Mental Ill Health

This topic area covers statistics and information relating to mental ill health in Hull including local strategic need and service provision. Further information relating to Mental Health and Emotional Wellbeing (and Self-Harm and Suicide for adults) is given under Health Factors within Adults and within Children and Young People. A needs assessment was completed in Hull during 2023 for people with multiple unmet needs which included people who had poor mental health. The report – which was finalised in 2024 – is available within Multiple Unmet Needs under Vulnerable Groups.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• Severe mental illness affects around 1% of the population, and almost 2% of the population in the most deprived fifth of areas of England (which encompasses just over half of Hull). With an estimated resident population of around 272,000 in 2023, this equates to between 2,720 and 5,440 residents of Hull affected by severe mental ill health.
• Mental ill health is also a significant risk factor for suicide.
• It has profound effects not just on the individual including on their physical health, but on their families, community and on the health system. People with severe mental illness die on average 15 to 20 years earlier than the general population.
• In 2023/24, 2,928 (0.93%) patients registered with Hull GPs were diagnosed with severe mental illness (with a diagnosis of schizophrenia, bipolar affective disorder and other psychosis). This is marginally lower than the prevalence for England at 0.96%, but as severe mental illness is associated with deprivation, it is likely that there are additional people in Hull with severe mental illness who have not been diagnosed and who are not included on the GP severe mental illness register.
• Just under three-quarters of adults in contact with secondary mental health services are in stable and appropriate accommodation, and around one in nine are in paid employment.
• In 2014/15, over half of people with severe mental illness in Hull smoked.
• Premature (under 75) mortality is significantly higher for adults (18-74 years) with severe mental ill health compared to those without severe mental ill health. In Hull for deaths registered during 2020-22, premature mortality rates were 160% higher for people with severe mental ill health compared to those without severe mental ill health (based on having a contact with secondary mental health services or not in the five years preceding death). Rates were 132% higher for cardiovascular disease, 42% higher for cancer, 236% higher for liver disease and 207% higher for respiratory disease. However, these excess premature mortality rates were substantially and statistically higher in England (386%, 292%, 127%, 561% and 531% respectively) which is likely associated with the overall higher premature mortality rates in Hull for all individuals which makes the differential in the premature mortality rates between those with and without severe mental ill health smaller for Hull. This is not to say that premature mortality rates for people with severe mental health is lower than England. It is not. When the premature mortality rates for people with severe mental health are examined alone (not compared with people without severe mental ill health), the rates are much higher in Hull compared to England.
• Premature mortality in adults (18-74 years) with severe mental ill health was 79% higher in Hull compared to England for deaths registered during 2020-22. In Hull, there were 199 deaths per 100,000 population compared to 111 deaths per 100,000 population for England. The mortality rate had increased by 22% from 163 to 199 deaths per 100,000 population in Hull between 2015-17 and 2020-22. Premature mortality rates for people with severe mental ill health in Hull were more than double that of England where the cause of death was cardiovascular disease (41.8 versus 19.9 deaths per 100,000 population) and the rate had increased in Hull by 32% from 31.7 deaths per 100,000 population in 2015-17. Rates in Hull were almost double that of England where the cause was cancer (37.7 versus 20.2 deaths per 100,000 population) or respiratory disease (19.8 versus 10.6 deaths per 100,000 population), and 50% higher for liver disease (13.0 versus 8.7 deaths per 100,000 population).
• In Hull, there were 1,040 deaths registered during 2020-22 from people aged 18-74 years with severe mental ill health (in contact with secondary mental health services in the five years preceding death). Of these 1,040 deaths, 215 were from cardiovascular disease, 195 from cancer, 65 from liver disease and 100 from respiratory disease.
• The COVID-19 pandemic has had a significant impact on people’s mental health and emotional wellbeing, and the effects of which could be an increased need for services in the coming years. Furthermore, the pandemic has tended to have had a more adverse affect on people living in the most deprived areas thus increasing the inequalities gap.

The Population Affected – Why Is It Important?

The World Health Organization states:

• There are many different mental disorders, with different presentations. They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others.
• Mental disorders include: depression, bipolar disorder, schizophrenia and other psychoses, dementia, and developmental disorders including autism.
• There are effective strategies for preventing mental disorders such as depression.
• There are effective treatments for mental disorders and ways to alleviate the suffering caused by them.
• Access to health care and social services capable of providing treatment and social support is key.

The Global Burden of Disease estimates that in 2013 depressive disorders ranked eighth highest for causes of disability-adjusted life years in England.

