Health, 2013)
that smoking is a significant cause of morbidity and mortality among those with a mental illness. Smoking is
around twice as common among people with a mental illness. Adults with mental health problems, including
those who misuse alcohol or drugs, smoke 42% of all the tobacco in England.
See also: Cardiovascular Disease ; Cancer ; Diabetes Mellitus ; Smoking ; Obesity and Excess Weight ; Illicit
Drug Use
Groups most at risk
Age & Gender
Women appear to have a higher risk of showing symptoms of common mental health problems, although it is
known that there is a high level of under-diagnosis of anxiety and depression among men.
Whereas physical illness tends to impact more with increasing age, mental illness often begins in childhood
and impacts heavily on the working age population. Up to the age of 65, mental illness accounts for nearly as
much morbidity as all physical illnesses put together.
The prevalence of mixed anxiety and depressive disorders peaks among males aged 40-49, whereas among
women, prevalence is greatest among those in their twenties, after which it starts to decline.
Ethnicity
Research shows that rates of mental health problems are generally higher among minority ethnic groups than
among the white population, but are less likely to be diagnosed in General Practice. [1]
Lesbian, Gay, Bisexual and Transgender (LGBT)
Research shows that Lesbian, gay, bisexual and transgender (LGBT) people have higher incidence of common
mental health problems than the general population and have generally poorer health outcomes. [2]
LGBT people can experience difficulty accessing health services due to lack of awareness and understanding of
issues effecting them, the prevalence of heterosexism, services not designed to meet LGBT needs, and
discrimination as well as stigma and fear.
Parental Mental Health
Research by the Social Care Institute for Excellence emphasises the extent of the impact of parental mental ill
health on dependants: [3]

Children of mothers with mental health problems are up to twice as likely to develop emotional disorders.

Parental mental ill health is a factor in a third of serious case reviews in children’s services.

Up to two thirds of children whose parents have mental health problems will experience mental health
difficulties themselves.

Nearly a third of young carers are estimated to care for a parent with a mental health problem, and are the
group least likely to be offered a carers’ assessment.
Carers
Research shows that carers frequently feel isolated and lonely. Due to their caring responsibilities carers have
difficulty in continuing with the life they led before – work, education, leisure and community participation.
People with Learning Disabilities
The prevalence of mental health problems is generally considered to be higher among those with learning
disabilities, and the severity of the mental health problem tends to increase along with an increase in the
severity of the learning disability. [4]
While it is difficult to establish a true local picture of the extent of the issue due to lack of accurate
information, a report by the Mental Health Foundation suggests between 25% and 40% of people with
learning disabilities have a mental health problem. [5]
Offenders
Evidence suggests there is interdependency between offending and mental health problems, with the
prevalence of mental illness among offenders being much higher than among the general population.
Research by the Mental Health Foundation indicated that the prevalence of mental health problems among
young people in the criminal justice system is between 21% and 85%, with the most common conditions being
conduct disorders, emotional disorders and attentional disorders. [6]
Evidence from NICE suggests there is high prevalence of poly-misuse among the prison population, with
between 12% and 21% having at least four disorders simultaneously, including drug and alcohol dependence,
personality disorder, neurotic disorder and psychosis. [7]
Victims of Domestic Abuse
People who have been abused or been victims of domestic violence have higher rates of mental health
problems. Women’s Aid noted that it is now well accepted that abuse (both in childhood and in adult life) is
often the main factor in the development of depression, anxiety and other mental health disorders, and may
lead to sleep disturbances, self-harm, suicide and attempted suicide, eating disorders and substance misuse.
Housing & Homeless
Being Homeless or ‘vulnerably’ housed is linked to increased risk of common mental health problems as is
poor quality accommodation and overcrowding. Members of overcrowded families are more likely to
experience depression, anxiety, problems sleeping and difficulties with family relationships.
People with Drug & Alcohol Problems
Problem or harmful drinking has obvious implications for physical health. There is also a great deal of overlap
between alcohol and mental illness. At least two-thirds of people entering treatments for alcohol dependency
have depressive or similar symptoms.
Students
National Union of Students Research indicates that 20% of students experience mental health problems. [8]
The problems relate to coursework deadlines , exams, financial difficulties, pressures about "fitting in" and
homesickness.
Stress is the most common symptom with many students also reporting a lack of energy or motivation,
anxiety, insomnia and panic.
The report indicated that 14% of students had considered self-harm and 13% reported suicidal thoughts.
Asylum Seekers & Refugees
It is estimated that around two thirds of refugees have experienced anxiety and depression, often linked to
past experiences. [9]
Veterans and their families
A number of UK studies have found links between active service and mental health problems in armed service
personnel involved in recent conflicts. Common mental disorders and alcohol misuse were the most
frequently reported mental disorders among UK armed forces personnel. In particular, levels of alcohol
misuse overall were substantially higher than in the general population.
People with Long Term Pain
Many people have long term pain due to conditions such as arthritis, back pain, and diabetes nerve pain. It is
recognised that pain is a complicated and hard-to-treat, and the answer may not always be painkillers
(analgesics).
Those living with pain are at risk of depression or poor mental health and may also be at risk of becoming
overweight due to inactivity. Pain can reduce mobility as people try to protect themselves and can result in
exacerbation of existing conditions, social isolation due to reduced contact, loss of confidence due to falls and
reduced life expectancy. [10]
[1] Mental Distress Survey Overview, NUS Services Limited, May 2013 www.nus.org.uk/en/news/news/20per-cent-of-students-consider-themselves-to-have-a-mental-health-problem
[2] http://www.pacehealth.org.uk/files/1614/2978/0087/RARE_Research_Report_PACE_2015.pdf
[3] Social Care Institute for Excellence (2011) Think Child, Think Parent, Think Family Guide 2011
http://www.scie.org.uk/publications/guides/guide30/index.asp
[4] National Institute of Health & Clinical Excellence (2011) Common mental health disorders: The NICE
guideline on identification and pathways to care
http://www.nice.org.uk/nicemedia/live/13476/54604/54604.pdf
[5] Mental Health Foundation (2007) The Fundamental Facts.
http://www.mentalhealth.org.uk/publications/fundamental-facts/
[6] Mental Health Foundation (2002) The Mental Health Needs of Young Offenders
[7] National Institute of Health & Clinical Excellence (2011) Common mental health disorders: The NICE
guideline on identification and pathways to care
http://www.nice.org.uk/nicemedia/live/13476/54604/54604.pdf
[8] Mental Distress Survey Overview, NUS Services Limited, May 2013 www.nus.org.uk/en/news/news/20per-cent-of-students-consider-themselves-to-have-a-mental-health-problem
[9] Mental Health Foundation (2007) The Fundamental Facts.
http://www.mentalhealth.org.uk/publications/fundamental-facts/
[10] Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and
parallels with other chronic disease states. (July 2011) http://www.ncbi.nlm.nih.gov/pubmed/21752179
What are we doing and why?
The national strategy “No Health without Mental Health: across government mental health outcome strategy
for people of all ages” (2011) aims to mainstream mental health and establish a parity of esteem between
mental and physical health services. It takes a life course approach and recognises the relationship between
the wider social determinants, social isolation and poor mental health. [1]
The department of health has worked with a range of partners and across government to develop a set of six
shared objectives to improve mental health outcomes for individuals as well as the population as a whole.
The Key Objectives:

