You may as well call it an epidemic

As so much of the time it seems that everyone is warning of the increase in mental health problems and the possible epidemic I have been considering the myths of mental health again and whether this is one of them.

Last year I did a piece on increasing suicide rates at Christmas and found to my surprise that actually they didn’t. I did a piece about how suicide rates were rising because of the recession and found again that actually they hadn’t yet although I definitely expect them too.

So now with headlines about the increased prevalence of mental health is? I wonder whether actually this is just a gap in some peoples understanding rather than an actual rise. It seems that my own perceptions of how bad mental health problems are may be greatly increased due to my own long term issues.

So is there an impending epidemic of mental health problems?

There’s certainly been increasing amounts of coverage but then the population of the UK has also increased by 3.6 million (England) and 2.9 million (Wales) since 2001 which is an increase of 7.2% and 5.2% on the National census 2011 which suggest to me that also the number of cases of mental health problems would have increased even if the overall prevalence of problems remained the same.

Now if you go to the coroner’s report and look at the comparison for the last 10 years you will see that both suicide and open verdicts have been falling, For suicide from 18% in 1995 to 12% in 2011 and open verdicts from 11% to 7% which kind of suggest that there have been fewer deaths due to people efforts to die. However it is also noted that unclassified verdicts (which include narrative verdicts and therefore may contain suicides) have risen from 2001 from less that 1% to nearly 15%. This increase would give a possible rise in suicide of 6% approximately which is less than the increase in the population.

I believe it can be reasonably assumed that care for those with mental health issues has improved during this time and so this isn’t surprising but this doesn’t really give a very good picture of the prevalence. People on average are killing themselves less but it doesn’t mean fewer people are suffering from problems.

So what about care?And is it possible to tell if more people are suffering?

Well one way to see what’s happening is to look at the number of people who are detained under the various parts of the mental health act which can be found here
This data runs from 2007/2008 and shows that the total number of detentions has increased by 10% over the past five years, which is more than the population increase over the same time period, unfortunately it is not clear whether there was a similar trend prior to this and also the number of detentions does not equal the number of people suffering as there may be repeat admissions/ detentions.
 The act has had significant changes and revisions particularly to the inclusion of CTO‘s (community treatment orders). So since their introduction in 2008 CTOs have increased in number as have their revocations/admission to hospitals, a natural progression of the introduction of new legislation and therefore I don't think particularly indicative of any changein prevelance.
In this reporting year there were

·      4220 CTO made (an increase of 10% on the last reporting year or 386)

·      there were 1712 discharges (increase of 47% or 545 approx.)

·      3551 (44% increase or 931 approx included in total detentions included in overall detention percentage earlier) recalls revocations ie extensions to and or admissions to hospital.

But it is difficult to tell whether this shows a large overall increase or not and realistically the changing face of treatment and the ideas that promote hospital stays as apposed to care in the community could influence the decisions that are made.

In fact as I go though the data and look at other areas, for instance removals to places of safety within hospitals 841 in the last reporting year an increase of 5.8% I wonder how much the data is influence by non or inaccurate reporting. Note that I have already excluded orders where the detentions were in police custody suites which are known to be incomplete the author notes

Information was extracted from local custody suite databases at the 43 forces (excluding British Transport Police) and represents people who went directly to a station, rather than those arrested for substantive offences and subsequently assessed. Uses of Section 136 within police custody suites accounted for an estimated proportion of at least 37 per cent of all uses of Section 136 during 2011/12. It is not presently possible to collect data on persons taken to alternative places of safety (e.g. residential care homes or the homes of relatives or friends willing to accept them) at present, and therefore the scale of this practice is unknown.

All that I can really say is that there appears to be a steady increase that is larger than the population increase over the last 10 years but it is known to have huge reporting problems. In fact it’s quite likely that mental health removals are grossly under-reported.

Should we be worried about this?

I wouldn’t like to say. There have been attempts to estimate how prevalent the problem is, such as the Adult psychiatric morbidity in England, 2007 which I have quoted in the past and deals with common mental disorders and shows a huge number of people are not seeking help when they have been deemed to need it however this does not necessarily translate to continuing mental health problems. This report is also now five years old and is not therefore very accurate for today.
 What I’m really concerned about is the almost total lack of knowledge about the scope of the problem. From how big it is, to how much it’s increasing or not and until such time as accurate collection of figures is happening it may well be a very good idea to say it’s an epidemic since we have no idea whether it is or not.

In fact this reminds me so much of the AIDS epidemic....oh yes remember that when everyone was so scared of the unknown because no one would talk about it and issues surrounding the lifestyles that made it more likely were not so talked about either. Yes I remember very well, it was the big bad! And look how that turned out. It was the big bad, but it wasn’t what they expected and until people are talking we’re really not going to know now either.

Just a little thought

Epidemics often get under way because the proper cause of action is not identified earlier enough and given to everyone that requires it! And look what the government is doing, cutting funding to mental health services. They’ve really got that one sorted haven’t they?