Depression in Adults

A chapter of Croydon’s mental health Joint Strategic Needs Assessment 2012/13

Health and Wellbeing Board 5 December 2012

Bernadette Alves, Locum Consultant in Public Health

Croydon’s 2012/13 mental health JSNA

• Overview chapter - mental health and well-being• Depression in adults• Schizophrenia• Emotional health and well-being of children and

young people (aged up to 18 years)• Croydon key dataset update

Aims of depression JSNA chapter

• Provide an overview of current and future need

• Identify assets and gaps

• Identify priorities for development

Depression

• Low mood, loss of interest / pleasure / energy / concentration, feelings of guilt or low self-worth, disturbed sleep or appetite

• Categorized as mild / moderate / severe• Can recur / be chronic

In the words of one contributor…

“the totally mind-numbing effect of serious clinical depression, from my experience, makes one unable to do anything, even to organising getting the money together to go out for a bus trip, and, at an even more alarming stage, getting out of bed at all”

Impact of depression

• Common • Leading cause of disability• Impacts on family, friends and carers • reduces the ability to work effectively• reduces ability to communicate and sustain relationships • increases risk of having physical health problems• Increases the risk of mortality

Groups most at risk of depression include those:

1. with long term physical health problems

2. with medically unexplained symptoms

3. living in households with low income.

4. who are carers

5. who are lesbian, gay, bisexual or transgender

6. who are asylum seekers

7. with serious mental illness

8. with substance misuse problems

9. who have had adverse childhood experiences

10. whose parents, especially mothers, had mental health problems

Policy contextDepartment of Health (2011) No health without mental health• More people will have good mental health • More people with mental health problems will recover • More people with mental health problems will have good physical health • More people will have a positive experience of care and support • Fewer people will suffer avoidable harm • Fewer people will experience stigma and discrimination

DH (2011) Talking therapies: A four-year plan of action. • Access for people aged over 65• children and young people; • people with long-term physical conditions or medically unexplained symptoms• people with severe mental illness

• PLUS …..Black and minority ethnic groups

Need and future need

Condition % prevalence 2012

Number in 2012

% change 2012 to 2021

Mixed anxiety and depressive disorder 9.2% 26,715 5.0%

Generalised anxiety disorder 4.4% 12,811 5.2%

Depressive episode2.4% 6,949 4.3%

All phobias 1.5% 4,289 5.0%

Obsessive compulsive disorder 1.2% 3,398 3.5%

Panic disorder 1.1% 3,207 5.4%

Any Common Mental Health Disorder

16.4% 47,824 5.0%

Wellbeing: Resilience, promotion, prevention, protection, recovery.

Step 0 Whole population promotion of wellbeing and resilienceDescribed in the overview chapter

Step 1 Identification, advice or referral, watchful waitingScreening of those with coronary heart disease / diabetesPrimary care diagnosis

Step 2 and Step 3

Mild to moderate and moderate to severe low-intensity interventions andhigh intensity interventionsLow intensity psychosocial interventionsLow intensity and high intensity psychological therapies:Counselling services:Structured Group Physical Activity programme; Medication: Anti-depressant treatment

Step 4 and Step 5

More complex needs

Crisis resolution / home treatment CMHT supportInpatient treatment: ECT Medication:High intensity psychological interventions

Challenges for people with depression:

“Social isolation. Lack of stimulation and support”“getting out of the house” “Lack of motivation”

“not a lot of support in relation to the holistic approaches”“social activities” “loneliness”

“Social factors ie change in benefits,housing issues”“We know that people want peer support services to allow people to end

loneliness and isolation“

Recommendations:

Prioritise public mental health in Croydon based on the available evidence of what works in the short, medium and long term and promote factors that increase population resilience

Ensure wellbeing services and activities are available to people with depression and ensure that mechanisms are in place to provide fair access, for example by older ages and BME groups.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

WhiteBritish

WhiteIrish orOtherWhite

Mixed Asian orAsian

British

Black orBlack

British

Chineseor otherethnicgroup

Notrecorded

Ethnic group

Prev

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Males

Females

Prevalence of diagnosed depression in Croydon by ethnic group

Source: Croydon GP database March 2012 (five year prevalence)

Prevalence of diagnosed depression in people with

long term conditions in Croydon

Source: Croydon GP database March 2012 (five year prevalence)

Source: Croydon GP database March 2012 (five year prevalence)

Recommendations:• Develop a strong primary mental health care service

and take steps to reduce unwarranted variation in primary care quality.

• Address inequality in access to services by BME groups. Improve diagnosis rates in primary care, access to talking therapy services and secondary care community teams.

• Commissioners of physical health services and commissioners of mental health services should work together to deliver integrated mental and physical healthcare for people with long term physical health conditions and mental health conditions.

Antidepressant prescribing in Croydon practices 2011-12

Percentage Dosulepin items of total

antidepressants. Croydon July 2011 to June 2012

Talking Therapies

• Effective and cost effective

• National Programme IAPT (improving access to psychological therapies)

• Croydon provision– Voluntary sector– IAPT– CIPTS (more complex need)– Private provision

People who have entered IAPT treatment as a proportion of people with anxiety or depression (2011/12)

Recommendation:• Increase the capacity of talking therapy

services and improve access by older people and people from BME groups

AssetsGP and primary care• “My GP & CMHT are brilliant” • “Some GPs are very able and helpful with diagnosis and care / signposting”• “Some GP services have expert primary care professionals in house who

are excellent”

Voluntary Sector• “Good voluntary sector services (esp. counselling and supporting people to

make lifestyle changes)”• “social inclusion services”• “support groups”• “voluntary and charity organisations”• “support available in Croydon in the voluntary sector”

Counselling and secondary care services“Some of the SLAM employees are brilliant and do a great job”“an innovative and creative IAPT service staffed with very motivated people”

Develop a strategy and action plan Collect and act on service user experience

Promote population resilience Develop wellbeing, advice and prevention services

Improve access (BME, older people)

Improve primary mental health services

Better information, integration and coordination

Reduce variation in primary care quality

Improve quality of antidepressant prescribing

Increase capacity of talking therapies

Join up physical / mental health services

Improve support for people with medically unexplained symptoms

Review FACS / CPA access criteria

Improve data quality around activity, evaluation and outcomes

Recommendation Framework

Next steps

• Comments by 17 December

• January - submit to health and wellbeing board exec for sign off

• Comments to:

• Fiona.assaly@croydonpct.nhs.uk

• Bernadette.alves@croydonpct.nhs.uk