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Introduction

A Mental Health Indicator, designed to identify areas with relatively high proportions of people whose quality of life was deemed to be impaired by mental ill health was first used in the compilation of the English Indices of Deprivation 2004 (ID 2004). Originally constructed on the basis of 1997-2002 data, the indicator was updated using 1999-2003 information and again with the ID 2007 covering the period 2001-2005 Information is available for Lower Layer Super Output Areas (LSOAs). Full downloads of the first two sets of data by these LSOAs for the whole of England are available from the Office for National Statistics Neighbourhood Statistics website whilst the latest data are available from the Department for Communities and Local Government site. Data relating specifically to Lancashire can be obtained from the Lancashire Profile Data Download Centre. The latter also provides rankings of the mental health indicator scores for LSOA within both a Lancashire and England context.

Background

"Mental ill health is a condition that can severely impact on the quality of life of those suffering from it and those immediately around them. It may also lead to other forms of deprivation such as unemployment or homelessness; potentially individuals may find themselves in a downward spiral that may be difficult to break out of. This makes it an important component of overall health which should be included in a small area measure of health deprivation." (Department for Communities and Local Government - The English Indices of Deprivation 2007)

Mental illness is very common. About one in four people in Britain have this diagnosis and many others have suffered from it to a degree at some point in their lives. The term encompasses a large range of disorders from schizophrenia, depression, Alzheimer's, self-harm and eating disorders to anxiety (including panic attacks, obsessive-compulsive disorder, phobias and post-traumatic stress disorders). However, despite its prevalence and the social stigma often attached to it, there remains huge controversy about what mental illness is, what causes it and how people can be helped to recover. The argument is still running about whether mental illness is caused by nature or nurture with consequent divides between those who believe that counselling and therapy rather than drugs or operations are the solution. Many take the view that both elements are contributory factors and that mental illness is usually the result of multiple interacting and contributing factors that are likely to include biochemistry, brain damage, diet, allergies and infections, drug and substance misuse, family environment, genetics, hormones, stressful life experiences, personality, pregnancy and birth complications, psychological factors and viruses.

Lancashire Care Foundation Trust Headquarters, Bamber Bridge, Providing Mental Health and Substance Misuse Services

Source www.lancashirecare.nhs.uk

Whatever the causes of mental ill health and its impact on individuals, there is also a large economic cost placed on society at large. Numerous estimates of these costs have been made including or excluding many intangibles but a recent year-long study published by the King's Fund, "Paying the Price" suggests that mental illness (including dementia) in England cost £50bn in 2007. Almost half of this sum, 22.5bn, represented money spent on direct NHS and social care services to support people with mental disorders (within the NHS it accounted for more than 12% of the total budget). More than half of the overall costs of mental illness, £26.1bn, represented the estimated cost to the economy of earnings lost because of the thousands of people unable to work due to their mental illness.

Note on the Data

The data used for compiling the mental health indicator are drawn from a number of administrative sources including drug prescribing data relating to depression and anxiety from general practitioner's (GP) practices; numbers of people in receipt of Incapacity Benefit and Severe Disablement Allowance because of anxiety or depressive disorders; secondary care data using hospital inpatient information to identify hospital spells (or episodes) where depression or anxiety disorders were diagnosed; and mortality data where the cause of death was suicide. Because each of these datasets covers a slightly different group of psychiatric conditions, it has only been possible to produce an estimate for a sub-group of these conditions rather than a 'general' mental health measure. Therefore the Mental Health Indicator focuses on adults under 60 years of age suffering from mood (affective) disorders and neurotic, stress-related and somatoform (anxiety) disorders. This group is believed to represent a large proportion of the total population suffering from mental ill health.

It should be noted that the data used in the composite indicator derived from the diverse data sources represents a ratio or "standardised measure" of mental illness, rather than an absolute count or percentage. For each area it is assumed that a figure of 0 (zero) is the value that might be expected to occur given the age and sex distribution of the population within that area. Therefore, a figure of less than 0 shows a lower prevalence of mental illness compared to the expected figure given the age and gender distribution in the area. Conversely, a figure of greater than 0 indicates a higher prevalence compared to the expected value. Presenting the data in this way provides a consistent basis for comparisons between areas, allowing the data to be ranked in a meaningful way.

