Shropshire Mental Health Needs Assessment February 2018 Contents Executive Summary ...................................................................................................................... 3 Recommendations........................................................................................................................ 3 Preface: What is Mental Health? ................................................................................................... 5 Introduction ................................................................................................................................. 6 Mental Health during the course of Life ..................................................................................... 7 Risk Factors for Children and Young People ................................................................................ 7 Risk Factors for Adults ............................................................................................................... 8 National Policy Context ............................................................................................................. 9 Purpose of the Shropshire Adult Mental Health Needs Assessment ............................................... 10 Methodology .......................................................................................................................... 10 Section 1: Shropshire Profile Demographics ................................................................................. 12 Population.............................................................................................................................. 12 Population Projections (2017 to 2037) ..................................................................................... 13 Ethnicity ................................................................................................................................. 14 Economy and Employment ...................................................................................................... 15 Deprivation ............................................................................................................................ 15 Office for National Statistics: Measuring Wellbeing and Life Satisfaction .................................... 19 Wider Determinants of Health and Wellbeing........................................................................... 21 Social housing/rented accommodation................................................................................. 21 Living alone......................................................................................................................... 24 Single Parent Family Households .......................................................................................... 26 Education (all age) ............................................................................................................... 27 Access to Services................................................................................................................ 28 Section 2: Common mental health disorders ................................................................................ 29 Findings from the Adult Psychiatric Morbidity Survey (2014) ..................................................... 29 CMD prevalence in Shropshire ................................................................................................. 30 Comparison of Shropshire male and female CMD prevalence .................................................... 33 CMD outcomes for Shropshire (Public Health England Fingertips Data) ...................................... 35 Demographics by Cluster......................................................................................................... 41 Non Psychotic illness - mild, moderate, severe ...................................................................... 41 Section 3: Severe and enduring mental illness .............................................................................. 44 Page 1 of 103 3.1 Severe and complex mental illness ..................................................................................... 44 Severe and complex mental health outcomes for Shropshire (PHE Fingertips Data) .................... 45 Non psychotic – very severe and complex disorders .............................................................. 47 3.3 Psychotic Disorders ........................................................................................................... 50 Group 1: psychosis 1st episode ............................................................................................. 52 Group 2: psychosis ongoing or recurrent............................................................................... 56 Group 3: Psychotic crisis ...................................................................................................... 59 Group 4: Psychosis with very severe engagement ................................................................. 62 Section 4: Crisis, Self-Harm and Suicide ........................................................................................ 65 Crisis ...................................................................................................................................... 65 Section 136 ............................................................................................................................ 65 Shropshire Sanctuary .............................................................................................................. 66 Suicide ................................................................................................................................... 67 Application to Shropshire..................................................................................................... 68 Suicide Prevention in Shropshire.............................................................................................. 69 Self-Harm ............................................................................................................................... 70 Shropshire demographics of self-harm ................................................................................. 71 Section 5: Mental Health and Substance Misuse – Dual Diagnosis ................................................. 77 Alcohol Consumption .............................................................................................................. 78 Drug misuse ........................................................................................................................... 79 Adults receiving substance misuse and mental health treatment ............................................... 80 Young people In Treatment (ages 10 to 18 years) ..................................................................... 81 Section 6: Co-morbidity in Mental and Physical Illness .................................................................. 82 Mental and Physical Health in Shropshire ................................................................................. 82 Section 7: Service User Feedback................................................................................................. 84 Overarching Themes ............................................................................................................... 84 Emerging Trends ..................................................................................................................... 85 Potential Improvements identified by service users and providers ............................................. 85 Section 8: Commissioned Mental Health services in Shropshire ..................................................... 87 Adult and Older People’s mental health services ...................................................................... 87 Emotional Health and Wellbeing Service (EHWB) ...................................................................... 88 Adult Learning Disability Services ............................................................................................. 89 Improving Access to Psychological Therapies ............................................................................ 89 Additional Services:................................................................................................................101 Page 2 of 103 Executive Summary The Shropshire Mental Health Needs Assessment seeks to identify and describe the patterns of mental health problems for adults within Shropshire, identify inequalities in mental health (including access to services) and to determine the priorities for the most effective use of resources to inform whether the content and configuration of existing services is appropriate for our population. Ensuring our population has good mental and emotional health is important as it impacts on all aspects of people’s lives, including links with good physical health, social participation, ability to cope with the normal stresses of life, developing personal relationships, education, training and ability to fulfil potential in employment opportunities. Managing a positive state of mental wellbeing is associated with a range of positive social outcomes such as educational success, wealth, employment, self-awareness and acceptance of others. There is however, no evidence that these social outcomes alone can improve mental wellbeing. Conversely, there is evidence that negative social factors such as educational failure, poverty, unemployment and