Coventry and Warwickshire Mental Health Needs Assessment (2021) - Publications

The populations of Coventry and Warwickshire are different however, and this means we might expect to see differences in what mental health services and support is needed for people. Coventry is broadly a younger city, with around 80,000 residents aged 20 to 29. Warwickshire has a larger population than Coventry and also a much greater proportion of residents over the age of 65.

There are also lower life expectancies and healthy life expectancies in Coventry than Warwickshire. In Coventry life expectancy (2017-19) is 82.2 years for females and 78.7 years for males. In Warwickshire it is 83.9 years for females and 80.1 years for males. This difference is reflected in the healthy life expectancies in both areas too.

There are parts of Coventry and Warwickshire that are ethnically diverse. Around 67% of residents in Coventry and 88.5% of residents in Warwickshire identified themselves as having a White British heritage at the time of the Census in 2011. The diversity within both areas is expected to grow in 2022 and therefore understanding the barriers to accessing services and support from these groups is critical.

Research shows that there is a gradient in the inequalities in mental health, based on socioeconomic status. There are again differences in deprivation, with Coventry being the most deprived Local Authority area, followed by Nuneaton and Bedworth and North Warwickshire.

Good mental wellbeing

Good mental health is not just the absence of a diagnosed mental illness, and other factors will influence people’s wellbeing. The Office for National Statistics defines wellbeing as ‘how we’re doing’ and has been carrying out a survey of national wellbeing since 2012.

Since the national wellbeing survey started there were improvements in people’s reported life satisfaction, happiness and how worthwhile people found their life. Similarly, there were reductions in people’s anxiety. These trends lasted until 2019, and in the year prior to the pandemic there were reductions across all of those four indicators.

Since the pandemic there have been large reductions in mental wellbeing across the four indicators. Compared to before the pandemic twice as many women reported low life satisfaction in April 2021, and at 10.8% is one in every 10 women. This increase was particularly seen in women with non-managerial roles.

There were big impacts on the wellbeing of younger people from the pandemic. One in every ten people aged 16-24 now have low self-worth, which is a three-fold increase since before the pandemic. There is the same level of low self-worth in 25 to 34 year olds, although for this age group this represents a six-fold increase.

Being able to take time to relax, and healthy coping strategies were related to increased wellbeing during the pandemic, whereas increased eating or alcohol use were related to lower wellbeing.

Common mental illnesses

Diagnosed mental health conditions such as depression or anxiety are a common experience in adulthood. The rates are higher in adults under 65, and in some areas around 1 in every 5 adults is estimated to have a diagnosable mental health condition.

By developing a local metric to estimate relative access to local IAPT services, a relatively low uptake of services was seen. Women were more likely to access IAPT than men, and younger people were more likely to access than older. The highest uptake rates were seen in women aged 16-24 (just under 1 in 5) lowest in men 65-74 (just over 1 in 20).

Access rates appeared to be lowest in Coventry and highest in Rugby. Broadly access seems to be higher in local authorities with lower levels of deprivation. People who are likely to describe themselves as having White British ethnicities had higher access rates than people from most other heritages. Some of the mental health professionals who were surveyed also felt that their patients are not generally representative of the population

Severe and enduring mental ill health

Severe and enduring mental illness (SMI) refers to the long-term experience of bipolar disorder, schizophrenia and psychosis. Those in contact with secondary mental health services have higher mortality rates than the rest of the population in general.

People with SMI will receive support from secondary and/or tertiary mental health services, and since 2018 the trend has been for a larger number of people under the age of 25 to access these services each year, although the numbers each year have remained similar overall. This is contrasted with a year on year growth in the number of people on GP registers diagnosed with SMI.

There is a significant gradient in admission rates by deprivation. People living in the 20% most deprived areas in Coventry and Warwickshire were three times likely to be admitted to hospital with an SMI than people living in the most affluent.

Parent and infant mental health

National evidence shows that up to 20% of women experience a mental health problem in the perinatal period. The mental health needs assessment survey carried out across Coventry and Warwickshire found that new mothers had felt particularly isolated during the pandemic.

Personality disorders

People with so-named ‘personality disorders’ experience considerable distress, suffering, and stigma. The definition itself remains open to some debate and the pejorative term used to bring with it a tacit admission that there was unlikely to be any effective recovery made.

Applying national estimates over 10,000 people in C&W are likely to have an Emotionally Unstable Personality Disorder, and over 80,000 people would likely meet the criteria for other personality disorders.

Eating disorders

Eating disorders are complex mental health conditions that are characterised by a person having a difficult relationship with food. Nationally 90% of people admitted with an eating disorder are female, although some national data indicates an increasing number of men have eating disorders, this isn’t yet reflected in local inpatient data

Learning disability

A learning disability affects the way a person learns new things throughout their lifetime and also affects the way a person understands information and how they communicate. On average, adults with a learning disability die 16 years earlier than the general population – 20 years for men, 13 years for women. There are estimated to be 7,000 people with a learning disability in Coventry and 11,000 in Warwickshire

Autism

Autism is defined as a lifelong neurodevelopmental condition that affects how a person develops, communicates and socially interacts with people. Every Autistic person is different and like the general population autistic people can have good mental health.

The UK does not have administration processes or surveys that capture data on the number of autistic children and adults, however there are estimated to be 3,000 people living with autism in Coventry, and nearly 4,700 in Warwickshire.