More people will have good mental health

More people with mental health problems will recover

More people with mental health problems will have good physical health

More people will have a positive experience of care and support

Fewer people will suffer avoidable harm

Fewer people will experience stigma and discrimination
No Health Without Mental Health: Implementation Framework published in 2012 highlights a range of actions
that local organisations such as Clinical Commission Groups (CCGs), local authorities, health and wellbeing
boards can do to support the implementation of the strategy.
Local Action
Mental health is a population issue which requires multiagency working and co-ordination. Greater
importance needs to be placed on public mental health across the life course focusing on promoting positive
mental health, recognising and treating problems early and preventing mental illness in those most at risk.
Research shows that a small improvement in population wide levels of wellbeing will reduce the prevalence of
mental illness as well as bring the benefits associated with positive mental wellbeing. [2]
Gateshead Mental Health partnership are currently working with stakeholders to develop and deliver a range
of activities to improve mental wellbeing and build community resilience, in relation to:

Promoting the ‘Five Ways to Wellbeing’

Supporting mental health and wellbeing training for non-mental health professionals

Supporting local businesses to improve the health and wellbeing of their workforce through the ‘Better
Health at Work Award

Working to reduce stigma in Gateshead through initiatives such as promoting the Mental Health
Charter for Sort and Recreation

Increasing access to activities to improve mental wellbeing, build social connections and community
resilience through our lifestyle programmes and campaigns.
The Live Well Gateshead team also offer advice, motivation and practical support to individuals in their local
communities. Staff and volunteers work with clients on a one-to-one basis to assess their health, wellbeing
and lifestyle risks.
Targeting high risk populations
There are a range of public sector and voluntary sector services and projects in Gateshead directed to
supporting those at high risk of developing mental illness. These complement and support NHS primary and
secondary care services. These include:

Local counselling services

Drug and alcohol services

Mental Health and Employment trailblazer

Vulnerable persons housing projects
[1] Department of Health (2011) No health without mental health: A Cross-Government Mental Health
Outcomes Strategy for People of All Ages. Available from:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf
[2] Hubbert F. (2008) State of Science Review: Psychological Wellbeing: evidence regarding its causes and
consequences mental capital and wellbeing. Making the most for ourselves in the 21st century, Foresight
What would success look like?
Early identification of mental health problems allowing individuals early access to appropriate local support
services.
Individuals receive regular reviews and are supported to be involved in decisions being made about their care.
Effective relapse prevention work to ensure that fewer people are readmitted to inpatient care, and
individuals are able to maintain social, familial, and work relationships.
Individuals experiencing acute episodes of severe mental illness have access to a range of interventions
including home treatment, crisis beds, or inpatient treatments appropriate to their needs. Crisis is responded
to quickly and effectively and disruption of the individual’s life is minimised.
The physical health of people with mental illness would improve and more people with severe mental illness
would receive routine healthcare.
A whole family approach to support and ensuring that underlying issues are addressed to improve outcomes
for the whole family.
Challenges
The prevalence of mental illness is predicted to rise in the coming years due to the impact of increased
economic pressures on individuals, their families and communities. This will increase the risk for some of
developing mental health difficulties as well as affecting the ability of people to successfully manage their
conditions.
There is a need to shift investment towards mental health promotion, prevention and early intervention.
Mental health commissioners have huge task in ensuring appropriate, effective services are in place to meet
these needs and improve health outcomes particularly in the current economic climate.