Mental health and emotional wellbeing
Mental health is everyone’s business – individuals, families, employers, educators and communities all have a contribution to make. Good mental health and resilience are fundamental to physical health, relationships, education, training, work and to achieving potential.
Half of all lifetime mental illness starts before the age of 14 years. Suicide is a leading cause of years of life lost in England, particularly affecting middle aged men.
Key factors such as social position, employment, income, housing and education have a significant influence on people’s mental health, including their chances of recovering from mental illness (1). Those who are most disadvantaged (financially and/or socially) are most likely to experience both mental illness and poorer mental wellbeing. Mental health is both a consequence and a cause of inequalities (2).
There is strong evidence of the economic and social returns of preventing and promoting mental wellbeing. Mental health problems represent the largest single cause of disability in the UK, the cost of which to the economy is estimated at £105 billion. There is a national drive to develop parity of esteem across the health and social care system, meaning that equal status needs to be given for physical and mental health (3). The evidence indicates that a real difference can be made to address this inequity by commissioning and working towards effective prevention and early interventions and treatments.
Commissioners and services should be pro-active in looking wider than health and social care in relation to what communities can offer to enable good mental health and wellbeing for all. ‘The ‘Integrated Wellness service’ being scoped by Public Health is one example of how this could be achieved. It goes beyond looking at single-issue, healthy lifestyle services, with a focus on illness, and instead aims to take a whole-person and community centred approach to improving health.
Describe the issue?
Mental health is a dynamic functional state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community (4). The key features of mental wellbeing focus on our ability to live our lives to their full potential, enjoy mutually rewarding interpersonal relationships, maintain good physical health and stay resilient in the face of life’s stresses and challenges (5). Poor mental health is associated with poverty, deprivation and addictions, but anyone could be affected by their mental health at any stage of their life. Early intervention and prevention in mental health will significantly impact on the rising costs of mental health problems (6).
Nationally 1 in 6 adults has a mental health problem at any one time (7), as do 1 in 10 children aged 5-16 years, and many continue to have mental health problems into adulthood (8). These figures are reflected locally (9). Overall, 9.6% (6,125) of 5-16 year olds have some form of mental health disorder; and there is variance between genders in the 5-10 age group where prevalence in boys is almost double that of girls (10% against 5%), (1,700 against 855). In the 11-16 age groups the gap narrows, but there is still a 3% increase in prevalence amongst boys (10).
Suicide is a leading cause of years of life lost with 8.9 suicides per 100,000 population in England between 2012-14. The suicide rate in England has risen since 2007, reinforcing the need to focus on evidence based preventive measures. The most recent Suicide Audit in Kirklees showed that the typical profile of a person committing suicide locally is a white British male, aged between 40-49 years, facing significant recent life stressors. Professionals need to be alert to this profile, including those who have a history of drug and/or alcohol misuse and mental health problems, as these people are more likely to be at risk of suicide.
The Warwick Edinburgh Mental Wellbeing Being Scale (11,12) is one way of measuring positive mental wellbeing, including clear thinking, self-acceptance, good relationships and positive feelings (optimism, cheerfulness, relaxation). In 2012, adult Kirklees residents had an average WEMBWS score of 47.5, below the national average for England (51) (9). The average score for children and young people across Kirklees is 47.7, which is the same as the Yorkshire and Humber region and England (13).
The main factors associated with wellbeing include relationships with friends and family, good health and community, civic participation, level of education, relative income and beliefs. Emotional resilience is “the ability to adapt compassionately in the face of adversity, it includes letting go, learning and growing as well as finding healthy ways to cope.” (14). The resilient individual can be viewed as having a good level of self-esteem and confidence. By identifying what makes children and adults resilient, it is possible to help them to develop the fundamental life skills needed (15).
What are the factors that affect this issue?
Key factors such as social position, employment, income, housing, education have a significant influence on people’s mental health, including their chances of recovery (1). Poor mental health and wellbeing contribute to poorer outcomes in many areas of life, which reinforces inequalities. Those who are most disadvantaged are most likely to experience both mental illness and poorer mental wellbeing. So, mental health is both a consequence and a cause of inequalities (2).
The Five Ways to Wellbeing (16) are a set of evidence-based actions which promote people’s wellbeing. They are: Connect, Be Active, Take Notice, Keep Learning and Give. These activities are simple things individuals can do in their everyday lives. All services should embed these behaviours into their design and delivery so that positive mental health is part of our core offer. Having resilience means that individuals are able to cope when facing difficult times. Building resilience and positive mental wellbeing can reduce the risk of having poor mental health. Those who are living with poor mental health or a diagnosed mental health problem are able to have good mental wellbeing, have strong resilience and live well with their condition. Most recent policy confirms that self-help, peer support, user led organisations, community networks, and voluntary sector provision need to be increasingly developed to improve population wellbeing. Good mental health and resilience are fundamental to physical health, relationships, education, training, work and to achieving potential.
