If mental disorder accounts for almost a quarter of our health burden, why so far down pecking order?

With thanks to South London and Maudsley psychiatrist Jonathan Campion, here is a summary of the report I referred to in my debate with Oliver James in yesterday's Observer. This statistic that 23percent of our health burden comes from mental disorder, compared with 16percent for cancer and cardiovascular, needs to become as well known and as accepted as 'one in four.' It might lead to the government reviewing its approach to mental health issues, badly needed at the time of austerity. I have a second reason to thank the Maudsley, or at the least the Lambeth psychiatric hospital part of it. A scene in my next novel is set there, and I had drafted it before someone I know was taken ill, and treated there. The doctors, among them Mr Campion, were very helpful in letting me test the reality of the environment against what I had already committed to paper from my imagination and experience elsewhere. So thanks. Here is the summary of the report, co-authored by Mr Campion.   The Joint Commissioning Panel for Mental Health has recently published public mental health commissioning guidance. In summary, the guidance outlines that mental disorder (which includes mental illness such as depression, anxiety disorders and psychosis as well as drug problems, alcohol problems and dementia):   • Is responsible for 23% of burden of disease in the UK compared to 16% for cancer and 16% for cardiovascular disease • Affects 1 in 4 of the population at any one time • Results in broad range of impacts across health, education, work and criminal justice as well as health risk behaviour and associated premature mortality. As an example, 42% of adult tobacco consumption in England is by those with mental disorder while 43% of smokers under 17 have either emotional or conduct disorder • Costs England at least £105 billion each year   However, only a minority of people with mental disorder in the UK get any treatment despite cost effective interventions. This is in contrast to cancer where almost everyone gets treatment. This inequity in action has a broad range of associated health impacts and costs. In particular, since the majority of life time mental disorder has arisen by the mid 20's, these impacts continue over a large part of the life course.   Mental wellbeing also has a broad range of impacts with considerable economic consequences. National mental health and public health policy highlights effective interventions to both promote wellbeing and prevent mental disorder and commits to action on these areas. The Public Health White Paper signals a new approach which places mental health and wellbeing 'at the heart' of the new system and highlights the key role of Directors of Public Mental Health in public mental health. However, an even smaller minority in the UK who benefit from such interventions receive them.   Treatment, prevention and promotion result in a broad set of improved outcomes. Furthermore, evidence from the London School of Economics in last year’s mental health strategy highlights such interventions also result in considerable economic savings even in the short term (DH, 2011). For instance, the LSE estimated that promotion of mental health at work results in net savings of £10 for each £ after one year, early intervention for depression at work results in net savings of £5 for each £ spent while early intervention for psychosis results in net savings of £18 for each £ spent.   The public mental health guidance highlights that levels of mental disorder and poor wellbeing vary according to the area people live in and in particular the levels of deprivation they experience. It enables local estimation of: • Numbers with mental disorder and poor wellbeing including from higher risk groups • Risk and protective factors • Numbers from particular groups at higher risk of mental disorder and poor wellbeing • Proportion of people getting treatment, prevention or mental health promotion and thereby unmet need • Impacts on public health, NHS and social care outcomes • Savings from investment in treatment, prevention and promotion and which arise in a broad range of area   This enables information about mental disorder and wellbeing (including for higher risk groups) to be included in the Joint Strategic Needs Assessment which informs the Health and Wellbeing Boards strategy and commissioners about level of unmet need. The board and commissioners can then make transparent decisions about what proportion of people who require such interventions should receive them.   The guidance also highlights the broad impacts of a range of evidence based interventions to address this unmet need. It enables estimation of the local savings which arise from interventions and the local costs of lack of intervention.   For further information, please contact Dr Jonathan Campion, email Jonathan.Campion@slam.nhs.uk