Mental health in the United Kingdom involves state, private and community sector intervention in mental health issues. One of the first countries to build asylums, the United Kingdom was also one of the first countries to turn away from them as the primary mode of treatment for the mentally ill. The 1960s onwards saw a shift towards Care in the Community, which is a form of deinstitutionalisation. The majority of mental health care is now provided by the National Health Service (NHS), assisted by the private and the voluntary sectors.
The Madhouses Act 1774 was the first legislation in the United Kingdom addressing mental health. Privately funded lunatic asylums were widely established during the nineteenth century. The County Asylums Act 1808 permitted, but did not compel, Justices of the Peace to provide establishments for the care of "pauper lunatics", so that they could be removed from workhouses and prisons. The Lunacy Act 1845 established the Board of Commissioners in Lunacy. Justices were required to build lunatic asylums financed by the local rates. [1]
In 1859, there were about 36,000 people classified as lunatics in all forms of care in England and Wales. About 31,000 were classed as paupers and 5,000 were private patients. Over 17,000 of the paupers were in county asylums or on contract in licensed houses, about 7,000 were in workhouses, while a similar number were living 'with friends or elsewhere'. Ten per cent of workhouse infirmaries provided separate insane wards. The Lunacy Act of 1862 permitted voluntary admission. Any person who had been a patient in any type of mental hospital during the previous five years could enter a licensed house as a voluntary boarder. The Lunacy Commissioners could remove lunatics from workhouses to county asylums, and the harmless chronic insane could be moved from the overcrowded asylums to the workhouses. [1]
The Metropolitan Asylums Board, established by the Metropolitan Poor Act 1867 (30 & 31 Vict. c. 6) built two large asylums for London, Leavesden Mental Hospital and Caterham Asylum. [2] They were built to similar designs by the same architect and each was intended to accommodate 1560 patients in six three-storey blocks for 860 females and five blocks for 700 males. They were both extended by around 500 places within five years. [3] In 1870 there were about 46,500 poor law mental health cases: 25,500 in county asylums, 1,500 in registered establishments, 11,500 in workhouses and the remainder boarded out with relatives. In 1876, there were nearly 65,000 people classified as mentally disordered in England and Wales. It is not clear that there was actually an increase in the prevalence of mental illness.
From around 1870 there were moves to separate what was then called idiot children from adults. Darenth School for 500 children with learning disabilities was opened by the Metropolitan Asylums Board in 1878 and a separate institution next to the school, with accommodation for 1,000 adults, was opened in 1880. The Lunacy Act 1890 placed an obligation on local authorities to maintain institutions for the mentally ill. By 1938 131,000 patients were in local authority mental hospitals in England and Wales, and 13,000 in District Asylums in Scotland, where there were also seven Royal Mental Asylums. Mental hospitals were overcrowded and understaffed. [4]
Mental health services were not integrated with physical health services when the NHS was established in 1948. Shortages of money, staff and buildings continued. Confederation of Health Service Employees organised an overtime ban in 1956, the first national industrial action in the NHS. Iain Macleod increased capital spending from 1954, hoping to increase bed numbers by 2,800. Rising numbers of patients, especially the elderly, caused a shift in policy away from institutions and towards day centres and community care. [5]
In 1961 Enoch Powell, then Minister of Health, made his Water Tower Speech. He said "in fifteen years time there may well be needed not more than half as many places in hospitals for mental illness as there are today". [6] This marked a shift towards Care in the Community, the British version of deinstitutionalisation, which was given further impetus by a series of scandals over long-stay hospitals from 1968 onwards. [7]
In 1998, Child and Adolescent Mental Health Services (CAMHS) began to be established, taking over from an earlier multidisciplinary child guidance approach. Children, generally until school-leaving age, are supported by CAMHS organised locally often by local government area, operated by the NHS but jointly financed by the NHS and local government. [8] [9]
On World Mental Health Day 2018, the Prime Minister, Theresa May appointed Jackie Doyle-Price as the UK's first suicide prevention minister. This occurred while as the government hosted the first ever global mental health summit. [10]
In September 2023, Labour Party leader Keir Starmer scrapped the position of mental health minister from his Shadow Cabinet. [11] Rosena Allin-Khan, who formerly held the role in his cabinet, said that Starmer does "not see a space for a mental health portfolio in a Labour cabinet". [12] [13] The CEO of the British Association for Counselling and Psychotherapy (BCAP), Anna Daroy, responded saying that it, "shows a disappointing disregard for the nation's mental health and a worrying lack of foresight about one of the major issues facing the UK now and over the coming years, particularly among young people". [14]
Most mental health problems are not easily defined. The American Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems are most generally used.
