Indications of Public Health in the English Regions - 7 - Mental Health
This report is the seventh in the series ‘Indications of Public Health in the English Regions’ commissioned by the Chief Medical Officer. It has been produced by the Association of Public Health Observatories, led by the North East Public Health Observatory.
Mental health is identified as one of the six national priorities for action in the White Paper Choosing Health. In the past, indicators of mental health have been hard to find. Targets for mental health improvement have largely concentrated on suicide rates, which although important, give a limited picture of the mental health of a community. This report presents a wide range of data on the factors which can give rise to poor mental health, the mental health status of populations, provision of interventions of care for mental illness, service user experience and traditional outcomes such as suicide. We have had the advantage of access to the Durham Mental Health Service Mapping, which provided a systematic overview of mental health services in England until 2006.
We have also been able to make use of the Mental Health Minimum data set (MHMDS) which was developed by one of the authors of this report (Gyles Glover).
The report is structured in a similar way to previous reports and looks at indicators of:
- Risk and protective factors and determinants;
- Population health status;
- Interventions;
- Effectiveness of partnerships;
- Service user experience; and
- Workforce capacity.
Many of the risk factors for mental illness are linked to deprivation, so a general pattern occurs with the three northern regions (North East, North West and Yorkshire and Humber), showing worse measures than the three southern regions (South East, South West and Eastern England) and the two midlands regions (West Midlands, East Midlands) in between.
London has a very inconsistent pattern appearing at different places on different indicators. The service based indicators do not often show this pattern, with the northern regions often doing better.
Our findings fall into three main categories:
- Where there appear to be important differences between the regions, e.g., alcohol consumption.
- Where regional differences appear to be unimportant or insignificant, e.g., expenditure on gambling.
- Issues where there is an absence of data or the data are too poor quality to interpret, e.g., ethnic coding.
There are areas where there is scope for tackling the determinants of poor mental health (e.g., drugs, alcohol, physical activity). The report also identifies important variations in the provision of mental health services between regions in relation to need.
Conclusions and key messages
There is a need to undertake more work at a sub-national level on mental health data. Work needs to be undertaken to develop suitable mental health indicators which can be used as part of the Local Area Agreement (LAA) process. Initially sub-regional analysis needs to be undertaken in order to gain better understanding of the local position.
There is an urgent need to develop new indicators of mental health to enable countries of Europe to be compared, also paying attention to the possibility of comparisons at a subnational level. At the present time, mortality data provide one of the few ways of making any informed comparisons: suicide is commonly used, but we know that there are very different approaches in European countries which make comparisons difficult. Within this report there are some important differences which we highlight between regions; however some of the usual patterns which are frequently seen when making health comparisons are very different in mental health.
Readers of this report will be struck by the range and nature of the indicators we have used: this reflects the complexity of the subject and also the wide range of determinants of good mental health.
We hope that Regional Directors of Public Health, Directors of Public Health in PCTs and CSIP (Care Services Improvement Partnership) Directors will find the report a valuable resource in making decisions and in holding to account those responsible for the delivery of mental health care services and improving the mental health of the population.
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