Statistics 7: Treatments and services for people with mental health problems

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Introduction

Services for people with mental health problems
Figures for people making contact with services
Contact with GPs as a result of mental health problems
Availability of mental health hospital beds

Treatments for people with mental health problems
Medication taken by type of neurotic disorder
Counselling and therapy by type of neurotic disorder
The most commonly used treatments for neurotic disorder
Medication taken by people with and without psychotic disorder
Counselling and therapy used by people with and without psychotic disorder
The most commonly used treatments for probable psychotic disorders
Use of other physical treatments
Choice of treatments available
Access to complementary and alternative therapies for mental health problems

Introduction

This factsheet is targeted at mental health professionals, journalists and students. However, it is also our aim to present statistics in a way which makes Mind’s statistics factsheets accessible to all those who are interested in mental health.

The language used in this factsheet reflects sources referred to. The use of such language does not automatically imply Mind’s acceptance of it.

Services for people with mental health problems

Treatment and care for people with mental health problems is provided in a number of ways by various sources. People may come into contact with mental health services through referral by a GP or through other services, such as accident and emergency departments, the police, the courts and the prison service. Referrals may also come from services for homeless people and other voluntary organisations. Some mental health services can be accessed without a formal referral.

Mental health services are provided within the statutory, voluntary and private sectors and may be hospital or community based. Also, some GP surgeries provide counselling as part of their practice. Carers, friends and relatives may provide informal care and support.

Assertive outreach teams [1] also known as 'assertive community treatment teams' focus on the needs of people with severe mental health problems and are particularly useful for those reluctant to receive services. Provision includes day-to-day engagement and active health care and rehabilitation.

Figures for people making contact with services

Evidence suggests that one in four people with a mental health problem have not contacted any professional about it. [2]

Not everyone who experiences mental distress will come into contact with a service: [3]

• Around 300 people out of 1,000 will experience mental health problems every year in Britain
• 230 of these will visit a GP
• 102 of these will be diagnosed as having a mental health problem
• 24 of these will be referred to a specialist psychiatric service
• 6 will become inpatients in psychiatric hospitals.

Contact with GPs as a result of mental health problems

A national survey of NHS patients suggests that around one per cent of the population are not registered with a GP. [4] Around 82 per cent of those questioned in the survey had seen a doctor within the last 12 months. [5] Up to 91 per cent of people with a mental health problem will be treated entirely within primary care. [6] [7] In other words, less than 10 per cent of cases are referred to specialist mental health services.

An estimated third of all GP consultations are the result of psychosocial problems, although this may not always be recognised as such. [8] It has been suggested that there are two key reasons for this: (1) at least 25 per cent of people with symptoms of disorders such as depression and anxiety do not report this to a GP; (2) of those who do consult a GP, up to 50 per cent might present with only somatic or physical symptoms rather than depression. [9] Another reason why depression and other mental disorders are not recognised might be lack of training in mental health for GPs and other health professionals. One survey found that only one-third of doctors had received training in mental health in the past five years. Ten per cent suggested said they were concerned about their training and skills needs in mental health. [10]

Another survey found that a large number of nurses who administer depot injections and who were involved with ensuring compliance with antipsychotic medication and monitoring side effects of psychotropic drugs. had not had specific training in mental health issues. [11]

Availability of mental health hospital beds

In the past 15 years or so, the average daily number of NHS beds available for mental illness in England has more than halved with 63,000 beds available in the year 1988 to 1989 and only 30,000 available in 2005 to 2006. [12]

In Wales, there were 3,727 available mental health beds in the year 1991 to 1992 and only 2,235 in 2005 to 2006 - a fall of around 40 per cent in 15 years. [13]

In England, the most common reason for admission to hospital, related to psychiatric illness, is depression and anxiety. This group accounted for around 30 per cent of all psychiatric admissions. [14] Schizophrenia and related psychosis account for around 26 per cent of admissions. However, as people with the psychotic disorders stay in hospital longer than others, they account for a higher number of bed-days than other groups. [15]

Although women are more likely to be diagnosed with a mental disorder, more men are admitted to hospital due to mental illness than women. [16]

Treatments for people with mental health problems

Medication taken by type of neurotic disorder

* Medication acting on the Central Nervous System. Source: The Office for National statistics [17]

Counselling and therapy by type of neurotic disorder

Source: The Office for National statistics [18]

The most commonly used treatments for neurotic disorder

According to an ONS survey, [19] close to one quarter (24 per cent) of people with a neurotic disorder, such as depression or anxiety, receive some form of treatment. One fifth (20 per cent) take psychoactive medication and nine per cent have some form of talking treatment. Only a small proportion, around four per cent, receives both medication and talking treatment. People with phobias were more likely than others to receive treatment. In this group, 54 per cent received treatment. More than a quarter (27 per cent) had medication only, while nine per cent had talking treatments only. Almost a fifth (18 per cent) received both medication and some form of talking treatment.

