1. Mental Health - Predicting Need
We know that a range of risk factors influence the development and course of mental illness.
These include socio-economic disadvantage, homelessness, and unemployment, poor
educational attainment, being a member of a minority group, being a lone parent or teenage
mother. Section 3 has also shown that the number of people with a mental illness is expected
to rise by 11% in Barnet up to the period 2025 with levels of mental illness differing between
localities.
People with good mental health are more likely to be, and remain, in work and be financially
independent. In Barnet there are In Barnet, 4,650 people are on incapacity benefits related to
mental health issues which constitutes 44% of the total number of claimants of incapacity
benefits. (Figures taken from IAPT submission, Barnet PCT). There is little support when
people fall out of employment and people with mental health difficulties are at more than double
the risk of losing their jobs. The majority of people who spend more than six months out of work
after an episode of mental ill health will never work again. Loss of self esteem and aspiration
stops people from continuing their education, getting jobs, making friends and establishing
relationships. Often it is the expectation of stigma that stops people leading fulfilling lives and
enjoying themselves. People with mental health difficulties often experience discrimination in
everyday life. 44% of people with mental health problems surveyed for the Government’s Social
Exclusion Unit felt that they had experienced discrimination from GPs, while 18% said they
would not disclose their condition to a GP. Fewer than 40% of employers say that they would
consider employing someone with a history of mental health problems. (
There is a strong evidence base in respect of the correlation between severe and enduring
mental illness and poorer physical health. There are higher mortality rates for people with
schizophrenia as people with schizophrenia are 2.5 times more likely to die from respiratory
disease, 1.8 times more likely from digestive disorders, 1.6 times more likely from genito-
urinary problems and 1.1 times more likely to die from cardio-vascular disease. In addition
people with schizophrenia are twice as likely to have diabetes and 74.6% of people with
schizophrenia living in mental health settings smoke compared to 27% of general population.
Depression increases the risk of heart disease fourfold, even when other risk factors like
smoking are controlled. Depression has a significant impact on health outcomes for chronic
physical illness such as asthma, arthritis and diabetes
Poorer physical health together with mental health needs is linked to poverty, social exclusion
exacerbated by poorer motivation and tiredness, poor lifestyle including diet, smoking and a
lack of exercise Compared to the general population people with mental health problems are
one and a half times more likely to live in rented housing, with higher uncertainty about how
long they can remain in their current home; twice as likely to state that their housing is in a poor
state and four times more likely to say that their health has been made worse by their housing.
This is reflected in the survey related to housing needs referred to in section 3.
Data is available from the Quality and Outcomes Framework information from GP Practices on
the number of people with severe long term mental health problems who are known to GP’s. In
March 2008, this was ### individuals. As Health services are often divided down the middle
split between physical health and mental health. This can lead to diagnostic overshadowing
and result in physical health care issues being ignored and attributed to mental health problems
Whilst Barnet has marginally over the average rate of mental illness, this does vary across the
Borough with four wards with a high level of mental illness.(Burnt Oak, Colindale, West Hendon
and Coppetts). In these areas we need to ensure resources are targeted particularly for primary
care services.

2. Rates of suicide are a good indicator of the overall level of mental health in a population.
Around 5,000 people are known to take their own lives in England every year. In the last 20 or
so years suicide rates have fallen in older men and women but have risen in young men and
suicide is the most common form of death for men under 35.
Responding to changing needs
Over the last 10 years since the publication of the National Service Framework we have made
significant improvements in our services for people with mental health needs. New
development in acute mental health services have seen a redesigned acute care pathway with
improved inpatient environments and reduced beds supported by home treatment. Whilst there
has been more support for people with longer term mental health needs, including the recovery
team and the development of a specialist service for people between the ages of 14-35 to
support the early detection and intervention of people who experience a psychotic episode and
a wider recognition of the need to promote social inclusion and recovery based approaches ,
mental health services have not been required to work to a clear outcomes based approach as
part of the roll-out of the National Service Framework.
The move away from registered residential care to supported living and increased support in
people’s own home for people with more severe mental health difficulties. This includes a major
redevelopment programme which is underway to modernise four large mental health hostels to
develop a spectrum of accommodation and support options by 2010.
Key Messages for Mental Health Services
The issues that need to be addressed over the lifetime of this Joint Strategic Needs
Assessment in respect of the changes in demand and models of Adult Mental Health
Services include:-
• Mental Health Promotion and prevention to support the development of healthier
communities and to address the causes of poor mental health.
• Increasing choice and control for people with common mental illnesses through Primary
Care Based Mental Health Services that can be accessed directly by individuals. This
includes ensuring that there is increased access and availability to Psychological Therapies
in primary care for the high levels of common mental health difficulties and Pathways to
Work for people with mental health difficulties on incapacity benefit.
• Increasing Choice and Control for people with Severe and Enduring Mental Health difficulties
through the delivery of Self Directed Care to promote social inclusion
• To continue expanding early intervention and detection for people with severe mental health
conditions, with a much greater focus on social inclusion, challenging inequalities and
supporting the delivery of a recovery based model.
• As with Learning Disabilities, increasingly the service delivery agenda is to ensure that
people have access to a whole range of mainstream community services which include the
development of high quality accommodation and support in people’s own homes.