Suicide

Suicide behaviours are complex; there is no single explanation of why people take their own life and multiple factors usually contribute to each death. Around 10 people died by suicide in every 100,000 people in Coventry and Warwickshire between 2017 and 2019.

Similar to the national picture of deaths from suicide, around 3 in every 4 deaths were male. Higher numbers of deaths of men were aged 40 to 59. For women the highest numbers are seen aged 20 to 29. The majority of deaths occurred at the home address of the deceased.

Nationally the pandemic does not seem to have changed the number of deaths from suicide, however, local data is being monitored to understand any changes in the trend.

Wider determinants of mental health

The wider determinants of mental health describe the range of social, economic and environmental factors which influences mental and physical health.

For some of these factors there is a close relationship with mental health. Housing quality is a determinant of mental health and 9.5% of households in Warwickshire and 12.1% in Coventry live in fuel poverty.

There has also been a trend in recent years that an increasing proportion of homeless households owed a main duty to house is due to a household member who is vulnerable with a mental health condition.

Poor mental health is also a cause and consequence of homelessness, and 44% of people experiencing homelessness and rough sleeping have been diagnosed with a mental health condition and 86% reporting mental health difficulties.

Good employment can be beneficial for mental health and wellbeing, whereas both stressful or poor employment and unemployment contributes to mental ill health.

In a Warwickshire survey around 75% or respondents said that their workplace actively promotes mental health and wellbeing, although only 60% agreed that their workplace was supportive of people with mental health difficulties.

There has been an increase in unemployment since the start of the pandemic on some indicators, with national surveys showing that young adults, and adults close to retirement have been most impacted.

The number of jobs advertised nationally has also fallen during the pandemic showing potential difficulties in getting back into work.

Since the start of the pandemic, a growing proportion of businesses in Coventry and Warwickshire think that the economic outlook is positive, although this has not yet returned to pre-pandemic levels.

Access to green space is known to be beneficial for mental wellbeing, however, access to private gardens or similar is own green space lower than the West Midlands average in Coventry and Rugby.

There was less park use during the January 2021 lockdown than over the summer, and home schooling was also an additional stress for many residents during that lock down.

Fewer people have been commuting to work during the pandemic, and this can also be a source of stress.

Ethnically diverse communities

People from ethnically diverse backgrounds are highlighted to potentially have greater rates of mental health illness compared to White British people.

A recent survey conducted by CWPT identified challenges such as the complexity of health care system, difficulties in access, lack of empathy, compassion or general support, and a lack of resources alongside a lack of awareness and sensitivity to the specific issues experienced by people from ethnically diverse backgrounds.

These themes were emphasised by the survey carried out to inform this assessment, where issues also emerged around translation and the need to actively work with communities of under-represented groups.

LGBTIQ+

LGBTIQ+ stands for lesbian, gay, bisexual, trans, intersex, queer or questioning.

In 2017 Stonewall carried out a survey of over 5,000 LGBT people across England, Scotland and Wales to understand their experiences of mental health, which identified higher levels of depression or self harm.

Being LGBTIQ+ doesn’t cause these problems. But some things LGBTIQ+ people go through can affect their mental health, such as discrimination, homophobia or transphobia, social isolation, rejection, and difficult experiences of coming out.

Veterans

A military veteran is any person that has served at least one day in HM British Armed Forces (Regular or Reserve) or Merchant Mariners who have seen duty on legally defined military operations. There are approximately 2.5 million military veterans in the UK.

Most veterans enjoy good mental health after a rewarding and challenging career and research has shown that help seeking ‘veterans’ as an overall group are at broadly similar levels of risk in terms of clinical depression and anxiety disorders as the general population. However, serving in conflicts can increase the risk of Post-Traumatic Stress Disorders (PTSD), which was seen amongst 9% of members of the UK Armed Forces who deployed, compared to 5% for veterans who did not deploy.

Carers

A carer is anyone who cares, unpaid, for a family member or friend who due to illness, disability, a mental health problem or an addiction, cannot cope without their support.

Locally it is estimated that there are approximately 34,000 unpaid carers in Coventry and 62,000 in Warwickshire. In Coventry there are approximately 2,500 young carers (0-24 years old) and 3,500 in Warwickshire.

One hundred and ninety one people responding to the local Mental Health Needs Assessment Survey reported having caring responsibilities. Comments included reports of carers feeling confused and sometimes unsupported when relatives were experiencing a mental health problem.

In addition, carers face barriers in getting support for their own wellbeing. A recent Healthwatch survey in Warwickshire found that 55% of respondents reported barriers to accessing support such as not having the time, not being sure where to go for help or support, and that the person or people they care for only want the carer (and no one else) to look after them.

Asylum seekers

Asylum seekers and refugees face unique and complex challenges related to their mental health and are often at greater risk of developing a mental health problem, with research suggesting they are five times more likely to have mental health needs than the general population.

In Coventry there are around 600 asylum seekers at any time (this is a constantly changing population as it is dependent on legal status). This includes unaccompanied asylum seeking children. There are approximately 400 refugees resettled under home office schemes, with around 120 per year coming into the city. There are approximately 2,000 other refugees and asylum seekers with unsuccessful applications.

Since November 2016, 36 Syrian refugee families have been resettled across Warwickshire through the Syrian Vulnerable Persons Resettlement Scheme. A separate needs assessment for this group found a lack of expertise and understanding amongst mainstream health and mental health providers, as well as inconsistent use of interpreters by services, and a cultural stigma around mental illness.