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Mental Health   Download this section

This content has recently been published (on 30th July 2014) and forms a starting point for the information currently available around mental health locally. The Joint Strategic Needs Assessment is an assessment of need that is based upon changing information and will be updated regularly to reflect changes. 

As such, we will be holding a consultation event on the content published here in order to give people the opportunity to feedback on the information and identify any gaps. This will be held on Monday 8th December between 9:30 - 12:00 at the City of York Council's West Offices. Places are limited so people are asked to book by e-mailing healthandwellbeing@york.gov.uk

This content highlights the following recommendations:

  1. Locally appropriate recommendations from the Department of Health’s ‘Closing The Gap:  Priorities for essential change in mental health’ report are applied.
  2. To increase community based services which can keep people with mental health conditions out of hospital when they don’t need to be there.
  3. To jointly scope options between housing support services, local housing associations, mental health services, the voluntary sector and NHS Vale of York CCG to increase the provision and support arrangements for supported living arrangements for people with mental health needs.
  4. To share information between general practices and City of York Council about people with a learning disability in order to increase the number of people with learning disability known to local authority so that services can be offered and provided where appropriate.
  5. To improve the percentage of people with a learning disability who receive an annual health check.
  6. Improvements in IAPT service provision is considered which increases investment, referral rates, and positive outcomes and reduces wait times, non-attendances and unsuccessful outcomes.
  7. To further develop our local understanding of the prevalence of self-harm and to enhance means to prevent and reduce instances of self-harm.

 

Mental ill health represents up to 23% of the total burden of ill health in the UK – the largest single cause of disability. Nearly 11% of England’s annual secondary care health budget is spent on mental health. Estimates have suggested that the cost of treating mental health problems could double over the next 20 years.  More than £2 billion is spent annually on social care for people with mental health problems (HM Government, 2011). In their ‘Achieving Parity Between Mental and Physical Health report, The Royal College of Psychiatrists argue that ‘parity is about equal value being placed on mental health and mental healthcare, and responses being proportionate to need: funding must be allocated as required to achieve parity so that those with mental health problems can expect the same access to services and the same quality of care as those with physical health problems’ (Royal College of Psychiatrists, 2013).

The national mental health strategy: No Health Without Mental Health (2011)  identifies some key issues surrounding mental ill health:

  • The costs of mental health problems to the economy in England have recently been estimated at £105 billion per year which includes sickness absence and lost productivity
  • Improved mental health and wellbeing is associated with a range of better outcomes for people of all ages and backgrounds. These include improved physical health and life expectancy, better educational achievement, increased skills, reduced health risk behaviours such as smoking and alcohol misuse, reduced risk of mental health problems and suicide, improved employment rates and productivity, reduced anti-social behaviour and criminality, and higher levels of social interaction and participation
  • People with mental health problems often have fewer qualifications, find it harder to both obtain and stay in work, have lower incomes, are more likely to be homeless or insecurely housed, and are more likely to live in areas of high social deprivation
  • Some mental health problems are long lasting and can significantly affect the quality of people’s lives, especially if they are not treated. Some people only experience a single episode of mental ill health. Others, who may have longer-standing problems, can enjoy a high quality of life and fulfilling careers
  • The stigma attached to mental ill health and the social barriers that surround it amplify its direct effects and damage the life chances of people with mental health problems
  • There are indications that some problems are becoming more prevalent: for example, more young people have behavioural and emotional problems. The incidence of mental health problems – including in young people – can increase in times of economic and employment uncertainty, as can the rate of suicide
  • Mental health problems can also contribute to perpetuating cycles of inequality through generations. However, early interventions, particularly with vulnerable children and young people, can improve lifetime health and wellbeing, prevent mental illness and reduce costs incurred by ill health, unemployment and crime
  • The number of older people in our population is growing, with a corresponding increase in the number of those at risk of dementia and depression
  • Little has been done to promote mental health and wellbeing
  • Only recently has attention been paid to the importance of employment and housing in the recovery process
  • A great deal of public money is spent on dealing with the consequences of mental health problems. Much of this money could be spent more efficiently, and many of the personal, social and economic costs could be prevented, by addressing the causes of these problems and identifying and treating them if, and as soon as, they arise

A King’s Fund (2012) report into long-term conditions and mental health shows that more than 15 million people in England – 30 per cent of the population – have one or more long-term conditions and that mental illness within this group of people is greater than in the population who do not have a long-term condition.

  • Depression is two to three times more common for people with cardiovascular disease than in the general population
  • Depression is two to three times more common for people living with diabetes than in the general population
  • Mental health problems are about 3 times more common for people living with chronic obstructive pulmonary disorder
  • Depression is common in people with chronic musculoskeletal problems.

Patients with long-term conditions are very intensive users of health care services.  Those with long-term conditions account for 31% of the population, but use 52% of all GP appointments and 65% of all outpatient appointments (Department of Health, 2008).

Poor physical health and poor mental health can be connected and mental illness has a negative impact on life expectancy. NHS England reports the numbers of those people with specific conditions who also have depression as:

  • 27% of people with diabetes
  • 29% of people with hypertension
  • 31% of people with stroke
  • 33% of people with cancer
  • 44% of people with HIV / AIDS

Source: NHS England: Valuing mental health equally with physical health or “Parity of Esteem”

Life expectancy for someone with a mental illness is less than the general population. NHS England estimates this difference to be:

  • 7 – 10 years less for people with depression
  • 10 – 15 years less for people with schizophrenia
  • Almost 15 years less for people who misuse drugs or alcohol

Source: NHS England: Valuing mental health equally with physical health or “Parity of Esteem”

In a 2013 British Medical Journal article, the higher death rate associated with mental illness is reported as having been extensively documented, but that most of the focus is on the elevated risk of suicide, whereas most of the risk can be attributed to physical illness such as cardiovascular and respiratory diseases and cancer (80% of deaths).

Of the few studies of life expectancy in people with mental illness, some studies have reported a gap of 14 years for males and 6 for females while others a gap of 20 years for males and 15 for females. Little is known on whether life expectancy between people with mental illness and the general population has changed over time.

The Department of Health (2014) Closing The Gap: priorities for essential change in mental health report aims to show how changes in local service planning and delivery can make a difference to the lives of people with mental health problems.

It identifies 25 aspects of mental health care and support where change is expected within 4 broad areas:

  • Increasing access to mental health services
  • Integrating physical and mental health care
  • Starting early to promote mental wellbeing and prevent mental health problems
  • Improving the quality of life of people with mental health problems

Recommendation: It is recommended that local service planning and commissioning arrangements take these factors into consideration when commissioning and managing service provision.

The recommendations applicable for local consideration are provided below, numbered as they are within the Closing the Gap document. Where objectives are primarily the remit of national organisations, these have been omitted from this report (in the list below, recommendation numbers 2 and 11 are not deemed appropriate for local consideration). A suggested example of how this action might be taken forward locally is provided below each recommendation. 

The full list of recommendations can be seen within the Closing the Gap report here.

High-quality mental health services with an emphasis on recovery should be commissioned in all areas, reflecting local need

 We will, for the first time, establish clear waiting time limits for mental health services

  • Guidance on waiting times is not expected until 2015, however, local requirements to reduce wait times could be implemented into future commissioning arrangements

We will tackle inequalities around access to mental health services

  • Access to mental health services is inequitable for BME and older adult populations. Requirements for services to consider factors such as ethnicity and age profiles of their patients in order to assess equity of access and to tailor services to population groups with unmet need could be built into commissioning arrangements
  • To consider how services are commissioned to adequately meet the needs of other population groups where health inequalities are apparent e.g. offenders and ex-offenders; LGBT; and military veterans

 Over 900,000 people will benefit from psychological therapies every year

  • Local commissioning of adequate levels of psychological therapies that will reduce wait times and ensure these services are more accessible could be considered

 There will be improved access to psychological therapies for children and young people across the whole of England

 The most effective services will get the most funding

  • To consider building into future commissioning arrangements more robust elements of quality and outcome measures linked to payment

 Adults will be given the right to make choices about the mental health care they receive

We will radically reduce the use of all restrictive practices and take action to end the use of high risk restraint, including face down restraint and holding people on the floor

We will use the Friends and Family Test to allow all patients to comment on their experience of mental health services – including children’s mental health services

  • To build into commissioning requirements an expectation that service providers use the Friends and Family Test as a means of identifying poor quality services early as identified within the Francis Report.