Which groups or communities are most affected by this issue?
Anyone can suffer from a mental health problem at any point during their life, but the following groups are particularly vulnerable to experiencing mental health distress.
Children and young people
Mental health problems can contribute to perpetuating cycles of inequality through generations. One in 10 children in England aged 5-16 years has a mental health problem (8). Children and young people with learning disabilities are at greater risk of developing mental health problems as compared with their peers. 36% of children and young people with learning disabilities will have a mental health condition, compared with 8% of non-disabled children (17). Many ‘looked after’ children have complex needs and high levels of mental health problems, frequently as a result of abuse, neglect, loss or attachment difficulties prior to coming into care (18). Early interventions, particularly with vulnerable children and young people, can improve lifetime health and wellbeing, prevent mental illness and reduce costs incurred by ill health, unemployment and crime (4).
Locally, work is currently underway to develop a concept of ‘Learning and Community Hubs’ to enable schools to become community leaders. In particular, supporting schools, parents, and the community to shape and influence services and resources to meet identified local need. It is planned that the community hub approach will extend to the commissioning and development of innovative and integrated services that improve mental and emotional wellbeing outcomes for children and young people and families.
Locally in 2012, 1 in 5 (21%) adults self-reported depression, anxiety or other nervous illness. This figure has increased slightly since 2008, notably amongst males reporting depression from 18.5% in 2008 to 19.9% in 2012. Depression and anxiety levels were highest amongst 35-44 year olds (21.8%) compared to other age groups (9).
Unlike physical health problems and lontg term conditions, anxiety/ depression is more commonly reported in younger adults. In 2012, One in four adults aged under 65 years reported experiencing anxiety or depression compared with one in eight adults aged over 65 years (9).
Locally, the percentage of patients aged 18 and over with depression, as recorded on practice disease registers is 8% (19). Public attitudes toward mental health are changing but those experiencing mental health problems still need to be encouraged to seek help.
- The impact of mental health problems amongst working age adults on employment and the local economy are important. Work-related mental health problems are a particular concern. Locally, of those adults who had taken time off work due to ill health, one in four of them reported taking time off work for stress, anxiety or depression (9).
People over 65 years old
Feelings of loneliness has been found to be a risk factor for suicide amongst older people, while active participation in organisations has been found to be a protective factor. Both loneliness and social isolation can be particularly important for older people, but also others including people with mental health problems to support their recovery.
Where is this causing greatest concern?
Children and Young People
Child admissions for mental health per 100,000 (0-17) is 49.8 which is lower than the England figure of 87.4 (2014/15). Young people hospital admissions for self-harm per 100,000 (10-24) is 339.6 which is lower than England 352.3 (20)
The following information from the Children and Young People’s survey (2014) highlights where particular unhealthy behaviours are having an impact on mental wellbeing in children and young people across Kirklees. This was measured in Years 9 and 12 using the Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS) (11,12) and provides a mean score out of 70. Wellbeing was significantly higher in Huddersfield District Committee than the other three districts. Wellbeing scores differed between males (48.52) and females (43.88) with males having a higher level of wellbeing than females (21).
- The wellbeing of those who smoke (41.96) is significantly lower than those who do not smoke (47.23). 1 in 20 (5%) young people in year 9 smoke regularly and is similar across Kirklees.
- The wellbeing of those who have tried drugs (46.74) is significantly lower than those who have not tried drugs (42.05). 1 in 11 (9%) young people in year 9 have tried drugs. This was highest in Batley and Spen where 1 in 10 (10%) young people in year 9 have tried drugs.
- The wellbeing of those who have tried alcohol (47.90) is significantly lower than those who have not tried alcohol (44.82). 1 in 2 (51%) young people in year 9 have tried alcohol. This was highest in Kirklees Rural where two out of three (66%) young people in year 9 had tried alcohol.
The findings for those who self-reported having a long term health condition had lower mental wellbeing. This was also found for those who said they have anxiety or depression.
- The wellbeing of those who have a long term condition (45.02) was significantly lower than those without a long term condition (47.21). 1 in 8 (13%) young people in Kirklees have a long term condition. This was highest in Batley and Spen with 1 in 6 (16%) young people having a long term condition.
