Dr C I OkochaMB, BS; Ph.D; FRCPsych

No health without mental health: the challenges ahead

Assurance Medical & Underwriting Society Seminar

16 March 2011

Overview • Mental health problems and burden• Physical health risks• Government spending on NHS and MH• Mental health projections - 20 year’s on• New horizons and no health without

mental health• Coalition governments reform of the

NHS

Scope of mental health problems (MHP)

• 10% of 5-16 year olds have a MHP• 10% of 15-16 year olds have self harmed• 25% of people will experience a MHP

– 50% by age 14– 75% by age 25

• 17% of adults have a MHP at any time• 50% of all adults will experience depression in life• 1% have SMI• 10% of women have postnatal depression• 60-90% of homeless and prisoners have personality

disorder

Mental and physical health• Mental illness increases risk for other illnesses

– Depression and stroke– Schizophrenia and diabetes (5x)– SMI and accidental/non accidental injuries– SMI and high risk exposure/lifestyle– Reduced life expectancy by up to 20 years

• Physical illness increases risk for mental illness– Disability and depression

Mental Illness and Physical Illness

Global burden of mental illness•Neuropsychiatric disorders

– Schizophrenia– Mood disorders– Substance abuse– Dementia

•Contribute more to global disease burden than– Cancer– Cardiovascular disease

•WHO 20 year global projection•Depression will be the most significant burden than

– COPD– IHD– Diabetes– Stroke– Vision or hearing loss

Cost of mental ill health

• 23% of total ill health burden in UK

• Largest cause of disability in UK– 43% of 2.6 million

people on health related benefits

• Costs could double by 2031

• £77 billion in 2003• £105 billion now

– £30 billion is work related

– £8.4 billion sickness absence

– £15.1 billion reduced productivity

• £2 billion on social care

NHS budget• NHS Budget - £102billion (2008/9)• Equates to a contribution of £1,980 per

person• 60% for staff pay • 20% for drugs and other supplies• 20% for buildings, medical equipment,

catering, cleaning and training – 80% of the total budget is distributed by local

trusts in line with the particular health priorities in their areas.

Mental health spending• Direct costs of mental health in England

are now around £22.5 billion a year– includes spending in health and social care and a

variety of other agencies– but not the indirect costs of the impact on the

criminal justice system– and in lost employment.

• It accounts for more than 12% of NHS total budget.

Future issues1. Rise in dementia and a growing population

of older people. Costs will rise from £15 billion in 2007 to nearly £24 billion in 2026 and more if the real cost increases of employing staff at that time are included.

2. Not all those in need of services, are known e.g., a third with depression and half with anxiety disorders remain undiagnosed and untreated.

3. Has mental health promotion reduced prevalence & risks of mental disorders?

Impact of population changes

GP Registers of Dementia and Estimated prevalence London PCTs (2007/08)

.

Road traffic accident deaths: 2942

Suicides 3690

Suicides & open verdicts: 5188

Depression and Suicide

National service framework for mental health 1999

• Much directed at increasing the range and quality of services provided

• Evidence suggests that there have been significant improvements.

• Serious questions remain about:– the nature of the current commissioning & provision – the extent to which it is fit for purpose – how mental health services should respond to future

demands.

FutureNew Horizons - Labour Government 2009Emphasis on promoting positive mental health and wellbeing and preventing mental health problems fromdeveloping. 

No health without mental health - A cross government mental health strategyEmphasises 6 objectives and commitments

No Health Without Mental Health

Objectives Commitments

1. Good mental health Public health priority

2. Recovery £400m talking therapies – 2m to 3.2m users by 2015

3. Good physical health Prioritise early intervention

4. Positive experience of care and support

Expand provision for children

5. Less avoidable harm Review HV and school nursing practice

6. Less stigma and discrimination Improve offender access to services

Liberating the NHSAim Headline InitiativeRevolutionise NHS accountability

•Huge reduction in central management and Arms Length Bodies•GPs commissioning services and approving service changes•Competition between FTs, social enterprise & private sector to provide NHS services•Increase democratic scrutiny via Local Authorities

A patient led NHS •Increased choice•Increased management of own care•Increased patient voice

Promote better outcomes

•National outcome measures•Patient reported outcomes•Payment linked to performance

Better Public Health •DH focus on public health•LA lead role

Health and Social Care Bill changes

It’s goodbye to … … and hello to

Strategic Health Authorities

PCTs

LINkS

NHS Trusts

NHS Commissioning Board

GP Consortia

HealthWatch

Health and Well-Being Boards

NHS Foundation Trusts

How it will be in 2013

National Commissioning

Board

Sec of StateParliament

Dept ofHealth

LAsPublic HealthHealthWatch

CQC HealthWatch

Monitor

Social Enterprise

PrivateSector

200 +FTs

GP Consortia150 - 500

Health and Social Care Bill

• Largest piece of NHS legislation ever• Main health unions and Health Select Committee

concerned re timing, size, speed, untested nature of reforms

• Will cost £1.2bn to implement – projected savings £1.3bn pa

• Government view cannot afford not to implement or to slow down

LifeStage

Early Years

MiddleYears

LaterYears

Mortality

Injuries

Suicide

Alcohol

CHD

Cancer

RespiratoryDisease

CVA

Falls

Morbidity

Emotional&

ConductDisorders

MentalIllness

Obesity

Chronic &

LongTerm

Conditions

Disability

WiderRisk

Factors

ChildPoverty

UnsafeEnvironmt

Socio-Economic

Inequalities

Unemploy-ment

FuelPoverty

WiderProtectiveFactors

ReduceChild

Poverty

GoodEducation

ViolencePrevention

SafeGreenSpaces

Employ-ment

WarmInsulated

Homes

IndividualRisk

Factors

AdverseChildhood

EventsIncludingViolence& Abuse

MentalHealth

Problems

SmokingAlcohol& DrugMisuse

PoorNutrition

Lack ofActivity

& Exercise

IndividualProtectiveFactors

Parenting

EarlyInterventn

ForMentalHealth

Psycho-Logical

Therapies

InterventnsTo reduceSmokingAlcohol

PromoteActivityHealthy Eating

Treatmentfor CHD& Cancer

INTERVENTIONS

A Life Course Approach to Understanding & Addressing Inequalities in Health

Summary• The cost of mental ill-health to individuals and

society is huge• There are significant physical health risks

associated with mental ill-health• Health promotion, prevention, early

intervention and addressing the treatment gap are crucial

• Good quality commissioning and government policy are needed to address gaps and future needs

References

1. White paper equity and excellence: liberating the NHS. Published by the DoH, 2010

2. No health without mental health: a cross government mental health outcomes strategy for people of all ages. Published by DoH 2011

3. Paying the price: the cost of mental health care in England to 2026. Published by the Kings Fund, 2008