Professor Martin Knapp examines key research findings in mental health
Digest of the digest
● People with mental health problems are at higher risk of falling into financial difficulties.
● People with mental health problems from ethnic minority communities respond well to interventions adapted to their culture.
One in six adults aged 18-65 in Britain has symptoms of mental illness, most commonly depression or an anxiety disorder, but about 2% have schizophrenia or bipolar disorder. It is also estimated that one in 10 children has a mental health problem, with behavioural (6%) and emotional (4%) issues the most common. The pattern is different again among older people: depression is the most common problem, but rates of dementia are very high in the oldest age groups (as much as 30% among the over-90s).
If a mental health need is spotted, treatment and support can be costly, but also highly effective. Too often, however, mental health needs are missed and costs are high for other reasons: problems with employment, family difficulties, perhaps violent crime or suicide in a few cases. The Centre for Mental Health has published new figures showing the scale of the overall economic impact: £105bn for England alone.
Whether or not mental health needs are identified and treated, there are big implications for social care because the consequences of mental illness can be far-reaching and long-lasting. Family and other personal relationships, employment, income, housing and social roles might all suffer.
Effects of financial debt
The financial crisis of recent years and the recession that followed have increased the prevalence of financial problems for individuals and households. These can damage health, particularly mental health (Murray). Not only do financial problems increase the risk of developing a mental illness, but people with such an illness are also at higher risk of difficulties with their finances (Jenkins et al).
However, there is also evidence that debt counselling works, helping to improve quality of life (Pleasance and Balmer).
Social capital describes “resources embedded within social networks” (Webber et al) and the shared values that they might generate. So can social capital influence mental health? Webber and colleagues found that having access to more social capital did not lead to improvements, but that the emotional content of close relationships was influential. Their research was only short-term, following people for six months, and they posit that some of the benefits of social capital might take longer to emerge.
To what extent this might support the Big Society agenda is unclear, but it is inevitable that more attention will be focused on the informal, unfunded resources of individuals, families and communities, and their ability to prevent and meet mental health and other needs.
The links between ethnicity, mental health needs and responses are complex and sometimes controversial. Research evidence is accumulating on what those needs are, what treatments might work in which circumstances, and what individuals and their families want by way of support and control. Three papers illustrate the growing understanding of some of these topics.
The first considers the social determinants of psychosis in migrant and ethnic minority populations (Morgan and Hutchinson). They describe the higher rate of schizophrenia and other psychoses in black Caribbean and black African populations as “a public health tragedy, and one that remains neglected”. Many of the social determinants of psychosis are preventable, particularly in childhood.
Gater and colleagues evaluated a social intervention for British Pakistani women that had a “culturally acceptable content and mode of delivery”. Its aim was to address social difficulties, isolation and poor access to primary care. After some initial caution, participants welcomed the intervention, and their social functioning and satisfaction were better compared with a group of women treated with antidepressants alone.
The third study looked at self-harm, drawing on data on more than 20,000 people. Jayne Cooper et al found significant differences between ethnic groups. Self-harm rates were highest among black females aged 18-34, yet this group was also the least likely to gain access to psychiatric care. As with the previous two papers, the implications for social care appear to be considerable even if not fully discussed.
● Centre for Mental Health (2010), Economic and social costs of mental health problems in 2009-10, CMH, London www.centreformentalhealth.org.uk.
● Cooper J et al (2010), “Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study”, British Journal of Psychiatry, 197, 212-218.
● Gator R et al (2010), “Social intervention for British Pakistani women with depression: randomised controlled trial”, British Journal of Psychiatry, 197, 227-233.
● Jenkins R et al (2008), “Debt, income and mental disorder in the general population”, Psychological Medicine, 38, 1485-1493.
● Morgan C, Hutchinson G (2010), “The social determinants of psychosis in migrant and ethnic minority populations: a public health tragedy”, Psychological Medicine, 40, 705-709.
● Murray J (2010), “Debt and reducing stress associated with the economic downturn”, Journal of Public Mental Health, 9, 27-35.
● Pleasance P, Balmer N (2007), “Changing fortunes: results from a randomized trial of the offer of debt advice in England and Wales”, Journal of Empirical Legal Studies, 4, 651-673.
● Webber M et al (2010), “Social capital and the course of depression: six-month prospective cohort study,” Journal of Affective Disorders, pre-publication online.
What do you think? Join the debate on CareSpace
Keep up to date with the latest developments in social care Sign up to our daily and weekly emails
About the author
Martin Knapp is professor of social policy at London School of Economics, and director of the NIHR School for Social Care Research