17. mental health, self-harm and alcohol specific...

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17. Mental health, self-harm and alcohol specific conditions

17.1 Prevalence of chronic mental healthconditions (ICD10: F20-F48)

Mental health problems are commonplace, with approximatelyone in four people in Britain suffering from mental health problems,illnesses and psychiatric conditions at some stage in their lives 74.There is a great deal of controversy about what mental illness is,what the causes are, and how people can be helped to recover.According to The National Association for Mental Health (MIND),“Mental illnesses are some of the least understood conditions insociety. Because of this, many people face prejudice anddiscrimination in their everyday lives”74. Mental illness or distresscan take a number of forms, which vary appreciably in severity andlevel of incapacity. These include depression, anxiety, panicattacks, obsessive-compulsive disorder, phobias, manicdepression, and schizophrenia. Mental illness is linked todeprivation and poverty, and varies by gender. Governmenttargets seek to reduce death rates from suicide and undeterminedinjury by at least a fifth 23. The conditions included in this analysisare schizophrenia, depression, neuroses and anxiety disorders.

l Map 17.1 displays regional variations in the prevalence ofdiagnosed mental health conditions (schizophrenia, mooddisorders and neuroses), which result in a hospital admission.High ratio levels, based around a regional average of 100, areshown across Rossendale, Burnley, Bury, Salford and centralLiverpool, as well as urban areas within Manchester,Warrington, Halton, Wirral and Carlisle. However, higher urbanratios are more concentrated geographically than for manyhealth conditions illustrated. Rural localities and countiesconsistently show lower than average ratios for mental healthconditions.

l Figure 17.1a shows a non-linear relationship betweendeprivation levels and rates of admission for mental health,with the prevalence rate for mental illness 2.75 times higher forthe most deprived quintile of population in the region, than thatfor the most affluent. Poor mental health increases rapidlybetween the third and fifth poorest quintiles of population. Asimilar curve in mental health prevalence is shown bygeodemographic lifestyle group in Figure 17.1b. However, theNew Starters grouping shows appreciably higher levels ofmental illness prevalence, than other similar lifestyle groups.Predominantly non-White area populations have statisticallysignificant higher prevalence rates, Chinese excepted (Figure17.1c), with urban populations showing appreciably higheraverage rates of prevalence (Figure 17.1d).

l The North West Local Authorities with the highest hospitalisedprevalence ratios for mental health conditions are Burnley(151), Halton (144) and Rossendale (141); the lowest are Wyre(51), Barrow-in-Furness (58) and Ribble Valley (59).

17.2 Incidence of self-harm (ICD10:X80-X84, Y10-Y34)

Self-harm occurs when a person deliberately injures or hurts himor herself. Self-harm includes cutting or burning one-self,overdose through tablets or medicines, inhaling or sniffing harmfulsubstances, swallowing non-edible items and self mutilation. Self-harm may be undertaken on a regular basis, or on one or a fewoccasions. It can be part of coping with a specific problem 75.Where a hospital admission is reported to be due to self harm therelevant code will be recorded as an ‘external cause’.

l Map 17.2 shows variations in admission ratios for self-harmacross the North West. Higher ratios are shown to be localisedwithin urban areas, though in the case of self-harm, Liverpooland central Manchester do not show the typical high ratiolevels seen for many health issues linked to deprivation. WithinCumbria, pockets of high ratio self-harm incidence are seen inBarrow-in-Furness, Carlisle and in western coastal towns.Within Lancashire, areas of Lancaster, Blackpool, Preston andChorley, for example, are amongst those with higher thanaverage ratios. Localised areas with high ratios are seenacross Greater Manchester and Merseyside, for example inWirral, Halton and St Helens. Cheshire, and a greater part ofLancashire than usually seen, in contrast, show lower thanaverage self-harm ratios.

l As with many health conditions, self harm incidence ratesincrease appreciably by relative levels of deprivation, as shownin Figure 17.2a. The rate of admissions for the most deprivedquintile of population is 3.4 times that for the least deprivedquintile. The same relationship is seen by geodemographiclifestyle group, though Qualified Metropolitans andMulticultural Centres lifestyle groups show lower rates ofadmission than neighbouring groups (Figure 17.2b).Predominantly Black and Chinese groups show lower rates ofadmission for self harm (Figure 17.2c) whilst sparsepopulations, whether urban or rural based, show the highestadmission rates for self-harm (Figure 17.2d).

l The North West Local Authorities with the highest hospitalisedincidence ratios for self-harm are Carlisle (229), Barrow-in-Furness (225) and Wirral (201); the lowest are Ribble Valley(25), Hyndburn (29) and Blackburn with Darwen (30).

17.3 Prevalence of alcohol specific conditions(ICD10: F10, K70, K73, K74, X45)

Alcohol misuse is a major cause of ill health and premature death,with only smoking and raised blood pressure representing higherrisk factors. Alcohol-related conditions include cirrhosis of the liver,cardiovascular diseases, a heightened risk of developing somecancers, and a greater risk of injury and violence 76. Certaindiagnoses, for example cirrhosis of the liver and alcohol poisoning,are considered to be specific to alcohol.

l Map 17.3 shows regional variations in the prevalence ofalcohol specific conditions, which result in a hospitaladmission. Areas of the North West with the highest ratiosinclude Liverpool, Wirral, St Helens, Blackpool, Halton, partsof Warrington, north and south Manchester and localisedcentral areas within major towns of the North West, forexample, Bolton, Bury, Rochdale, Burnley, Oldham, Tameside,Salford and Preston. Rural districts consistently present lowerthan average admission ratios.

l Figure 17.3a details how alcohol specific prevalence ratesincrease rapidly for the most deprived quintiles of populationwithin the North West, with prevalence rates being some fivetimes higher for the most deprived quintile of population whencontrasted to the most affluent quintile. This steep curvedgradient is reflected by geodemographic groupings (Figure17.3b), although the New Starters lifestyle group exhibitshigher alcohol condition rates than similar income group. Allareas with predominantly non-White populations show higherrates of alcohol specific prevalence, those for predominantly

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Mental health, self-harm and alcohol specific conditions

Black areas being over double that for predominantly Whiteareas (Figure 17.3c). Prevalence rates for predominantlyChinese areas are relatively higher than that seen for themajority of health variables illustrated. Rural populations showappreciably lower rates of alcohol specific prevalence than dourban localities (Figure 17.3d).

l The North West Local Authorities with the highest hospitalisedprevalence ratios for alcohol specific conditions are Liverpool(178), Halton (156) and Burnley (145); the lowest are RibbleValley (42), South Lakeland (44) and Eden (45).

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Map 17.1: Hospitalised Prevalence for Mental Health Conditions

North West residents: HES 1998-2002

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Map 17.2: Hospitalised Emergency Incidence for Self Harm


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Map 17.3: Hospitalised Prevalence for Alcohol Specific Conditions


17. mental health, self-harm and alcohol specific...

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