Mental health in the United Kingdom

Mental health in the United Kingdom involves state, private and community sector intervention in mental health issues. One of the first countries to build asylums, the United Kingdom was also one of the first countries to turn away from them as the primary mode of treatment for the mentally ill. The 1960s onwards saw a shift towards Care in the Community, which is a form of deinstitutionalisation. The majority of mental health care is now provided by the National Health Service (NHS), assisted by the private and the voluntary sectors.

According to an investigation in 2018, the NHS is struggling to cope with rising demand for mental health care, with a shortage of beds, patients facing long delays in accessing treatment, and receiving inadequate care when they do. Areas of concern include support for pregnant women and new mothers; depression, anxiety and suicidal thoughts in school-age children and adolescents; and the use of restraints on mental health patients.

The Minister of State for Mental Health, Suicide Prevention and Patient Safety, Nadine Dorries is responsible for Mental Health. Scotland has a Minister for Mental Health, Clare Haughey.

History

The Madhouses Act 1774 was the first legislation in the United Kingdom addressing mental health. Privately funded lunatic asylums were widely established during the nineteenth century. The County Asylums Act 1808 permitted, but did not compel, Justices of the Peace to provide establishments for the care of "pauper lunatics", so that they could be removed from workhouses and prisons. The Lunacy Act 1845 established the Board of Commissioners in Lunacy. Justices were required to build lunatic asylums financed by the local rates.[1]

In 1859, there were about 36,000 people classified as lunatics in all forms of care in England and Wales. About 31,000 were classed as paupers and 5,000 were private patients. Over 17,000 of the paupers were in county asylums or on contract in licensed houses, about 7,000 were in workhouses, while a similar number were living 'with friends or elsewhere'. Ten percent of workhouse infirmaries provided separate insane wards. The Lunacy Act of 1862 permitted voluntary admission. Any person who had been a patient in any type of mental hospital during the previous five years could enter a licensed house as a voluntary boarder. The Lunacy Commissioners could remove lunatics from workhouses to county asylums, and the harmless chronic insane could be moved from the overcrowded asylums to the workhouses.[1]

Leavesden Mental Hospital, near London

The Metropolitan Asylums Board, established by the Metropolitan Poor Act 1867 built two large asylums for London, Leavesden Mental Hospital and Caterham Asylum.[2] They were built to similar designs by the same architect and each was intended to accommodate 1560 patients in six three-storey blocks for 860 females and five blocks for 700 males. They were both extended by around 500 places within five years.[3] In 1870 there were about 46,500 poor law mental health cases: 25,500 in county asylums, 1,500 in registered establishments, 11,500 in workhouses and the remainder boarded out with relatives. In 1876, there were nearly 65,000 people classified as mentally disordered in England and Wales. It is not clear that there was actually an increase in the prevalence of mental illness.

From around 1870 there were moves to separate what was then called idiot children from adults. Darenth School for 500 children with learning disabilities was opened by the Metropolitan Asylums Board in 1878 and a separate institution next to the school, with accommodation for 1,000 adults, was opened in 1880. The Lunacy Act 1890 placed an obligation on local authorities to maintain institutions for the mentally ill. By 1938 131,000 patients were in local authority mental hospitals in England and Wales, and 13,000 in District Asylums in Scotland, where there were also seven Royal Mental Asylums. Mental hospitals were overcrowded and understaffed.[4]

Mental health services were not integrated with physical health services when the NHS was established in 1948. Shortages of money, staff and buildings continued. Confederation of Health Service Employees organised an overtime ban in 1956, the first national industrial action in the NHS. Iain Macleod increased capital spending from 1954, hoping to increase bed numbers by 2,800. Rising numbers of patients, especially the elderly, caused a shift in policy away from institutions and towards day centres and community care.[5]

In 1961 Enoch Powell, then Minister of Health, made his Water Tower Speech. He said "in fifteen years time there may well be needed not more than half as many places in hospitals for mental illness as there are today".[6] This marked a shift towards Care in the Community, the British version of deinstitutionalisation, which was given further impetus by a series of scandals over long-stay hospitals from 1968 onwards.[7]

In 1998, Child and Adolescent Mental Health Services (CAMHS) began to be established, taking over from an earlier multidisciplinary child guidance approach. Children, generally until school-leaving age, are supported by CAMHS organised locally often by local government area, operated by the NHS but jointly financed by the NHS and local government.[8][9]

On World Mental Health Day 2018, the Prime Minister, Theresa May appointed Jackie Doyle-Price as the UK's first suicide prevention minister. This occurred while as the government hosted the first ever global mental health summit.[10]

Incidence of mental health problems

Most mental health problems are not easily defined. The American Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems are most generally used.

