Statistics 6: The social context of mental distress

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Employment and mental health
Gender and mental health
Prevalence of mental distress within Black and ethnic minority communities
Older people and mental health
Young people and mental health
Urban and rural environments and mental health
Social class and mental health
Links between mental health, housing and homelessness
Carers of people with mental health problems
Young carers

Please note: The language used in this factsheet reflects the terminology used in the sources referred to. The use of such language does not automatically imply Mind's acceptance of it.

Employment and mental health

• It is estimated that stress related illness is costing the NHS between £300 and £400 million every year. [1] 
• According to the Sainsbury Centre for Mental Health, the total cost of mental health problems is around 77 billion per year.
• Around 6.8 million people of working age in the UK are disabled. [2] This is around 20 per cent of the working age population.
• More than 2.5 million individuals receive incapacity benefit and/or severe disability allowance. [3] 
• Close to one million people are claiming incapacity benefit due to mental ill health. [4] 
• People who are disabled because of mental health problems have lower employment rates than all other disabled groups.
• Only around 20 per cent of people with mental health problems are in employment. [5] 

Many people with mental health problems want to work. The Department of health suggests that 40 per cent of people who claim incapacity benefit have a mental health problem. They also suggest that most of them want to work. [6] Unfortunately one survey shows that only around 37 per cent of employers are willing to take on someone with a mental health problem. [7] In contrast, more than 60 per cent of employers are willing to take on someone with a physical disability. The Social Exclusion Unit suggests that 75 per cent of employers would not consider employing anyone who had a diagnosis of schizophrenia. [8] The Social Exclusion also found that 55 per cent of people with a mental health problem found that stigma was a barrier to employment.

One person told Mind that 'On two occasions I lied when I applied for jobs. On both these occasions I said that my two and a half years absence from employment was due to time spent in prison. I was accepted for the first [job] and short-listed for the second. Whenever I have been truthful about my psychiatric past, I have never been accepted for a job'. [9]

Research indicates that if people who have experienced mental illness are offered support and vocational interventions, many are able to return to work. [10] The Government say they want to help people with mental health problems back to work. Yet there are few vocational interventions designed for people who have experienced mental health problems, including those who have had long-term mental ill health. [11]

(See Mind's factsheet Seeking employment and their resource pack Managing for mental health.)

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Gender and mental health

Statistically, women are more likely than men to experience mental and emotional distress (where psychotic elements are not present). Research by the Office for National Statistics (ONS) shows that 20 per cent of all adult women between the ages of 16 to 65 have 'significant mental health problems', as compared with 14 per cent of men between these ages. [12]

Gender differences in mental health have been widely debated, and a number of explanations are commonly given: that these reflect the greater stresses that many women face in society; that women are more likely to admit to mental health problems and seek help; and that psychiatrists are much more likely to diagnose women as suffering from a mental health problem than men. [13]

For psychosis, which affects 0.5 per cent of the population, there are no significant gender differences in prevalence rates. However, for schizophrenia, the onset of illness is, on average, later in women and women are more likely to make a full recovery. [14] [15]

(See Men's mental health and Women and mental health.)

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Prevalence of mental distress within Black and minority ethnic communities

Ethnic monitoring only became mandatory in publicly funded mental health services in 1995. [16]Therefore, little reliable data has been available on how minority ethic groups are treated by mental health services in England and Wales.

However, both past and recent research suggests that some groups – notably Black Caribbean, Black African and other Black groups – are over-represented in psychiatric hospitals. [17] (See Mental health of the African Caribbean community in Britain.)

The high numbers of African Caribbean people being diagnosed with schizophrenia is well documented, with some studies reporting between two to eight times higher rates of diagnosis compared to the White population. [18]

Data from the 2001 Census showed that men from Black and White/Black mixed groups had the highest rates of admission to psychiatric hospitals. They were three or more times likely than the general population to be admitted. Women from the Black and mixed White/Black groups were two or more times likely than the general population to be admitted to psychiatric hospital.

White British, Chinese and Indian men were less likely than the average population to be admitted.