The Surrey and Borders Partnership NHS Foundation Trust provided a useful summary of severe mental illness. They state that there are many types of mental illness but most of them can be classified as either psychotic or neurotic. Neurotic conditions are related to ‘normal’ emotions but are more extreme, and are the most common types of mental illness. Being clinically depressed is a far deeper experience than ‘feeling depressed’, and has a marked effect on life, preventing the patient from looking after themselves or being able to work, and in extreme cases can lead to suicide. Other examples of neurotic illnesses are phobias, obsessive compulsive disorder and anxiety. Psychotic conditions are unrelated to normal emotions, and the word psychosis is used to describe symptoms or experiences that happen together. These symptoms cause the patient to not experience reality like most people. Symptoms may include hallucinations, delusions, thought disorder, lack of insight and not recognising that they are unwell, and appearing unusually excited or withdrawn and avoiding contact with other people. Examples include schizophrenia, bipolar disorder (manic depression) and psychotic depression.

In their Severe Mental Illness and Physical Health Inequalities briefing in 2018, The Office for Health Improvement & Disparities (formerly Public Health England) give a prevalence of around 1% for severe mental illness, although it is slightly higher among women compared to men, and higher among those aged 35-74 years compared to those aged 15-34 years. The prevalence is around 0.5% for people living in the least deprived fifth of areas of England compared to around 1.8% for people living in the most deprived fifth of areas of England.

NHS England discuss the serious inequalities with regard to serious mental health and links to physical health. They state that serious mental illness obviously has a huge effect on mental wellbeing, but can also influence physical health. People with serious mental health are more likely to have poor physical health, and people with poor physical health are more likely to have poor mental health. People with serious mental illness are also more likely to have unhealthily lifestyles further affecting health and wellbeing. There is a recognition that smoking rates are very high with around one-third of people with mental health problems and two-thirds of people in psychiatric units smoking. In The Office for Health Improvement & Disparities’ 2018 briefing, the mortality rates of people with severe mental illness with the general population, and people with severe mental illness:

• die on average 15 to 20 years earlier than the general population.
• have 3.7 times higher death rate for ages under 75 years than the general population.
• experience a widening gap in death rates over time.

They go on to state that two in three deaths from physical illnesses can be prevented among people with severe mental illness.

The diagnosed prevalence of severe mental illness can be examined from data collected as part of the Quality and Outcomes Framework within primary care. Severe mental illness was defined as having a diagnosis of schizophrenia, bipolar affective disorder or other psychosis. Quality of care indicators are also included, and it means that high percentage of the patients diagnosed with severe mental illness have annual reviews which gives medical staff the opportunity to provide information and encourage their patients to improve their lifestyle behaviours to improve their health, and lower their risk of morbidity and mortality from their condition. Local analysis of the QOF data has been completed with prevalence calculated for each GP practice and Primary Care Network group.

The Hull Picture

Severe Mental Ill Health Among Patients Registered to Hull GPs

The Office for Health Improvement & Disparities’ Fingertips presents information from the Quality and Outcomes Framework on severe mental illness (schizophrenia, bipolar affective disorder or other psychosis).

The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas).

In 2023/24, there were 2,928 patients registered with Hull GPs diagnosed with severe mental illness which is very similar to the prevalence in England (0.93% versus 0.96%).

There is a strong association between deprivation and severe mental illness, and whilst the prevalence in Hull is slightly lower than England in 2023/24. It is likely that a higher percentage of people have severe mental illness but have not been diagnosed in Hull due to the high levels of deprivation in Hull.

On the whole, the prevalence has been slowly increasing in Hull. It is not known if this reflects an increased prevalence or higher rates of diagnosis and better recording. The prevalence in Hull has been very similar to England especially between 2017/18 and 2022/23, although has fallen in Hull in the last year by a greater amount than the decrease for England so the recorded prevalence in Hull is now marginally lower than England.

There was a statistically significant association between average deprivation score of registered patients (based on the Index of Multiple Deprivation 2019) and the prevalence of diagnosed severe mental ill health across the 28 practices in Hull for 2023/24. The prevalence was 0.7% among practices serving the patients living in the least deprived areas of Hull compared to 1.4% among practices serving the patients living in the least deprived areas of Hull. For every increase in the deprivation score of 10 units, the prevalence of severe mental ill health increased by 0.3 percentage points. Further analysis of diagnosed disease by the average deprivation score of practice patients is given within Local Analysis of Quality and Outcomes Framework Data.

There was no statistically significant association between the prevalence of diagnosed severe mental ill health and the average age of registered patients across the 28 practices.

