Introduction

The World Health Organisation (WHO) defines mental health as ‘a state of wellbeing in which the individual realises his or her abilities, can cope with the normal stresses of life, work productively and fruitfully, and is able to make a contribution to his or her community’ [1].

Mental health is more than the absence of mental disorders. It exists on a complex continuum, which is experienced differently from one person to the next, with varying degrees of difficulty and distress and potentially very different social and clinical outcomes. Mental health conditions include mental disorders and psychosocial disabilities as well as other mental states associated with significant distress, impairment in functioning, or risk of self-harm. People with mental health conditions are more likely to experience lower levels of mental well-being, but this is not always or necessarily the case[2].

Many mental health conditions can be effectively treated at relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low. Increased investment is required on all fronts: for mental health awareness to increase understanding and reduce stigma; for efforts to increase access to quality mental health care and effective treatments; and for research to identify new treatments and improve existing treatments for all mental disorders. In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

In 2022, WHO launched the World Mental Health Report: Transforming Mental health for All.

Across England, 1 in 6 adults report a common mental health disorder and almost 551,000 have a severe mental illness (SMI), such as schizophrenia or bipolar disorder [3]. Poor mental health is estimated to carry an economic and social cost of £105 billion a year in England [4]. Mental health problems and suicide can be preventable. Promoting good mental health will impact on physical health and many other aspects of people’s lives.

Data Overview

Table 1 below is taken from the Projecting Adult Needs and Services Information Tool and is based on the report Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014 (2016), NHS Digital. The rates have been applied to Oldham's population. The survey was carried out by NatCen Social Research in collaboration with the University of Leicester, and was commissioned by NHS Digital.

• Common mental health disorders comprise different types of depression, anxiety and obsessive compulsive disorder. They cause marked emotional distress and interfere with daily function, but do not usually affect insight or cognition. Although usually less disabling than major psychiatric disorders, their higher prevalence means the cumulative cost of common mental health disorders to society is great.

• Personality disorders are longstanding, ingrained distortions of personality that interfere with the ability to make and sustain relationships. Antisocial personality disorder and borderline personality disorder are two types with particular public and mental health policy relevance.

• Psychotic disorders produce disturbances in thinking and perception severe enough to distort perception of reality. Psychoses can be serious and debilitating conditions, associated with high rates of suicide and early mortality. 

• Psychiatric comorbidity - or meeting the diagnostic criteria for two or more psychiatric disorders - is known to be associated with increased severity of symptoms, longer duration, greater functional disability and increased use of health services.

Table 1: People aged 18-64 predicted to have a mental health problem, projected to 2040
	2023	2025	2030	2035	2040		% increase 2023 to 2040
People aged 18-64 predicted to have a common mental disorder	26,893	27,105	27,472	27,829	28,222		4.94%
People aged 18-64 predicted to have a borderline personality disorder	3,415	3,442	3,489	3,534	3,584		4.95%
People aged 18-64 predicted to have an antisocial personality disorder	4,758	4,793	4,874	4,928	5,000		5.09%
People aged 18-64 predicted to have psychotic disorder	995	1,003	1,018	1,030	1,045		5.03%
People aged 18-64 predicted to have two or more psychiatric disorders	10,240	10,319	10,468	10,599	10,750		4.98%
Source: Projecting Adult Needs and Information Service (PANSI)

Depression affects different people in different ways but it can include some or all of the following symptoms: feelings of sadness and hopelessness, losing interest in things, feeling tearful, feeling constantly tired, sleeping badly and having no appetite. It can result in significantly reduced quality of life for the patient, their family and carers. Depression is responsible for 12% of the global burden of non-fatal disease and is responsible for 109 million lost working days every year in England at a cost of £9 billion [5].

There has been a steady increase in depression prevalence across both Oldham and England since 2012/13. The rate has increased by roughly 125%. In addition to the prevalence rising, the gap between the depression prevalence in Oldham and England is widening gradually year on year.

Figure 1: Depression QOF prevalence, aged 18+ trend
Source: OHID GP Profiles

Similarly to the prevalence rate, the incidence has been on an overall steady increase 2012/13, with a temporary decrease in 2020/21, most likely due to the Covid-19 pandemic affecting recording of new cases. Figures for the latest year (2022/23) show a slight drop when compared to the 2021/22 rates for both Oldham and England. Oldham's rate has been higher than England's since 2014/15. Oldham ranks 5th lowest across Greater Manchester for the latest year of data. With the exception of Bolton's rate that is equal to the national rate, no Greater Manchester authority has a rate below the England average.

