Annual Public Health Report 2014Mental Health and Wellbeing

in Kingston

Dr Jonathan HildebrandDirector of Public Health

www.kingston.gov.uk

I will discuss• What is in the report?• Key Kingston statistics• Main issues from this year’s report

www.kingston.gov.uk

What is in the report?Sections on:• Improving mental wellbeing• Better environment for mental health• Parenthood, children and mental health• Adults and mental illness• Physical health, lifestyles and mental health• Detailed mental health profile• General demographic information

www.kingston.gov.uk

Population key facts• 2013 mid year estimate is 166,793 residents and the

population is projected to increase to 176,402 by 2018• Highest % increase in people aged 70 -79 (36%)• People from Black and Minority Ethnic groups comprised

26.2% of the total population in 2012• A total of 197,291 people were registered with Kingston GPs

in March 2014 - nearly 30,500 more than the 2013 resident population

• There were 2,328 births in Kingston in 2011, which is 39 more births than the previous year

www.kingston.gov.uk

Population key facts/cont’d• Life expectancy for men is 81.4 years, 2.2 years more than the

England average whilst for women it is 84.8 years, 1.6 years more than the England average

• Kingston ranks 36th out of 346 LAs for men and 33rd for women• Healthy life expectancy – based on a self-reported measure -

in Kingston is 63.5 years for men and 64.4 years for women• So on average men in Kingston will spend just under 18 years

in poor health whilst for women the figure is 20 years• In Sweden and Switzerland healthy life expectancy is 73 years

www.kingston.gov.uk

Population key facts/cont’d• The gap in life expectancy between the most and least

deprived tenths of the local population is 5.8 years for men and 3.7 years for women

• The largest cause of the gap is circulatory disease which makes up 47% of the gap in women and 36% in men...and can be addressed by preventive measures

• There were 1,020 deaths in Kingston in 2012, 9 less than the previous year

• 70% of deaths in 2012 were due to three disease groups:

281 (27%) circulatory disease

269 (26%) cancer

181 (17%) respiratory diseasewww.kingston.gov.uk

Mental wellbeing

• Mental wellbeing is a positive state of mind and body, feeling safe and able to cope and having a sense of connection with people, communities and the wider environment

• It results in a greater sense of belonging and participation, better physical health and longer life expectancy

www.kingston.gov.uk

Five ways to wellbeingThe mental health equivalent of fruit and veg. 5 a day

1. Connect with others...invest time in families, friends, colleagues and neighbours

2. Be physically active...doing something you enjoy that suits your overall fitness level

3. Take notice...be mindful of the world around you4. Keep learning new things5. Give to others...or do something nice for

someone

www.kingston.gov.uk

Resilient communities• Resilience is the ability of a community to utilise resources and

assets to withstand adverse circumstances and vulnerabilities that would otherwise impact on their wellbeing

• Most vulnerable parts of our community are people living in areas of disadvantage and some minority groups

• Life expectancy of Gypsy and Traveller men is 20 years less than the national average & two thirds of refugees and asylum seekers have experienced mental health problems

• Local actions taken include the ECET run Community Engagement for Health Course – 59 graduates so far

‘...thank you for giving me the self esteem and confidence to study as an adult’

www.kingston.gov.uk

Resilient Communities/Cont’d• Three Participatory Needs Assessments completed – most recently

in Malden Manor.• Working with the community by techniques such as digital photo-

diaries• Information used by the local Children’s Centre to increase family

registration from 65% to 76%

• Refugee Action Kingston runs a time bank where everyone’s time is valued equally • This enables refugees and asylum seekers to use their skills and play an active role in the community• Participants have reported a reduction in levels of isolation

www.kingston.gov.uk

Housing • Living in poor quality housing and not having a

permanent home impacts upon mental wellbeing• The number of households in Council provided

temporary accommodation has reduced from 812 in 2006 to 436 in 2013

• The ‘Better Homes’ programme improved 662 homes last year and will result in £16M being spent by June 2015

• Action is being taken to assist householders who are in fuel poverty

www.kingston.gov.uk

Green spaces

• Contact with safe green spaces improves people’s mental wellbeing

• Three Kingston parks received a ‘Green Flag’ award in 2014 – Canbury Gardens, Fishponds Park and Manor Park

• A Sports Development Manager has been working with local fitness providers to make full use of local parks and the regular appearance of this type of activity in green spaces provides assurance to other visitors

• Additional areas in the full report are Active Travel and Planning

www.kingston.gov.uk

Work and income• Economic security is important in maintaining mental wellbeing, as is

being in work• People with high levels of debt are at a threefold risk of mental health

problems whilst economically inactive adults have a nearly twofold risk• Kingston CAB runs the ‘Money Talks’ programme for both professionals

and residents giving advice on budgeting, energy bills and debt avoidance

• Balance CIC works with vulnerable people including those with mental health problems to support them into work. 119 people have been supported into employment since 2011

