The Epidemiology of Mental Health in Bradford and Airedale

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The Epidemiology of Mental Health in Bradford and Airedale Powered By Docstoc
					  Mental Health Needs Assessment
        and Strategy Review


Dr Andrew O’Shaughnessy            Mick James
Consultant in Public Health        Mental Health Commissioning Lead
NHS Airedale, Bradford and Leeds   NHS Airedale, Bradford and Leeds
November 2011
Background
• Rolling programme of HNAs in Public Health
• Began 2008
• Sexual Health, Children, Smoking, Alcohol,
  Obesity…
• Next up Substance Abuse, ASD, Dementia
• Process focus on commissioning
• Updated annually
• Live approach – Observatory

Thanks to AL and DC
 Health Needs Assessment
The elements of health care needs assessment



   Incidence
                                                                    Effectiveness and
     and/or                                                                              Strategy
                                                                    cost-effectiveness
   prevalence
                                                                                         Partnerships
                                                                                         Commissioning
                                                                                         JSNA
                                                                                         Prioritisation
                                                                                         Reorganisation
                                     Existing
                                     services



   Cost-effectiveness allows us to consider the relative priority of different needs
Data Issues
•   Multiple data sources
•   Differing methodologies
•   Differing samples
•   Differing numerator populations
•   Differing denominator populations
•   Data gaps
•   Local improvisation to derive estimates
•   Policy statements
•   Maintains utility
•   NB Observed vs Expected

Appendix B
Taxonomy
Diagnosis                 Demographic
• Affective disorders     • Gender
• Bipolar disorders       • Age group
• Psychotic disorders     • Young
• Personality disorders   • Working age
• Others e.g. suicide     • Older people
Overall Burden of Illness
      Broad Epidemiological Perspective                                           Corresponding Epidemiology
                                                                                     in Bradford & Airedale
                                                       Adults

      20% of working-age women are affected by depression or anxiety                       29,420

      7% of working-age men are affected by depression or anxiety                          13,000


      3% of women can be assessed as having a personality disorder                          5,950

      5% of men can be assessed as having a personality disorder                            9,500


      1.9% have a psychotic disorder such as schizophrenia or bipolar affective             8,530
      disorder during their lifetime

                                                 Children (0-15yrs)

      10% of children have a diagnosable mental health condition                           11,310


       Source: Estimated from New Horizons and ONS mid 2008 population estimates
Children 1
                                          Boys (%)                                Girls (%)                All 5-16 year olds
                                                                                                                      (%)

 Age                         5-10 year olds    11-16 year olds   5-10 year olds          11-16 year olds




 Conduct disorder                 6.9                8.1              2.8                     5.1                 5.8


 Hyperkinetic disorder            2.7                2.4              0.4                     1.4                 1.5


 Emotional disorder               2.2                 4               2.5                     6.1                 3.7


 Less common disorders            2.2                1.6              0.4                     1.1                 1.3


 Any disorder                    10.2                12.6             5.1                     10.3                9.6




Source: Mental Health of Children and Young People in Great Britain, ONS 2004
Children 2
Age Range                               Number of Children   Prevalence   Number with a mental health disorder




5-10 years                  Female           21,057             5.1                      1,074

                             Male            22,048             10.2                     2,249

                            All 5-10         43,105             7.7                      3,319

11-15 years                 Female           17,501             10.2                     1,785

                             Male            18,195             13.1                     2,384

                            All 11-15        35,696             11.7                     4,176



5-15 years                     All           78,801             9.6                      7,565




Source: CAMHS Needs Analysis Review 2007
Older People
• There are an estimated 4,080 older people with Bipolar I disorder in
  Bradford District
• There are an estimated 1,912 older people with Personality Disorder
  in Bradford District
• There are an estimated 270 older people with schizophrenia in
  Bradford District
• Affective Disorders:

                 Age      Population   Population      Any         Any neurotic
                group        (F)          (M)       neurotic (F)       (M)