Carers will be better supported and more closely involved in decisions about mental health service provision

  • Specific support services for carers to include respite care should be considered as part of any future commissioning and service provision

Mental health care and physical health care will be better integrated at every level

  • To consider how improvements can be made within local primary care settings around meeting the physical health needs of those with mental health problems and accessibility to emergency and crisis care
  • To consider building in training requirements for primary care provider staff in line with Health Education England training courses to develop greater awareness of mental health problems and how they may affect their patients

We will change the way frontline health services respond to self-harm

  • To ensure within future commissioning arrangements that there is a requirement that Emergency Departments should refer all those who present with self-harm for a psychosocial assessment, as set out in the CG16 NICE guideline.
  • To require that GPs refer people who disclose self-harm to psychological therapies as appropriate.

No-one experiencing a mental health crisis should ever be turned away from services

We will offer better support to new mothers to minimise the risks and impacts of postnatal depression

  • To build into future commissioning arrangements a requirement for provider services to ensure that health visitor staff are adequately trained to identify mental health problems in expectant or new mothers in line with the Institute for Health Visitors training.
  • To build into future commissioning and service provision arrangements specialist staff roles within birthing units to ensure there are trained in perinatal mental health specialists in line with Health Education England plans to have a specialist staff member in every birthing unit by 2017.

Schools will be supported to identify mental health problems sooner

  • To build into future commissioning requirements an expectation that there should be clear arrangements in place between local health partners, schools, colleges, early years providers and other organisations for making appropriate referrals to Child and Adolescent Mental Health Services (CAMHS).
  • The new Special Educational Needs (SEN) Code of Practice, which is expected to be introduced in September 2014, will provide statutory guidance for education and health services on identifying and supporting children and young people with mental health problems who have a special educational need.

We will end the cliff-edge of lost support as children and young people with mental health needs reach the age of 18

People with mental health problems will live healthier lives and longer lives

Integrated Physical Health Pathway

Source: Rethink Mental Illness. The Integrated Physical Health Pathway

THE LESTER UK ADAPTATION – Positive Cardiometabolic Health Resource: an intervention framework for patients with psychosis on antipsychotic medication

Positive Cardiometabolic Health Resource

Source: Royal College of Psychiatrists. Positive Cardiometabolic Health Resource: an intervention framework for patients with psychosis on antipsychotic medication

  • In March 2013 the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) reported that 48.5% of deaths of people with learning disabilities are avoidable. Because of their intellectual disability they need a targeted approach (Department of Health, 2014).

More people with mental health problems will live in homes that support recovery

  • To scope the possibility of utilising the Care and Support Specialised Housing (CASSH) Fund to support the construction of a small number of housing projects for people with mental health problems or learning disabilities locally. These projects will be designed in close conjunction with mental health and learning disability policy experts and representatives of relevant charities.

Anyone with a mental health problem who is a victim of crime will be offered enhanced support

  • To consider joint commissioning arrangements with Police & Crime Commissioner for provision of mental health services to support victims of crime who have mental health problems.

We will support employers to help more people with mental health problems to remain in or move into work

  • To locally support the Government’s proposed Health and Work service through local service provision and commissioning requirements

We will develop new approaches to help people with mental health problems who are unemployed to move into work and seek to support them during periods when they are unable to work

The Health & Social Care Information Centre (2013) report into adult mental health services shows that for people recorded as being users of adult mental health services in 2011-2012 there are differences in the use of hospital based services by this group of people compared to those who are not users of adult mental health services.

There were just over 1.6 million individuals who are recorded as being users of adult mental health services in 2011-2012; of these mental health service users:

 

  • 78% accessed hospital services (Inpatient episode of care, Outpatient appointment or A&E attendance) at least once in the year, compared to 48% of non mental health service users

 

  • 71% were admitted to hospital as an emergency, compared to 40% of non mental health service users

 

  • 46% of the patients were aged 70 or over during the episode of care, compared to 35% of non mental health service users

 

  • 54% arrived at A&E departments by ambulance or helicopter, compared to 26% of non mental health service users

 

  • 36% are admitted to hospital following the A&E attendance, compared to 22 of non mental health service users

 

  • Adult mental health service users had an average of 6.9 outpatient appointments each, compared to 4.8 for non mental health service users

 

The life expectancy of those with severe mental illness is on average 20 years less for men and 15 years less for women, when compared with the population as a whole. People with severe mental illness are significantly more likely to have worse physical health than people without; for example, those aged under 50 are three times more likely and those aged 50–75 are two times more likely to die from coronary heart disease.

Early intervention can also result in cost savings. For example, early intervention for psychosis leads to total returns of £17.97 for every £1 invested, with net savings starting by year 1. The mental health strategy estimated that extension of current early-intervention services to cover the total population in England would cost the NHS £57 million over 10 years but result in net NHS savings of £290 million, increasing to £550 million if wider economic savings are taken into account.

As well as evidence that severe mental illness dramatically reduces life expectancy, it is becoming increasingly clear that common mental health problems such as anxiety and depression also cause significant premature mortality.

Research consistently shows that people with mental health problems have higher rates of physical ill health and die earlier than the general population, largely from treatable conditions associated with modifiable risk factors such as smoking, obesity, substance misuse and inadequate medical care. These factors lead to reduced life expectancy and higher levels of physical ill health several decades later’ (Royal College of Psychiatrists, 2013).

The Community Mental Health Profile data for York shows that the excess mortality rate for adults under the age of 75 with serious mental health illness affected 1,199 people. This means that 1,199 with a mental health illness died prematurely in 2013.

The prevalence of modifiable risk factors which contribute to premature mortality – that is, lifestyle factors such as smoking, alcohol consumption, poor diet and being physically inactive – are much more common in people with mental health problems. This increases with the severity of mental health condition (Department of Health, 2014)

The following charts show the levels of smoking, alcohol misuse, obesity and physical inactivity in the general population and in those with mental health problems. For those people with mental health problems, they are more likely to smoke, misuse alcohol, be obese and take part in less physical activity.

Smoking bar chart

Alcohol Misuse bar chart

Obesity bar chart

Physical inactivity bar chart

Source:  Department of Health. Living well for longer

The 2012 King’s Fund report into long-term conditions and mental health highlights some of the key issues concerned when people have mental health issues and a long-term health condition which can ultimately lead to significantly poorer health outcomes and reduced quality of life. Mental health problems can make a long-term condition worse which places additional cost onto the health care system. The report estimates that a co-morbid mental health problem (that is, when a person has more than one condition e.g. diabetes and depression), care costs are increased by at least 45%.

This suggests that between 12% -18% of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year. The more conservative of these figures equates to around £1 in every £8 spent on long-term conditions.

People with long-term conditions and co-morbid mental health problems disproportionately live in deprived areas and have access to fewer resources of all kinds. The interaction between co-morbidities and deprivation makes a significant contribution to generating and maintaining inequalities (King’s Fund, 2012).

