Anomalías cromosómicas estructurales del cromosoma Y

Primary care

• Approximately 30% of all GP consultations are related to a mental health problem.178

• About 90% of people with mental health problems receive all their treatment from primary care services (as opposed to specialist mental health services), as do at least a quarter of those with severe problems.179 _On

average, a person with severe mental health problems has 13 to 14 consultations per year with their GP.180

Community care

Community mental health teams now provide most local specialist mental health services.

• Mental health nursing care is provided for 540,000 people living in the community, and there are 2.1 million attendances a year at NHS day care facilities as well as 2 million consultant outpatient attendances.181

• During 2005/06, crisis and home treatment teams provided 84,000 episodes of home treatment for people who would otherwise have been admitted to hospital.182

This was an increase from 69,000 in 2004/05, although the number of crisis resolution teams reduced to 266 in 2006 from 343 in 2005.183

• At the end of March 2006, around 19,000 people were receiving care from assertive outreach teams in the community, usually because these people were reluctant to engage with other mental health services. This represents an increase of 7% on the previous year.184

• 8,000 people received early intervention in psychosis treatment in 2005/06 (up from 4,600 in 2004/05) from 128 early intervention teams (compared with 109 in 2004/05).185

30%

Hospital provision

• The number of NHS beds for mental health problems in England was 31,667 in 2004/05. In 1999/2000 there were 34,173 beds.186 _{In 1983, there were 82,000 beds.}187

• The NHS spent about £575 million on acute psychiatric in-patient hospital care in 2005/06,188 _{about 68% of its}

budget for clinical mental health services.

• In 2003/04, the average cost of a hospital bed was £225 a day for an acute bed and £440 for intensive care. Costs of secure hospital care were £351 a day in low-secure units and £400 a day in medium-secure units. The weekly cost of local authority residential and nursing care for adults with mental health problems was £496 per person in England in 2004/05.189

• While the number of NHS adult mental health

admissions fell by about 10% over four years to 122,260 in 2002/03, the average length of stay per admission was stable at roughly 18-19 days.190

• Child and adolescent psychiatric units are unevenly distributed across England and Wales, with a

concentration in London and the South East. More than a quarter of child and adolescent beds are now provided by the independent sector.191 _{In 2002, 124 NHS Trusts}

were identified as providers of specialised child and adolescent mental health services – between them they had 732 teams and 7,340 staff.192

82,000 1983 31,667 2004/05 34,173 1999/00 0 20 40 60 80 100

TREATMENT AND CARE

The Mental Health Act (1983)

The Mental Health Act (1983) is the principal Act governing the treatment of people with mental health problems in England, Wales and Northern Ireland. It covers all aspects of compulsory admission and subsequent treatment.

• There were 46,700 detentions under the Mental Health Act (1983) in 2004/05. On 26,752 occasions the Mental Health Act was used to admit a person to hospital (an increase from 25,642 in 1994/95). On almost 20,000 occasions in 2004/05 the Mental Health Act was used to detain a person already admitted voluntarily to hospital in order to prevent them leaving, down very slightly from a decade earlier.193

• A mental health census in 2005 found that 46% of men and 29% of women in mental health units were detained under the Mental Health Act.194

• In 2005, 53% of compulsory admissions under the Mental Health Act to NHS hospitals were male, but at a given point in time there were almost twice as many men as women detained. The Office of National Statistics speculates that this could be due to a longer average period of detention for men or to more men being detained to prevent them leaving hospital following a voluntary admission, but notes these data are not collected.195

• The highest rate of detentions in 2005 was in London (134 people per 100,000) followed by the North West (93 per 100,000). The East of England had the lowest rate (69 per 100,000).

• Research suggests that use of crisis plans, also known as advance statements or advance directives, drawn up jointly between professionals and patients can reduce the number of compulsory admissions under the Mental Health Act by more than 50%.196

• The 2005 mental health ethnicity census found that people from ethnic minorities are more likely to be detained under the Mental Health Act. Inpatients from the Black Caribbean, Black African, and Other Black groups were more likely (by between 33% and 44%) to be detained when compared with the average for all inpatients. The rate of detention for inpatients from the Other White group was also slightly higher than average.197

Percentage of people detained in mental health units under the Mental Health Act194

46% 29%

Men Women

46% 29%

Users’ experience of staff

• Most service users are positive about the way they are treated by mental health staff. In one study three quarters rated their care as good, very good or excellent, compared with 9% who said it was poor or very poor.198

• 15% of people using mental health services say they do not have enough say in decisions about their treatment, while 44% say they only have a say to some extent. 18% say their diagnosis has not been discussed with them.199

Informal care

• In the UK adults with mental health problems receive about 21 million hours a week of informal (unpaid) care from family and friends.200

• Up to 420,000 people in the UK care for someone with a mental health problem,201 _{including between 6,000 and}

17,000 children and young people.202 _{Including carers}

of people with dementia, estimates rise to around 1.5 million. 31% of these are involved in caring for more than 50 hours a week.203

• A 2003 survey found that 75% of people who care for a person with a mental health problem are women, and the average age of carers was 62 years. The average age of recipients of care was 39 years, and 68% were male. 44% cared for a person with schizophrenia and 9% for a person with bipolar disorder.204

• 29% of the 175,000 young carers in the UK are looking after people with mental health problems. 82% of young carers provide emotional support to the person they care for.205

• 27% of carers said they had been turned away when trying to access help for the person they care for.206 _56%

cited an access related issue as the most frustrating aspect of dealing with mental health services.207

A quarter of carers felt they do not have sufficient information available.208

27%

TREATMENT AND CARE

Treatment