Men from Black Caribbean, Black African, and other Black groups were more likely than other groups to have been detained under the Mental Health Act 1983.

Studies have shown that Irish people have higher rates of mental illness than the general population. [19] The Irish are often overlooked because they are White. Yet studies have found that Irish-born people living in the UK have a higher rate of suicide than any other minority ethnic group living in the country. [20] (See Mental health of Irish-born people in Britain.)

(For more detailed statistical information on race and mental health, see Mind's factsheet Mental Health Statistics 3: Race, Culture and Mental Health.)

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Older people and mental health

As people get older, they are more in need of healthcare services. Around 20 per cent of people aged 60 or over accounts for more than 40 per cent of the people staying in NHS hospitals. [21] People aged 75 and over account for 7.5 per cent of the general population, but make up half of those treated by community nurses. More than 50 per cent of individuals aged over 85 are cared for by community nursing services.

Mental health problems are common in older adults. Around 40 per cent of older people who visit a GP are thought to have a mental health problem. [22] Around 50 per cent of older general hospitals patients might also experience a mental health problem. In care homes, as many as 60 per cent of older residents might suffer from some form of mental illness.

Older people who experience a physical illness are more likely to also experience a mental health problem. One study estimated that 70 per cent of all new cases of depression in older people might be caused by some form of disability following physical illness. [23]

The most common mental health problem among older people is depression. Estimates suggest that around 10-15 per cent of people over 65 experience symptoms of clinical depression. [24] Around 750,000 people in the UK are suffering from dementia. [25] Those with Alzheimer's disease make up around 55 per cent of all cases of dementia. Many more – around one in five – show some signs of cognitive impairment. [26]

(See Older people and mental health and Understanding dementia.)

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Young people and mental health

In 2004, a survey carried out by the ONS found that among children aged 5 to 16 years a total of 9.6 per cent had a clinically diagnosed mental disorder. [27] Of these:

• 3.7 per cent had emotional disorders - anxiety and depression
• 5.8 per cent were assessed as having conduct disorders
• 1 per cent were rated as showing signs of hyperkinesis (hyperactivity).
• 11 per cent of boys had a mental disorder compared with eight per cent of girls.

Children with mental health problems in Britain – by age and sex [28]

This means that more than one million children in the UK might benefit from specialist mental health  services. [29] Up to 45,000 young people are thought to suffer from a severe mental health disorder. Around 40 per cent of children with a mental health disorder are not receiving specialist support. [30]

Mental health problems that are not treated, cause distress to the children and young people who experience them. It also causes distress for their families and carers. Furthermore, children and young people who experience mental health problems are more likely than others to fail in school and to display offending and antisocial behaviour. [31]

Homelessness among young people also brings significant problems. Off to a bad start, a study of homeless people in London aged 16 to 21 years, found that almost two-thirds had suffered recently from psychiatric disorders. A third also reported at least one attempted suicide at some point. Only one fifth, however, had been in contact with psychiatric services in the past year. [32]

(See Children and young people and mental health.)

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Urban and rural environments and mental health

Studies indicate that people who live in rural areas are likely to experience slightly better mental health than people living in urban areas. [33]

However, studies show that farmers are among the occupational groups with the highest risk of suicide in England and Wales. [34] This compounds the fact that farmers are less likely to report feeling depressed than then general population.

One study indicates that the rate of mental health problems may be higher than the figures indicate. [35] There are significantly fewer health services in rural areas compared to urban areas. If an individual with a mental health problem lives in a rural area they may be left with two choices; to stay where they are and not get the treatment they need or move to a more urban area where help is available.
(See Rural issues in mental health.)

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Social class and mental health

Studies from Britain and other countries have consistently, over many years, suggested that people from lower socio-economic groups have higher levels of common mental health problems, such as depression and anxiety, than people from higher socio-economic groups. [36] The European Survey of Surveys from 2002, shows that it is difficult to compare surveys from different countries as they use different measures and methods. However, none of the studies contradicted the link observed between social disadvantage and higher levels of mental health problems. [37] It is therefore of concern that levels of poverty are particularly high in the UK. The Healthcare Commission states that 2.6 million children in the UK live in households with below 60 per cent of the average income. [38] This means that the UK has a record high level of child poverty compared to other European countries. Furthermore, over two million pensioners live in poverty in the UK.