The national mental health strategy:  No Health Without Mental Health (2011) provides some key headline facts which show that:

  • At least one in four people will experience a mental health problem at some point in their life and one in six adults has a mental health problem at any one time
  • One in ten children aged between 5 and 16 years has a mental health problem, and many continue to have mental health problems into adulthood
  • Half of those with lifetime mental health problems first experience symptoms by the age of 14 and three-quarters before their mid-20’s
  • Self-harming in young people is not uncommon (10–13% of 15–16-year-olds have self-harmed)
  • Almost half of all adults will experience at least one episode of depression during their lifetime
  • One in ten new mothers experiences postnatal depression
  • About one in 100 people has a severe mental health problem
  • Some 60% of adults living in hostels have a personality disorder
  • Some 90% of all prisoners are estimated to have a diagnosable mental health problem (including personality disorder) and/or a substance misuse problem

The Mental Health Foundation website provides a range of information about mental health conditions, information, statistics and prevalence figures. The key statistics are listed below:

  • 1 in 4 people will experience some kind of mental health problem in the course of a year
  • Suicides rates show that British men are three times as likely to die by suicide than British women
  • Self-harm statistics for the UK show one of the highest rates in Europe: 400 per 100,000 population

Source:  Mental Health Foundation

There are a wide range of measures which are recorded within the English health system, many of which will be included within the content of this report. Within the UK, the classification of mental health conditions is underpinned by the World Health Organisations International Classification of Diseases (ICD-10) which classifies diseases and conditions. This section will not necessarily cover all of these classifications in full detail but will provide information about conditions where this is available:

The table below summarises known prevalence rates for a range of mental health conditions. These rates have been applied to the local population to estimate local prevalence estimates where possible and can be seen in the ‘What does this look like in York’ section.

Condition

Prevalence

Source

Dementia

Varies with age band

POPPI

Psychosis and Schizophrenia

5 per 1,000 people aged 18-74

NICE CG82

Psychosis and Schizophrenia

1% of the adult population

NICE CG178

Psychotic Disorder

0.4% of adult population

HSCIC

Schizophrenia

Age corrected 0.11% of population (estimate ranges between 0.07% - 0.17%)

NICE CG82

Psychosis & Schizophrenia in young people

0.4% aged 5-18

NICE CG155

Depression

2.6% - 11.4% of adult population

National Collaborating Centre for Mental Health

Learning Disability - Severe

Varies with age band

POPPI

PANSI

Learning Disability – Moderate or Severe

Varies with age band

POPPI

PANSI

Down’s Syndrome

6.25 per 10,000 population

PANSI

Self harm

4.6% - 6.6% of population

400 per 100,000 population

NICE CG16

National Collaborating Centre for Mental Health

Suicide

18.2 per 100,000 men and 5.2 per 100,000 women

Adult Psychiatric Morbidity Survey

Perinatal mental health problem

1 in 10 women within a year of giving birth

National Society for the Prevention of Cruelty to Children

Childhood mental health problem

1 in 10 between ages 5-16

Department of Health

Post traumatic Stress Disorder

8.9% of those ever to have experienced a traumatic event

Adult Psychiatric Morbidity Survey

Common mental health disorder

Varies with age, gender, ethnicity, marital status and level of income

Adult Psychiatric Morbidity Survey

Antisocial Personality Disorder

0.3% of adults aged over 18

Adult Psychiatric Morbidity Survey

Borderline Personality Disorder

0.4% of adults aged over 18

Adult Psychiatric Morbidity Survey

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 4 / 6 measures on ASRS scale

Adult Psychiatric Morbidity Survey

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 6 / 6 measures on ASRS scale

Adult Psychiatric Morbidity Survey

Eating Disorder - positive SCOFF screening for 2 or more measures

Varies with age band

Adult Psychiatric Morbidity Survey

Eating Disorder - positive SCOFF screening for 2 or more measures & report of significant impact

Varies with age band

Adult Psychiatric Morbidity Survey

Anorexia Nervosa

19 per 100,000 in women & 2 per 100,000 in men

Adult Psychiatric Morbidity Survey

Bulimia Nervosa

1% in women

Adult Psychiatric Morbidity Survey

 

Care for large numbers of people with long-term conditions could be improved by better integrating mental health support with primary care and chronic disease management programmes, with closer working between mental health specialists and other professionals.

  • Collaborative care arrangements between primary care and mental health specialists can improve outcomes with no or limited additional net costs.
  • Innovative forms of liaison psychiatry demonstrate that providing better support for co-morbid mental health needs can reduce physical health care costs in acute hospitals.
  • Clinical commissioning groups should prioritise integrating mental and physical health care more closely as a key part of their strategies to improve quality and productivity in health care.

Improved support for the emotional, behavioural and mental health aspects of physical illness could play an important role in helping the NHS to meet the Quality, Innovation, Productivity and Prevention (QIPP) challenge. This will require removal of policy barriers to integration, for example, through redesign of payment mechanisms (King’s Fund, 2012).

The picture around mental health need is not necessarily as clear as it could be.  There is often little detailed information which can support the commissioning and provision of best practice services. Public Health England is establishing a National Mental Health Intelligence Network which aims to be a single shared intelligence resource to support commissioners and providers of services. It will be based on the format of the successful National Cancer Intelligence Network. The network will aim to provide information on population mental health and wellbeing, including need and community assets; service data across the pathway of care to include primary care, social care and specialist services information on access, quality, outcomes and spend; information and data about recovery from mental health (Public Health England, 2013). It is expected to be in place at some point in 2014-2015.

This is not to say that there is currently no information. There is a range of information that already exists to help understand the picture around mental health which will be provided within this assessment of need. These include:

Community Mental Health Profile

Minimum Monthly Data Set

Public Health Outcomes Framework

GP Quality and Outcomes Framework

Local Health Profiles

Spend and Outcomes Tool

However, understanding local prevalence of some specific conditions is difficult when only national measures are available that report information as lifetime prevalence – that is, the likelihood that an individual will have been diagnosed with a specific condition at some point in their life.

This is useful to know but doesn’t necessarily help us understand the needs of a local community and the requirements on service provision over the course of a year. For example, the NICE Guideline on Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care gives a lifetime prevalence figure for Psychosis and Schizophrenia of 5 in every 1,000 people aged between 18-74 years old, that is, 5 people in every 1,000 will at some point in their life have had a diagnosis of Psychosis or Schizophrenia.

From this prevalence estimate, we can calculate that across the entire NHS Vale of York Clinical Commissioning Group this equates to 1,331 people. Within the York based practices only, this equates to 724 people and within all practices based outside the City of York Council boundary, this equates to 607 people. However, from this information we cannot say how many of this group of people will have a need of services to support conditions of psychosis or schizophrenia over the course of a year, month or week.

Another way of finding out about local need is to look at the data held in primary care settings (GP’s) on disease registers. Each primary care practice keeps a register of people within their practice who are known to have specific diseases or conditions. These give a good indication of the number of people locally who are diagnosed with a particular condition. For example, a depression register is kept which records the number of people who have been diagnosed with depression in the previous year. This gives a local prevalence figure for that disease. However, not everyone who has depression will see their GP about it and those who are not known about are not recorded. 

The Public Health England spend and outcome tool (SPOT) identifies where NHS Vale of York Clinical Commissioning Group is spending its money. The tool also identifies what the outcomes are for the various services which are funded.

The largest spend per person across the clinical commissioning group is on mental health. For NHS Vale of York Clinical Commissioning Group this equates to £190 per head of population which is higher than the average spend of comparable Clinical Commissioning Group areas (this is £185 per head) but lower than the England average spend per head of population which is £212.

The following chart shows where the clinical commissioning group spends its money compared to other clinical commissioning groups in the Office for National Statistics’ ‘Prospering Smaller Towns’ category.

NHS Vale of York Clinical Commissioning Group Spend per Head of Population

Source:  Public Health England SPOT tool

 

In terms of reported outcomes, NHS Vale of York Clinical Commissioning Group is reported to have lower spend and better outcomes for mental health when compared to other CCG’s in England. The full report can be accessed here.

