Profile of mental health in Merton

Community Mental Health Profiles (NEPHO, January 2013) provide an overview of mental health risks, prevalence and services, and provide useful comparative information to supplement local data. However, it is important to note that they only provide a borough-wide overview and do not reflect geographical, gender or ethnic variations across Merton.

The Mental Health Profiles indicate that overall in Merton mental health risks, prevalence and access to services are generally either similar to or better than England. However, there are a number of indicators where Merton is significantly worse than England.

Wider determinants of mental health

Social economic and environmental conditions influence the mental and physical health of individuals and communities, such as deprivation, employment, crime, alcohol and drug misuse. In Merton, indicators are generally significantly better than England, however the rate of unemployment has been identified as a factor that is worse than England, but better than London.

Mental health risk factors

Individual factors that increase the likelihood of developing mental health problems include homelessness, long-term illness, youth crime and low levels of physical activity. In Merton, first-time entry into the youth justice system has been identified as a risk factor where rates are significantly worse than England and slightly worst than London. Levels of physical activity are also lower than England and London.

Levels of mental health and illness

Nationally at any one time about 1 in 6 people will be experiencing a mental health problem, and it is important to monitor levels of mental health. In Merton, the proportion of adults with dementia and depression is significantly lower than in England, but higher than in London.

Mental health treatment services

Treatment and early intervention can help to minimise the impact of mental illness. A high number of people in contact with mental health services may indicate high prevalence, but may also reflect good recognition and diagnosis of mental health conditions and availability of services.

The NEPHO profile for Merton states that overall the rate of total contacts with mental health services was significantly lower than England and London. However, for hospital admissions for mental health the rate was significantly higher than England, but lower than London, as was the rate of admissions for schizophrenia, schizotypal and delusional disorders. The rate of people on a ‘Care Programme Approach’ and rate of contact with Community Psychiatric Nursing were significantly lower than England and London. Average spend for mental health per health of population each year was similar to both England and London. This finding suggests that patients are not being identified and treated early and requires a more detailed review to support service redesign if necessary.

Mental health outcomes

The overall aim of mental health services is to improve patient outcomes. Little data is available at a national level about patients following their use of mental health services. Proxy indicators include people with mental illness in settled accommodation, emergency hospital admissions for self-harm, and hospital admissions caused by unintentional and deliberate injuries. For these indicators Merton was significantly better than England and better than London. However, recovery rates following the use of Improving Access to Psychological Therapies (IAPTs) were significantly lower than in both England and London, supporting a need to review accessibility of early intervention and prevention services for mental health.

Overall in Merton mental health risks, prevalence and access to services are generally either similar to or better than England. However there are a number of areas where Merton is significantly worse than England. In terms of risk factors, there should be continued focus on reducing unemployment, particularly in the east of the borough, and a focus on reducing youth crime and entry into the criminal justice system. Increasing levels of physical activity would have an impact on improving both mental and physical health.

In terms of treatment services, commissioners should focus on developing a whole system approach to mental health with more joined-up services to improve experience and outcomes. They should also focus on developing better data and local information on outcomes, and on addressing health inequalities in relation to mental health. There should be further investigation into why Merton has higher rates of depression than London, in light of its wider good health, and a focus on improving recovery rates following psychological therapies.

For further details see Community Mental Health Profiles 2013 (Public Health England website).

Key facts on suicide

Mental illness increases the likelihood of suicide. For example, suicide rates are nine times higher amongst those with schizophrenia than in the general population. About one quarter of people committing suicide have had contact with mental health services in the year before death. Suicide is a leading cause of premature death and has important social inequalities:

  • Suicide is five times more common in men (aged 20-64) in social class V than social class I.
  • Those at risk are often socially excluded and vulnerable to other health inequalities. Key associated factors are: unemployment, confinement in prison, living alone, and alcohol and drug misuse.
  • Men are more likely than women to commit suicide at any age.

Between 1993 and 2010, on average 14 local residents died of suicide and injury undetermined each year and there was an overall reduction in the standardised rate over time. Generally over this time mortality rates for Merton were below those for London and England (based on a three-year rolling average of directly standardised rates).

Merton mortality due to suicide by gender compared with London and England, three-year rolling averages from 1993-2010. The graphs show that mortality from suicide or injury of undetermined intent in males and females is lower in Merton than in London or England. However the trend has been variable in time and it shows a current downward trend in females but in contrast an upward trend in males. Whether this trend continues from 2010 to 2013 needs to be studied.