Stable and Appropriate Accommodation Among Secondary Mental Health Service Users

Fingertips presents information on the percentage of people in contact with secondary mental health services who are in stable and appropriate accommodation. For 2020/21, the percentage in Hull at 70% was much higher than England (58%), although the percentages were considerably higher among Hull women (78%) compared to Hull men (63%).

The percentage of people in contact with secondary mental health services who are in settled accommodation increased in Hull between 2011/12 and 2017/18, but has subsequently fallen over the last three years. Despite the recent fall, the percentage in Hull has been consistently and significantly higher than England.

Employment Among Secondary Mental Health Service Users

The inequalities gap in the employment rate among people in contact with secondary mental health services and who are on a Care Plan Approach is high in Hull at 62.2 percentage points. During 2020/21, the overall employment rate was 73.2% (not shown) with an employment rate of 11% for people in contact with secondary mental health services giving an inequalities gap of 62.2 percentage points.

The inequalities gap has also been increasing for people in contact with secondary mental health services in relation to employment with the latest year 2020/21 having the highest gap of 62.2 percentage points.

Overall, 56 people aged 18-69 years in contact with secondary mental health services and on the Care Plan Approach in Hull are in paid employment for 2020/21.

Smoking Prevalence Among People with Severe Mental Ill Health

In 2014/15, over half of people in Hull with severe mental illness smoked. Smoking prevalence in the general population in Hull has reduced in Hull from around 23% to 19% so it is possible that the prevalence of smoking could have reduced among people with severe mental illness. However, it is likely that – even if it has reduced slightly – the prevalence of smoking is still very high among people in Hull with severe mental illness and that the prevalence is still much higher in this group compared to the general population.

Mortality

Whilst severe mental health can shorten life dramatically, many mental health conditions can have a significant impact on daily life and quality of life.

The direct standardised mortality rates per 100,000 population (standardised to the European Standard Population) among 18-74 year olds with severe mental ill health is 79% higher in Hull compared to England for 2020-22 with 199 deaths per 100,000 population in Hull compared to 111 per 100,000 population for England, and also higher for cardiovascular disease, cancer, liver disease and respiratory disease with mortality rates in Hull almost double that of England for cancer and respiratory disease, more than double for cardiovascular disease, and 50% higher for liver disease.

Severe mental ill health is defined as having a referral to secondary mental health services in the five years preceding death (excluding learning disabilities and autism).

The premature mortality rate among people with severe mental ill health has been increasing over time for both Hull and England. As the indicator examines mortality rate among people who have had contact with secondary mental health services in the last five years preceding death, it is possible that changes over time to the way services are run and access to services could influence the rate. It is possible that this could explain the increases over time, although it is also possible that the severity of mental ill health of service users could have increased over time.

Whilst there has been a slight increase in the premature mortality rate from cardiovascular diseases for people with severe mental ill health over time for England, the increase is relatively small increasing by 11% from 17.9 to 19.9 deaths per 100,000 population between 2015-17 and 2020-22. In contrast, the increase for Hull has been much greater increasing by 32% from 31.7 to 41.8 deaths per 100,000 population over the same time period.

There were 215 Hull residents who died prematurely from cardiovascular diseases who had contact with secondary mental health services in the five years preceding death whose deaths were registered during the three years 2020 to 2022.

There has been some year-on-year variability in the premature mortality rate from cancer among Hull residents who had severe mental ill health, but the mortality rate has consistently been higher than England throughout the entire period 2015-17 to 2022-22.

There were 195 Hull residents who died prematurely from cancer who had contact with secondary mental health services in the five years preceding death whose deaths were registered during the three years 2020 to 2022.

The premature mortality rate from liver disease among people with severe mental ill health has been consistently higher in Hull compared to England. The rate in England has gradually increased by 26% from 6.9 to 8.7 deaths per 100,000 population between 2015-17 and 2020-22. The rate in Hull has also increased over the same time period by 13% from 11.5 to 13.0 deaths per 100,000 population although the increase occurred in the last two years with the mortality rate prior to 2018-20 remaining relatively unchanged at around 11 deaths per 100,000 population.

There were 65 Hull residents who died prematurely from liver disease who had contact with secondary mental health services in the five years preceding death whose deaths were registered during the three years 2020 to 2022.

The premature mortality rate from respiratory disease among adults (aged 18-74 years) with severe mental ill health increased in Hull between 2015-17 and 2017-19, but has decreased since the COVID-19 pandemic. The number of deaths from chronic obstructive pulmonary disease and respiratory diseases in general has decreased during and immediately following the pandemic likely associated with a relatively high number of people with pre-existing respiratory disease dying from COVID-19. The mortality rate in England has followed a relatively similar pattern of change although there were smaller changes to the mortality rate. It does appear that any decreases have ceased in Hull with a marginal increase in the mortality rate in the last year.