The Community Mental Health Profile shows a range of performance indicators for mental health services in York. The full profile can be accessed here. Some of the measures are highlighted below. These show that York has:

  • Higher rates of hospital admissions for mental health conditions and specifically for unipolar depression (that is, depression that is not bi-polar in diagnosis), Alzheimer’s and Schizophrenia than the England average.  For Alzheimer and Schizophrenia hospital admission rates, these are significantly worse than the England averages. 
  • A higher number of in-patient ‘bed days’ – that is, the amount of time a person will spend in hospital with a mental health problem – per head of population than the England average
  • A higher number of people using secondary care adult mental health services but a lower number of total contacts with mental health services compared to the England average. The number of contacts with mental health services is significantly lower.
  • A significantly lower number of contacts with community psychiatric nurses than the England average
  • A lower spend on mental health per head of population than the England average

A lower percentage of referrals entering treatment from the Improving Access to Psychological Therapy (IAPT) programme.

 How to interpret spine charts 1

Treatment spine charts

It could be argued that these performance indicators highlight an over reliance upon secondary mental health care services (hospital based services) and that levels of community based services could be enhanced to provide support to people in the community so that hospital admission rates can be reduced where it is not necessary for an individual to be admitted to hospital for mental health treatment if this need could be met in community based services. The available data on service provision in the York area shows that there appears to be greater use and demand for secondary care services than in other parts of the UK. There is insufficient early support for people seeking help and limited voluntary sector activity. The messages coming out of the data/deep-dive are summarised below:

  • Primary care health-checks for people at risk of mental health problems would improve overall care around for example Body Mass Index, blood pressure checks and stop smoking services
  • 446 more people would need to access IAPT Services for NHS Vale of York Clinical Commissioning Group area to reach the same average levels of access as benchmark Clinical Commissioning Groups.
  • NHS Vale of York Clinical Commissioning Group has higher than average mortality rates for patients under 75 and high numbers of admissions for self-harm
  • Hospital discharge planning is not followed up quickly enough in the community

Anecdotally, the view of local stakeholders is that this is one of the key issues with current service provision – that service provision is too focussed on hospital based services and that there is not enough emphasis on preventing hospital admissions and preventing mental health problems becoming severe enough to require a hospital admission.

Recommendation: To review mental health care pathways and service provision to increase access to and availability of community based services which can keep people with mental health conditions out of hospital when they don’t need to be there.

The following data summarises key information about local hospital admissions in relation to mental health problems and highlights that, across all inpatient activity:

  • 8% of all inpatient admissions costs to York Teaching Hospitals NHS Foundation Trust are from admissions which have a mental health diagnosis
  • Mental health is coded as a secondary diagnosis in 93% of the mental health admissions
  • 56% of patients admitted with a mental health diagnosis have had more than 1 mental health admission in 2012-2013
  • The average cost of an admission in 2012-2013 at York Teaching Hospitals NHS Foundation Trust was £1,267. The average cost of an admission including a mental health diagnosis was £2,200.
  • The average length of stay for an admission in 2012-2013 at York Teaching Hospitals NHS Foundation Trust was 4.6 days. The average length of stay for an admission including a mental health diagnosis was 8 days.
  • The average number of excess bed days for an admission in 2012-2013 at York Teaching Hospitals NHS Foundation Trust was 0.7 days. The average number of excess bed days for an admission including a mental health diagnosis was 1.2 days.

NHS Vale of York Mental Health (including Dementia and Self Harm) Inpatient Activity at YFT in 2012/13

 

Spells

Final £

Average Cost per Spell

No. of patients

No. of patients with multiple admissions

Average Length of Stay (excluding day cases)

All inpatient admissions

72,841

£92,307,715

£1,267

44,757

11,361

4.6

Mental health admissions **

5,616

£12,353,918

£2,200

4,148

2308

8

Mental health admissions where Mental Health is main cause of admissions

391

£794,840

£2,033

335

30

10.5

For elective (planned) admissions:

  • 2% of elective inpatient admissions (that is, planned hospital procedures such as planned surgery) costs to York Teaching Hospitals NHS Foundation Trust are from admissions which have a mental health diagnosis
  • Mental health is coded as a secondary diagnosis in 99% of all of the mental health elective admissions
  • 8% of patients admitted with a mental health diagnosis have had more than 1 mental health elective admission in 2012/13
  • The average cost of an elective admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was £806. The average cost of an elective admission including a mental health diagnosis was £1,359.
  • The average length of stay for an elective admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was 2.7 days. The average length of stay for an elective admission including a mental health diagnosis was 5.1 days.

NHS Vale of York Mental Health (including Dementia and Self Harm) Elective Inpatient Activity at YFT in 2012/13

 

Spells

Final £

Average Cost per Spell

No. of patients

No. of patients with multiple admissions

Average Length of Stay (excl Daycases)

All elective inpatient admissions

39,006

£31,448,298

£806

22,646

6,104

2.7

Mental health elective admissions **

644

£875,205

£1,359

557

47

5.1

Mental health elective admissions where Mental Health is main cause of admissions

7

£7,057

£1,008

6

1

9

 For Emergency Inpatient Admissions:

  • 18% of emergency admissions costs to York Teaching Hospitals NHS Foundation Trust are from admissions which have a mental health diagnosis
  • Mental health is coded as a secondary diagnosis in 92% of the mental health emergency admissions
  • 21% of patients admitted with a mental health diagnosis have had more than 1 mental health emergency admission in 2012/13
  • The average cost of an emergency admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was £1,952. The average cost of an emergency admission including a mental health diagnosis was £2,340.
  • The average length of stay for an emergency admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was 5.7 days. The average length of stay for an emergency admission including a mental health diagnosis was 8.4 days.
  • The average number of excess bed days for an emergency admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was 0.8 days. The average number of excess bed days for an emergency admission including a mental health diagnosis was 1.2 days.

NHS Vale of York Mental Health (including Dementia and Self Harm) Emergency Inpatient Activity at YFT in 2012/13

 

Spells

Final £

Average Cost per Spell

No. of patients

No. of patients with multiple admissions

Average Length of Stay

All emergency inpatient admissions

26,565

£51,850,963

£1,952

18,917

4,588

5.7

Mental health emergency admissions **

4,664

£10,915,748

£2,340

3,492

717

8.4

Mental health emergency admissions where Mental Health is main cause of admissions

380

£776,596

£2,043.67

326

30

10.2

For non-elective, non-emergency admissions:

  • 4% of non-elective non-emergency admissions costs to York Teaching Hospitals NHS Foundation Trust are from admissions which have a mental health diagnosis.
  • Mental health is coded as a secondary diagnosis in 99% of the mental health non-elective non-emergency admissions.
  • 18% of patients admitted with a mental health diagnosis have had more than 1 mental health non-elective non-emergency admission in 2012/13.
  • The average cost of a non-elective non-emergency admission in 12/13 at YHT was £1,239. The average cost of an non-elective non-emergency admission including a mental health diagnosis was £1,828.
  • The average length of stay for a non-elective non-emergency admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was 1.9 days. The average length of stay for a non-elective non-emergency admission including a mental health diagnosis was 4.5 days.
  • The average number of excess bed days for a non-emergency non-elective admission in 12/13 at York Teaching Hospitals NHS Foundation Trust was 0.3 days. The average number of excess bed days for a non-emergency non-elective admission including a mental health diagnosis was 0.7 days.