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Links between mental health, housing and homelessness

Homelessness and housing problems increase a person's chances of physical and mental ill health. Homeless people are more likely to experience physical, mental and emotional problems than the general population. [39] Around nine per cent of households accepted as unintentionally homeless are in priority need due to mental illness. [40]

Many homeless people find it difficult to register with a GP. As being registered with a GP is often the first step towards getting support, homeless people often fall outside the system and get no help. [41] This is particularly worrying as around 30-40 per cent of rough sleepers have mental health problems. Some have suggested that as many as 70 per cent of homeless people experience some form of mental health problem. [42]

When a scheme aimed at helping homeless people was introduced in Exeter, they found that referrals to psychiatric support facilities dropped by 76 per cent. [43]

One in five people say that mental health problems were a reason for becoming homeless. One survey suggests that 94 per cent of homeless men and 90 percent of homeless women developed mental health problems before they became homeless. [44]

Mental ill health is also a major contributor to homelessness among young people. A study in London found that more than 18 per cent of young homeless people had received a psychiatric diagnosis including schizophrenia, bipolar disorder and clinical depression. [45] The diagnoses were made before they became homeless.

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Carers of people with mental health problems

Every year over two million people become carers. [46] According to Carers UK, the number of informal carers is around 6 million. [47] This means that approximately one in eight adults are carers. As many as three in five is likely to become a carer in their lifetime. As many as 1.25 million carers provide 50 or more hours of care per week. Between 1.7 million and 1.9 million carers provide 20 or more hours of care per week. The majority of carers (58 per cent) are women, and women are more likely to carry the main responsibility for caring, where there is more than one person with some responsibility. [48]

Carers UK has estimated that home care saves the country at least £57 billion a year. [49]

Around half of those with severe mental illness live with family or friends, and are likely to receive considerable support from them. [50] Unfortunately many of these carers feel that they do not get the support that they need. Since 1996 carers have had a right to request a carers assessment. The Social Services Inspectorate found that the number of assessments done was particularly low for carers of people with mental health problems and carers from minority ethnic communities. [51]

Carers of people with mental health problems report higher levels of mental distress than other carers since becoming a carer. [52] Many are treated for anxiety, depression and stress. Carers of people with mental health problems were less likely than other groups to get increased levels of support after having had a carer's assessment. Only 25 per cent of carers who reported unmet needs got more support after an assessment. This was in spite of the fact that 75 per cent of carers of people with mental health problems reported unmet needs. [53] Carers UK suggests that the NHS should pay particular attention to carers of people with mental health problems, as they are more likely than other groups to have unmet needs.

Not surprisingly, surveys find that those providing 50 hours or more care per week, were more likely than others to experience ill health, including mental health problems. [54] As eight out of ten carers are of working age (between 16-65) many combine full-time work with many hours of caring every week. Around 400,000 carers in the UK combine full-time work with caring for 20 or more hours per week. [55]

Many carers find that they have to give up work. Consequently many will experience loss of earnings and financial difficulties, [56] which in turn can increase levels of stress and other mental health problems.

Young carers
The 2001 Census suggests that there are around 175,000 young carers in the UK. Previous figures suggested that the numbers were between 20,000 and 50,000 children and young people caring for members of their own family. [57]  In 2004, Carers UK and the Children's Society published a survey of young carers and the following represents a brief summary of their findings. [58]

• According to the Carers National Association, 29 per cent of all young carers are providing care for someone with a mental health problem.
• The average age of young carers is 12.
• Fifty six per cent are girls, 44 per cent boys. Girls are more likely to be involved in all aspects of care, especially domestic tasks and intimate care. Those caring for a person with a mental health problem are likely to provide emotional support.
• Fifty six per cent of young carers live in lone parent families.
• Ten per cent are caring for more than one person.
• Seventy per cent of care recipients in lone parent families are mothers. In two parent families 46 per cent of care recipients are siblings.
• Around 27 per cent of young carers of secondary school age show signs of educational difficulties.
• Twenty per cent of young carers and their families receive no outside support services other than their contact with the young carers project.
• Only 18 per cent of young carers have been assessed under any legislation. Of these, 11 per cent had been assessed under the Children Act. However, this is 6 per cent more than the number of young carers assessed in 1997.

