Understanding severe mental health problems

Knowledge summaryThis knowledge summary provides an introduction to understanding severe mental health problems. It covers prevalence, associated social problems and interventions that can promote recovery.

The information presented here is adapted from fully referenced source material at Emotional Wellbeing.

How common are severe mental health problems?

Severe mental illness is often used to describe psychosis and bipolar disorder. About one in 200 people have psychosis or bipolar disorder1 – some need high levels of support and skilled interventions but many with the right support, will be recovering and managing their lives well

Depression, anxiety disorders, eating disorders and severe emotional difficulties can also be very distressing and debilitating.

Approximately half of those with lifetime mental health problems first experience symptoms by the age of 142: three-quarters by their mid-20s so these can last a lifetime3.

Associated social problems

Estimated unemployment rates amongst individuals with severe mental illness are up to 95%4.

Nearly half (24,429) of all clients with disabilities accessing Supporting People housing-related support in 2008/09 had a mental health disability. Of these 50% were subject to the Care Programme Approach (CPA) 5. People with mental health conditions are more likely to live in rented accommodation than to be owner occupiers.

People with mental health conditions are twice as likely as those without mental health conditions to be unhappy with their housing and four times as likely to say that it makes their health worse. Mental ill health is frequently cited as a reason for tenancy breakdown. Housing problems are frequently cited as a reason for a person being admitted or re-admitted to inpatient care: finding appropriate accommodation is a major reason for delays in discharge6.

People with severe problems die on average 20 years earlier than the general population 7.

What can promote recovery from severe mental illness?

The following interventions can promote recovery from severe mental illness

Anti-stigma campaigns
Campaigns such as Time to Change (www.time-to-change.org.uk/) can help to tackle the stigma associated with mental illness. Read more »

Early Intervention
Can help to redurce the Duration of Untreated Psychosis (DUP) and provide long-term benefits in terms of cost and health gain including recovery8 Early Intervention »

Medication
Is used for most serious problems: the evidence-base for the use of antipsychotics in psychosis, antidepressants in severe depression and mood stabilisers in bipolar disorder is robust.

Psychosocial treatments
These are commonly known as Talking therapies. They are valued by those receiving them, they have demonstrable effectiveness and, even with modest cost assumptions, appear to reduce high cost care in people with psychosis, bipolar disorder and severe emotional difficulties (‘borderline personality disorder’). Talking therapies »

Meaningful activity
Contributes to socialisation, self-esteem and financial situation. Social prescribing is a mechanism for linking patients with non-medical sources of support within the community e.g. ‘exercise on prescription’ and ‘prescription for learning’.

Employment support
Evidence shows that people are far more likely to recover from mental health problems if they are in employment than if they are not. Employment »

Accommodation
Having secure and settled accommodation, with the right kind of support, can have a positive impact on people’s recovery. Housing »

Personalised care
Aims to meet the needs of individuals in ways that work best for them. It includes prevention, early intervention, and self-directed support where people are in control of arranging and managing their own support services.

Primary care
Is key to changing the high rates of physical illness amongst people with severe problems and promoting recovery. Primary care »

Specialist and Integrated Community Mental Health Teams
Community mental health teams (CMHT) have been the mainstay of community based provision for 20-30 years providing long term support to people with serious mental health problems. The introduction of specialist teams (early intervention, assertive outreach and crisis resolution and home treatment) as part of the National Health Service (NHS) Plan in 2000 have had a major impact on service delivery in England but integrated teams are now re-emerging in some areas.

Rehabilitation services
2/3rds of people with complex and long-term mental health needs who are supported by rehabilitation services can progress to successful community living within five years and around 10% will achieve independent living within this period9. Those who receive support from rehabilitation services are eight times more likely to achieve and/or sustain successful community living than people with similar problems who were receiving support from generic community mental health services10. Rehabilitation services »

Specialist services
This includes Perinatal mental health services, Eating disorder services, ‘Borderline personality disorder’ services, Mood disorders clinics, Psychosis specialist services and services for specific groups, e.g. hearing impaired, autism, ADHD.

Integration of physical and mental health care
Improved collaboration between primary, community and secondary care services can help to tackle to the fact that people with severe problems are likely to die 20 years earlier than the rest of the population7 Physical health »

Support for Carers
Support from families, friends and carers can have a strong influence on recovery, supporting a crisis and relapse prevention. Carers »

Care programmes and pathways
Can empower service users, carers, staff and commissioners, guiding them through a complex system, which need not be chaotic, making choice and effective treatment available, driving necessary change while improving efficiency and quality11.

References

1. NHS Information Centre (2009) Adult psychiatric morbidity in England, 2007: results of a household survey. London: NHS Information Centre. https://www.ic.nhs.uk/pubs/psychiatricmorbidity07

2. Kim-Cohen J., Caspi A., Moffit T. (2003) Prior juvenile diagnoses in adults with mental disorder. Archives of General Psychiatry 2003;60:709-17. https://www.ncbi.nlm.nih.gov/pubmed/12860775

3. Kesser R., Wang P. (2007) The descriptive epidemiology of commonly occuring mental disorders in the United States. Annual Review of Public Health 2007;29:115-29. https://www.ncbi.nlm.nih.gov/pubmed/18348707

4. Burns T., Catty J., Becker T., Drake R. E., et al. (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 2007;370(9593):1146-52. https://www.ncbi.nlm.nih.gov/pubmed/17905167

5. Office of the Deputy Prime Minister (2004) Mental Health and Social Exclusion: Social Exclusion Unit report. London: HMSO. https://www.communities.gov.uk/archived/publications/corporate/mentalhealth

6. Tulloch A.D., Fearon P., David A.S. (2012) Timing, prevalence, determinants and outcomes of homelessness among patients admitted to acute psychiatric wards. Social Psychiatry and Psychiatric Epidemiology 2012;47(7):1181-91. https://www.ncbi.nlm.nih.gov/pubmed/21755344

7. Brown S., Kim M., Mitchell C., Inskip H. (2010) Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 2010;196:116-21. https://www.ncbi.nlm.nih.gov/pubmed/20118455

8. Hegelstad W. T., Larsen T. K., Auestad B., Evensen J., Haahr U., Joa I., et al. (2012) Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. The American Journal of Psychiatry 2012;169(4):374-80. https://www.ncbi.nlm.nih.gov/pubmed/22407080

9. Killaspy H., Zis P. (2012) Predictors of outcomes of mental health rehabilitation services: a 5-year retrospective cohort study in inner London, UK. Social Psychiatry and Psychiatric Epidemiology 2012;.

10. Lavelle E., Ijaz A., Killaspy H. (2011) Mental Health Rehabilitation and Recovery Services in Ireland: a multicentre study of current service provision, characteristics of service users and outcomes for those with and without access to these services: Final Report for the Mental Health Commission of Ireland, 2011. https://lenus.ie/hse/handle/10147/208790

11. Gask L., Khanna L. (2011) Ways of working at the interface between primary and specialist mental healthcare. British Journal of Psychiatry 2011;198:3-5. https://www.ncbi.nlm.nih.gov/pubmed/21200068