NHS Vale of York Mental Health (including Dementia and Self Harm) Non-Elective Non-Emergency Inpatient Activity at YFT in 2012/13

 

Spells

Final £

Average Cost per Spell

No. of patients

No. of patients with multiple admissions

Average Length of Stay

All non-elective non-emergency inpatient admissions

7,270

£9,008,454

£1,239

3,798

1,801

1.9

Mental health non-elective non-emergency admissions **

308

£562,965

£1,828

238

42

4.5

Mental health non-elective non-emergency admissions where Mental Health is main cause of admissions

4

£11,187

£2,797

4

-

37

The NHS Confederation provides a series of resources and information about mental health and makes the points within it discussion papers and factsheets about mental health that mental health is clearly linked to physical health needs.  In their Mental Health and Community Services briefing paper, opportunity to integrate mental and physical health provision is identified and some providers report a change in the way they work to incorporate provision of care for non-mental health related needs.

Recommendation: That the re-commissioning of mental health services considers development of a service model that increases community based support and reduces the hospital admission rates for mental health problems.

Public Health England have produced a data resource around local mental health performance which compare a range of performance indicators for NHS Vale of York Clinical Commissioning Group with other clinical commissioning groups which share similar characteristics in their populations. This report is not yet published on the Public Health England but shows that NHS Vale of York Clinical Commissioning Group performs worse across all measures when compared to comparator clinical commissioning groups. 

The Commissioning for Value pack compares the performance of NHS Vale of York Clinical Commissioning Group to a group of other clinical commissioning groups who share similar population characteristics. Performance is measured in terms of quintiles – that is, measures of performance that are split into 5 categories.  Performance that is lower than average would be seen in the bottom quintiles and performance that is above average can be shown in the upper quintiles.

The darker bar to the left of the chart represents the worst performing quintile.  The left hand edge of this bar represents the lowest performance recorded.

The lighter coloured bar represents performance across the entire comparison group and the right hand edge of the bar represents the best performance recorded.

 Spine Chart example 0.1

The yellow dot represents the performance of NHS Vale of York Clinical Commissioning Group and the blue diamond shows the average performance of the top 50% best performers in England.

 Spine Chart showing Hospital admissions

Spine Chart showing disability figures

 Percentage Spine Chart

The Commissioning for Value Insight Pack information highlights areas within primary care where NHS Vale of York Clinical Commissioning Group is performing below average in comparison to other Clinical Commissioning Groups with comparable patient populations. Areas for improvement include general healthcare for those patients with a mental health diagnosis such as review of alcohol consumption, BMI, blood pressure tests and ensuring patients have an up-to-date care plan. Some practices also need to improve how they monitor patients who have long-term mental health needs. Access levels to IAPT (Improving Access to Psychological Therapy) are lower than average, but for those referred to the service, the recovery rate of patients is higher than the benchmark average of 50%.

Housing

Stable and appropriate housing is vital to allow people to address and receive treatment/support for mental ill-health. This promotes individual outcomes, and reduces impact on communities and on interventions from health, social work, and housing teams. For most people, general needs housing is the best place to live, with visiting care or support tailored to their needs. However for some people supported housing is a ‘step down’ from residential or hospital based care, or can be a temporary ‘step up’ for people struggling to manage in their existing home. A small minority of people may always require some level of supported housing (York Supported Housing Strategy 2014-2019).

Locally, the Community Mental Health Profile data shows that York has a higher than national average rate of statutory homeless households at 2.18 per 1,000 households compared to the England average of 2.03. This difference is not statistically significant. However, the difference between local and national figures for the number of people with mental health and / or disability in settled accommodation is significant. The local rate is 5.7 compared to a national average of 66.8. This shows that York has a far lower number of people with mental health problems and / or a disability who live in settled accommodation.

City of York Council’s housing department have concerns about the amount of support that people with mental health needs require, the impact that this has on compliance with tenancy requirements and the ability for people with mental health issues to successfully live independently. There is a perceived lack of appropriate levels of specialist mental health support available to help individuals maintain settled accommodation.

Recommendation: To more fully scope the needs for supported living arrangements for people with mental health issues and to review the levels of community based support required to help people with mental health needs maintain settled accommodation.

Housing Support Services at City of York Council recently completed an audit of mental health needs amongst customers accessing housing support services and mental health services. 267 individuals completed the survey which showed that:

  • 56% of people completing the survey were accessing housing support services and 44% accessing mental health services
  • 60% of respondents were male and 39% female (gender was not stated for 1% of respondents)
  • The largest response was from people aged between 40-59

 PrimaryMHIssue

  • The largest self reported condition was depression, followed by schizophrenia and then anxiety. The methodology of targeting clients in contact with mental health services might explain the high levels of self reported schizophrenia. The figure reported here is far higher than prevalence rates would suggest it should be within this number of people.  The prevalence rate of schizophrenia within the adult population aged 18-74 is 0.11% of the population. Applied to this sample size and assuming a prevalence rate in line with national prevalence estimates across the entire adult population, it would be expected that less than 1 person would have schizophrenia.

What this does highlight is that those people who are accessing housing support related services have high instances of self reported mental health problems and when this is considered alongside the data which shows that people with mental health problems are less likely to live in settled accommodation within York, it indicates that housing support for those with mental health needs is an issue within the city.

Housing services within City of York Council report that a number of tenants with mental health needs do not have support arrangements in place to help them maintain independent living and that this causes a range of tenancy enforcement problems.

The Department of Health (2014) Closing the Gap report identifies:

‘...that having settled accommodation can be invaluable for people living with a long term mental health problem. When people live in a place that helps them feel safe and secure, it can support recovery and reduce the likelihood of further episodes of mental illness. It can also help safeguard their physical health. However, there are currently no clearly defined models for what such accommodation should look like.'

To help define models, we would like to allocate up to £43 million from the Care and Support Specialised Housing (CASSH) Fund to support the construction of a small number of housing projects for people with mental health problems or learning disabilities. These projects will be designed in close conjunction with mental health and learning disability policy experts and representatives of relevant charities.

Our ambition is to receive bids from potential developers by 2015 and we would hope to see some homes available by 2017.

By using some of the Care and Support Specialised Housing Fund to encourage developers to think specifically about homes that can support people who have a mental illness or learning disability to live safely and more independently for longer we can help showcase some good practice for future developments.’ (Department of Health, 2014).

Recommendation: To jointly scope options between housing support services, local housing associations, mental health services and NHS Vale of York Clinical Commissioning Group to increase the provision and support arrangements for supported living arrangements for people with mental health needs.

Counselling and Voluntary sector provision:

Counselling:

There are over 35 independent counsellors and psychotherapists registered in the York/Selby area with the BACP Register which can be accessed on a private basis.  York College and other education providers support the students in their college through a free counselling service. Demand from young people for “talking therapies” is growing, and the services provided through MIND, and Relate all have waiting lists for appointments. York College has currently closed its waiting list, and currently has 21 students waiting for assessment or on-going counselling. In the past students on the waiting list have had to wait over 2 months, and this is being addressed by the college providing additional capacity and using trained volunteers. The number of referrals has increased by 60% in the last 4 years (from 127 in 2008-2009 to 220 in 2012-2013)

Carers:

In the 2011 census, 18,224 people described themselves as carers in York. The impact of the caring role on mental health issues is often exacerbated by carers being unable to find time for medical check-ups or treatment, with two in five carers saying that they were forced to put off treatment because of their caring responsibilities – unable to trust or find suitable and affordable replacement care. Research by Carers UK includes cases of carers discharging themselves from hospital because of an absence of alternative care. The likelihood of mental health problems developing for carers increases for those providing more higher levels of care (over 20 hours a week).

Recovery College:

The Retreat York has a Recovery College. The majority of provision is fee-paying, however some subsidies are available. It is a collaborative educational learning environment for people who use services, their friends and family, staff working in mental health services and volunteers. The college follows an educational model and aims to deliver a responsive, peer led education and training curriculum of recovery focused workshops and courses. A holistic approach to recovery is used, including work opportunities and career guidance. www.yorkrecoverycollege.org.uk

The TUKE centre

The Tuke Centre is a counselling and therapy service which offers discreet, confidential support for people through difficult times. The centre offers a free telephone consultation which members of the public can refer themselves into.  This can be accessed by calling 01904 430370 or visiting the TUKE Centre website.