Estimates to the prevalence of mental illnesses can vary significantly, depending on how the question is presented. The 2014 Adult Psychiatric Morbidity Survey found that 1 in 6 respondents had shown the symptoms of a common mental disorder in recent days, and 1 in 8 reported seeing mental health treatment.[11][12] In the same year, the Health Survey for England found that 25% of respondents had been diagnosed with a mental illness at some point in their life and a further 18% had had one that was not diagnosed.[11] A survey in Scotland found 26% of respondents reported having experienced a mental health problem at some point in their life, but the figure increased if respondents were shown a list of conditions. A 2017 survey found that 65% of Britons have experienced a mental health problem, with 26% having had a panic attack and 42% saying they had suffered from depression.[13]

Surveys have found that mental health problems have been on the rise since 2000, although growing awareness may also be a factor, and there are some countertrends such as a decline in suicide. One survey found that the number of responders who had reported having suicidal thoughts in the past year increased from 3.8 per cent in 2000 to 5.4 per cent in 2014.[14] 2018 was the first year that mental health factors like stress and anxiety caused over half of all absences from work.[14] According to a survey of 3,500 participants by the Office for National Statistics (ONS), the number of adults in Britain with depression has doubled during the coronavirus pandemic with 19.2% experiencing depression in June 2020.[15]

Benefit cuts and sanctions "are having a toxic impact on mental health" according to the UK Council for Psychotherapy. Rates of severe anxiety and depression among unemployed people increased from 10.1% in June 2013 to 15.2% in March 2017. In the general population the increase was from 3.4% to 4.1%.[16]

Suicide

6,045, 5,608 and 5,675 people aged 15 and over died by suicide in the time from 2009–2011 respectively.[17][18]

Mental health treatment

England

Mental health treatment is regulated in the UK by the Mental Health Act 1983 (amended by Mental Health Act 2007) and the Mental Capacity Act 2005. Legislation includes the power to admit those accused of crimes to be detained as restricted patients if certain conditions are met.[19]: 4 

The numbers of patients attending accident and emergency departments due to psychiatric problems rose by 50% between 2011 and 2016 and reached 165,000 in that year, amounting to as many as 10% of A&E visits in some trusts. There are calls for increased provision of in patient psychiatric services and community psychiatric services because otherwise patients will be failed, sometimes with tragic results. A&E is stressful and far from ideal for people in a mental health crisis but many patients in mental distress, some suicidal have nowhere else to go.[20]

Some mental health services have increased but many have been cut. 40% of mental health trusts have seen their budget reduced. Marjorie Wallace of mental health charity Sane, said "cuts to services across the country continue and people seeking help are still being failed".[21]

In 2019 it was reported that many children with autism in England were waiting 137 days or more following referral for a diagnosis, against a target of 91 days.[22] In December 2019 the Voluntary Organisations Disability Group reported that 2,250 people with special needs were detained in long-stay NHS accommodation. 463 had been there for more than five years and 355 for more than 10 years. Effective provision of care in the community appeared a remote prospect for these patients.[23]

The number of NHS mental health hospital beds fell by 25% between 2011 and 2021. There were 23,447 consultant-led mental health beds in 2011 and 17,610 in 2021.[24]

In 2021 children with mental health needs faced very long delays before receiving treatment. 51% waited under four weeks, 29% waited four to twelve weeks, 20% waited over twelve weeks. Some children with mental health problems had to go to A&E because a crisis developed while they were waiting. Some children were admitted to inappropriate adult wards through lack of room on children's wards.[25]

Medical restraints in the UK

The Millfields Charter is an electronic charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds.[26] Organisations opposed to restraints include Mind and Rethink Mental Illness. YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients, especially women and girls who have previously been victims of physical and/or sexual abuse.[27]  The use of restraints in UK psychiatric facilities is increasing.[28] In June 2013 the UK government announced that it was considering a ban on the use of face-down restraint in English mental health hospitals.[29] They are particularly opposed to face-down restraints, which are used disproportionately on female patients.[27]

Proposals

NHS Improvement began plans to help trusts in England integrate mental and physical health care in June 2017.[30] Claire Murdoch said that more than 10,000 staff would be required to deliver the promised service improvements.[31]

