Mental Health Joint Strategic Needs Assessment (JSNA) Topic Report

Measures of population mental health and wellbeing in Buckinghamshire, before and during the COVID-19 pandemic compared to England are now available.

Overall, the data suggest that over this time period, residents in Buckinghamshire enjoyed higher levels of good mental health and wellbeing compared with the England average. However, when we look at trends over time, on many indicators the population’s mental health and wellbeing, as is seen in other areas, is worsening. On wellbeing measures, in particular, there appeared to be a dip around the start of the COVID-19 pandemic, but more recent data suggests that this is returning to pre-pandemic levels. Key data, for children and young people and adults, are summarised below.

Overall, data suggest that the burden of mental health disorders in children and young people in Buckinghamshire, as in England, has been growing over time with this trend starting before the Covid-19 pandemic. Across most measures mental health disorders in Buckinghamshire seem to be statistically similar to national rates. Local survey data indicate a small decline in self-reported wellbeing between 2020 and 2021. Hospital admissions are higher for eating disorders in Buckinghamshire, in line with wider evidence that suggests these are more common in less deprived populations.

The 2021 OxWell Children’s Buckinghamshire Health and Wellbeing Survey collected data on the wellbeing of 4,200 children and young people. The results must be treated with some caution as they are drawn from a sample that may not be representative of all children and young people within Buckinghamshire. The survey found that for children and young people that responded, around two in 10 (18.3%) primary and four in 10 (39.1%) secondary students had a low wellbeing score; both higher when compared to 2020 (16% and 31% for primary and secondary respectively. For children with a low wellbeing score, more than half (56.1%) stated that reasons included that they were worried about what others think and/or about their appearance. Around a third said the climate (33.2%) and feeling sad (30.9%) were reasons.

It is estimated 1 in 10 children will have a clinically diagnosed mental disorder in childhood. Childhood mental health problems have been rising during recent years, particularly during the COVID-19 pandemic. The findings of a national survey indicated that the proportion of 6 to 16-year-olds in England with a probable mental disorder increased from 11.6% in 2017 to 17.4% in 2021. Applying this to the Buckinghamshire population would suggest an estimated 16,546 children locally have a probable mental disorder.

In children and young people across Buckinghamshire, there has been an increase in all hospital admissions for mental health problems over the last decade; this is consistent with the national picture. In 2020/21 the hospital admission rate for mental health disorders in 0- to 17-year-olds in

Buckinghamshire was 86.8 per 100,000 population (110 admissions). This was similar to the average for England (87.5 per 100,000), and the South-East (99.4 per 100,000) average. However, whilst hospital admission rates have declined and plateaued for England and the South-East region, the rate of hospital admissions in Buckinghamshire increased between 2010/11 and 2018/19, with a plateau or decline only seen in more recent years (2019/20 and 2020/21).

The rate of hospital admissions for self-harm in Buckinghamshire in children and young people (399.9 per 100,000 population) was similar to the national average (421.9 per 100,000) and statistically significantly below the South-East rate (505.6 per 100,000). Whilst the admission rate has increased over the last five years, the change between these dates is not statistically different.

Overall, hospital admission rates for eating disorders in children and young people under the age of 25 have generally increased in Buckinghamshire, as in England, since 2011/12. Hospital admission rates for eating disorders in this group have been higher in Buckinghamshire compared with England since 2014/15. In 2020/21 the rate 11 in Buckinghamshire was 34.6 per 100,000 population, statistically significantly above the rate in England (22 per 100,000). This is consistent with evidence that suggests that a diagnosis of an eating disorder is more common among people living in less deprived areas.

Mental ill health is not distributed equally across the population. In England in 2015, children from the most deprived 20% of households were four times more likely to have serious mental health difficulties by age 11 compared to those from the least deprived 20% of households. There are also groups of children and young people that are more vulnerable to poorer mental health outcomes, including residents with Special Educational Needs, Child Protection Plans, Children in Care, Care Leavers, Young Carers, Domestic Abuse and Youth Justice.

Perinatal mental health conditions are those that occur during pregnancy or in the first year following the birth of a child. It is estimated nationally that up to 27% of new and expectant mums are affected by poor perinatal mental health covering a range of conditions including anxiety, depression, post-traumatic stress disorder and postpartum psychosis. If left untreated, these mental ill-health conditions can have significant and long-lasting effects on women, children, and the wider family.