In 2013 the TUKE centre supported over 700 people through more than 7,000 appointments.

 

2013

2012

2011

2010

2009

Total Number of People seen

701

643

658

610

656

Total Number of Attended Appointments

7230

7063

6392

5810

6206

 The profile of people supported by the TUKE centres is that the majority (approximately two thirds) are women of white ethnicity (it is acknowledged that there is a need to differentiate better in data gathering between White British and other White ethnicities).

The age profile of clients is fairly varied with the biggest client group aged between 20-29.

 

2013

2012

2011

2010

2009

Age

Number

%

Number

%

Number

%

Number

%

Number

%

<20

6

4.92

4

3.23

3

2.54

4

2.44

0

0

20-29

30

24.59

29

23.39

22

18.64

31

18.9

30

16

30-39

27

22.13

33

26.61

29

24.58

52

31.71

68

37

40-49

27

22.13

21

16.94

29

24.58

39

23.78

51

28

50-59

17

13.93

24

19.35

22

18.64

19

11.59

25

14

>59

15

12.3

13

10.48

13

11.02

19

11.59

8

4

Total

122

 

124

 

118

 

164

 

182

 

The most common issues which clients were seeking support for were anxiety and stress, depression, interpersonal relationships and self-esteem. This has remained fairly consistent since 2009.

 

2013

2012

2011

2010

2009

Presenting Problem

No.

%

No.

%

No.

%

No.

%

No.

%

Total Problems Identified

495

 

569

 

508

 

723

 

860

 

Anxiety/Stress

106

21.41

108

18.98

99

19.49

132

18.26

153

17.79

Depression

84

16.97

102

17.93

88

17.32

130

17.98

141

16.4

Interpersonal/ Relationship

78

15.76

89

15.64

80

15.75

111

15.35

125

14.53

Self Esteem

66

13.33

77

13.53

64

12.6

85

11.76

109

12.67

Work/Academic

44

8.89

60

10.54

56

11.02

75

10.37

89

10.35

Bereavement/Loss

27

5.45

29

5.1

30

5.91

44

6.09

60

6.98

Living/Welfare

27

5.45

31

5.45

34

6.69

44

6.09

49

5.7

Trauma/Abuse

24

4.85

26

4.57

24

4.72

28

3.87

49

5.7

Physical Problems

12

2.42

16

2.81

13

2.56

20

2.77

25

2.91

Other

3

0.61

5

0.88

2

0.39

3

0.41

8

0.93

Eating Disorder

4

0.81

7

1.23

7

1.38

7

0.97

15

1.74

Addictions

9

1.82

5

0.88

6

1.18

12

1.66

14

1.63

Personality Problems

11

2.22

10

1.78

5

0.98

26

3.6

19

2.21

Cognitive/ Learning

0

0

4

0.7

0

0

5

0.69

3

0.35

Psychosis

0

0

0

0

0

0

1

0.14

1

0.12

Voluntary Sector activity:

The figures below are a “snapshot” of the type of services people in York can access who are experiencing mental health issues, from the voluntary and community sector.

No. of clients March-Dec 2013

Gaps in provision:

The voluntary and community sector is able to provide significant alternatives to admission, and can potentially deliver services cost effectively in comparison to the NHS and social care. Current NHS and social care provision is under review and the role of the “third sector” to support people’s mental health needs will be considered. All “talking therapy” services currently provided have long waiting lists.

Secondary Care:

Secondary care refers to the provision for Vale of York delivered currently by Leeds and York Teaching Hospitals NHS Foundation Trust who have a contract for the delivery of mental health, learning disabilities and psychological therapies. The provider delivers services in the community, and through in-patient care at Bootham Park Hospital and in other community units. More people are in contact with secondary care services in the area than in comparable CCG areas. Patient experience is below average overall, with little change year on year. By remodelling services, an estimated 2,750 people could receive care outside of specialist mental health provision.

For patients who require on-going support with their mental health needs, a GP can refer to the community mental health teams which are led by consultant psychiatrists. The team is made up of psychiatric nursing staff, social workers, physiotherapy and Occupational Therapists. The teams work alongside psychological teams and other specialist departments to support the general healthcare needs of patients with mental health care needs. In addition an assertive outreach assessment team (CAT) can work alongside patients who need intensive support to avoid hospital admissions.

Of those patients in touch with secondary care, the NHS trust does not perform well in providing care planning support (CPA) and the CCG area has below average performance in relation to emergency admissions for self-harm. The average number of York Patients seen by Leeds and York Partnership is 3000 per month (further information is available here).

 

Jun-13

Jul-13

Aug-13

Sep-13 

Oct-13

Nov-13

Dec-13

Jan-14

Mar-13

York Patients

2999

3017

3033

3024

3024

3021

3063

3044

3052

 

Mental Health Act Detentions

The total number of occurrences of Mental Health Act detentions managed by Leeds and York Partnership (excluding detentions by the Ministry of Justice totalled 511 between April and Dec 2013. Length of stay in hospital is an average of 15 days. The most common form of “section” is the Section 136 Place of Safety, used when someone is detained in a police or other community setting.

Hospital discharge planning:

Locally, York performs poorly in comparison to other CCGs around the hospital discharge planning process for patients leaving psychiatric hospital settings. Specifically, less than 20% of patients are currently followed up within 7 days of leaving hospital.

Housing

The City of York Housing Department's Supported Housing Strategy highlights the importance of joint working between housing staff and mental health NHS staff to support vulnerable adults on leaving hospital. This is crucial in maintaining and improving mental health in the community. Stable and appropriate housing is vital to allow people to address and receive treatment/support for mental ill-health. This promotes individual outcomes, and reduces impact on communities and on interventions from health, social work, and housing teams.

Many of the people who access supported housing services in York are likely to have mental health needs, based on national figures from the NHS Confederation key facts about mental health (2014) report:

  • 43% of those accessing homeless services have a mental health condition
  • An estimated 69% of rough sleepers have both a mental health and a substance misuse problem.
  • 72% of male and 70% of female prisoners also have a mental health issue
  • 22-44% of adult psychiatric in-patients in England also have a substance misuse problem

City of York Council’s vision is that those with mental health support needs should have these met through mainstream housing wherever possible, rather than in residential or institutional settings. In order to achieve this close links with community mental health teams and with other involved professionals are vital. A small proportion of people may always require some level of supported housing. In York, a range of supported housing is available and is accessed via the mental health accommodation panel:

  • 14 units with 24 hour support provided through Leeds and York NHS trust
  • 13 units of short term 24 hour supported housing through the Council.
  • 31 units of supported housing through York Housing Association. These offer a range of medium and long term accommodation, across a range of shared and self-contained units.
  • 5 units of medium term low level supported accommodation through Richmond Fellowship

There are a relatively small number of people with multiple needs and exclusions. These may include mental ill-health, substance misuse, homelessness, offending or family breakdown. These individuals can struggle to access services, as it is not clear which is the ‘primary presenting need’ or they fail to fit service criteria due to substance misuse, or chaotic lifestyle. These individuals can represent a disproportionate cost to services and the community, as they are more likely to become ‘revolving door’ admissions as the situation breaks down in one place, and they are forced to move on.

Further partnership working across housing, health and social care is required to provide targeted support to these complex individuals. The MEAM (Making Every Adult Matter) approach suggests a toolkit for use at local level, in building partnerships to deliver co-ordinated interventions to those with multiple/complex needs and exclusions.

Psychiatric Liaison:

York Foundation Trust Hospital has a higher than average hospital admission rate for older people with a secondary diagnosis of dementia, and also for patients with alcohol specific conditions. Patients aged 65+ account for half of the mental health admissions (49%) and over two thirds of the costs. The average cost of an admission in 12/13 at York Foundation Trust was £1,267. The average cost of an admission including a mental health diagnosis was £2,200.