• Public Health works with local employers so that they can be awarded the Healthy Workplace Charter – 10 businesses have received this so far

www.kingston.gov.uk

Mental health of parents• More than 1 in 4 people will have mental health problems in their life, and

many of these will have parenting responsibilities at the time of their illness• Meeting the needs of families where parents have mental health problems

raises practical, professional and organisational challenges for services• The Social Care Institute for Excellence guide ‘Think Child, Think Parent,

Think Family’ outlines a recommended approach• A consultation was held with parents with mental health problems and

professionals in 2014 which revealed that half of respondents had sought help unsuccessfully at some point and that fear of being seen as a ‘bad parent’ or being afraid of their children being taken away acted as factors that stopped people seeking help

• A ‘Families Connected’ pilot project is underway in Kingston and evaluation of this will assist in the development of a permanent service

• The report also discusses postnatal depression in depth www.kingston.gov.uk

Prevention of mental health problems in children

• Between 25% and 50% of adult mental illness can be prevented if there is early intervention in childhood or adolescence

• 40-70% of children with conduct disorders develop antisocial personality disorder later in life

• If depression is untreated in young people it tends to be more treatment resistant in adult life

• Economic analysis shows that social and emotional learning programmes impact on conduct disorder and cost £132 per child with a return of £10,032 after 10 years. Improving parenting skills have also been shown to give a nearly tenfold return on investment after 25 years

• A range of actions are being undertaken locally including the provision of Parenting Classes, participating in the Healthy Schools Award and provision of free training for schools

www.kingston.gov.uk

Child and adolescent mental health services

• Tier 2 early intervention services are provided locally by the Family Advice Support Service team (FASS) whilst tier 3 services (specialist services working with children with complex needs) are provided by the Family Adolescent and Child Team (FACT)

• One would expect the number of referrals to FASS to be more than FACT, but the reverse has been the case with 372 FASS referrals in 2012/13 compared with 893 FACT referrals

• In the past the FASS service provided advice rather than undertaking direct work with children and young people, which may explain why referrers – with GPs making up 50% of these - used the FACT service

• The Tier 2 service has just been relaunched and aims to provide a wider range of evidence based treatments for children and young people

www.kingston.gov.uk

Mental illness in adults• Mental health problems accounts for 23% of the total

burden of disease in the UK – compared with 16% for cardiovascular disease

• More than one in six of us have a mental health problem at any one time

• This means that over 21,000 people in Kingston are affected as we speak

• Over a year that figure increases to one in four• Many people do not seek treatment and so prolong their

illness because of the stigma that is still attached to mental illness

www.kingston.gov.uk

Stigma• Stigma arises from inaccurate negative stereotypes held about people with mental illness• The portrayal of people with mental health problems can

be unhelpful:

www.kingston.gov.uk

Sept 2013

Stigma/cont’d

2002 2013

• 70% of mental health service users felt that they have to conceal their illness

• 50% reported being shunned by other people• 25% reported being verbally or physically abused• 87% reported experiencing discrimination in at least one

aspect of life in the last yearwww.kingston.gov.uk

Stigma/cont’d• Public Health have been promoting ‘Time to Change’ – the national

programme to end stigma and discrimination run by Mind and Rethink Mental Illness

• 23 people have been trained as eitheradult or young peoples Mental HealthFirst Aid instructors and they havetrained 300 local people so far

• A student mental health conference was held in February 2014 and pupils

went on to hold assemblies in theirown schools‘Going to the conference...enabled me to help and give necessary advice to the peoplesurrounding me...in a way it gave me theconfidence I need to help’

www.kingston.gov.uk

Common mental illness• Primarily anxiety and depression• More common in women than men and highest in mid-life• In mid life there can be the realisation of limited achievement,

caring responsibilities for children and parents, work stress and life events such as marital breakdown

• Nationally, only 24% of people with common mental illnesses were receiving treatment in 2007

• The vast majority of people with common mental illnesses are treated in primary care – self care advice, psychological therapies (provided by the Kingston Wellbeing Service) and medication are used

www.kingston.gov.uk

Severe mental illness• Much rarer than common mental illnesses and mainly consist of

schizophrenia and bipolar disorder• Schizophrenia affects people’s perceptions, thoughts, mood and

behaviour• Approximately 1% of the population will have this illness at some point

in their lives• Bipolar disorder is a mood disorder where a person’s mood alternates

between highs and lows• Over a lifetime between 0.4% and 1.6% of people will have bipolar

disorder• Most people with severe mental illness should generally be treated in

primary care with support when required from specialist services including Community Mental Health Teams and Early Intervention in Psychosis services

www.kingston.gov.uk

Pattern of mental health care in Kingston

• More people are in contact with specialist MH services in Kingston than in boroughs with similar populations:– Kingston 1,951 per 100,000 population in April – June 2013– Richmond 1,514 per 100,000– Sutton 1,124 per 100,000