               65 to 69     9,984        9,038         1,519           604
               70 to 74     9,337        7,354         1,139           643
                 75+        18278        15507         2514           1180
                Total      37,599       31,899         5,172          2,428
Affective Disorders




        Female ~ 32,000   Male ~29,000
Bipolar Disorders
 • Lifetime prevalence (i.e. those who have the disorder for at least part of their
   lifespan) of Bipolar I disorder is approximately 1.3%
 • Prevalence of Bipolar spectrum disorder (including Bipolar I,II and cyclothymia
   much less clear but may be between 2.6% and 6.5%
 • Bipolar spectrum disorders often go unrecognized and undiagnosed – hidden
   and unmet need


                               Males       Females           All
                0-16            790           770          1560
                17-64           3370         2010          5380
                >65             2050         2030          4080
                Total           6210         4810         11020
Psychotic Disorders
• ~1,700 adults of working age and 270 older people with
  schizophrenia in Bradford District
• Larger numbers with schizophrenic disorder
• NB broad taxonomy of psychosis

             16-64yrs   65+yrs                     Numbers for Bradford adults (+16yrs)
                                                                 (95% CI)
Female         797       153
                                 Diagnosis            One year              Lifetime
Male           895       115
                                 Schizophrenic   2332 (1477 to 3537)   5635 (311 to 9211)
All adults    1731       272     disorder
Personality Disorders
Type of personality                      Female                                Male                                All adults
      disorder
                           16-34   35-54          55-74   All    16-34   35-54        55-74   All    16-34   35-54        55-74      All

Obsessive-Compulsive         -     527            1630    2312   1554    1706         1247    4622   1524    2235          2911     6757

Avoidant                   136     988             88     1245   636     1115           -     1778   831     2104           86      2845

Schizoid                   407       -            969     1423   565     131          873     1600   970     131           1883     2845

Paranoid                   204     329              -     534    636     1378          83     2133   831     1709           86      2489

Borderline                 340     461              -     711    141     1574           -     1778   416     1972               -   2489

Antisocial                 340      0               -     356    565     1115           -     1778   970     1183               -   2134

Dependent                    -       -             44      0     353       -            -     356    416       -                0   356

Schizotypal                 68      66             44     178      -      0             -      0     139     131            86      356

Histrionic                   -       -              -      -       -       -            -      -       -       -                -     -

Narcissistic                 -       -              -      -       -       -            -      -       -       -                -     -

Any personality disorder   1154    1911           2775    6047   3673    3805         2202    9601   4710    5785          4965     15648

 Source: Psychiatric Morbidity survey 2000 (from clinical interviews).

