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Title of Report Adult Mental Health and Emotional Wellbeing Health Needs Assessment for Wiltshire Image to symbolise topic can go in here Adult Mental Health and Emotional Wellbeing: Health Needs Assessment for Wiltshire Part of the JSA Family Part of the JSA family Needs Assessment/Report prepared by: Dr Charlotte Bigland Public Health Telephone: 01225 716879 Email: [email protected] www.wiltshirejsa.org.uk Page 1 Part of the JSA Family Adult Mental Health and Emotional Wellbeing: Part of the JSA Family Health Needs Assessment for Wiltshire Executive Summary Background Mental health is everybody’s business and there is no other area of health that combines mental health’s frequency of occurrence with its persistence and breadth of impacts. Mental health is a significant cause and effect of health inequalities. Thus reducing mental health inequalities is an important part of tackling wider population inequalities. Working towards parity of esteem for mental health is a key goal enshrined in both local and national policy. The national guiding principles for mental health service provision are that o Decisions must be locally led. o Care must be based on the best available evidence o Services must be designed in partnership with people who have mental health problems and with carers o Inequalities must be reduced to ensure all needs are met, across all ages o Care must be integrated – spanning people’s physical, mental and social needs o Prevention and early intervention must be prioritised o Care must be safe, effective and personal, and delivered in the least restrictive setting o The right data must be collected and used to drive and evaluate progress These principles are in line with local policies developed by Wiltshire Council and Wiltshire CCG. This mental health and wellbeing needs assessment takes a traditional epidemiological, corporate and comparative approach and aims to provide information and analysis that allows Wiltshire Council and Wiltshire CCG to better meet their strategic aims. This needs assessment does not focus on dementia or those with learning disabilities as these are substantive issues outside the scope of this document. Local Demographics The population of Wiltshire is 486,000. In the next 25 years the population is expected to grow by 61,000 people (13% increase). The Wiltshire population structure has a higher proportion of older people than the national average and projections suggest that in 2026 the number of people over 65 will exceed the number under 20. Military rebasing is a significant driver of population growth; by 2020 it is expected there will be ~18,000 serving military personnel many of whom will have spouses and children. Approximately 6.6% of the population is BME which is around a third of the proportion observed nationally (20.2%). Page 2 Part of the JSA Family Adult Mental Health and Emotional Wellbeing: Health Needs Assessment for Wiltshire Part of the JSA Family 90% of the county is classified as rural. The county is relatively affluent. However, there has been an increase in relative deprivation since 2004 and there are substantial pockets of deprivation. Salisbury St Martin Central is in the 10% most severely deprived areas in the country. Factors Protective to Mental Health There is an important role for protective factors in promoting positive mental health and wellbeing in the population. The 5 Ways to Wellbeing Model is an established framework for considering protective factors that comprises o Connect o Be Active o Take notice o Keep learning o Give For Wiltshire, in the area of connect, there are some community areas with a very high risk of loneliness in the older population. A higher proportion of Wiltshire carers report feelings of isolation than the national average. In terms of physical activity, Wiltshire generally performs better than average although there are still significant portions of the population recorded as inactive. Wiltshire benefits from a large amount of green space although community area satisfaction with provision of green space is variable ranging from 70% to 88%. Education and employment levels in Wiltshire are generally good and above the national average, but there is a higher than average proportion of 16-17 year olds who are unemployed. There is little formal data available on volunteering levels in the county and it is hard to assess the level of protection being achieved in the “give” category. Risk Factors for Poor Mental Health There are a number of risk factors for experiencing poor mental health. The relationship between risk factors and mental health is often complex with many factors being both causes and effects of poor mental health. An understanding of local risk factors and their distribution allows services to be tailored to effectively manage local need. Risk factors can occur at a number of levels and this means that there are certain groups at increased risk of poor mental health as well as broader societal factors that can put people at risk. At risk populations