1. Depression in Adults A chapter of Croydon’s mental health Joint Strategic Needs Assessment 2012/13 Health and Wellbeing Board 5 December 2012 Bernadette Alves, Locum Consultant in Public Health

2. Croydon’s 2012/13 mental health JSNA Overview chapter - mental health and well-being Depression in adults Schizophrenia Emotional health and well-being of children and young people (aged up to 18 years) Croydon key dataset update

3. Aims of depression JSNA chapter Provide an overview of current and future need Identify assets and gaps Identify priorities for development

4. Depression Low mood, loss of interest / pleasure / energy / concentration, feelings of guilt or low self-worth, disturbed sleep or appetite Categorized as mild / moderate / severe Can recur / be chronic

5. In the words of one contributor… “the totally mind-numbing effect of serious clinical depression, from my experience, makes one unable to do anything, even to organising getting the money together to go out for a bus trip, and, at an even more alarming stage, getting out of bed at all”

6. Impact of depression Common Leading cause of disability Impacts on family, friends and carers reduces the ability to work effectively reduces ability to communicate and sustain relationships increases risk of having physical health problems Increases the risk of mortality

7. Groups most at risk of depression include those: 1.with long term physical health problems 2.with medically unexplained symptoms 3.living in households with low income. 4.who are carers 5.who are lesbian, gay, bisexual or transgender 6.who are asylum seekers 7.with serious mental illness 8.with substance misuse problems 9.who have had adverse childhood experiences 10.whose parents, especially mothers, had mental health problems

8. Policy context Department of Health (2011) No health without mental health More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination DH (2011) Talking therapies: A four-year plan of action. Access for people aged over 65 children and young people; people with long-term physical conditions or medically unexplained symptoms people with severe mental illness PLUS …..Black and minority ethnic groups

9. Need and future need Condition% prevalence 2012 Number in 2012 % change 2012 to 2021 Mixed anxiety and depressive disorder 9.2% 26,715 5.0% Generalised anxiety disorder 4.4%12,8115.2% Depressive episode 2.4%6,9494.3% All phobias 1.5%4,2895.0% Obsessive compulsive disorder 1.2%3,3983.5% Panic disorder 1.1%3,2075.4% Any Common Mental Health Disorder 16.4%47,8245.0%

10. Wellbeing: Resilience, promotion, prevention, protection, recovery. Step 0Whole population promotion of wellbeing and resilience Described in the overview chapter Step 1 Identification, advice or referral, watchful waiting Screening of those with coronary heart disease / diabetes Primary care diagnosis Step 2 and Step 3 Mild to moderate and moderate to severe low-intensity interventions and high intensity interventions Low intensity psychosocial interventions Low intensity and high intensity psychological therapies: Counselling services: Structured Group Physical Activity programme; Medication: Anti-depressant treatment Step 4 and Step 5 More complex needs Crisis resolution / home treatment CMHT support Inpatient treatment: ECT Medication: High intensity psychological interventions

11. Challenges for people with depression: “Social isolation. Lack of stimulation and support” “getting out of the house” “Lack of motivation” “not a lot of support in relation to the holistic approaches” “social activities”“loneliness” “Social factors ie change in benefits,housing issues” “We know that people want peer support services to allow people to end loneliness and isolation “ Recommendations: Prioritise public mental health in Croydon based on the available evidence of what works in the short, medium and long term and promote factors that increase population resilience Ensure wellbeing services and activities are available to people with depression and ensure that mechanisms are in place to provide fair access, for example by older ages and BME groups.

12. Prevalence of diagnosed depression in Croydon by ethnic group Source: Croydon GP database March 2012 (five year prevalence)

13. Prevalence of diagnosed depression in people with long term conditions in Croydon Source: Croydon GP database March 2012 (five year prevalence)

15. Recommendations: Develop a strong primary mental health care service and take steps to reduce unwarranted variation in primary care quality. Address inequality in access to services by BME groups. Improve diagnosis rates in primary care, access to talking therapy services and secondary care community teams. Commissioners of physical health services and commissioners of mental health services should work together to deliver integrated mental and physical healthcare for people with long term physical health conditions and mental health conditions.

16. Antidepressant prescribing in Croydon practices 2011-12

17. Percentage Dosulepin items of total antidepressants. Croydon July 2011 to June 2012

18. Talking Therapies Effective and cost effective National Programme IAPT (improving access to psychological therapies) Croydon provision –Voluntary sector –IAPT –CIPTS (more complex need) –Private provision

19. People who have entered IAPT treatment as a proportion of people with anxiety or depression (2011/12)

20. Recommendation: Increase the capacity of talking therapy services and improve access by older people and people from BME groups

21. Assets GP and primary care “My GP & CMHT are brilliant” “Some GPs are very able and helpful with diagnosis and care / signposting” “Some GP services have expert primary care professionals in house who are excellent” Voluntary Sector “Good voluntary sector services (esp. counselling and supporting people to make lifestyle changes)” “social inclusion services” “support groups” “voluntary and charity organisations” “support available in Croydon in the voluntary sector” Counselling and secondary care services “Some of the SLAM employees are brilliant and do a great job” “an innovative and creative IAPT service staffed with very motivated people”

22. Recommendation Framework

23. Next steps Comments by 17 December January - submit to health and wellbeing board exec for sign off Comments to: Fiona.assaly@croydonpct.nhs.uk Bernadette.alves@croydonpct.nhs.uk