Patients admitted into a general hospital setting in York who also have a mental health need, are likely to experience worse outcomes than patients without any mental illness.

  • Patients admitted to York Foundation Trust Hospital, with a primary or secondary mental health condition as the reason for admission, were more than twice as likely to be readmitted to hospital. In 2012-2013, patients with a mental illness accounted for 8% of all hospital admissions and 20% of readmissions
  • Patients are likely to stay in hospital longer. The average length of stay for an admission in 2012-2013 at YHT was 4.6 days. The average length of stay for an admission including a mental health diagnosis was 8 days

The NHS Vale of York Clinical Commissioning Group is working with NHS and social care partners to establish a liaison psychiatry service which will enhance the experience of patients with mental illness in the acute hospital setting, and improve the efficiency and speed of psychiatric assessments for people admitted via the Emergency Department.

Social Care:

For anyone over 18, social care services provided by the local authority are accessed through an initial assessment which determines the person’s level of need, and eligibility for access to care. An assessment can be requested by their GP or link worker. The services the person receives will vary according to the persons individual circumstances. Care services are not generally available for patients who have low to moderate needs. This might have an impact on future service demand. By not being able to provide support to people with low to moderate needs that is focussed on prevention or recovery, this may contribute to low to moderate needs worsening and requiring intensive input at a later point.  There is no direct evidence to support this, however, when considering that levels of access to IAPT services (which are designed to support people with access to short duration talking therapies for specific conditions such as anxiety or depression) are relatively low it might be that referrals could be made into IAPT services for people with low to moderate needs who do not meet the threshold for social care support. However, there are a range of open access preventative services available for all.

Professional Support:

The following teams currently provide professional social work support to service users with a primary need of mental health.

Social Work Team

Caseload

NE Locality Hub

100

SW Locality Hub

106

Forensic

22

Early Intervention

25

Assertive outreach team

3 social workers supporting 80 active cases as part of MDT approach

Long Term Team (OP)

3 AMHPs + 1 mental health social worker working with older people with mental health needs.

As a snapshot of provision, the figures below show the services provided by City of York Council between 01/04/2013 to 31/12/2013. There was a total of 318 clients aged 18-64, and 320 people over 65 with a primary need of mental health, receiving the following social care services:

 

Home Care

Day Care

Meals

Short term residential not respite

Direct Payments

Professional Support

Equipment & Adaptations

Other

Residential

Nursing

Primary client type:

 

 

 

 

 

 

 

 

 

 

18-64

9

25

0

7

13

167

11

3 

77

6

65+

22

8

0

0

7

31

55

18

99

81

 

 

 

 

When a person’s health and wellbeing is reported as at risk a safeguarding referral will be reviewed by the Council’s safeguarding team. As a snapshot, between 01/04/2013 and 31/12/2013 there were a total of 777 safeguarding referrals to City of York Council of which 113 related to people with a mental health problem. A total of 309 went to investigation stage and of these 32 related to people with a mental health problem:

Safeguarding Referrals

Social Care Providers:

The following providers deliver different types of care to eligible service users through City of York Council social care assessment and care planning process:

Short term Assessment, respite and non-hospital crisis avoidance beds.  Telephone support line.

Long-term

Medium term

Long-term Floating Support

Temporary Floating Support

Direct Payments and domiciliary care:

Day Support

22 The Avenue

7 different locations across York

2 different properties

Richmond Fellowship

CYC Community Support Team

Support purchased for a range of activities/support, and range of home care providers in the city

Sycamore House

Mental Health Residential Care Homes in York

42 homes providing 1399 beds are registered to provide residential or nursing care in York for people with mental health needs. The majority cater for over 65’s. Six cater for working age adults with a primary diagnosis of mental health.

Local Prevalence Estimates

The Adult Psychiatric Morbidity Survey (APMS) series provides data on the prevalence of both treated and untreated psychiatric disorder in the English adult population (aged 16 and over. This survey is the third in a series and was conducted by the National Centre for Social Research in collaboration with the University of Leicester for the NHS Information Centre for health and social care.

The full report is available here.

The following table summarises the estimated prevalence for a range of mental health conditions in York. These estimates have been calculated from a variety of national prevalence sources and applied to the NHS Vale of York Clinical Commissioning Group practice population as broken down into age bandings and provided by the Health and Social Care Information Centre (2014).

These estimates do have some limitations to be aware of:

  • Some of the GP practice population information by age groups do not exactly match the prevalence estimate age groups
  • The estimates are all based on national prevalence figures and so do not account for any local variances
  • A range of methods to calculate each national prevalence figure have been used which may mean there is some difference in which conditions are included in the estimates and that the rates are not directly comparable.  For example, the national prevalence estimates for depression include anxiety and depression but the local GP practice registers for recording levels of depression include only depression
  • The prevalence rates can cover different time periods. For example, the prevalence estimates for PTSD are lifetime prevalence estimates – that is the number of people would be diagnosed with PTSD at some point in their adult lives. The prevalence rates for all other conditions are given as numbers of people recorded with that particular condition at a specific point in time.

Condition

Prevalence Rate

Prevalence Source

Entire NHS Vale Of York CCG Population

 

Total all

Total Male

Total Female

/

 /

(HSCIC 2014)

347,244

169,955

177,289

Dementia

Varies with age band

POPPI

4,606

1,641

2,965

Psychosis and Schizophrenia

5 per 1000 people aged 18-74

NICE CG82

1,331

658

673

Prevalence of Psychotic Disorder

0.4% of adult population

NICE CG178

1,396

510

886

Psychosis and Schizophrenia

1% of adult population

HSCIC

2,731

1,329

1,403

Schizophrenia

age corrected 0.11 prevalence

NICE CG82

382

187

195

Schizophrenia

age corrected 0.07 lower limit

NICE CG82

243

119

124

Schizophrenia

age corrected 0.17 upper limit

NICE CG82

590

289

301

Schizophrenia in young people

0.4% aged 5-18

 NICE CG155

228

114

115

Depression

people aged 18+ recorded on depression register

 

13,921

/

/

 

2.6% lower limit estimate

NICE CG90

9,028

/

/

 

11.4% upper limit estimate

NICE CG90

39,586

/

/

Learning Disability

People known to GP's with a learning disability (4.25 per 1,000 people)

Public Health England

 

 

 

Learning Disability - Severe

Varies with age band

POPPI

PANSI

303

150

153

Learning Disability - Moderate or Severe

Varies with age band

POPPI

PANSI

1,481

727

754

Down's Syndrome

6.25 per 10,000 population

PANSI

217

/

/

Self harm

4.6% lower limit estimate ever self harmed

NICE CG16

15,973

7,818

8,155

 

6.6% upper level estimate ever self harmed

NICE CG16

22,404

11,217

11,187

 

400 per 100,000 population

NICE CG16

1,389

680

709

Perinatal Mental Health

1 in 10 within a year of giving birth

NSPCC
ONS

/

/

210

Childhood Mental Health Problem

1 in 10 between ages 5-16

Department of Health

4,356

2,182

2,174

Post Traumatic Stress Disorder (PTSD)

8.9% of those who experienced trauma develop PTSD

HSCIC

9,358

3,796

5,562

Any Common Mental Disorder

Varies with age band

HSCIC

47422

17623

29798

Anxiety & Depression

Varies with age band

HSCIC

26649

9853

16796

General Anxiety Disorder

Varies with age band

HSCIC

12703

4764

7939

Depressive Episode

Varies with age band

HSCIC

6812

2636

4176

Phobia

Varies with age band

HSCIC

4051

1092

2959

Obsesssive Compulsive Disorder

Varies with age band

HSCIC

3397

1324

2072

Panic Disorder

Varies with age band

HSCIC

3033

1318

1715

Antisocial Personality Disorder

0.3% of adults aged over 18

HSCIC

886

733

153

Borderline Personality Disorder

0.4% of adults aged over 18

HSCIC

1314

385

929

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 4 / 6 measures on ASRS scale

HSCIC

16134

7996

8138

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 6 / 6 measures on ASRS scale

HSCIC

1664

954

709

Eating Disorder - positive SCOFF screening for 2 or more measures

Varies with age band

HSCIC

19001

5090

13910

Eating Disorder - positive SCOFF screening for 2 or more measures & report of significant impact

Varies with age band

HSCIC

4507

730

3777

Anorexia Nervosa

19 per 100,000 in women & 2 per 100,000 in men

NICE CG9

37

3

34

Bulimia Nervosa

1% in women

NICE CG9

1519

/

1519

 

The following local prevalence estimates are also provided across the City of York Council population only (this is a smaller population group than the entire NHS Vale of York Clinical Commissioing Group population).