may share some common characteristics but are diverse groups with diverse needs that need to be addressed at the individual level if services are to be effective. As a result, services need to be culturally competent to cope with diverse groups. Within Wiltshire key high risk groups include minorities, older people, carers, military and veterans, those with other issues such as poor physical health or learning disabilities and those at transition points e.g. moving out of care Page 3 Part of the JSA Family Adult Mental Health and Emotional Wellbeing: Part of the JSA Family Health Needs Assessment for Wiltshire The broader societal factors that increase the risk of poor mental health are complex and interconnected and will require a whole systems approach to amelioration. Health Inequalities and Deprivation Health inequalities are variations in health between population groups resulting from a variety of societal and economic processes that are unequally distributed within or between populations. They are avoidable and unfair. Those who experience poor mental health often experience health inequalities as a result of this. Ultimately, those with severe mental health conditions die between 15-25 years earlier on average than the general population. Additionally, there are inequalities in the distribution of risk factors for mental health such as smoking, harmful alcohol use and poor physical health and in the ability to access mental health services. Locally barriers to access include geographical inequalities and difficulties with getting transport to services. Population Need: - The Prevalence of Mental Health Problems In Wiltshire The main source of prevalence data used is from the Adult Psychiatric Morbidity Survey 2014 whose results were published in September 2016. This allows national estimates of prevalence split by age and sex to be applied to the Wiltshire population to provide local prevalence estimates. CMD There are an estimated 67,000 people in Wiltshire experiencing a common mental disorder. The prevalence rates for CMDs are growing faster in women than men. Treatment seeking habits are changing with 37% of cases receiving treatment compared to 23% seven years ago. This increase in treatment is seen across the number of prescriptions, GP consultations, community care appointments and IAPT. Applying the 37% treatment rate to Wiltshire, we would expect around 25,000 people to be receiving treatment for a CMD. PTSD Within Wiltshire, based on national prevalence rates, we can expect around 15,000 people to be experiencing PTSD. Adjusting for the military and veteran population this number may be even higher. This population is believed to be largely undiagnosed currently. Many of those with PTSD have other co-existing mental health issues making them complex cases requiring more specialist treatment. Eating Disorders There are an estimated 6,000 people in Wiltshire with eating disorders of whom the majority are younger women. Prevalence rates are thought to be growing. It is estimated 8/10 people nationally with eating disorders currently receive no treatment representing a large, under-served population. Page 4 Part of the JSA Family Adult Mental Health and Emotional Wellbeing: Health Needs Assessment for Wiltshire Part of the JSA Family Psychotic Disorders Nationally the rates of psychotic disorders are thought to be stable at around 0.5%, translating to an estimated 2,100 cases in Wiltshire. National incidence rates suggest we would expect to see 243 new cases in Wiltshire per year. This figure based on national prevalence, may slightly overestimate the local prevalence due to Wiltshire’s lower than average BME population. Personality Disorders There are an estimated 22,000 people in Wiltshire with a personality disorder. According to national data around two thirds will not be receiving treatment although around 10-15% will have requested treatment. Again, this represents an underserved population. Bipolar Disorder There are an estimated 7,700 people in Wiltshire living with bipolar disorder. This is a lifelong condition that can have significant impact on a person. Suicide and Self-harm The reported prevalence of self-harm is rising particularly amongst young women; a quarter of 16-24 year old women report self-harming. Overall, there are estimated to be around 29,000 cases of self-harm in Wiltshire a year. Most go unreported. There is also a slight increase in the rate of reported suicidal thoughts and attempts. Drug and Alcohol misuse There are an estimated 12,200 harmful drinkers in Wiltshire. The prevalence is growing in 55-64 year olds and falling in 16-24 year olds. This is a change and one services will need to adapt to. There are an estimated 12,100 people with a drug dependence in Wiltshire (includes cannabis, legal highs, opioids etc). Demand: Service Use Data The quality and quantity of service use data that is available is suboptimal for comprehensively assessing the gap between need and demand for mental health services in Wiltshire.
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