This factsheet was written by Inger Hatloy, February 2007.

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Footnotes

[1] TAEN, 2006, Key Facts, Health, Employment and Age
[2] Disability Rights Commission, 2006, Disability Briefing, Making Rights a Reality
[3] DWP, 2006, Incapacity Benefit/Severe Disablement Allowance Caseload: Working Age/Pension Age split by IB ICD (disease) summary code, Time Series, Aug 06
[4] NIMH, 2005, Making it possible, Improving Mental Health and Well-being in England
[5] Disability Rights Commission, 2006, Disability Briefing, Making Rights a Reality
[6] Government News Network, 2007, downloaded March 2007 from http://www.gnn.gov.uk/Content/Detail.asp?ReleaseID=260250andNewsAreaID=2
[7] Disability Rights Commission, 2003, Coming together – mental health service users and disability rights
[8] ODPM, 2004, Mental Health and Social Exclusion, Social Exclusion Unit Report
[9] Mind, 2000, The Worknet Network, downloaded March 2007
[10] Bertram, M and Howard, L, 2006, 'Employment status and occupational care planning for people using mental health services', Psychiatric Bulletin (2006) 30: 48-51
[11] Bertram, M and Howard, L, 2006, 'Employment status and occupational care planning for people using mental health services', Psychiatric Bulletin (2006) 30: 48-51
[12] ONS, Psychiatric Morbidity in Great Britain, 2000, Prevalence of Psychiatric Morbidity Among Adults Living in Private Households, London, 2001
[13] Miles, A., 1987, The Mentally Ill In Contemporary Society, (2nd Edition) Oxford: Basil Blackwell
[14] Miles, A., 1987, The Mentally Ill In Contemporary Society, (2nd Edition) Oxford: Basil Blackwell
[15] Warner, R., 1994, Recovery From Schizophrenia – Psychiatry and Political Economy, London: Routledge
[16] Commission for Healthcare Audit and Inspection, 2005, Count me in, Results of a national census of inpatients in mental health hospitals and facilities in England and Wales, November 05, available online
[17] Commission for Healthcare Audit and Inspection, 2005, Count me in, Results of a national census of inpatients in mental health hospitals and facilities in England and Wales.
[18] Harrison, G., 2002, 'Ethnic minorities and the Mental Health Act', The British Journal of Psychiatry 180: 198-199
[19] Fitzpatrick, M., 2005, 'Profiling mental health needs: what about your Irish patients?', British Journal of General Practice, October 2005.
[20] NIMH, 2003, Inside outside, improving mental health services for black and minority ethnic communities in England, DH.
[21] Healthcare Commission, 2004, State of Healthcare Report 2004
[22] Philip, I. and Appleby, L., 2005, Securing better health for older adults, Department of Health
[23] Evans, O, Singleton, N, Seltzer, H, Stewart, R and Prince, M, 2003, The Mental Health of Older People, ONS
[24] Evans, O, Singleton, N, Meltzer, H, Stewart, R and Prince, M, 2003, The Mental Health of Older People, ONS
[25] Alzheimer's Society, 2007, Facts about dementia
[26] Evans, O, Singleton, N, Meltzer, H, Stewart, R and Prince, M, 2003, The Mental Health of Older People, ONS
[27] Green, H, McGinnity, A, Meltzer, H, Ford, T, and Goodman, R, 2004, Mental health of children and young people in Great Britain, 2004, ONS
[28] Green, H, McGinnity, A, Meltzer, H, Ford, T, and Goodman, R, 2004, Mental health of children and young people in Great Britain, 2004, ONS
[29] DH, 2005, CAMHS standard, National Service Framework for Children, Young people and Maternity services