• Kingston has a higher % of MH service users in hospital than the national average (3.9% compared with 2.4% - Oct to Dec 2013) and the picture is the same for bed days per 100,000 population (6,456 compared with 4,686) - but the hospital episode rate for schizophrenia is similar to the national average

• Suggesting that in Kingston people are more likely to be in contact with specialist MH services and more likely to be admitted (perhaps with less severe problems) than in an ‘average’ area

www.kingston.gov.uk

Pattern of mental health care in Kingston/cont’d

• Given that good practice indicates that a model of service that provides the least intrusive care should be provided and from the previous slide this is not the case at present, commissioners plans to transform mental health care so that most people are cared for in primary care with voluntary sector support and input from specialist MH services if required

• This transformation needs to be co-produced with service users and carers

• The Kingston Mental Health Planning Board and Mental Health Parliament will be key to this work

www.kingston.gov.uk

Mental illness in older people• In dementia there is a progressive decline in memory, reasoning,

communication skills and the ability to carry out daily activities - there are approximately 1,600 Kingston residents with dementia

• Vascular dementia is the second most common cause of dementia and can be prevented by the same lifestyle changes that prevent heart attacks and strokes

• Actions that need to be taken in Kingston include increasing diagnosis rates – currently at 40%, adapting health and care services so they meet the needs of people with dementia and building dementia friendly communities. The Kingston Dementia Action Alliance was launched in May 2014

www.kingston.gov.uk

Mental illness in older people/cont’d

• 1 in 5 older people living in the community suffer from depression and 2 in 5 living in care homes which equates to over 5,600 people in Kingston

• A third of people providing care for a relative with dementia have depression

• Many people are never diagnosed – stigma no doubt playing a part in this – and when diagnosed many are not treated appropriately with talking therapies being underused

• Although the relationship is not fully understood, people with depression are at higher risk of developing dementia so it is vital that depression in older people is both diagnosed and treated appropriately

www.kingston.gov.uk

Carers• Carers of people with mental health problems make up 25% of the

estimated 6 million carers in the UK• Of the 1,600 local carers known to Kingston Carers Network, 514 (32%)

are caring for someone with a mental health problem• 114 of these are young carers are caring for a parent with a mental health

problem• Caring can have detrimental effects, with carers tending to have reduced

employment and learning opportunities and also carers’ mental and physical health can be affected, especially when they have been caring for a long period of time

• Support available for carers is detailed in the report• The Triangle of Care is a best practice guide on how mental health services

can work in partnership with carers to ensure the best possible journey for both the service user and their carer through the service

• This is being introduced in local mental health services www.kingston.gov.uk

Long term conditions and mental health

• People with long term physical health conditions are two to three times more likely than the general population to have mental health problems

• People with both have worse outcomes and poorer quality of life. The cost of care is also increased with the average cost of someone with a long term condition (LTC) and a mental health problem being 45% higher than someone with a LTC but no mental health problem

• Patients with cancer who are also depressed have a 17% greater death rate

• Depression is often viewed as ‘normal’ in people with LTCs which hampers appropriate management

www.kingston.gov.uk

• There are approximately 12,000 people in Kingston with a LTC and a co-existing mental health problem

• The King’s Fund recommended a framework for care and support to reduce the number of people with LTCs going on to develop mental health problems, and there are a range of actions being taken to meet these

Lifestyle issues and mental health

• People with severe mental illness have a mortality rate two to three times higher than the general population

• This is mainly due to physical illnesses such as heart disease, cancer and diabetes

• Underlying reasons include under diagnosis and under treatment of physical illness in people with mental health problems, altered help seeking behaviour and lifestyle issues such as smoking, diet and exercise

• People with mental health problems are more likely to smoke than the general population (33% compared with 22%)

• 42% of all tobacco consumption is by people with mental health problems• Smokers with severe mental illnesses live on average 25 years less than

the general population• Tailored support needs to be given to help smokers with mental health

problems to quit www.kingston.gov.uk

Lifestyle issues/cont’d• Physical activity reduces the symptoms of depression and anxiety – even 10

minutes of activity improves people’s mood• A consultation was held in 2013 to gather views about physical activity from

people with mental health problems, leisure providers and mental health providers

• The need for reduced intensity exercise and a buddy scheme was highlighted• A one year pilot programme – the Good Energy Club – has been launched

which includes a buddy scheme and training for leisure providers so that they better understand mental health issues and how they can make their facilities accessible for this population group

‘I joined the charity Hestia...to volunteer helping other people with mental health problems participate in physical exercise. You soon realise that others do need help and encouragement to change their lifestyles and incorporate exercise into their daily lives’

• Other lifestyle issues discussed in the report include obesity, sexual health, alcohol and drugs

www.kingston.gov.uk

Many thanks to:• People in Kingston who permitted us to quote

them in the report• 65 authors and contributors from 18

organisations• The hard working and long suffering editorial

team – Helen Raison, Liz Trayhorn, Sundus Hashim, Helen Nation, Dr Andrew Cross and Dr James Moore

www.kingston.gov.uk

Many thanks for listening- any questions?

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