A 2017 survey found that 65% of Britons have experienced a mental health problem, with 26% having had a panic attack and 42% saying they had suffered from depression. [15] [16] Surveys have found that mental health problems have been on the rise since 2000, although growing awareness may also be a factor, and there are some counter trends such as a decline in suicide. One survey found that the number of responders who had reported having suicidal thoughts in the past year increased from 3.8 per cent in 2000 to 5.4 per cent in 2014. [17]
2018 was the first year that mental health factors like stress and anxiety caused over half of all absences from work. [17] According to a survey of 3,500 participants by the Office for National Statistics (ONS), the number of adults in Britain with depression has doubled during the coronavirus pandemic with 19.2% experiencing depression in June 2020. [18]
According to a 2023 study conducted by The Dawn, a nationwide investigation into the mental health of 1,000 professionals in executive roles in the UK revealed significant challenges within the professional sphere. Among C-suite executives, 69% reported experiencing work-related stress, with over half (54%) facing burnout or exhaustion, leading to 16% taking extended leaves of up to three months. [19] Work-induced stress manifested as regular anxiety and panic attacks for 54% of respondents, while 47% reported physical symptoms such as heart palpitations and headaches. Additionally, 29% of high-earning professionals admitted to having suicidal thoughts. Furthermore, the study found that 72% of executives surveyed reported suffering from depression, with 34% experiencing severe depression. [19]
Benefit cuts and sanctions[ when? ] "are having a toxic impact on mental health" according to the UK Council for Psychotherapy. Rates of severe anxiety and depression among unemployed people increased from 10.1% in June 2013 to 15.2% in March 2017. In the general population the increase was from 3.4% to 4.1%. [20]
Estimates to the prevalence of mental illnesses can vary significantly, depending on how the question is presented. The 2014 Adult Psychiatric Morbidity Survey found that 1 in 6 respondents had shown the symptoms of a common mental disorder in recent days, and 1 in 8 reported seeing mental health treatment. [21] [22] In the same year, the Health Survey for England found that 25% of respondents had been diagnosed with a mental illness at some point in their life and a further 18% had had one that was not diagnosed. [21]
Between 2005 and 2017, the number of adolescents (12 to 17 years) who were prescribed antidepressants has doubled. However, antidepressant prescriptions for children aged 5-11 decreased between 1999 and 2017. [23] [24] From April 2015, prescription increased for both age groups (for people aged 0 to 17) and peaked during the first COVID-19 lockdown in March 2020. [25]
Between 1998 and 2017, children and adolescents living in deprived areas were more often prescribed antidepressants while Black, Asian and minority ethnic (BAME) teenagers were less likely to receive prescriptions than their White peers. Males were slightly more likely to report incidences of depression, but only 34.1% are prescribed antidepressants, 65.9% to females. [23] [24]
A survey[ when? ] in Scotland found 26% of respondents reported having experienced a mental health problem at some point in their life, but the figure increased if respondents were shown a list of conditions.[ citation needed ]
6,045, 5,608 and 5,675 people aged 15 and over died by suicide in the time from 2009–2011 respectively. [26] [27] [ needs update ]
Mental health treatment is regulated in England and Wales by the Mental Health Act 1983 (amended by Mental Health Act 2007) and the Mental Capacity Act 2005, in Scotland by the Mental Health (Care and Treatment) (Scotland) Act 2003, and in Northern Ireland by the Mental Health (Northern Ireland) Order 1986, which has been amended by the Mental Health (Amendment) (Northern Ireland) Order 2004. In England, legislation includes the power to admit those accused of crimes to be detained as restricted patients if certain conditions are met. [28] : 4
The numbers of patients attending accident and emergency departments due to psychiatric problems rose by 50% between 2011 and 2016 and reached 165,000 in that year, amounting to as many as 10% of A&E visits in some trusts. There were calls in 2017 for increased provision of in patient psychiatric services and community psychiatric services. A&E is stressful and far from ideal for people in a mental health crisis but many patients in mental distress, some suicidal have nowhere else to go. [29]
Some mental health services have increased but many have been cut. 40% of mental health trusts have seen their budget reduced.[ when? ] Marjorie Wallace of mental health charity Sane, said "cuts to services across the country continue and people seeking help are still being failed". [30]
In December 2019 the Voluntary Organisations Disability Group reported that 2,250 people with special needs were detained in long-stay NHS accommodation. 463 had been there for more than five years and 355 for more than 10 years. Effective provision of care in the community appeared a remote prospect for these patients. [31]
The number of NHS mental health hospital beds fell by 25% between 2011 and 2021. There were 23,447 consultant-led mental health beds in 2011 and 17,610 in 2021. [32]
