Gloucestershire’s Adult Mental Health and Wellbeing Needs Assessment Jennifer Taylor, GCC Public Health

Objectives To achieve a shared understanding of the mental health needs of Gloucestershire residents aged 18 years and over in order to inform the commissioning and provision of services To understand current prevalence of mental wellbeing and mental illness in Gloucestershire and consider how it may change in the future To describe current services and assess if they are appropriate and meet the need in Gloucestershire To highlight inequalities in mental health provision and areas where resource allocation and distribution do not match need for services. This needs assessment excludes children and adolescents and people with dementia

The Challenge! National prevalence data is often out of date and data quality can be poor/variable – but it’s the best we’ve got Scope is extremely broad – whole system, wide age range, range of commissioners and providers Prevention / early intervention need and activity difficult to scope and quantify

Structure Gloucestershire Population profile Determinants of mental health and wellbeing High risk groups Mental and emotional wellbeing in Gloucestershire Prevalence of mental health conditions Mental health services Perceived and felt needs

Common mental health disorder - risk and related factors Area Socioeconomic deprivation: overall IMD score (2015) Socioeconomic deprivation: % of people living in 20% most deprived areas Adults with low education: % of adults that have no qualifications or level one qualifications Long-term health problems or disability: % of people whose day-to-day activities are limited by their health or disability Statutory homelessness: rate per 1000 households Supported asylum seekers: Rate per 10,000 population Unpaid carers: % of population who provide substantial unpaid care Cheltenham 15.1 10.5 27.9 * 1.7 Cotswold 11.2 0.0 31.3 16.1 0.8 1.8 Forest of Dean 17.0 1.6 38.9 19.6 0.4 2.7 Gloucester 22.0 23.5 37.9 16.8 3.4 5.7 2.3 Stroud 10.9 31.1 16.7 0.2 2.0 Tewkesbury 12.1 3.3 32.5 16.5 2.4 Gloucestershire   7.5 33.1 1.4 2.1 England 21.8 20.2 35.8 17.6 3.9 Gloucestershire ranks 124 out of 152 upper-tier authorities according to the Index of Multiple Deprivation (IMD) 2015, putting it in the least 20% deprived County for overall deprivation in England. However 7.5% of people in Gloucestershire are living in 20% of most deprived areas in England. However, 13 neighbourhoods (Lower Super Output Areas, i.e. LSOAs) in the County are identified as among the most deprived 10% nationally for the IMD, an increase from 8 areas in 2010 (10 from Gloucester, 3 from Cheltenham). These areas account for around 20,600 people, i.e. 3.4% of the population in the County, comprising 4,700 children and young people aged 0-17, 13,300 people aged 18-64 and 2,600 older people aged 65+. Source: PHE, Public Health profiles, Common mental health disorder Compared with England: Higher Lower Similar * no data Based on early findings, Gloucester and Forest of Dean highlight higher levels of risk factors vs the England average.

Gloucestershire population groups (18+) with relevance to risk factors impacting on mental health and mental wellbeing People with learning disability People living with a physical disability People living with a life limiting illness People with alcohol or substance misuse problems People who have suffered domestic abuse People within the criminal justice system Carers (including carers of people with mental health conditions) YP who transition from CYPS to Adult MH YP who have received CYPS but don’t transition into Adult MH Young people leaving care Adults who were in care as young people People who are unemployed (particularly long term unemployed) People who are in debt Homeless people Gypsy and Traveller groups Refugee and asylum seekers People who are LGBT People within black and minority ethnic communities Armed forces Mental health is influenced by a multitude of factors ranging from individual and population characteristics such as age, gender, ethnicity, sexuality and disability to wider determinants of health such as social, economic and environmental conditions. However, we identified specific population groups in Gloucestershire who were likely to be at greater risk of developing mental ill health. These include:

Self reported wellbeing for Gloucestershire Self-reported wellbeing scores for Gloucestershire residents were similar to the English average. However within the comparison group, Gloucestershire is one of the four lowest LAs. The same trend is observed in relation to feeling worthwhile, feeling happy or feeling anxious – the scores are similar as England average, however the scores are worse than most of statistical neighbour comparison group. There is a higher proportion of residents reporting low score of life satisfaction than England average. Self-reported wellbeing scores on “satisfied, worthwhile, happiness and anxious” for Gloucestershire residents were similar to the English average. However within the comparison group, Gloucestershire is one of the lowest LAs.