 N.B crossover with other types of mental illness e.g. OCD vs. OCPD
Hospital Admissions
 • Data were collected from Bradford District Care Trust
 • 60% no diagnosis code so necessary to estimate total
   admissions by age and disorder type
 • 2008 and 2009 (combined) there were 3,291 admissions
   (~1,600 pa)
 • Psychotic disorders (n=485 per year) and Affective disorders
   (371) account for half of all annual admissions to BDCT
 • Significant numbers of admissions for drug (98) and alcohol
   (129) dependency
 • Older people: Dementia is the largest diagnosis type
   accounting for over 40% of admissions, with affective
   disorders comprising a further 30%
 • N.B. admissions elsewhere and “composite” admissions –
   actual admission burden likely to be higher
Hospital Admissions
Ethnicity
•   People from minority ethnic groups living in the UK are more likely to
     – Be diagnosed with mental health problems
     – Be admitted to hospital with mental health problems
     – Experience a poor mental health treatment outcome.
•   There may also be low levels of reported and diagnosed mental health
    disorders due to negative stigma. This results in low engagement with services
•   Rates of affective disorders 15-20% higher within the S. Asian pop. of England
•   Black groups have lower prevalence for affective disorders than the general
    pop
•   African Caribbean people are 3 to 5 times more likely to be diagnosed and
    admitted to hospital for schizophrenia than other groups.
•   Evidence is inconclusive as to whether South Asian groups have higher rates
    of schizophrenia than whites, although they have better rates of recovery
•   No relationship between any of the QoF MH indicators and South Asian
    ethnicity in B&A
•   Those from South-Asian ethnic groups in B&A have higher levels of satisfaction
    with their financial situation than those from the White group
Prescribing
 •   587,000 prescribed items per year in Bradford District
 •   Cost of £5.9 million per year
 •   Antidepressants comprise more than half
 •   Substantial variation in prescribing across the District
Benchmarking 1
• Bradford’s relatively deprived population,compared
  nationally, may be expected, at the population level, to
  generally suffer higher levels of bipolar and psychotic
  disorders
• Almost two thirds of those in need receive either
  enhanced or standard CPA in Bradford, compared to
  one third in our peers and England as whole
• In Bradford District 10,440 people claim mental health
  incapacity benefit. This is 3.5% of the working age
  population, compared to 1.7% nationally
• In 2008/2009 there were 32,111 patients with diagnosed
  depression on GP depression registers. This is 6.1% of
  total patients on lists compared to 7.7% in Yorkshire and
  Humber and 8.1% in England
Benchmarking 2
• The rate of access to mental health services for adults is below our
  PCT peers and England for older people but above the England
  average for adults of working age
• Bradford has a lower proportion of contacts with psychiatrist /
  psychologist / psychotherapists, at 14% compared with our PCT
  Peers at 24%
• In Bradford patients are more likely to be admitted than those in
  contact with services in similar PCTs or in England as a whole
• Approximately 1,400 people were detained under the Mental Health
  Act 1983. The proportion formally detained for at least one day is
  similar to our PCT peers but above the national average
Local Geographic Variation
 •   Residents from City and South and West Alliance areas were slightly more likely to
     report feeling downhearted and depressed
 •   Levels of life satisfaction are lowest in the South and West Alliance area
 •   Substantial variation in QoF prevalence between practices, with greatest variation
     between practices in the City Care and South and West Alliance
 •   Of the 13 practices achieving less than 90% of mental health reviews for patient, 9
     are in City Care Alliance. Patients within these practices are also less likely to have a
     comprehensive mental health care plan or be followed up for non-attendance of 15
     months reviews
 •   Antipsychotics drug prescribing rates and cost per head of population are similar
     across the 4 alliances. South and West alliance has the highest prescribing rate (0.16
     items per head) with Airedale alliance the highest cost per head (£5.19)
 •   However, there is a huge range in prescribing of antipsychotic drugs between
     practices ranging from 0.02 items per head (£0.41) to 0.6 items per head (£11.40).
 •   City Care Alliance has the lowest number of items and cost per patient for
     antidepressants (£2.14 per head of population) and hypnotics and anxiolytics (£0.86).
     For hypnotics and anxiolytics, prescribing rates and cost are broadly similar across
     other alliances
 •   S&W alliance has the highest number of items per patient for anti-depressants,
     although Airedale and YPCA/BANCA alliances have higher costs per patient,
     suggesting variation in the type and quantity of drugs prescribed by GPs
Strategy Review
•   Need to review local strategy
•   Changing Commissioning landscape
•   Public Health changes
•   Health and WellBeing Boards
•   Integration
•   Personalisation
•   Joint Commissioning
•   Alcohol, Substance Abuse
CCG Context
•   Strategic planning
•   Commissioning plans
•   Partnership working
•   Prevention and Management
•   Focused workstreams
     – IAPT Need/Capacity planning
     – Antipsychotic prescribing in Primary Care
     – Antipsychotics in Dementia
     – Guidance Taxonomy
     – Autism HNA
     – Dementia HNA
Next Steps
•    Complete the HNA triangle
•    In tandem with commissioners as part of MH strategy
     development:
    – Analysis of need and service provision with gap
         analysis
    – Use of evidence and guidance to identify
         approaches to address these
    – Assessment and application of published clinical
         and strategic guidance on mental health and well-
         being.
    – Focused review of published research literature as
         required
    – Engagement with partners including clinicians in
         Primary and Secondary Care

				
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