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While mental illness like schizophrenia and psychosis are relatively uncommon, one in six people are likely to be affected at some point in their lives by common mental health problems such as stress, anxiety and depression. Over a third of attendances at GP surgeries and a high proportion of absences in the workplace are also associated with mental health problems.

In 2004/05,12.8 million working days were lost to depression and anxiety. About 2% of NHS expenditure goes on dealing with depression and anxiety.

Depression

• Depression is the most common psychiatric disorder. It refers to a spectrum of mental health problems characterized by the absence of positive affect (i.e. a loss of interest and enjoyment in ordinary things and experiences), low mood, and a range of associated emotional, cognitive, physical, and behavioural symptoms [NICE, 2004a]. Day-to-day functioning is often impaired.
• Mild depression accounts for approximately 70 per cent of cases, moderate depression for 20 per cent and severe depression for 10 per cent [NICE, 2004a].
• An episode of depression serious enough to require treatment occurs in about one in four women and in one in ten men at some point in their lives [NICE, 2004a]. About two-thirds of adults will at some time experience depressed mood of sufficient severity to interfere with their normal activities.
• Depression is the third most common reason for consultation in general practice in the UK. Between 5% and 10% of people consulting their GP meet the criteria for major depression, and two to three times as many people have depressive symptoms but do not meet the criteria for major depression [NHS CRD, 2002; Butler et al, 2004].
• Depressive disorders are expected to show a rising trend over the next 20 years, and are expected to become the second most important cause of disability and disease burden by 2020 [Murray and Lopez, 1997a; Murray and Lopez, 1997b].
• The total cost of services for depression in England in 2007 was estimated to be £1.7 billion. Lost employment brings the total cost to £7.5 billion. By 2026 these figures are projected to be £3 billion and £12.2 billion respectively. Most of this increase is due to expected increases in the cost of services over and above inflation. Paying the Price, King's Fund 2008
• Depression can be difficult to recognise [NICE, 2004a]. Often, people do not admit to having psychological symptoms, but present instead with mainly physical or somatic symptoms. At least two-thirds of depressed people who see their GP present with physical symptoms rather than psychological symptoms.
• Depression is a major cause of impaired quality of life, reduced productivity, and increased mortality [MeReC, 2000]. Social difficulties are common (e.g. social stigma, loss of employment, marital break-up). Associated problems, such as anxiety symptoms and substance misuse, may cause further disability.
• Other psychiatric conditions may coexist with depression, e.g. anxiety, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders.
• Unemployed people are twice as likely to have depression as people in work
• People with depression are at increased risk of suicide.

Anxiety

• Anxiety disorders may cause people a number of different physical and psychological problems. Conditions include generalised anxiety disorder, agoraphobia, social phobia, and panic disorder.
• The psychological symptoms of anxiety include feelings of dread and irritability, and increased muscle tension and activity of the nervous system. Only when the symptoms are more intense or long-lasting do they interfere with a person's concentration and ability to do routine tasks. Royal College of Physicians
• Anxiety disorders are quite common, affecting 5 per cent of the population at any one time and are generally treated in primary care settings. More women than men are affected. Anxiety disorders often start in the 20s but may begin earlier. Sometimes they occur in older people.
• The total number of people with anxiety disorders was estimated to be 2.28 million in 2007 and this is projected to rise to 2.56 million by 2026.
• 51 per cent of people with anxiety disorders are not in contact with services and of those who are, 46 per cent do not receive medication or psychological therapy. Paying the Price, King's Fund 2008
• The cost of services for anxiety disorders for the whole of England in 2007 was approximately 1.2 billion. Including lost employment costs brings the total to £8.9 billion. By 2026 it is projected that service costs for anxiety disorders will be £2 billion with total costs at £14.2 billion. Paying the Price, King's fund 2008

Risk Factors

The prevalence of depression is greatly influenced by a number of factors, which interact in a complex way [NHS CRD, 1993; NICE, 2004a]. These factors include:

• Gender: most studies indicate that the incidence of depression in women is about twice that in men [Butler et al, 2004]. In most studies, however, the difference between elderly men and elderly women seems to be smaller.
• Age: some studies have shown an equal incidence of depression in older people and in younger adults, while others have suggested that the incidence decreases with age. Depressive episodes in elderly people are often milder but more protracted.
• Socio-economic factors: episodes of depression are strongly associated with adverse social and economic circumstances, such as unemployment, inadequate housing, poverty, and lower social class.
• Other stressful life events and difficulties such as divorce or separation, demanding childcare, bereavement, and caring for a dependant relative.
• Co-morbidity: depression is more common in people with chronic medical conditions such as diabetes, chronic obstructive pulmonary disease, and cardiovascular disease.
• Discrimination

Other risk factors include:

•  Dual diagnosis

Research indicates that 30-50% of people with mental health problems also have current drug or alcohol issues, and as many as 50-75% of people who come into contact with substance misuse treatment services may also have some kind of mental health problem.  This latter group will not necessarily have contact with mental health services.

• Offending

More than 70% of the prison population has two or more mental health disorders (Psychiatric Morbidity Among Prisoners in England and Wales,1998). For more information read the offenders section of the JSNA. 

• Homelessness

Mental health problems are more prevalent among homeless people than among the general population (Getting through (2007).  For more information read the homeless section of the JSNA.

• Ethnic minorities

People from BME communities can suffer inequalities in access to mental health services and in their experience of them, including language barriers, cultural barriers to assessment, lack of knowledge about statutory services and lack of access to bilingual health professionals (Inside Out).

• Domestic violence

People who have been abused or been victims of domestic violence have higher rates of mental health problems.  For more information read the domestic violence section of the JSNA.

• Sexual identity and sexual orientation

Lack of self esteem, not being able to be 'out' and the associated discrimination are significant factors in the mental and emotional wellbeing of the LGBT (lesbian, gay, bisexual and transgender) community. 1 in 5 lesbian and bisexual women have self harmed in the last year compared to 0.4 of the general population. (Department of Health Briefings) and (Stonewall's Prescription for Change (Lesbian and bisexual women's health check)

• Disability

The North East has the highest proportion of people with disabilities in England.  There is a clear link between physical disability and poor mental health, regardless of which presented first, although services are usually configured to deal with these separately.

• In Newcastle 9.5% of the working age population are on incapacity benefit with much higher levels in some disadvantaged neighbourhoods. Mental illness accounts for 46% of these. (Draft Mental Health Profile Newcastle March 2008)
• Incapacity benefit claimants, homelessness, number of young people in the 'Looked After System', common mental illness predictions and suicide rates are all higher in Newcastle than the average for the region. (Draft Mental Health Profile Newcastle March 2008)Prevalence
• In 2006 46% of Newcastle's population aged 16-74 were estimated to have a common mental health problem. A break down is provided below.

Source: North East Public Health Observatory Mental Health Briefing No 4 May 2008 estimating the prevalence of common mental health problems in PCTs in England.

• The number of clients receiving community mental health services in Newcastle between 1 April 2006 and 31 March 2007 were:
  • Clients aged 18-64: 780
  • Clients aged 65 and over: 385

Source: RAP proforma P1

• Supporting People Client Record Form (CRF) data submitted to the Centre for Housing Research during 2006/07 revealed that, of the 3,393 clients accessing a Supporting People service in Newcastle in 2006/7, 321 had mental health recorded as their primary need, and 294 as a secondary need. In addition, 15% of clients who had single homeless as their primary need had mental health recorded as a secondary need.
• Proportion of people with depression and/or anxiety disorders who are offered psychological therapies (Vital Sign VSC02).