See also
  • List of asylums commissioned in England and Wales
  • Health in the United Kingdom
  • Improving Access to Psychological Therapies
  • Mental Health Research UK
  • Praxis Care

References
  1. Ayers, Gwendoline (1971). England's First State Hospitals. London: Wellcome Institute of the History of Medicine. Retrieved 11 July 2017.
  2. "Saint Lawrence's Hospital, Caterham". AIM25. Retrieved 11 July 2017.
  3. "St Lawrence's Hospital". Lost Hospitals of London. Retrieved 11 July 2017.
  4. Webster, Charles (1988). The Health Services Since the War. London: HMSO. p. 9. ISBN 0116309423.
  5. Webster, Charles (1988). The Health Services Since the War. London: HMSO. p. 338. ISBN 0116309423.
  6. "Enoch Powell's Water Tower Speech 1961". Studymore. Retrieved 11 July 2017.
  7. Munson- Barkshire, Amy (1981). Scandals in Chronic Sector Hospitals contents. Manchester: Socialist Health Association. Retrieved 11 July 2017.
  8. "A brief timeline of CAMHS policy in England". YoungMinds. 2014. Archived from the original on 2 April 2017. Retrieved 2 April 2017.
  9. Sarah Wright (16 November 2016). "The 30-second briefing: What are CAMHS?". TES Connect. Archived from the original on 3 February 2017. Retrieved 2 February 2017.
  10. "World Mental Health Day: PM appoints suicide prevention minister". BBC News. 10 October 2018. Retrieved 31 October 2020.
  11. "One in four? How many people suffer from a mental health problem". Full Fact. 11 August 2017. Retrieved 20 January 2020.
  12. "Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014". NHS Digital. 29 September 2016. Retrieved 17 July 2017.
  13. Two thirds of adults experience mental health problems such as anxiety or depression, survey finds. The Independent. Published 8 May 2017. Retrieved 26 January 2018.
  14. "The charts that show how the UK is in the midst of a mental health awakening". The Daily Telegraph. 14 May 2019. Retrieved 21 January 2020.
  15. Duncan, Pamela; Butler, Patrick (18 August 2020). "Depression in British adults doubles during coronavirus crisis". The Guardian. ISSN 0261-3077. Retrieved 11 September 2020.
  16. "Government welfare cuts blamed for 50% surge in mental health issues among unemployed". Independent. 17 July 2017. Archived from the original on 12 May 2022. Retrieved 17 July 2017.
  17. "UK suicide rate rises 'significantly' in 2011". BBC News. 22 January 2013. Retrieved 18 March 2013.
  18. "Suicide rates in the United Kingdom, 2006 to 2010" (PDF). Office for National Statistics. Retrieved 18 March 2013.
  19. "Restricted Patients Statistical Bulletin" (PDF).{{cite web}}: CS1 maint: url-status (link)
  20. Woodcock, Nick Triggle and Sophie (10 January 2017). "Steep rise in A&E psychiatric patients" – via www.bbc.co.uk.
  21. "Mental health care cuts in England 'to total £4.5m'". 25 April 2017 – via www.bbc.co.uk.
  22. "Autism: 'Unprecedented' demand creates long appointment waits". BBC. 27 November 2019. Retrieved 21 February 2020.
  23. "'National scandal' sees hundreds of people detained in UK hospitals for more than 10 years". Homecare Insight. 9 December 2019. Retrieved 22 February 2020.
  24. Campbell, Denis (5 July 2021). "Number of NHS mental health beds down by 25% since 2010, analysis shows". The Guardian. Retrieved 5 July 2021.
  25. Children face 'agonising' waits for mental health care BBC
  26. "Archived copy". millfieldscharter.com. Archived from the original on 5 December 2006. Retrieved 12 January 2022.{{cite web}}: CS1 maint: archived copy as title (link)
  27. End humiliating restraint of mentally ill people, say charities
  28. Mental health trusts restrain patients 'every 10 minutes' BBC
  29. "'Excessive' use of face-down restraint in mental health hospitals". bbc.co.uk. 18 June 2013. Retrieved 19 June 2013.
  30. "Exclusive: Regulator expands national mental health team". Health Service Journal. 19 June 2017. Retrieved 14 July 2017.
  31. "Mental health workforce needs "greater than" PM's promise". Health Service Journal. 23 June 2017. Retrieved 16 July 2017.

Further reading
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