[30] DH, 2005, CAMHS standard, National Service Framework for Children, Young people and Maternity services
[31] DH, 2005, CAMHS standard, National Service Framework for Children, Young people and Maternity services
[32] Craig, T.K. and Hodson, S. Homeless youth in London: I. Childhood antecedents and psychiatric disorder, Psychological Medicine 28, 1379-1388 1998
[33] Weich, S, Twigg, L, and Lewis, G, 2006, 'Rural/non-rural differences in rates of common mental disorders in Britain', The British Journal of Psychiatry 188: 51-57.
[34] Thomas, HV, Lewis G, Thomas, D Rh, Salmon, Chalmers, RM, Coleman, TJ, Kench, SM, Morgan-Capner, P, Meadows, D, Sillis, M, and Softley, P, 2003, 'Mental Health of British Farmers', Occupational and Environmental Medicine 2003;60:181-186
[35] Smith, A.J. and Ramana, R. (1998) Mental health in rural areas: experience in South Cambridgeshire, Psychiatric Bulletin, 22, pp 280-284
[36] Fryers, T, Meltzer, D, Jenkins, R, and Brugha, T, 2005, The distribution of common mental disorders; social inequalities in Europe, Clinical Practice and Epidemiology in Mental Health 2005, 1:14 downloaded February 2007, from www.cpementalhealth.com/content/1/1/14#IDAHKZYC [37] Fryers, T, Meltzer, D, Jenkins, R, and Brugha, T, 2005, The distribution of common mental disorders; social inequalities in Europe, Clinical Practice and Epidemiology in Mental Health 2005, 1:14 downloaded February 2007, from www.cpementalhealth.com/content/1/1/14#IDAHKZYC
[38] Dr Raleigh, V.S. and Polato, G.M, 2004, Evidence of health inequalities, Healthcare Commission
[39] Office of the Deputy Prime Minister, 2004, Homelessness Statistics December 2003 and Addressing the Health Needs of Homeless People, Policy Briefing 7, Homelessness and Housing Support and DH
[40] Office of the Deputy Prime Minister, 2004, Homelessness Statistics December 2003 and Addressing the Health Needs of Homeless People, Policy Briefing 7, Homelessness and Housing Support and DH
[41] Office of the Deputy Prime Minister, 2004, Homelessness Statistics December 2003 and Addressing the Health Needs of Homeless People, Policy Briefing 7, Homelessness and Housing Support and DH
[42] Broadway, 2004, Homelessness and Mental Health Factsheet
[43] Office of the Deputy Prime Minister, 2004, Homelessness Statistics December 2003 and Addressing the Health Needs of Homeless People, Policy Briefing 7, Homelessness and Housing Support and DH
[44] Dr Dean, R and Prof Craig, T, 1999, Pressure points: Why people with mental health problems become homeless, Crisis
[45] Mental Health Foundation, 2006, Making the link between mental health and youth homelessness - A pan-London study
[46] Carers UK, 2004, Ten facts about caring
[47] Carers UK, 2002, Without Us...? Calculating the value of carers' support
[48] Carers UK, 2005, Facts about Carers
[49] Carers UK, 2002, Without Us...? Calculating the value of carers' support
[50] H.M. Government, 1999, Caring about Carers: A National Strategy for Carers, HMSO, London
[51] Carers UK, 2003, Missed Opportunities, The impact of new rights for carers
[52] Carers UK, 2003, Missed Opportunities, The impact of new rights for carers
[53] Carers UK, 2003, Missed Opportunities, The impact of new rights for carers
[54] Carers UK, 2005, Facts About Carers
[55] Carers UK, 2005, Facts About Carers
[56] Carers UK, 2005, Facts About Carers
[57] Banks, P and Cheeseman, C. Taking Action to Support Carers, King's Fund 1999
[58] Dearden, C and Becker, D, 2004, Young Carers in the UK, The 2004 Report, London: Carers UK

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