- Of those who said they had a long term condition, 1 in 37 (3%) young people self-reported that they have anxiety or depression. Kirklees Rural had the highest amount of young people reporting they have anxiety or depression at 1 in 29 (4%) young people and also the lowest wellbeing score out of the four District Committees. The wellbeing score for those who said they have anxiety or depression was (37.49).
The findings suggest that those being bullied or losing sleep due to feeling anxious tended to have lower mental wellbeing.
- The wellbeing of those who were bullied several times a week (44.10) was significantly lower than those who experience no bullying (41.03). 1 in 10 (10%) year 9 students experienced bullying and this was highest in Batley and Spen with 1 in 7 (14%) experiencing bullying.
- The wellbeing of those who lost sleep due to feeling anxious 5 or more nights a week (36.84) was significantly lower than those who did not lose any sleep (49.79). Overall for Kirklees, 1 in 20 (5%) young people have problems sleeping due to anxiety and this was higher in Kirklees Rural (1 in 17, 6%) than the other four District Committees.
Wellbeing was significantly higher in Kirklees Rural District Committee than the other three districts. Wellbeing scores differed between females (47.70) and males (47.15) with females having a higher level of wellbeing than males.
People over 65 years old
Overall, 71% of people over 65 said that they were satisfied with life nowadays. This was higher in Batley and Spen (73%) and Kirklees Rural (73%) District Committees and males (72%) tended to say they were more satisfied with life than females (70%). 71% said that they felt happy, this was highest in Kirklees Rural (73%) and Males and females rated this similarly. 74% felt like the things they do in their life are worthwhile, this was highest in Kirklees Rural (75%) and males (75%) tended to rate this higher than females (73%). The wellbeing score for people over 65 (48.32) was slightly higher than the overall adult wellbeing score (47.5) (9).
In relation to managing their own health, four out of five (80%) said that they felt confident to manage this on their own. One in seven (13%) self-reported that they had depression or anxiety. Those who live in Kirklees Rural (11%) tended to have the lowest levels of anxiety or depression than the other District Committees and males (12%) less than females (15%). When asked about whether they feel isolated, four out of five people across Kirklees (80%) said that they never or don’t very often feel lonely or isolated. The lowest level of isolation tended to be in Batley and Spen (81%) and Kirklees Rural (81%). 85% said that they have someone to count on when they are upset. This was highest within Kirklees Rural (90%). Females (91%) tended rate this higher than males (86%). 90% said they have someone to count on to help them out in a crisis, this was similar across District Committees and females (92%) rated this higher than males (88%) (9).
Views of local people who have used local mental health services
"I've only been coming cycling three weeks but now I don't want to miss it. It's great to be able to come ride the bikes for free and meet people too."
"I have been diagnosed with Bi-polar Affective Disorder and the scheme really helped get me out of my shell. I became more active, more confident and my illness was my own, I could deal with it better and am socialising more with friends and family."
"By talking to other people it helped me realise that I could recover as some of them had. I started college in September studying Maths and English and my depression and anxiety is now ok. I can now travel on buses as my mum used to drive me everywhere, and I feel independent. I have made new friends and socialise out of college with them. I feel like a new person and am planning to do GCSE’s and A levels. I feel better than I have for a long time. I don’t have time to dwell on things."
“The day I joined I was very anxious, apprehensive and nervous, As weeks and months progressed I began painting and writing my own songs and poetry and my attention and focus levels started to increase and my confidence grew and grew, and have over the past few months applied to college and enrolled on an unconditional placement”
“When I was referred I was not in a good place. I was not happy in my job. This affected my confidence and self-esteem and also my marriage. . I felt relaxed and supported by everyone I enjoyed being with a group of people who had experienced the same feelings as me. When I attended these sessions, I felt like a different person and it gave me hope. I am now more positive, and although my confidence has increased, this is still a work in progress. I am now working part-time, in a job that I really enjoy doing.”
“My favourite things about volunteering are simply enjoyment and mixing with other people. I feel comfortable when volunteering, it’s a relaxed environment and not pressured. When I am volunteering I am getting away from my problems. I enjoy learning off other people – there is always room for improvement and it’s quite fascinating to hear other ideas. I also enjoy sharing my skills with others.”
"Substance misuse and mental health go hand in hand. I didn't think I deserved help. Now I make a valuable contribution to society”
“I feel valued, needed, respected for what I have to say.”
Health assets are those things that enhance the ability of individuals, communities and populations to maintain and sustain health and well-being. These include things like skills, capacity, knowledge, networks and connections, the effectiveness of groups and organisations and local physical and economic resources. They also include services or interventions that are already being provided or beginning to emerge which contribute to improved health and wellbeing outcomes.
Assets are hugely important to how we feel about ourselves, the strength of our social and community connections and how these shape our health and wellbeing.
