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As many as one in six adults are affected at any one time, and a variety of factors play a part. For example, mental health and illness vary according to age, gender, ethnicity, socio-economic status, geography, employment and education. There is a link between mental health and physical health. For example, depression has been consistently linked to mortality following a heart attack; it increases the risk of heart disease fourfold, even when other risk factors like smoking are taken into account. In addition, there is a stigma associated with mental ill health despite the fact that many of us have some understanding of how it may feel to be stressed and/or depressed. Staying mentally well is as important as staying physically healthy - and this applies to everyone, at work or at home whether or not they have a mental health problem. 1 in 10 children and young people under the age of 15 suffer from a mental disorder and in a recent survey undertaken by the Office for National Statistics of children looked after by Local Authorities, 45% were assessed as having a mental disorder. 1 in 6 adults at any one time has a mental disorder - maybe as many as nine million people are affected. Up to 670,000 people in the UK have some form of dementia - 5% of people over 65 and 10 to 20% of people over 80. In 2001/2, around 500,000 people believed they were experiencing work-related stress at a level that was making them ill. This accounts for an estimated 13.5 million lost working days. Earlier research indicated that about 1 in 5 workers believe their job was either very or extremely stressful. Incapacity Benefit data (Department for Work and Pensions National Statistics Incapacity and Severe Disablement Allowance Quarterly Summary Statistics May 2003) show that 865,900 adults on incapacity benefit in England report their primary condition to be mental ill health. Stress related conditions are now the commonest reported cause of sickness absence. Although the rate of death by suicide is falling, there is still a high level of risk for some people. Young men are at particular risk. Up to 1 in 4 consultations with a GP concern mental health issues. As many as 630,000 people are in contact with specialised mental health services at any one time. Many more are in contact with services in the non-statutory sector. Statistics about the prevalence of mental health problems inform local needs assessment and help to identify priorities for action. However, they also need to be seen in the context of ongoing debates about the validity and usefulness of diagnostic criteria. These debates raise important issues for those working to promote mental health and to develop a shared vision for a local mental health promotion strategy. There are also ongoing debates about the validity and usefulness of diagnostic criteria, notably in relation to schizophrenia. Key critiques include the view that diagnoses are simply labels that classify and describe certain types of behaviour. They do not shed any light on the nature or causes of symptoms and frequently inhibit or deny patients an opportunity to participate in making sense of their experiences. There are also concerns that diagnoses like depression or anxiety disorder medicalise forms of distress which may be a normal response to grief, deprivation, trauma or abuse. "We do our patients a disservice if we restrict their distress to a clinical condition. Personal, relational, social, economic, political, and spiritual factors have significant impact on people's circumstances, feelings, and future development. Medical assessment often effectively minimises or dismisses these issues, to the detriment of ourselves and our patients. The medicalisation of modern society has already deskilled many other professions and led patients into an unhealthy dependence on medical care. We should be careful not to reinforce this further." (Winston 2000) A biomedical model draws a boundary between mental health and mental illness and measures an intervention, for example arts on prescription, anti-depressants or cognitive behavioural therapy, in terms of its impact on symptoms. By contrast, a recovery model measures success in terms of regaining a meaningful life rather than by freedom from symptoms. In this case, quality of life indicators such as opportunities for friendship or feeling in control might be used to assess effectiveness. Another problem is that diagnostic tools may be culturally specific and misleading when applied to different ethnic populations. Research and screening instruments for identifying mental health problems have rarely been developed or validated with different ethnic minority groups, so that over or under diagnosis among certain groups may reflect different cultural understandings of mental health. Work to promote mental health and the development of local mental health promotion strategies will need to engage with different cultural and ethical perspectives on the meaning and interpretation of mental health problems. This will involve placing the views and experiences of users and survivors at the centre, as well as developing indicators of the mental health, as opposed to the mental illness of individuals, organisations and communities. We also need broad measures of progress that can be used to assess the impact of local mental health promotion strategies. These might include explicit inclusion of mental health promotion in all relevant policy initiatives across the locality/region and programmes with supporting goals such as Coronary Heart Disease, Sexual Health, Older People or Neighbourhood Renewal strategies. An increase in settings with mental health promotion activity or organisations with mental health promotion policies would also provide positive measures. For example, the number of schools signed up to the Healthy Schools initiative, prisons adopting Health Promoting Prison status, or the number of local employers including mental health within their equal opportunities policy. All these debates are significant for the evaluation of mental health promotion interventions because they will influence: how the problem is defined; identification of appropriate responses to the problem; how success is measured and by whom. |
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www.mentality.org.uk |