There were 100 Hull residents who died prematurely from respiratory disease who had contact with secondary mental health services in the five years preceding death whose deaths were registered during the three years 2020 to 2022.

Despite very high levels of premature mortality among people with severe mental ill health in Hull compared to England, the excess premature mortality rate for people with severe mental ill health is lower than England when expressed as the percentage increased risk due to severe mental ill health compared to those without severe mental ill health. This is likely because there is a much higher rate of premature mortality in Hull compared to England in the overall population, so that the differential in the premature mortality rate between people with and without severe mental ill health is smaller in Hull.

As for premature mortality, severe mental ill health is defined as having a referral to secondary mental health services in the five years preceding death (excluding learning disabilities and autism).

The excess premature mortality rate among Hull adults with severe mental ill health has remained relatively constant between 2015-17 and 2020-22 with premature mortality rates between 160% and 170% higher among people with severe mental ill health compared to people without severe mental ill health.

Excess premature mortality for England has shown a slight increase over the same time period increasing from 350% higher to almost 390% higher among people with severe mental ill health compared to people without severe mental ill health in England.

Despite the premature mortality rate from cardiovascular diseases for people with severe mental ill health increasing by one-third in Hull between 2015-17 and 2020-22 as illustrated above, the excess premature mortality rate for people with severe mental ill health when compared to people without severe mental ill health has shown hardly any change over time being around 95% higher among people with severe mental ill health compared to those without. There has been a relatively consistent difference between Hull and England.

The excess premature mortality rate from cancer for people with severe mental ill health compared to those without severe mental ill health has been a little variable in Hull but has been consistently lower than England. For most time three-year periods, there has been around a 20% increase in the premature mortality rate from cancer for people with severe mental ill health compared to those without severe mental ill health in Hull. The excess mortality rate in England has increased slightly from 105% to 127% between 2015-17 and 2020-22.

The excess premature mortality rate from liver disease for people with severe mental ill health compared to those without severe mental ill health has been a little variable in Hull but has been consistently lower than England. There was a 332% increase in the premature mortality rate from liver disease for people with severe mental ill health compared to those without severe mental ill health in Hull for 2015-17, but this has reduced to an increased risk of 144% for 2020-22. The rate for England has remained relatively unchanged at around 550% higher mortality rate for people with severe mental ill health compared to those without severe mental ill health.

The excess premature mortality rate from respiratory disease for people with severe mental ill health compared to those without severe mental ill health decreased from 144% higher in 2015-17 to 117% higher in 2019-21, but has increased back to 141% for 2020-22. The excess premature mortality rate has been consistently lower in Hull compared to England where the excess mortality rate is around 540% higher for people with severe mental ill health compared to those without severe mental ill health.

Strategic Need and Service Provision

Mental health is a priority locally due to the huge and wide implications. People with mental illness need to be identified early and encouraged to seek help early so that the consequences in terms of the effects on the individual, their family and their employment are minimised. This will reduce the number of issues which escalate and so reduce the levels of need for crisis and/or medical interventions. For both children, young people and adults, help and support should be provided on an individual basis taking into account the person’s circumstances. This early help should be timely, appropriate and build in resilience to help people cope with life challenges. A culture across Hull that celebrates diversity, gives respect and has a zero tolerance on hate crime should be encouraged, so that people feel able to come forward and are not stigmatised by seeking help.

There is a need to work with partners to ensure that services are integrated, high quality and accessible in ways that offer people appropriate choices. People need to be seen quickly and there is a real need to reduce waiting times.

Mental illness is very common, and is generally more debilitating than most chronic physical conditions, yet only a quarter of those with mental illness such as depression are in treatment. NHS England has established a Parity of Esteem Programme in order to focus effort and resources on improving clinical services and health outcomes so that “if I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses”. There are three initial priorities for urgent focus: (i) improving access to psychological therapies; (ii) improving diagnosis and support for people with dementia; and (iii) improving awareness and focus on the duties within the Mental Capacity Act.

The Mental Health Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis. Help is available for organisations and their partners to create and submit a mental health crisis declaration statement and an action plan to make the principles of the Crisis Care Concordat a reality in the local area.

The delivery model of Hull’s Early Help and Prevention offer is focused on a whole family approach which aims to identifies individuals or families with problems (such as those with severe mental ill health) and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way. The aim is to improve outcomes for the entire family as well as reducing demand in the system on more costly, acute and specialist services.