During the COVID-19 pandemic the UK experienced an increase in perinatal mental health related deaths, principally suicide. Deaths from mental health-related causes as a whole (suicide and substance abuse) accounted for nearly 40% of perinatal deaths in 2020 with maternal suicide remaining the leading cause of direct deaths in the perinatal period. More insight is needed to understand the causes of these increases and locally to see if the same patterns are reflected in the Buckinghamshire population. In 2017/18 it was estimated in Buckinghamshire that 137 women suffered with severe depressive illness in the perinatal period.

Across indicators of mental health and wellbeing, Buckinghamshire adults have better, or similar, mental health outcomes compared with England and the South-East. As can be seen in national data, there appears to have been a dip in average well-being scores in 2020/21 and this may be attributable to the Covid-19 pandemic. However, there is no evidence of a significant impact on the rates of hospital admissions for mental health over this time.

On measures of wellbeing, Buckinghamshire adult residents report higher levels of happiness and satisfaction with life, as well as a greater sense that the things they do in life are worthwhile, when compared to the population of England as a whole. Anxiety levels in Buckinghamshire are also lower compared to the England average. In Buckinghamshire, as in England and the South-East, there was an increase in anxiety in 2020/21, which may be attributable to the COVID-19 pandemic.

Adult rates of diagnosed common mental health disorders (such as depression) and more severe mental illness (SMI) are lower in Buckinghamshire when compared to the England average. The percentage of patients aged 18 and over with depression, as recorded on GP practice disease registers, was 12.2% (55,342 patients) in Buckinghamshire in 2021/22. This was significantly lower than the England average (12.7%) and the South-East (13.1%). In Buckinghamshire, as in England and the South-East, the percentage of patients with recorded depression has steadily and significantly increased since 2013/14 (currently at 6.3% in Buckinghamshire).

The percentage of patients recorded with an SMI in Buckinghamshire in 2021/22 was 0.77% (4,461 patients). This was significantly below the England average (0.95%) and the South-East region average (0.87%). The prevalence of SMI has not changed significantly over time.

The rate of mental health hospital admissions across all ages in Buckinghamshire increased from 139.0 per 100,000 population in 2012/13 to 241.9 per 100,000 in 2020/21. Over the same period, the rate of hospital admissions decreased for England overall, from 329.6 in 2012/13 to 275.3 in 2020/21. However, the Buckinghamshire rate started low and in 2020/21 remained significantly below the England average.

The rate of all mental health admissions among those aged 65 and over between 2018/19 and 2020/21 in Buckinghamshire (323.5 per 100,000) was significantly higher than the rate for all ages (236.0 per 100,000 population). Dementia accounts for 1 in 5 of all these admissions.

In Buckinghamshire in 2020/21, the rate of emergency hospital admissions for intentional self-harm (all ages) was 140.6 per 100,000 population (740 people). This was significantly lower than England at 181.2 per 100,000, and the South-East region at 201.9 per 100,000. Whilst the rate has increased over the last ten years; the increase is not statistically significant.

People with a SMI face one of the greatest health inequality gaps in England with many experiencing at least one physical health condition at the same time as their mental illness. This population group is at risk of dying on average up to 15 to 20 years earlier than the general population, mostly due to preventable physical diseases. In Buckinghamshire in 2018-20, the excess under 75 mortality risk in adults with SMI was more than four times the risk of premature mortality (416.8%) than adults without SMI.

In addition to existing inequalities in the rate of premature mortality in people with SMI, research suggests that people with SMI have been disproportionately impacted by the COVID-19 pandemic, including higher mortality rates. The death rate of adults aged 18-74 with SMI in Buckinghamshire in 2018-20 was 60.9 per 100,000 population (690 adults). This was significantly lower than England (103.6) and the South-East (83.4).

Across many measures, people living in more deprived areas in Buckinghamshire have poorer mental health outcomes, for example the most deprived fifth of the Buckinghamshire population had a significantly higher admission rate for self-harm compared to the Buckinghamshire average in 2020/21, whereas other deprivation groups were similar to the average.

Death by suicide is a leading cause of years of life lost. Suicide is preventable and when someone dies by suicide, the effect on people that are close to them – family, friends, colleagues – can be profound. The suicide rate in Buckinghamshire was 11 per 100,000 population (152 people) during 2019-21. This was not significantly different to the England average of 10.4 per 100,000 population.