In 2019 it was reported that many children with autism in England were waiting 137 days or more following referral for a diagnosis, against a target of 91 days. [33] In 2021 children with mental health needs faced very long delays before receiving treatment. 51% waited under four weeks, 29% waited four to twelve weeks, 20% waited over twelve weeks. Some children with mental health problems had to go to A&E because a crisis developed while they were waiting. Some children were admitted to inappropriate adult wards through lack of room on children's wards. [34]
According to National Institute for Health and Care Excellence (NICE) guidelines, antidepressants for children and adolescents with depression and obsessive compulsive disorder (OCD) should be prescribed together with therapy and after being assessed by a child and adolescent psychiatrist. However, between 2006 and 2017, only 1 in 4 of 12-17 year olds who were prescribed an SSRI by their GP had seen a specialist psychiatrist and 1 in 6 has seen a paediatrician. Half of these prescriptions were for depression and 16% for anxiety, the latter not being licensed for treatment with antidepressants. [35] [36] Among the suggested possible reasons why GPs are not following the guidelines are the difficulties of accessing talking therapies, long waiting lists and the urgency of treatment. [35] [37] According to some researchers, strict adherence to treatment guidelines would limit access to effective medication for young people with mental health problems. [38]
The Millfields Charter is an electronic charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds. [39] Organisations opposed to restraints include Mind and Rethink Mental Illness. YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients, especially women and girls who have previously been victims of physical and/or sexual abuse. [40] [41] In June 2013 the UK government announced that it was considering a ban on the use of face-down restraint in English mental health hospitals. [42] They are particularly opposed to face-down restraints, which are used disproportionately on female patients. [40]
NHS Improvement began plans to help trusts in England integrate mental and physical health care in June 2017. [43] Claire Murdoch said that more than 10,000 staff would be required to deliver the promised service improvements. [44]
Psychiatric hospitals, also known as mental health hospitals, or behavioral health hospitals are hospitals or wards specializing in the treatment of severe mental disorders, including schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder, and others.
Historically, mental disorders have had three major explanations, namely, the supernatural, biological and psychological models. For much of recorded history, deviant behavior has been considered supernatural and a reflection of the battle between good and evil. When confronted with unexplainable, irrational behavior and by suffering and upheaval, people have perceived evil. In fact, in the Persian Empire from 550 to 330 B.C., all physical and mental disorders were considered the work of the devil. Physical causes of mental disorders have been sought in history. Hippocrates was important in this tradition as he identified syphilis as a disease and was, therefore, an early proponent of the idea that psychological disorders are biologically caused. This was a precursor to modern psycho-social treatment approaches to the causation of psychopathology, with the focus on psychological, social and cultural factors. Well known philosophers like Plato, Aristotle, etc., wrote about the importance of fantasies, dreams, and thus anticipated, to some extent, the fields of psychoanalytic thought and cognitive science that were later developed. They were also some of the first to advocate for humane and responsible care for individuals with psychological disturbances.
Broadmoor Hospital is a high-security psychiatric hospital in Crowthorne, Berkshire, England. It is the oldest of England's three high-security psychiatric hospitals, the other two being Ashworth Hospital near Liverpool and Rampton Secure Hospital in Nottinghamshire. The hospital's catchment area consists of four National Health Service regions: London, Eastern, South East and South West. It is managed by the West London NHS Trust.
The Lunacy Act 1845 or the Lunatics Act 1845 and the County Asylums Act 1845 formed mental health law in England and Wales from 1845 to 1890. The Lunacy Act's most important provision was a change in the status of mentally ill people to patients.
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in England and Wales. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. The Act was significantly amended by the Mental Health Act 2007. A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely.
Fulbourn Hospital is a mental health facility located between the Cambridgeshire village of Fulbourn and the Cambridge city boundary at Cherry Hinton, about 5 miles (8 km) south-east of the city centre. It is managed by the Cambridgeshire and Peterborough NHS Foundation Trust. The Ida Darwin Hospital site is situated behind Fulbourn Hospital. It is run and managed by the same trust, with both hospitals sharing the same facilities and staff pool.
A mental health trust provides health and social care services for people with mental health disorders in England.
