2 Introduction to the nature and impact of mental health problems
Mental health problems – frequency and impact
Mental health is described by the World Health Organisation (WHO) (2007, p.1) as “a state of well being in which the individual realises his or her abilities, can cope with the normal stresses of life and can work productively and fruitfully to make a contribution to his or her community”. Yet the experience of emotional and psychological distress is a fairly common one. The majority of people will be able to identify times in their lives where they have felt overwhelmed by sadness, anxiety or emotional pain. This is important to bear in mind in any consideration of mental health problems as the issue of mental and emotional wellbeing is increasingly one for each individual, community and institution within our society. It also highlights that mental wellbeing and ill health are part of a continuum. This helps to challenge some of the beliefs within wider society that mental distress and the people who experience it are something to be feared, avoided or shunned. It is when these emotional and psychological experiences become so overwhelming as to restrict the extent to which people are able to live their daily lives, when they persist for a length of time or when they might put that person’s (or a) life at risk, that people may be diagnosed as experiencing a mental health problem and benefit from support from a mental health service or professional.
Mental health problems are a major health issue for the global community. The WHO estimates that hundreds of millions of people will experience mental health and neurological problems worldwide (WHO 2010). They also suggest that currently these problems account for the second biggest burden of illness after cardiovascular disease (WHO 2005). This highlights that mental health problems account for a significant health need and are an important area where health and social care services may impact positively on people’s lives.
International perspective
• An estimated 100 million people in Europe are believed to experience anxiety or depression (WHO 2005).
• 21 million people in Europe are estimated to suffer from alcohol misuse.
• Approximately 4 million people in Europe are estimated to be diagnosed with schizophrenia.
These figures are based on a total population of 870 million (WHO 2005).
Common mental health problems
There is evidence to suggest that common mental health problems are increasing in the UK (National Health Service (NHS) Centre for Information 2009a). Common mental health problems are generally those which bring the individual into contact with their GP and will include diagnoses such as depression, anxiety and phobias. Outlined below are some key trends emerging in relation to the changing picture of common mental health problems.
• Around one in six adults are thought to experience mental health problems at any one time (Office for National Statistics (ONS) 2001).
• In England, men are less likely than women to experience a common mental health problem.
• The proportion of the English population who could be diagnosed with a common mental health problem has increased from 15.5% in 1993 to 17.6% in 2007 (NHS Centre for Information 2009a).
• Research suggests that about half of people experiencing common mental health problems are not affected after 18 months, though there is a social inequality in this impact. Those who have long-term sickness due to other conditions, may be unemployed or are of lower socioeconomic status are more likely to still be affected.
• In the Scottish population, between the ages of 15 and 90, the estimated daily use of antidepressant medication has increased from 1.9% in 1992/1993 to 8.7% in 2005/2006. (Scottish Government 2009).
Serious mental health problems
• People with serious mental health problems have a reduced life expectancy and some evidence has suggested that this is up to 25 years less than the average adult population, a statistic reported in both Europe and America (Parks et al 2006).
• Detentions to hospital under the Mental Health Act in the UK rose to 28 100 in 2008/2009 (NHS Centre for Information 2009b).
• People with serious mental health problems are at increased risk of developing coronary heart disease, diabetes and respiratory disease (Sainsbury Centre for Mental Health 2010a,b).
Once you know where you are going for your mental health placement(s), Chapters 4 and 5 will help introduce you to the preparation for these practice areas. However, this chapter has started to introduce some basic information about the problems and challenges people using these services may face and has drawn on evidence to support this. The activity outlined below will help you build on this in relation to the area you are going to.
Ask yourself the following question about the placement area:
1. What do you already know about who may be receiving these services?
2. What pieces of information from this chapter do you think are most relevant for this?Then it will be important to identify what other sources might be useful for finding out this information. Below is a list of some possible Websites to access:
Suicide and self-harm
Self-harm can be used as a coping strategy to deal with emotional and psychological distress and may be used by people regardless of a diagnosis of mental health problems. However, considering people who have contact with mental health services have often experienced traumatic lives and are struggling with emotional distress, self-harm is an area where mental health nurses may offer individuals support. Self-harm is considered as a need to inflict physical wounds onto one’s own body to deal with severe and often unbearable psychological pain; the harm itself may be an attempt to cope with this and provide an emotional release. This is without intent to commit suicide (Sutton 2007). Self-harm has been described by survivors as a ‘painful but understandable’ response to distress, a form of silent scream (Pembroke 1994).
• In England, the percentage of people reporting self-harming during their lifetime has increased and the biggest increase has been in young women (16–24 years old) (NHS Centre for Information 2009a).
• The UK has one of the highest rates of self-harm in Europe (Mental Health Foundation 2006).
• According to reports by parents, 1.3% of 5–10-year-olds have tried to hurt, harm or kill themselves (Meltzer et al 1999).
Suicide is a traumatic and devastating occurrence. However, individuals who may be having suicidal thoughts will still have a need to be valued, understood and listened to (Noonan 2009). There are particular groups who are more at risk of suicide and this includes people who self-harm.
• In England, 5.6% of people aged 16 and over had reported having made a suicide attempt (NHS Centre for Information 2009a) and there is also evidence that in this group there is an increase in reporting of suicidal thoughts.
• After rising for 25 years, the suicide rate in young men fell in the UK between 1998 and 2007 though overall the suicide rate increased in 2008 (ONS 2010).
• Suicide is more common in men in all age groups and is the most common cause of death in men under 35 (Department of Health (DH) 2002).
Substance misuse
Defining problems around substance misuse and dependence can be problematic. Dependence may be physical or psychological and is generally considered as a need to continue using a substance on a regular and repeated basis (Kipping 2009). Withdrawal or lack of use could lead to experiencing physical or psychological symptoms. Some people may experience mental health problems alongside being dependent on a substance, which is described as dual diagnosis. However, support for people who are dependent on substances also tends to be provided by mental health services.
• The prevalence of alcohol dependency decreased in men between 2000 and 2007 whereas this prevalence stayed the same for women (NHS Information Centre 2009a).
• In the European region, 21 million people are believed to experience alcohol use disorders (WHO 2005).
• 3.4% of adults in England had some indication of being dependent on illicit or illegal drugs. The biggest part of this statistic was for those who were dependent on cannabis only (NHS Information Centre 2009).