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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Did you know? Information Briefing on Levels of mental disorder and treatment in England

 

Introduction

This briefing hightlights that while mental disorders are common, only a minority of people receive any intervention. This treatment gap is relevant, as it has widespread impact on services and costs. This information is therefore important for commissioners, health and public health professionals, shawdow health and wellbeing boards, local health and wellbeing strategies, as well as the general public. At a local level, this needs to be incorporated into the Joint Strategic Needs Assessment.

 

Key messages 

  • More than a fifth of the population in England experiences a mental disorder at any one time 10 although in Europe, 38% of the population have experienced at least one mental disorder in the previous year 15
  • An even larger proportion experience mental distress which impairs functioning, but does not formally meet any diagnostic criteria (sub-threshold mental disorder).
  • Almost half of adults experience at least one episode of depression during their lifetime.
  • Only a minority of those with mental disorder in England receive any intervention, except those with psychosis of whom two thirds receive some intervention. In comparison, almost all of those with cancer receive some intervention, with almost half having surgical treatment.      

Levels of mental disorder across England

In England, the most recent national surveys of psychiatric morbidity find that at any one time:

  • 10% of 5-16 year olds have a clinically recognised mental disorder; conduct disorder (6%) and emotional disorder (4%) are the most common disorders 5.
  • 17.6% (21.0% of women and 11.9% of men) experience a common mental disorder which includes anxiety or depressive illness 10.
  • 0.4% of adults have psychosis in the previous year 10.
  • 5.9% of adults have alcohol dependence 10.
  • 3.4% of adults have drug dependence mainly in those aged 16–24 years 10.
  • 21% of adults have nicotine dependence, although 42% of tobacco consumption in England is by those with mental disorder 9.
  • 5.4% of men and 3.4% of women have a diagnosable personality disorder 13, while 0.3% have antisocial personality disorder 10.
  • 25% of older people have depressive symptoms requiring intervention, 11% have minor depression and 2% major depression rising to 40% of people aged over 85 4.  
  • Dementia affects 5% of people aged over 65 and 20% of those over 80 8

 

Furthermore, almost half of all adults will experience at least one episode of depression during their lifetime 1,7.

 

Levels of sub-threshold disorder

This includes mental distress not reaching diagnostic criteria for mental disorder and results in significant burden.

  • 18% of 5-16 year olds have sub-threshold conduct disorder 3.
  • 17% of adults experience sub-threshold common mental disorder 10.
  • 6% have sub-threshold psychosis 14.
  • 24% have hazardous drinking 10.

Furthermore, people with sub-threshold mental disorder are at much higher risk of going on to develop mental disorder.

 

Proportion of children and adolescents receiving any intervention for mental disorder

  • 30–40% of children and adolescents who experience clinically significant mental disorder have been offered evidence-based interventions at the earliest opportunity for maximal lifetime benefits 5,11.
  • 64% of parents with children with emotional disorder had contacted a professional source usually a teacher (47%) 5.
  • For parents with conduct disorder 5:
  • 81% sought some form of advice or help.
  • 76% approached a professional source most commonly a teacher (60%).
  • 28% sought advice from a mental health specialist.
  • 24% sought advice from special educational services such as psychologists.
  • Levels of impairment or symptoms are undetected in 55% of children with autism and 57% of those with Asperger’s syndrome 12.

Proportion of adults receive any intervention for mental disorder

  • 24% with a common mental disorder - mostly in the form of medication 10.
  • 28% screening positive for Post-Traumatic Stress Disorder (PTSD) 10.  
  • 65% with ‘psychotic disorder’ treated in the past year 10.
  • 81% with probable psychosis received some form of treatment (85% in 2000) 10.
  • 20% screening positive for Attention Deficit Hyperactivity Disorder (ADHD) 10.  
  • 14% with alcohol dependence 10.
  • 14% with cannabis dependence 10.
  • 36% with dependence on other drugs 10.  
  • One in six of older people with depression discuss their symptoms with a GP and less than half of these receive adequate treatment 2.

In Europe, the situation is event worse with only 10% with mental disorder receiving notionally adequate treatment 15.

 

Level of mental disorder and treatment informs Joint Strategic Needs Assessments (JSNAs) and commissioning

JSNAs determine the level of unmet need including for mental disorder (JCP, in press). Local estimates of prevalence and treatment of levels for mental disorder are required by health and wellbeing strategies. Such information should determine level of interventions to be commissioned.

 

 

© Royal College of Psychiatrists. August 2012. This leaflet reflects the best available evidence available at the time of writing.

 

Dr Jonathan Campion, consultant pychiatrist at South London and Maudsley NHS Foundation Trust and Professor Kam Bhui, Professor of Cultural Psychiatry and Epidemiology and Hon Consultant Psychiatrist, Queen Mary, University of London.RCPsychlogo

 

This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its materials on other sites, but allows them to be linked directly.

 

Charity registration number (England and Wales) 228636 and in Scotland SC038369.
 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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