Figure 2: Depression QOF incidence (new diagnosis), aged 18+ trend
Source: OHID GP Profiles
Figure 3: Depression QOF incidence (new diagnosis), aged 18+ across Greater Manchester
Source: OHID GP Profiles

The definition for the mental health indicator below includes all patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses to avoid a generic phrase that is open to variations in interpretation.

The mental health prevalence has increased steadily since 2012/13 across both Oldham and England. Oldham's rate has increased by 24%, whilst the national rate has increased by 18%. The gap between the Oldham and England rate increased steadily until 2016/17 and has remained consistent since (roughly a 0.07 percentage point difference). Oldham ranks centrally amongst Greater Manchester neighbours at 5th highest.

Figure 4: Mental Health QOF prevalence (all ages) trendSource: OHID GP Profiles
Figure 5: Mental Health QOF prevalence (all ages) across Greater Manchester
Source: OHID GP Profiles

Suicide

Suicide is seen as an indicator of underlying rates of mental ill-health. Suicide is a major issue for society and a leading cause of years of life lost. Suicide is often the end point of a complex history of risk factors and distressing events, but there are many ways in which services, communities, individuals and society as a whole can help to prevent suicides.

The Suicide Prevention Strategy has the overall aim of reducing the suicide rate in the general population in England, improve support for people who have self-harmed and improve support for those bereaved by suicide.

The indicators that follow represent deaths from suicide and injury of undetermined intent.

In 2021/22, there were 335 hospital admissions to Oldham residents as a result of self-harm. This is a rate of 132 per 100,000 (DSR), lower than the North West average of 190 per 100,000 and the England average of 164 per 100,000.

Oldham's suicide rate has been below the national average since 2014-16. Ignoring yearly fluctuations in rate due to small numbers, the rate has remained fairly stable between 2001-3 and 2020-22 across the North West and England whilst the rate has decreased in Oldham. Oldham's most recent rate is lowest across Greater Manchester and lowest amongst CIPFA neighbours.

Figure 6: Suicide rate (persons) trend
Source: Office for National Statistics

Figure 7: Suicide rate (persons) across Greater Manchester
Source: Office for National Statistics

Figure 8: Suicide rate (persons) amongst CIPFA neighbours
Source: Office for National Statistics

There is a substantial difference between male and female suicide rates across the North West and England. Whilst this difference still exists in Oldham, it appears to be less pronounced. Whilst the rate is considerably below regional and national comparators for males, the Oldham rate exceeds North West and England averages. Consideration does need to be given to the small numbers behind these rates when interpreting the figures.

Figure 9: Suicide rate by sex across Oldham, North West and England
Source: Office for National Statistics

Further Information & Resources

WHO World Mental Health Report: Transforming Mental health for All
The World mental health report: transforming mental health for all is designed to inspire and inform better mental health for everyone everywhere. Drawing on the latest evidence available, showcasing examples of good practice from around the world, and voicing people’s lived experience, it highlights why and where change is most needed and how it can best be achieved. It calls on all stakeholders to work together to deepen the value and commitment given to mental health, reshape the environments that influence mental health, and strengthen the systems that care for mental health.

WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health 
In 2019, the World Health Organisation launched the WHO Special Initiative for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

Wellbeing and mental health: Applying All Our Health
This guide is part of ‘All Our Health’, a resource which helps health professionals prevent ill health and promote wellbeing as part of their everyday practice. The information will help front-line health and care professionals use their trusted relationships with patients, families and communities to improve their mental health and wellbeing.

Suicide Prevention Strategy for England 2023 to 2028
This Strategy present visions and aims to prevent self-harm and suicide, including the actions the government and other organisations will take to save lives.

Suicide Prevention Resources and Guidance
Help for local authorities, public healthcare professionals, police forces and others to prevent suicides in their areas.

References

[1] World Health Organization. Strengthening mental health promotion. Geneva: WHO; 2001.
[2] WHO Mental Health Topic page, accessed December 2023, https://www.who.int/health-topics/mental-health#tab=tab_1
[3] Health Profile for England 2018, accessed December 2023, https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-3-trends-in-morbidity-and-risk-factors#mental-health
[4] https://www.centreformentalhealth.org.uk/publications/economic-and-social-costs-mental-health-problems-200910/
[5] OHID Data Profiles, accessed January 2024.