As part of our KJSA development we are piloting a range of methods to capture and understand the assets that are active in Kirklees. Please see the assets overview section for more information about our approach and if you are interested in place-based information about assets in Kirklees have a look at the assets section in each of our District Committee summaries (Batley and Spen, Dewsbury and Mirfield, Huddersfield and Kirklees Rural). Where possible and appropriate we will provide information about local assets supporting people across different stages of the life course.
Given the evidence that self-help, peer support and community networks contribute to improved wellbeing it is important to acknowledge the diverse community assets that we have in Kirklees that are enabling people of all ages to connect with other people, have a say and learn new skills. For more information see the assets section of the KJSA.
The developing ‘learning and community hubs in Kirklees are also an important local asset because one of their key priorities will be to commission and develop those things that improve mental and emotional wellbeing outcomes for children, young people and families.
The Kirklees Healthy Child Programme and the integrated wellness service currently being scoped will be key local assets for improved mental and emotional health and wellbeing outcomes.
Across Kirklees, there are a range of emerging interventions aimed at improving men's mental wellbeing - click here for more details.
What could commissioners and service planners consider?
Commissioners, service planners and Councillors should consider local community assets such as those outlined above so that they can support and build on local strengths and also understand where there are gaps and unmet needs in particular places or amongst particular communities.
Other items of consideration should include:
- Improving the resilience of children and young people to build fundamental life skills from an early age
- Promote good mental health and reduce stigma within every arena and service delivery specification
- Utilise and embed the 5 ways to wellbeing (be active, keep learning, connect, take notice and give) as tool to improve population mental health and wellbeing
- Ensure those seeking help have timely access to support in their community
- Support individuals to manage their mental health by focusing on their aspirations and recovery
- Champion those living with and recovering from mental illness and work with these people to co-produce and design future services
- Focus on the wider determinants of wellbeing and mental health such as improved physical activity, good employment, access to open spaces and reducing isolation
- Embed wellbeing and mental health across the public health system, making it everyone’s business
- Commissioners and services should be pro-active in looking wider than health and social care in relation to what communities can offer to enable good mental health and wellbeing for all. ‘The ‘Integrated Wellness service’ being scoped by Public Health is one example of how this could be achieved.
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- Boardman J, Friedli L. Recovery , Public Mental Health and Wellbeing. Centre for Mental Health and NHS Confederation Mental Health Briefing. 2012.
- National Health Service. The Five Year Forward View For Mental Health: A report from the independent Mental Health Taskforce to the NHS in England. The Mental Health Taskforce. 2016.
- The Government Office for Science. Foresight Mental Capital and Wellbeing Project: Final Project report. 2008. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/292453/mental-capital-wellbeing-summary.pdf
- Department of Health. New Horizons: A Shared Vision for Mental Health. 2009.
- MIND. Our communities our mental health: Commissioning for better public mental health. 2013. Available from: http://www.mind.org.uk/media/2976113/mind_public-mental-health-guide_web-version.pdf
- Department of Health. No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. 2011.
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- NHS Kirklees, Kirklees Council. Current Living in Kirklees Survey 2012. 2012.
- Kirklees Council. Kirklees Future in Mind Transformation Plan Children and Young People’s Mental Health and Wellbeing. 2015.
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- Warwick Medical School. Warwick and Edinburgh Mental Wellbeing Scale. 2015. Available from: http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/
- Public Health England. Health behaviours in young people - What About YOUth? 2016. Available from: http://fingertips.phe.org.uk/profile/what-about-youth
- Action for Happiness. 10 keys to happier living. 2016. Available from: http://www.actionforhappiness.org/10-keys-to-happier-living/find-ways-to-bounce-back/details
- Marmot M. Fair Society , Healthy Lives Fair Society , Healthy Lives. 2010.
- Aked J, Marks NA, Cordon C, Thompson S. Five Ways to Wellbeing. New Econ Found. 2008;1–23. Available from: https://www.gov.uk/government/publications/five-ways-to-mental-wellbeing
- Emerson E, Hatton C. Mental health of children and adolescents with intellectual disabilities in Britain. Br J Psychiatry. 2007;191(6):493–9. Available from: http://bjp.rcpsych.org/content/191/6/493.abstract
- Child and Adolescent Mental Health Services. Children and young people in mind: the final report of the National CAMHS Review. 2008.
- Public Health England. Commen mental disorders. 2017. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/common-mental-disorders
- Public Health England. Children’s and Young People's Mental Health and Wellbeing. 2016. Available from: http://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh
- Kirklees Council. Children and Young People’s Survey 2014. 2014.
Date this section was last reviewed