Condition

Prevalence Rate

Prevalence Source

City of York Population

 

Total all

Total Male

Total Female

/

 /

(HSCIC 2014)

185, 232

90, 048

95, 184

Dementia Prevalence

 

POPPI

2, 453

866

1, 587

Psychosis and Schizophrenia

5 per 1000 people aged 18-74

NICE CG82

724

355

369

Prevalence of Psychotic Disorder

0.4% of adult population

NICE CG178

746

270

476

Psychosis and Schizophrenia

1% of adult population

HSCIC

1, 478

715

762

Schizophrenia

age corrected 0.11 prevalence

NICE CG82

204

99

105

Schizophrenia

age corrected 0.07 lower limit

NICE CG82

130

63

67

Schizophrenia

age corrected 0.17 upper limit

NICE CG82

315

153

162

Schizophrenia in young people

0.4% aged 5-18

 NICE CG155

117

57

60

Depression

people aged 18+ recorded on depression register

 

9, 245

/

/

 

2.6% lower limit estimate

NICE CG90

4, 816

/

/

 

11.4% upper limit estimate

NICE CG90

21, 116

/

/

Learning Disability

People known to GP's with a learning disability (4.25 per 1,000 people)

Public Health England

824

/

/

Learning Disability - Severe

Varies with age band

POPPI

PANSI

168

83

85

Learning Disability - Moderate or Severe

Varies with age band

POPPI

PANSI

809

395

415

Down's Syndrome

6.25 per 10,000 population

PANSI

116

/

/

Self harm

4.6% lower limit estimate ever self harmed

NICE CG16

8, 521

4, 142

4, 378

 

6.6% upper level estimate ever self harmed

NICE CG16

11, 872

5, 943

5, 929

 

400 per 100,000 population

NICE CG16

741

360

381

Perinatal Mental Health

1 in 10 within a year of giving birth

NSPCC
ONS

/

/

/

Childhood Mental Health Problem

1 in 10 between ages 5-16

Department of Health

2, 164

1, 074

1, 090

Post Traumatic Stress Disorder (PTSD)

33% aged 16 or over report traumatic incident

HSCIC

56, 530

27, 296

29, 235

 

8.9% of those who experienced trauma develop PTSD

HSCIC

5, 088

2, 047

3, 040

Any Common Mental Disorder

Varies with age band

HSCIC

25, 876

9, 532

16, 344

Anxiety & Depression

Varies with age band

HSCIC

14, 562

5, 344

9, 218

General Anxiety Disorder

Varies with age band

HSCIC

6, 851

2, 538

4, 313

Depressive Episode

Varies with age band

HSCIC

3, 686

1, 418

2, 268

Phobia

Varies with age band

HSCIC

2, 220

585

1, 636

Obsesssive Compulsive Disorder

Varies with age band

HSCIC

1, 929

738

1,191

Panic Disorder

Varies with age band

HSCIC

1, 650

724

926

Antisocial Personality Disorder

0.3% of adults aged over 18

HSCIC

527

434

94

Borderline Personality Disorder

0.4% of adults aged over 18

HSCIC

748

209

540

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 4 / 6 measures on ASRS scale

HSCIC

9, 021

4, 394

4, 627

Attention Deficit Hyperactivity Disorder (ADHD)

Varies with age band.  Proportion screening positive on 6 / 6 measures on ASRS scale

HSCIC

930

535

395

Eating Disorder - positive SCOFF screening for 2 or more measures

Varies with age band

HSCIC

10, 781

2813

7, 968

Eating Disorder - positive SCOFF screening for 2 or more measures & report of significant impact

Varies with age band

NICE CG9

2, 574

415

2, 159

Anorexia Nervosa

19 per 100,000 in women & 2 per 100,000 in men

NICE CG9

20

2

18

Bulimia Nervosa

1% in women

POPPI

831

/

831

 

Mental health and ethnicity

The Health & Social Care Information Centre calculate access to community mental health services by ethnic group. The table below shows what this was like for NHS Vale of York Clinical Commissioning Group during 2012-2013:

2012/13

NHS VALE OF YORK CCG

 

Total Number using Services

Population

Rate Per 100,000

Asian or Asian British

44

7608

578.3

    Any Other Asian Background

12

2221

540.3

    Bangladeshi

*

395

*

    Chinese

8

2732

292.8

    Indian

14

1787

783.4

    Pakistani

*

473

*

Black or Black British

20

1544

1,295.3

    African

11

1140

964.9

    Any Other Black Background

*

115

*

    Caribbean

*

289

*

Mixed

24

3442

697.3

    Any Other Mixed Background

7

914

765.9

    White and Asian

*

1288

*

    White and Black African

*

418

*

    White and Black Caribbean

7

822

851.6

Not Known

1592

 

 

    Not Known

1592

 

 

Not Stated

33

 

 

    Not Stated

33

 

 

Other Ethnic Groups

16

1073

1,491.2

    Any Other Ethnic Group

16

538

2,974.0

    Arab

Unavailable

535

 

Unspecified

194

 

 

    Unspecified

194

 

 

White

7253

329442

2,201.6

    Any Other White Background

87

9731

894.0

    British

7124

317589

2,243.2

    Irish

42

1658

2,533.2

    Gypsy or Irish Traveller

Unavailable

464

 

Grand Total

9176

343109

2,674.4

 Source:  Health & Social Care Information Centre (2013).  Indicator 2.9

The following indicator is a proxy measure of levels of severe mental illness in the community and a direct measure of socio-economic disadvantage in those ‘not in work’ because of mental illness. Severe mental illness severely restricts the capacity to fully participate in society and in particular the employment market. 

Unemployment rates are high amongst people with severe mental illness. In the UK, unemployment rates of 60-100% have been reported. These high rates not only reflect the disability caused by severe mental illness, but also reflect discrimination (unemployment rates are higher than in other disabled groups) and the low priority given to employment by psychiatric services.  

People with long-term psychiatric disabilities are even less likely to be in employment than those with long term physical disabilities. Despite high unemployment rates amongst the severely mentally ill, surveys have consistently shown that most want to work. These low rates of employment should be considered against the facts that at least 30-40% of people who are significantly disabled by enduring mental illness are capable of holding down a job. More than 900,000 adults in England claim sickness & disability benefits for mental health conditions. This group is now larger than the total number of unemployed people claiming Jobseeker’s allowance in England.

Number of claimants of incapacity benefit with mental or behavioural problems per 1,000 working age population, by Local Authority, 2008

Local Authority name

Number of Claimants

Population

Rate per 1,000 working age population

Lower 95% CI

Upper 95% CI

England

880,462

31,937,600

27.6

27.5

27.6

York UA

2,270

127,000

17.9

17.2

18.6

Source: Health & Social Care Information Centre (2013). Indicator 10.4




References

This page was last updated on 20 April 2015
This page will be reviewed by 20 April 2016