Mental health in adults (health and wellbeing needs in South Tyneside)

The Marmot Review: Fair Society Health Lives identifies a number of factors that have a negative impact on mental health. These include:

• Unemployment and stress
• Poor housing / homelessness
• Socio-economic deprivation
• Loneliness, isolation and bereavement
• Abuse, stigma and discrimination
• Poor physical health / trauma
• Substance misuse

The Marmot Report of 2010 described the role of addressing the wider determinants of health in improving health and reducing inequalities, and the contribution of positive mental wellbeing to preventing mental illness.

The adverse social factors linked to mental illness include unemployment, lower educational attainment, poorer material circumstances and increased risk taking behaviour (University of Galway: The influence of social, demographic and physical factors on positive mental health in children , adults and older people).

Mental illness is closely associated with many forms of inequalities.

Health inequalities are avoidable and unfair differences in health status and determinants between groups of people due to demographic, socioeconomic, geographical and other factors.

These differences can be in relation to prevalence, access to, experience and quality of care and support, as well as opportunities and outcomes. Health inequalities can mean reduced quality of life, poorer health outcomes and early death for many people (GOV.UK: Health matters reducing health inequalities in mental illness).

South Tyneside is one of the 20% most deprived local authorities in England and about 26.4% (6,770) of children live in low-income families (See:Our South Tyneside report 2023). Life expectancy for both men and women are lower than the England average.

Groups at risk

Perinatal maternal mental health

This refers to women's mental health during pregnancy up to the time immediately after childbirth.

The incidence of some conditions, such as anxiety, is not significantly changed in the perinatal period. However, perinatal obsessive, compulsive disorder and puerperal psychosis are specifically associated with pregnancy and childbirth.

Perinatal mental illness impacts on the health and wellbeing of women, children and families and affects between 10 and 20% of women during pregnancy or within the first year after having a baby (Centre for Mental Health: Costs of perinatal mental health problems).

Adverse childhood experiences

Mental health problems are higher among children who experience poverty, low educational attainment, domestic violence, and bullying.

Children who experience abuse have an increased risk of experiencing illnesses such as depression and post-traumatic stress disorder in adulthood, looked after children have an increased risk of suicide attempt and having multiple adverse childhood experiences is a major risk factor for many health conditions (PubMed (nih.gov): The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis). 

Other vulnerable children include those with a parent who will have some degree of common mental illness, as well as alcohol or drug problems and personality disorders. Few children live with a parent who has a severe mental illness (Royal College of Psychiatrists: Parental mental illness).

Domestic abuse 

Domestic abuse is has a devastating impact on physical and mental health, emotional wellbeing, housing, finances, work and, where children are impacted, their schooling and educational attainment. It can also result in victims and families moving away from their own homes, local community, and support networks for them to feel and be safe.

South Tyneside Domestic Abuse Strategy outlines the development of safe accommodation and improving the range of support available across South Tyneside to address the needs identified because of domestic abuse directly and indirectly in accordance with the Domestic Abuse Act 2021. 

In employment

A major factor in maintaining good mental health is stable employment. The relationship between mental health and unemployment is bidirectional.

Good mental health is a key influence on employability, finding a job, and remaining in that job. Unemployment causes stress, which ultimately has long term physiological health effects and can have a negative impact on mental health, including depression, anxiety, and lower self-esteem (The Health Foundation: Unemployment and mental health). 

Employment can also be a source of stress, particularly within work contexts in which people experience high demands and lack of control in their work environment. Working in insecure, low paid occupations is also a risk to mental health.

People with mental illness are also more likely to experience discrimination in the workplace.

Older people

As people live longer protecting their mental health and wellbeing will become more of a need to meet and prevent.

Depression is the most common mental disorder in people aged 9 over 65 years.

Dementia (see our Dementia JSNAA), delirium, and substance misuse are also linked with poor mental health in older people and schizophrenia affects about 1% of the older population.

Having a long-term condition 

Long term conditions such as diabetes, arthritis, asthma, cardiovascular diseases, and cancer is associated with higher risk of poor mental health.

Long term conditions can lead to significantly poorer health outcomes and reduced quality of life.

People with long term conditions disproportionately live in deprived areas and have access to fewer resources of all kinds.

Link between long term conditions and mental health

Around 40% of people with depression and anxiety disorders also have a long-term condition (LTC) such as cardiovascular disease, COPD, diabetes, and musculoskeletal disorders.

Around 30% of people with an LTC and 70% with medically unexplained symptoms (MUS), also known as persistent physical symptoms) also have mental health comorbidities.

The relationship between poor mental health and poor physical health is complex and bi-directional.

It is likely to involve a range of biological, psychosocial, environmental, and behavioural factors, which can have an impact on a person's physical health, both directly and indirectly.

Carers

Carers are more at risk of mental health problems, such as anxiety and depression than the general population, and are less likely than the population generally, to ask for support.

According to the 2021 census there are an estimated 14,875 unpaid carers in South Tyneside, with 14,000 adult carers.

Caregiving, whether paid or informal, can be a stressful role to play, with many carers experiencing 'carer strain', leading to declines in physical and mental health.

Unpaid carers are at higher risk of common mental health problems, with 42% experiencing increased stress, 33% suffering from anxiety, and 27% suffering from depression. Bereaved carers also exhibit poorer levels of overall mental health compared to the general population (ScienceDirect: The acute effects of mental fatigue on balance performance in healthy young and older adults).

Ethnic minority

Cultural perceptions about mental health can affect both access to and experience of services. An individual's experiences of mental health services may additionally be influenced by factors such as age and gender.

This means that there is no single 'BME mental health problem'.

They may range from a person whose first language has no word to describe depression, through to a person who has no confidence in statutory services.