Medication taken by people with and without psychotic disorder
Percentage receiving each type of medication

* Medication acting on the Central Nervous System. Source: The Office for National statistics [20]

Counselling and therapy used by people with and without psychotic disorder
Percentage receiving each type of therapy

Source: The Office for National statistics [21]

The most commonly used treatments for probable psychotic disorder

According to an ONS survey, [22] the majority of people with a probable psychotic disorder will receive medication – as many as 84 per cent. Less than half (40 per cent) receive counselling or psychotherapy. However, only one per cent of people with a probable psychotic disorder have some form of talking treatment without medication.

More than half of this group receives antipsychotic medication. In addition, they were more likely than any other group to receive other medication acting on the Central Nervous System (CNS). A total of 89 per cent of people with a probable psychosis were prescribed one or more CNS medications compared to 15 per cent of those without a psychotic disorder. Almost half (48) are prescribed antidepressants.

Use of other physical treatments

ECT (electro-convulsive therapy)

Although there has been a reduction in its use in recent years, a snapshot survey by the Department of Health showed that in the period January to March 2002, 2,272 people were prescribed ECT in England. [23] In total, around 12,800 administrations were carried out during this period.

Of these administrations:

• 94 per cent took place within NHS facilities; while six per cent were in private facilities.

• 79 per cent of all ECT administrations were within an inpatient setting, either for patients on an ordinary admission (79 per cent) or on a day case admission (2.5 per cent) to the hospital in question

• there were 2,835 people receiving treatment. Of these patients, around 70 per cent (1,923) were female, compared with 30 per cent (912) male

• 47 per cent of female patients and 45 per cent of male patients receiving ECT treatment were aged 65 and over

• of the 1,656 patients who were not formally detained under the Mental Health Act 1983 while receiving ECT, 98 per cent consented to treatment

• of the 616 patients formally detained under the Mental Health Act 1983 while receiving ECT, 60 per cent did not consent to treatment.

It should be noted that the Department of Health is concerned about serious under reporting of the use of ECT. Further, the Mental Health Act Commission (MHAC) found that 10 per cent of facilities providing ECT could not provide a register of this treatment. [24] MHAC also found that only around half of consultants in charge of ECT facilities had attended the ECT course provided by the Royal College of Psychiatrists.

ECT: treatments administered in England, 1985 to 1990-91, 1998-99 and 2001-02

Source: Department of Health [25]

Although many clinics using ECT have improved their practice, one study revealed that only around 33 per cent met the standard for administering ECT as stipulated by the Royal College of Psychiatrists. Of these, seven per cent were still using machines that were considered out-dated. Just over 30 per cent of clinics had clear policies to guide junior doctors to administer ECT effectively. [26]

A Mental Health Foundation study found that of the 27 per cent who had received ECT, 30 per cent found it helpful or helpful at times and 47 per cent had found it unhelpful. [27]

Note: For more detailed information on ECT administrations see the Statistical bulletin – Electro-convulsive therapy: Survey covering the period from January 2002 to March 2002, England, Department of Health. The survey is also available on the internet at: www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/ Statisticalhealthcare/DH_4000216Psychosurgery

There are currently no centres providing NMD in England. NMD operations have been available in Scotland since 1992 and in Wales since 1993. The Mental Health Act Commission panel authorised seven operations to go ahead in England and Wales in 1999/2000 and two in 2000/2001. [28] There were 17 operations performed from 1997 to 1999; there were 23 in England, Scotland and Wales in 1993; 27 in England and Scotland in 1992; 17 in England in 1991; and 26 in England in 1990. There has been one death associated with NMD in over 3,000 procedures. [29]

An analysis of data on 74 patients receiving NMD showed that 48 were women and 26 men. A look at their ages showed that nine were aged between 20 and 30, 16 were aged from 31 to 40, 23 were aged 41 to 50, 20 were aged 51 to 60, five were aged 61 to 70 and one was over 71. In the same group of patients, 12 were suffering from bipolar affective disorder (manic depression), 41 from depression, 18 from obsessions and three from anxiety. Of 42 patients on whom data was available, doctors reported significant improvement in 12, some improvement in 22, no change in six and some deterioration in two. [30]

Choice of treatments available

A survey found that information about, and access to, different treatments and therapies were limited for most people. For example, people with severe mental illness in particular are less likely to receive talking treatments; as are people from black and minority ethnic groups. [31]

In a Mind survey of mental health service users, 61 per cent said that they had not received enough information about their medication. [32]

Access to complementary and alternative therapies for mental health problems

In the UK, 2,050,000 alternative and complementary therapies are carried out each year for all types of health problems. [33] It is estimated that around 10 to 12 million people visit a practitioner every year. [34]

In a Mental Health Foundation survey, 85 per cent of those surveyed had found different types of complementary or alternative therapies to be helpful, and 97 per cent reported finding them helpful at times. [35]

Last updated by Inger Hatloy, Mind Information Unit, July 2007.

