Take action to reduce depressions prevalence and support those with depression to recover
Globally depression creates the greatest burden of mental ill health[i] and is predicted to be the second largest cause of global disability in 2020[ii]. In 2014, 19.7% of people in the UK aged 16 and above showed symptoms of anxiety and depression with this figure expected to have risen by 2019/2020[iii]. Depression is associated with poorer psychological and physical health outcomes for individuals, their surrounding family and friends and can be extremely costly to the UK economy[iv].
50% of mental health problems present by age 14 and 75% by age 24[v]. Depression reported in adolescent increases the risk for mental health difficulties in adulthood[vi] [vii]. More specifically, adolescence depression can be associated with suicidal ideation and suicide attempts as an adult[viii]. It has been recommended that preventative interventions are introduced early in children’s development to develop social and emotional skills with more specific problems areas such as violence and bullying targeting during adolescence some of which we have covered in the Children and Young People section of this resource.
Action for Local Authorities and the NHS
1. Support the rapid introduction of social prescribing
Social prescribing is a key component of Universal Personalised Care. A summary guide has been developed for people and organisations leading local implementation of social prescribing. It sets out what good social prescribing looks like and why social prescribing improves outcomes and experiences for people, their families and carers, as well as achieving more value from the system.
Social prescribing is a way for local agencies to refer people to a link worker. Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.
Link workers also support existing community groups to be accessible and sustainable, and help people to start new groups, working collaboratively with all local partners.
Social prescribing works for a wide range of people, including people:
- with one or more long-term conditions
- who need support with their mental health
- who are lonely or isolated
- who have complex social needs which affect their wellbeing.
When social prescribing works well, people can be easily referred to link workers from a wide range of local agencies, including general practice, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations. Self-referral is also encouraged.
The Rotherham Social Prescribing Pilot[ix] was delivered by Voluntary Action Rotherham (VAR) on behalf of NHS Rotherham CCG. It was funded for two years from April 2012 to March 2014 as part of a wider GP-led Integrated Case Management Pilot and aimed to increase the capacity of GP practices to meet the non-clinical needs of their patients with long-term conditions (LTCs). The pilot received around £1m as part of a programme to provide 'additional investment in the community' and began receiving referrals from September 2012 onwards.
Over the course of the Pilot:
- 24 voluntary and community sector (VCS) organisations received grants with a total value of just over £600,000 to deliver a menu of 31 separate social prescribing services
- 1,607 patients were referred to the service, of whom 1,118 were referred on to funded VCS services. In parallel, more than 200 referrals were made to non-funded VCS provision and more than 300 referrals were made to statutory services
- the five most common types of funded services referred to were information and advice, community activity, physical activities, befriending and enabling.
Patients who were referred to the Social Prescribing Pilot experienced improvements in their well-being and made progress towards better self-management of their condition. Analysis of well-being outcome data showed that, after three to four months, 83 per cent of these patients had experienced positive change in at least one outcome area. Importantly, when the results were broken down by category they showed that progress was made against each outcome measure and that a majority of low-scoring patients made progress.
2. Treat the whole person – ensure physical health needs of mental health patients are well served and vice versa.
To reduce depression and anxiety prevalence, there should be, in primary care, acute trusts and community provider services, mind-body care delivered in an educationally empowering model for people presenting with high risk physical symptoms.
Cardiac, respiratory, stroke, chronic back pain, musculoskeletal and irritable bowel syndrome patients, for example, all have heightened depression risk.
Joint physio and Cognitive Behaviour Therapy sessions and ‘Living well with chronic pain’ groups are examples of good practice.
The LIFT Psychology service in Swindon provides a model of what an upscaled primary care psychological wellbeing service can look like. It is the commissioned IAPT service for Swindon, but makes a much broader offer. It services all 26 GP practices in Swindon (population estimated in excess of 216,000) and is available by self-referral for any patient registered at one of those practices.
Unlike many established IAPT services, it has few exclusions and aims to be widely accessible. It does not have an upper age limit, but only sees those aged 16 years or older. About a quarter of those who use the service are aged 25 years or under. The only exclusion criteria are for people with an acute episode of psychosis requiring more urgent help and those who cannot guarantee their safety overnight. LIFT does however work with people who have stable psychosis, and in some cases jointly works with secondary care on more complex cases. It also reports working with people with levels of risk that most primary care psychological wellbeing and IAPT services would not be able to manage.
More than 90% of people referred into mental health services from Swindon by primary care will be seen by LIFT first. LIFT sees around 650 people per month with very positive outcomes.