Lancashire Results

The geographical distribution of areas across the Lancashire sub-region as defined through the Mental Health Indicator is illustrated in Figure 1. Table 1 details the top and bottom placed (1 = poorest) LSOAs according to both their ranking within Lancashire and their overall ranking across England (details for all other areas can be obtained from the Data Download Centre.

Figure 1 Standardised Mental Health Scores, 2001-2005, by LSOAs

Source ONS - Mental Health Indicator, 2001-2005

Lancashire may be seen to encompass virtually the whole range of scores produced under the Mental Health Indicator. An LSOA (010E) within the Rose Grove South & Weavers' Triangle area of Burnley, with an indicator score of 2.63 (i.e. nearly three times the expected value) not only ranks as the poorest in Lancashire but also as no less than the 15th poorest for mental health in the whole of England. There are, in fact, four very high scoring LSOAs within the Rose Grove South & Weavers' Triangle MSOA area of Burnley, representing a significant cluster of poor mental health. At the other end of the scale, an LSOA (019A) in the Ellel & Scotforth West area of Lancaster District achieved a score of -2.26, ranking it amongst the very best in England for mental health. It is of interest to note that across much of the sub-region there is, perhaps not surprisingly, a close association between areas with perceived issues of mental health and areas where high levels of "worklessness" is also present (see the Employment Deprivation research monitor) and also, though perhaps to a lesser degree, with areas suffering from Income Deprivation.

In contrast to the overall pattern across England where there are roughly equal numbers of areas with mental health scores above and below their expected values, the distribution in Lancashire is heavily skewed towards areas that have a greater prevalence of persons with mental illness than might have been expected on the basis of the local demographic profiles. In total, 770 or more than 82% of the Lancashire sub-region's LSOA have values above 0 or their expected score. Within a national context Lancashire has 26 LSOAs (nearly 3% of all Lancashire LSOAs) that rank amongst the poorest 1% for mental health in England and no less than 138 LSOAs (or nearly 15% of all Lancashire LSOAs) that rank within the poorest 5% in England.

LSOAs with the highest mental health scores (i.e. those with a greater prevalence of mental illness than expected on the basis of their demographic profiles) are to be found mainly within the larger urban centres. The larger urban centres such as Blackburn, Blackpool, Burnley and Preston have a significant number of such areas but some presence is also to be found in most urban areas including Lancaster/Morecambe, Chorley, Nelson and Colne, Accrington and urban parts of Rossendale. Rural/dormitory areas in the main fare much better. In some instances the presence of an institutional or communal establishment for people suffering from mental health issues can boost concentrations and local knowledge may be an important factor in the interpretation local results.

A slightly different interpretation of the distribution of standardised mental health scores in Lancashire relative to their distribution across England can be gleaned by grouping the LSOAs into deciles (Table 2/Figure 2). This further emphasises the skew towards poorer mental health scores in Lancashire relative to England. Across the sub-region 28% of Lancashire's LSOAs are in the first decile but only 0.3% of LSOAs are in the tenth decile. At the level of individual districts, the results can be even more extreme. In the case of Burnley, for example, no less than 60% of its LSOAs are in the lowest decile (i.e. six times the national average) and the district has no LSOAs at all in the 5th decile or above (i.e. no part of Burnley district has mental health scores above their "expected values"). A similar if less extreme pattern is also evident in Blackburn, Blackpool, Hyndburn, Pendle, Preston and Rossendale. All these districts, except for Rossendale are listed in the 2007 Index of Multiple Deprivation as being amongst the "50 most deprived" in England.

Figure 2 Standardised Mental Health Scores, 2001-2005: Deciles Distribution

Source ONS - Mental Health Indicator, 2001-2005

For further details, please contact:
Peter Kivell
Tel 01772 534157
Email Peter.Kivell@lancashire.gov.uk