The COVID-19 pandemic has had a wide ranging effect on people affecting all aspects of life. It has been recognised that the pandemic adversely affected mental health and emotional wellbeing, and increased social isolation for some individuals. It is anticipated that there will be an increased need for mental health specialist services in the coming years. The effect on children and young people has been significant. Babies and pre-school children missed baby and toddler groups, nursery and pre-school and so had a lower level of social interaction with others than they would normally be expected to have. Anecdotal evidence suggests that the pandemic has impacted young children’s communication skills development including speech. A higher percentage of children at the end of reception year have been classified as ‘not ready’ for school. Children and young people missed a lot of school and interactions with friends, and reduced structure in their lives. Many children have fallen behind in their schoolwork and a higher percentage of children are not at the expected levels of educational attainment for their age. Young people at transition points – moving from school to further education or the workplace – have been one group significantly affected by the pandemic. The effects on this group include: increased levels of stress and worry associated with examinations being cancelled (and replaced by teacher assessments for qualifications); limited opportunities to attend face to face sessions and interact with peers contributing to feelings of social isolation and heightened levels of anxiety and mental health issues; lost opportunities to access work placements during the pandemic impacting on all young people but especially those who were vocationally unsure and for whom work experience would have been a truly insightful and motivational experience. Professionals working with this age group continue to report increased levels of mental health issues, social anxiety and feelings of ‘hopelessness’. Employment was significantly affected during the pandemic with many staff across different sectors being furloughed or made redundant. A significant number of working-age adults had high levels of uncertainty about their employment, and working-age and older people also had significant concerns over their physical health and COVID-19. The adverse effect on employment for some individuals has meant increased debt. Levels of domestic abuse, smoking and alcohol consumption all increased during the pandemic and lockdowns. The percentage of primary school children who are overweight has increased dramatically in England among the most deprived areas of the country, and it is likely that this has occurred locally too as well as increases in overweight and obesity among adults. There has been a dramatic effect on the NHS and caring sector. Waiting lists have increased which will affect the physical health and emotional wellbeing of many individuals. Friends and relatives of people who died throughout the pandemic (from COVID-19 and other conditions) may not have had the opportunity to see them prior to their death due to visiting restrictions in hospitals and care homes. Additionally, there was an impact on funerals due to strict limits on attendance numbers during lockdown periods which could affect the grieving process. All these factors will have significant impact on mental health and emotional wellbeing. The effects of the pandemic have not been felt evenly across society, and the pandemic has tended to have had a more adverse affect on people living in the most deprived areas thus increasing the inequalities gap.

A Mentally Healthy Hull strategy has been produced which looks at how, as a city, we can collectively boost good mental health and prevent and reduce the impact of mental health problems.

Resources

World Health Organization. Mental disorders, 2019. https://www.who.int/en/news-room/fact-sheets/detail/mental-disorders

Newton JN, Briggs ADM, Murray CJL, et al. Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 2015; 6736 (15): 195.

http://dx.doi.org/10.1016/S0140-6736(15)00195-6

Surrey and Borders Partnership NHS Foundation Trust, What is mental illness?  Surrey and Borders Partnership NHS Foundation Trust: Leatherhead Surrey, 2014.

Public Health England (now Office for Health Improvement & Disparities). The burden of disease in England compared with 22 peer countries. A report for NHS England. Using data from the Global Burden of Disease 2017.

NHS England, Valuing mental health equally with physical health or “Parity of Esteem”.  www.england.nhs.uk. 2015, NHS England: London.

Public Health England (now Office for Health Improvement & Disparities). Smoking cessation in secure mental health settings.  Guidance for commissioners. 2015, Public Health England: London.

Public Health England (now Office for Health Improvement & Disparities). Severe Mental Illness and Physical Health Inequalities briefing in 2018. https://www.gov.uk/government/publications/severe-mental-illness-smi-physical-health-inequalities/severe-mental-illness-and-physical-health-inequalities-briefing

Hull’s Early Help and Prevention Strategy 2021-25. https://www.hull.gov.uk/downloads/file/1726/Hull_Early_Help_and_Prevention_Strategy_2021_25.pdf

How are you feeling today? THRIVE Hull. https://www.howareyoufeeling.org.uk/

THRIVE Framework. THRIVE Hull. https://www.howareyoufeeling.org.uk/thriving

HM Government and MIND, Mental Health Crisis Care Concordat.  www.crisiscareconcordat.org.uk. 2015, HM Government and MIND: London.

Updates

This page was last updated / checked on 10 October 2024.

This page is due to be updated / checked in March 2025.