Footnotes

[1] For further information, please see Mind’s Community care 1 factsheet at www.mind.org.uk
[2] Mann, A. et al. 1998, ‘British psychiatric morbidity’, British Journal of Psychiatry 173: 4-7.
[3] Based on figures from Goldberg, D & Huxley, P, 1992, Common Mental Disorders ­ A Bio-Social Model. Routledge.
[4] Boreham,R, Airey,C, Erens,B and Tobin, R, 2003, National Survey of NHS patients, General Practice 2002, DH
[5] Boreham,R, Airey,C, Erens,B and Tobin, R, 2003, National Survey of NHS patients, General Practice 2002, DH
[6] The Sainsbury Centre for Mental Health, 2007, Tools for common mental health problems
[7] Social Exclusion Unit, 2004, Factsheet 1, Stigma and Discrimination on Mental Health Grounds
[8] The Sainsbury Centre for Mental Health, 2006, The Future of Mental Health: a Vision for 2015
[9] Nice, 2004, Costing Clinical Guidelines: Depression (England and Wales)
[10] Lester, H, 2005, ‘Shared care for people with mental illness: a GP’s perspective’, Advances for Psychiatric Treatment (2005) 11: 133-139, The Royal College of Psychiatrists
[11] Lester, H, 2005, ‘Shared care for people with mental illness: a GP’s perspective’, Advances for Psychiatric Treatment (2005) 11: 133-139, The Royal College of Psychiatrists
[12] Department of Health 2006, Hospital Activity Statistics, Average daily number of occupied beds by sector, England, 2005-06
[13] National Assembly for Wales 2007, Health Statistics Wales 2007, Chapter 10, Hospital Statistics for people with a Mental Illness
[14] Thomson, A, Shaw, M, Harrison,G, Davidson, H, Gunnel, D, and Verne, J., 2004, ‘Patterns of hospital admission for adult psychiatric illness in England: analysis of Hospital Episode Statistics Data’, The British Journal of Psychiatry (2004), 185: 334-341
[15] Thomson,A, Shaw, M., Harrison,G., Davidson, H, Gunnel, D, and Verne, J., 2004, ‘Patterns of hospital admission for adult psychiatric illness in England: analysis of Hospital Episode Statistics Data’, The British Journal of Psychiatry (2004), 185: 334-341
[16] Thomson,A, Shaw, M., Harrison,G., Davidson, H, Gunnel, D, and Verne, J., 2004, ‘Patterns of hospital admission for adult psychiatric illness in England: analysis of Hospital Episode Statistics Data’, The British Journal of Psychiatry (2004), 185: 334-341
[17] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[18] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[19] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[20] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[21] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[22] Singleton, N, Bumpstead, R, O’Brian, M, Lee, A and Meltzer, H, 2001, Psychiatric Morbidity Among Adults Living in Private Households, 2000, ONS, The Stationary Office
[23] Department of Health, Electro-convulsive therapy: Survey covering the period from January 2002 to March 2002, England. Statistical Bulletin 2003/08
[24] Mental Health Act Commision, 2004, The Mental Health Act Commision’s ECT survey 1999-2002
[25] Department of Health, Electro-convulsive therapy: Survey covering the period from January 1999 to March 1999, England. Statistical Bulletin 1999/22 and Department of Health, Electro-convulsive therapy: Survey covering the period from January 2002 to March 2002, England. Statistical Bulletin 2003/08
[26] Duffet, R, Lelliot, P, 1998, ‘Auditing ECT: the third cycle’, British Journal of Psychiatry, 172:401-405.
[27] Faulkner, A. 1997, Knowing our own minds, Mental Health Foundation.
[28] The Mental Health Act Commission 2001 Ninth biennial report 1999-2001, The Stationery Office.
[29] Mind 2007, Neurosurgery factsheet, Mind Information Unit.
[30] Mental Health Act Commission 2001, Ninth biennial report 1999-2001, The Stationery Office.
[31] Mental Health Foundation 1999, The fundamental facts, second edition.
[32] Cobb, A, Darton, K, and Juttla, K, 2001, Mind’s yellow card for reporting drug side effects: a report of users' experiences, Mind.
[33] Patel, A., Knapp, M. 1998, ‘Costs of mental illness in England’, Mental Health Research Review No.5.
[34] The Mental Health Foundation 1999, The fundamental facts, second edition.
[35] Faulkner, A. 1997, Knowing our own minds, Mental Health Foundation