Mental health articles

OF mental health care and mentally ill

Most Common Mental Health Problems

Mental health problems do not affect all groups of people equally. Many factors are associated with mental health problems. It must however be remembered that association is not the same as causality. For example social isolation may both lead to mental health problems and be a psychological and social response to mental health problems. Epidemiological studies have found the following:

Isolation: people with a neurosis and more markedly people with a psychosis are more likely than the general population to be separated or divorced and live in a one-person family unit.

Social class: people with a probable psychosis are more likely to be defined as being in social classes IV or V.

Unemployment: 39 per cent of people with a neurosis and 70 per cent with a psychosis were found to be economically inactive compared to 28 per cent with no disorder.

Social deprivation: there are clear associations between social deprivation (e.g. poor housing/homelessness, employment and education) and mental illness morbidity. The Department of Health’s psychiatric needs index shows a four-fold variation in need between the most affluent local authorities and the most deprived. Many authors argue that the variation in need is even greater for the most severe mental health problems. It is thought that the need for assertive outreach style services for people with the most severe difficulties varies from 12 to 200 people per 100,000 people aged 16 to 64.

Physical ill health: 57 per cent of people with a neurosis and 62 per cent with a psychosis reported having a physical complaint, compared to 38 per cent of those with no mental health problem.

Black and minority ethnic communities: Asian and African-Caribbean people are less likely to have mental health difficulties recognized by their GP. The prevalence of schizophrenia among Black African and African-Caribbean people is a much contested area of research. Whatever the underlying reasons it is clear that these Black communities are considerably over-represented in secure settings and detentions under the Mental Health Act 1983. Many authors have argued that the cause is institutional racism, although this is seldom seen as the only factor and interventions coming too late in the development of problems is a major issue. Mental health services are also considered to fail in meeting the needs of these communities. More positive ways of responding have been proposed.

Suicide: about 5000 people a year in England take their own lives. The government’s National Suicide Prevention Strategy reports that on average somebody dies from suicide every two hours. It is the commonest form of death in men under 35 and is the main cause of premature death in people with mental illness. The majority of suicides occur in young adult men. Suicide rates are low among Asian men and older people but high in young Asian women. Suicide is far more common in social class V than any other social class. The most common means of suicide are hanging and poisoning with analgesic or psychotropic prescribed drugs.

Criminal justice system: all forms of contact with the police, courts, prison and probation system are associated with high prevalence rates of mental health problems. For example, 56 per cent of sentenced women and 37 per cent of sentenced men are considered to have a psychiatric disorder. The prevalence of mental health problems is higher for remand prisoners.

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