Data shows higher rates of common mental health disorders and psychotic disorders have been found in people from minority ethnic backgrounds.

There are disproportionate rates of people from ethnic minority populations being detained under the Mental Health Act 1983.

Lesbian, gay, bisexual and transgender (LGBTQI+)

Evidence suggests that people who identify as lesbian, gay, bisexual and / or transgender (LGBTQI+) are at higher risk of experiencing poor mental health (Cambridge University Press).

This higher prevalence could be associated with factors, such as discrimination, isolation, and homophobia.

Compared to the general population, members of the LGBT community have greater exposure to negative wider determinants of health, such as abuse, unemployment, and trauma.

They are recorded as having poorer experiences of hospital and residential care, poorer access to health and social care provision and are particularly subject to stigma, insensitivity, and discrimination. LGBTQI+ people have higher rates of poor mental health compared to the general population.

Offender mental health and wellbeing

Prisoners have been shown to have significantly higher rates of mental health problems compared to the general population.

Asylum seekers and refugees

Mental illness is more prevalent among asylum seekers and refugees.

Several factors have a detrimental impact, for instance experience of trauma, the process of claiming asylum and detention, separation from family, unemployment, and inadequate housing.

Veterans

A minority of veterans leaving the armed forces need access to mental health services, while others might require it later in civilian life.

Post-traumatic stress disorder, stress and anxiety are problems commonly experienced by veterans.

Homeless people

Mental illness is more common among homeless people.

Serious mental illness is present in 25 to 30% of people who are sleeping rough or in hostels.

Co-occurring mental ill health and substance dependence is common amongst people who sleep rough. Alcohol and drugs may be used to self-medicate poor mental health, and substances may also be used in conjunction to aid sleeping, pain, and cold temperatures.

It is common for people with mental health needs to have difficulties accessing treatment for co-existing alcohol or drug use, a particular problem for those diagnosed with serious mental illness, who may also be excluded from alcohol and drug services due to the severity of their mental illness. (GOV.UK: Health matters - Rough sleeping)

People with dual diagnosis

A person with dual diagnosis has both mental ill health and an alcohol or drug problem.

Elements of care, such as diagnosis and treatment are difficult and individuals have a higher risk of relapse, readmission to hospital, self-harm, and suicide.

Substance misuse among people with mental health problems is usual rather than exceptional and treatment for substance misuse problems often improves mental health.

Social inequalities and mental illness

Reduced life expectancy

People with serious mental health problems die prematurely.

The life expectancy of someone with a serious mental health problem, such as bipolar disorder or schizophrenia, is 15 to 20 years less than the general population. This is mostly from preventable physical health problems such as cardiovascular disease and cancers (GOV.UK: Wellbeing and mental health).

Life expectancy is 9.3 years lower for men and 8.1 lower for women in the most deprived areas of South Tyneside than in the least deprived areas. 

Poor physical health: People with common mental health disorders are more likely to engage in behaviours that are detrimental to overall health, such as poor diet, physical inactivity, heavy smoking and drug and alcohol misuse. 

In comparison people with Severe Mental Illness (SMI) often experience poor physical health as well as poor mental health, frequently developing chronic physical health conditions at a younger age than people without SMI.

It is estimated for people with SMI, 2 out of 3 deaths are from physical illness which are preventable (GOV.UK: Premature mortality in adults with severe mental illness).

Alcohol misuse

Excessive consumption of alcohol is associated with poor mental health. The risks of hazardous drinking increase following stressful life events.

There are an estimated 589,000 people who are dependent on alcohol in England and about a quarter of them are likely to be receiving mental health medication, mostly for anxiety and depression, but also for sleep problems, psychosis, and bipolar disorder (UK Health Security Agency: Alcohol dependence and mental health).

Smoking

Smoking remains the leading cause of premature mortality in England.

Smoking rates in people with Severe Mental Illness (SMI) are significantly higher compared to the general population (40.5% compared with 12.1%) with rates as high as 70% in people with schizophrenia and bipolar disorder.

There is also higher occurrence of smoking related harm among people with an SMI. Smoking is a key modifiable risk factor that contributes towards excess mortality in people with SMI, with an estimated 50% of deaths in people with SMI are attributable to smoking.

Depression

Older adults who are depressed are more likely to have existing physical health conditions and more likely to develop physical health conditions. In particular depression is associated with cardiovascular disease and diabetes (British Journal of Medical Practitioners: Depression in older adults).

Long-term physical health conditions

Long term physical health conditions are more common among older adults than those of a younger age, and they are associated with a twofold risk of poor mental health (Centre for Mental Health).

There is also evidence that people who have a co-occurring mental health problem alongside a physical illness have poorer outcomes for their physical condition, resulting in worse health for them and higher costs for health and care services.

Discrimination and stigma

Stigma is a common experience for people with mental health problems.

It may compound inequality, by reducing employment opportunities and weakening supportive social networks.

For some people, stigma is compounded by additional discriminations on the grounds of ethnicity, physical illness, cultural background or sexuality.

Social exclusion

People with mental health problems, particularly those with long-term psychoses, are among the most excluded groups in the United Kingdom.

They may be excluded from material resources (poverty), from socially valued productive activity, from social relations and neighbourhoods, from civic participation and from health and health services (Emerald Insight: Social exclusion and mental health - how people with mental health problems are disadvantaged).

The Commission for Equality in Mental Health (2020) has explored a wide range of ideas to boost mental health equality and whilst acknowledge there are no simple solutions or overnight remedies for entrenched injustices, have found that effective action is possible.

This is about communities, local organisations, and regional / national partners working together to generate change at scale to prevent social exclusion. Feedback received via the engagement work undertaken in South Tyneside also suggested that further community work is required to engage with and reach out to harder to reach cohorts.