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Severe mental health (SMI)

Key points from our SMI deep dive session

In November 2022, the Reducing Inequalities Alliance network came together to discuss severe mental illness (SMI).

People living with a severe mental health condition can experience psychological problems that are often so debilitating that their ability to engage in functional and occupational activities is severely impaired. To learn more about SMI visit the Mind in Bradford webpage.

Deprivation and inequality

Socioeconomic deprivation is both cause and consequence of severe mental illness.

Analysis from The Health Improvement Network (THIN), Active patients in England; data extracted May 2018 shows that there are differences in the prevalence within SMI patients with higher proportions in:

  • males (0.9%) than females (0.8%)
  • people aged 35 to 74 (1.1%) than 15 to 34 (0.6%)
  • patients living in the most deprived areas (1.8%) than in the least deprived areas (0.5%)

Social and environmental risk factors that contribute to SMI include:

  • Early life factors – maternal stress, birth and postnatal trauma
  • Childhood adversity
  • Stressful life events
  • Ethnicity
  • Migration
  • Urban living
  • Cannabis use
  • Other substance use

In the UK, among people who contact Citizens Advice, people with mental health problems have a greater number of practical problems:

  • 85% more likely to need advice following disconnection from their energy supply
  • 87% more likely to need advice following self-disconnection from their energy prepayment meter
  • 2 times more likely to need advice following disconnection from their mobile phone supply
  • 62% more likely to need advice on threatened homelessness
  • 3 times more likely to be homeless due to repossession by a housing association
  • 4 more times as likely to need advice on emergency accommodation
  • 61% more likely to need advice on accessing jobs than clients overall
  • 24% more likely than clients overall to need advice on enforcing employment rights

We don’t see a link with deprivation and SMI in Bradford and Craven in primary care. Is SMI under-recorded in primary care?

Life expectancy and premature mortality

Locally and nationally, rates of premature mortality continue to increase for people with severe mental illness. In Bradford, there has been 1,090 premature deaths in the last three years.

The below table show the number of deaths in people aged 18-74 years old, with SMI in Bradford from 2018 – 2020, with all numbers either similar to national numbers or worse. Premature mortality due to cardiovascular diseases in adults with SMI is in the worst 95% in England.

IndicatorCount
Premature mortality due to cancer in adults with SMI175
Premature mortality due to cardiovascular diseases in adults with SMI220
Premature mortality due to liver disease in adults with SMI80
Premature mortality due to respiratory disease in adults with SMI115
Premature mortality in adults with SMI1,090
Smoking prevalence in adults with SMI1,765

Inequalities in physical health

  • People with SMI aged 15 to 34 are five times more likely to have 3 or more physical health conditions
  • People with SMI living in more deprived areas have a higher prevalence of physical health conditions
  • Antipsychotic medication is linked to side effects and may be a contributory factor to the higher prevalence of obesity, diabetes and heart disease

Patients with SMI have a higher prevalence for 7 out of the 10 physical health conditions examined. The level of the health inequality between the SMI and all patients varies between the different conditions analysed in The Health Improvement Network (THIN), Active patients in England; data extracted May 2018. The rate ratio between the prevalence in the SMI and all patients are highest for:

  • obesity (1.8 higher for SMI)
  • asthma (1.2 higher for SMI)
  • diabetes (1.9 higher for SMI)
  • chronic obstructive pulmonary disease (COPD) (2.1 higher for SMI)
  • coronary heart disease (1.2 higher for SMI)
  • stroke (1.6 higher for SMI)
  • heart failure (1.5 higher for SMI)

Obesity and Diabetes are significantly higher at all levels of deprivation. Asthma is high in more deprived deciles and Hypertension high in younger age groups (<55).

Physical health improvement

In Bradford District and Craven Q1 2019/20:

  • Greatest number of interventions required for weight management and smoking
  • 3,253 people on SMI registers with a BMI of 25+
  • 1,895 people received a weight management or exercise intervention
  • Over 1,000 people who could benefit from a weight management or exercise intervention did not receive one
  • 34% (514 of 1526) patients with a record of high blood pressure received a lifestyle intervention
  • 94% of people who required a smoking cessation intervention received one (effectiveness not known)

Ethnicity and inequality

The crude rate of detention by ethnicity in West Yorkshire and Harrogate for people with SMI 2021/22 is:

  • Black: 274
  • Other: 167
  • Mixed: 91
  • Asian: 81
  • White: 69

Barriers to access across the UK include:

  • Mistrust of providers
  • Lack of interpreting
  • Talking Therapies: ethnic minority people less likely to self-refer or be referred by GP
  • Black children 10 times more likely than White British children to be referred to CAMHS via social services rather than GP

What we are doing in response

Community mental health transformation

Over the next few years some important changes will be made to the way community mental health services are going to be delivered in Bradford District and Craven. These changes will improve the way people with severe mental illness (SMI) access services within their community.

To support people in Bradford District and Craven to live ‘happy, healthy at home’ and to improve access to high quality, safe services, we are looking at how all the different organisations that provide support can work better together. This includes the NHS, local councils (Bradford Council and North Yorkshire Council), voluntary and community sector organisations, and primary care networks which are groups of GP practices working together. The aim is to focus on local patient care, will play a key role in the delivery of community mental health services in the future.

There are currently six workstreams within the transformation programme, these are core model, care provision, workforce, data and outcomes, focussed support, and cross cutting themes. Our work on SMI falls under the care provision workstream, and you can view an action plan which has been developed for SMI.

Find out more about the community mental health transformation programme.