Child and Adolescent Mental Health Services (CAMHS) is the name for care provided by the NHS and other organisations in the United Kingdom for children, generally until school-leaving age, who have difficulties with their emotional well-being or are deemed to have persistent behavioural problems. The service is also known as Children and Young People’s Mental Health Services (CYPMHS). CAMHS offer children, young people and their families access to support for mental health issues from third sector (charity) organisations, school-based counselling, primary care as well as specialist mental health services. The exact services provided may vary, reflecting commissioning and providing arrangements agreed at local level.
Gartnavel Royal Hospital is a mental health facility based in the west end of Glasgow, Scotland. It provides inpatient psychiatric care for the population of the West of the City. It used to house the regional adolescent psychiatric unit but this has recently moved to a new psychiatric unit at Stobhill Hospital. The Hospital is a venue used by the Mental Health Tribunal for Scotland. Some parts of the hospital are classified as a category A building and are also deemed at risk.
St Bernard's Hospital, also known as Hanwell Insane Asylum and the Hanwell Pauper and Lunatic Asylum, was an asylum built for the pauper insane, opening as the First Middlesex County Asylum in 1831. Some of the original buildings are now part of the headquarters for the West London Mental Health NHS Trust (WLMHT).
The Lawn is an early nineteenth century Greek revival building on Union Road, in Lincoln, Lincolnshire, England, 0.3 miles (0.5 km) to the west of Lincoln Cathedral. The complex features a walled garden and children's play area. The building housed The Lawn Hospital for Mental and Nervous Diseases from 1921 until 1985.
Kew Lunatic Asylum is a decommissioned psychiatric hospital located between Princess Street and Yarra Boulevard in Kew, a suburb of Melbourne, Australia. Operational from 1871 to 1988, Kew was one of the largest asylums ever built in Australia. Later known as Willsmere, the complex of buildings were constructed between 1864 and 1872 to the design of architects G.W. Vivian and Frederick Kawerau of the Victorian Public Works Office to house the growing number of "lunatics", "inebriates", and "idiots" in the Colony of Victoria.
Woodilee Hospital was a psychiatric institution situated in Lenzie, East Dunbartonshire, Scotland.
The lunatic asylum, insane asylum or mental asylum was an early precursor of the modern psychiatric hospital.
Blackberry Hill Hospital is an NHS psychiatric hospital in Fishponds, Bristol, England, specialising in forensic mental health services, operated by the Avon and Wiltshire Mental Health Partnership NHS Trust. The hospital also offers drug and alcohol rehabilitation inpatient services, and is the base for a number of community mental health teams.
This disability rights timeline lists events outside the United States relating to the civil rights of people with disabilities, including court decisions, the passage of legislation, activists' actions, significant abuses of people with disabilities, and the founding of various organizations. Although the disability rights movement itself began in the 1960s, advocacy for the rights of people with disabilities started much earlier and continues to the present.
Roundway Hospital was a psychiatric hospital in the parish of Roundway near Devizes, Wiltshire, England. It was originally called the Wiltshire County Lunatic Asylum and later the Wiltshire County Mental Hospital. It opened in 1851 and closed in 1995.
The Old Manor Hospital was a psychiatric hospital in Salisbury, Wiltshire, England. It was established in the early 19th century as a private licensed house called Fisherton House or Fisherton House Asylum, which became the largest private madhouse in the United Kingdom. In 1924, following a change of proprietors, it was renamed Old Manor Hospital and in 1955 it was amalgamated into the National Health Service. From 1813 to 1955 it was owned and managed by members of the same family. The Old Manor Hospital closed in 2003 and was replaced by Fountain Way, a smaller, modern, psychiatric hospital on part of the same site. In 2014 the site was acquired by Quantum Group for development as a residential estate and the conversion of the main building to a hotel.
Mental healthcare generally refers to services ranging from assessment, diagnosis, treatment, to counseling, dedicated to maintaining and restoring mental well being of people. In Nigeria, there is significant disparity between the demand and supply of mental health services. Though there are policies aimed at addressing mental health issues in Nigeria, in-depth information on mental health service in Nigeria is non-existent. This makes it difficult to identify areas of needs, coordinate activities of advocacy groups, and make an informed decision about policy direction. In effect, there is continued neglect of mental health issues. About 25-30 percent of Nigerians suffer from mental illness and less than 10 percent of this population have access to professional assistance. The World Health Organization estimates that only about three percent of the government's budget on health goes to mental health.
The shadow mental health minister role has gone from Labour's shadow cabinet.
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