Self reported wellbeing for Gloucestershire (2014-15) 5.1% of people reported low satisfaction score (England 4.8%) 4.2% of people reported low score of feeling worthwhile (England 3.8%) 9.3% of people reported low happiness score (England 9.0%) 17.2% living with high anxiety score (England average 19.4%), There is a higher proportion of residents reporting: low score of life satisfaction; low score of feeling worthwhile, low happiness score; than England average. Reviewing the lower end of the scores it highlights that there is higher than England average score for low satisfaction, worthwhile and happiness.

Early findings – prevalence in population   Gloucestershire England Prevalence of All phobias: Estimated % of population aged 16-74 1.9 1.8 Prevalence of Depressive episode: Estimated % of population aged 16-74 1.3 2.5 Prevalence of eating disorders: Estimated % of population aged 16+ 6.7 Prevalence of Generalised anxiety disorder: Estimated % of population aged 16-74 4.2 4.5 Prevalence of Mixed anxiety and Depressive disorder: Estimated % of population aged 16-74 9.4 8.9 Prevalence of Obsessive compulsive disorder: Estimated % of population aged 16-74 0.8 1.1 Prevalence of Panic disorder: Estimated % of population aged 16-74 0.6 0.7 Prevalence of post traumatic stress disorder (PTSD): Estimated % of population aged 16+ 3.1 3.0 Admissions for depression: Directly standardised rate for hospital admissions for unipolar depressive disorders per 100,000 aged 15 and over 24.4 32.1 Depression and anxiety among social care users: % people who use services who report that they feel moderately or extremely anxious or depressed 49.1 52.8 Emergency admissions for neuroses: Indirectly age and sex standardised rate per 100,000 population 12.0 21.7 Mortality from suicide and injury undetermined: standardised rate per 100,000 11.0 Future prevalence of All phobias: Estimated % of population aged 16-74 Future prevalence of Depressive episode: Estimated % of population aged 16-74 2.6 Future prevalence of Generalised anxiety disorder: Estimated % of population aged 16-74 4.1 4.7 Future prevalence of Mixed anxiety and Depressive disorder: Estimated % of population aged 16-74 9.2 9.3 Future prevalence of Obsessive compulsive disorder: Estimated % of population aged 16-74 Future prevalence of Panic disorder: Estimated % of population aged 16-74 Source: PHE, Public Health profiles, Common mental health disorder Majority of prevalence findings are lower or similar levels vs the England average yet, Mortality from suicide (2.1%) and Mixed anxiety and Depressive disorder (0.5%) are higher Future levels are predicted to be lower than the England average Compared with England: Higher Lower Similar

Prevalence of mental health in primary care Anxiety accounts for 65% of GP registered population of adult diagnosed with a mental health condition This is 2.12% of the total GP registered population (13,280) All other conditions (personality disorder, schizophrenia, bipolar and self-harm) account for 1.16% of the total GP registered population

Prevalence of mental health in primary care Similar trends are seen across all localities but North and South Cotswolds highlight a significantly higher proportion of people diagnosed with anxiety and a lower proportion of personality disorder and schizophrenia. Tewkesbury shows a higher proportion of people diagnosed with personality disorder. Initial findings show that in Gloucester there is clear relationship between surgeries in the most deprived areas and a higher proportion of patients with mental health issues registered to these GPs 5 highest level of mental health diagnosing surgeries are in deprived areas However in Cheltenham the central surgeries have a higher number of patients registered with a MH condition. The reason for this is not clear, however it possible that the reason for this is that, patients are travelling to a more centrally located surgery. The total number of patients registered in the most deprived area of Cheltenham is low.

Work in progress Further work to be completed on: Service data (CCG and 2gether Trust leading) Data on use of prevention / early intervention services and services provided by voluntary / private sectors Further work to complete data on high risk groups

How can you help? Feedback and reflections on early findings Guidance on what we might have missed Provision of / signposting to data that might fill the gaps Please send feedback to angelika.areington@gloucestershire.gov.uk