Mental Health Strategy for Scotland: 2012-2015 (published with corrections, November 2012)

The Challenge

Mental illness^[1] is one of the top public health challenges in Europe as measured by prevalence, burden of disease and disability. It is estimated that mental disorders affect more than a third of the population every year, the most common of these being depression and anxiety. About 1-2% of the population have psychotic disorders, and across Europe 5.6% of men and 1.3% of women have substance misuse disorders. The ageing population is leading to an increase in the number of people with dementia, 5% of people over 65 and 20% of those over 80 years of age. In all countries, most mental disorders are more prevalent among those who are most deprived. The prevalence of mental disorders does not appear to be changing significantly over time, though more people are accessing treatment and support as understanding grows and the stigma of mental illness is reducing^[2].

Across Europe, neuropsychiatric disorders are the second largest contributor to the burden of disease (DALYs), accounting for 19% of the total. There is considerable variation across Europe, with mental disorders already ranked highest in many high income Western European countries, but only fourth or fifth in some low income countries due, in part, to the continuing high prevalence of perinatal and cardio-vascular diseases. An important indicator of the disease burden on society and health systems is the contribution of specific groups to all chronic conditions.

Mental disorders are by far the most significant of the chronic conditions affecting the population of Europe, accounting for just under 40% of all Years Lived with Disability.

Years lived with disability in the WHO European Region

Depression alone is responsible for 13.7% of the disability burden, making it the leading chronic condition in Europe. This is followed by alcohol-related disorders (6.2%) in second place, Alzheimer’s and other dementias in seventh (3.8%), and schizophrenia and bipolar disorders in eleventh and twelfth position, each responsible for 2.3% of all Years Lived with Disability^[3].

A high percentage of people who receive social welfare benefits or pensions because of disability have, as their primary condition, mental disorders. Data from countries where information is available show that people with mental disorders account for as much as 44% of social welfare benefits or disability pensions in Denmark, 43% in Finland and in Scotland and 37% in Romania. Rates of employment for people with mental health problems in Europe vary between 18-30%. Higher figures for social welfare benefits do not necessarily indicate higher levels of illness, but reflect a combination of reporting arrangements, levels of stigma and discrimination and the different scope of welfare systems across Europe.

Mental disorders are strongly related to suicide. Suicide rates in Europe are high compared to other parts of the world. The average annual suicide rate in Europe is 13.9 per 100,000, but there is a wide variation. In Scotland the most recent figure is for 2010 and was 14.7 per 100,000 (which gives a three-year rolling average for 2008-10 of 15 per 100,000^[4]) placing Scotland a little above that average, but in the middle group of European countries. There are reports that suicide rates have been rising in Europe since 2008, with the greatest increases in those countries most affected by the economic recession, but in Scotland figures for suicide have continued to fall^[5].

People with mental disorders have a much higher mortality than the general population, dying on average more than 10 years earlier. That gap is widening as health gains have been made more quickly in the general population than for those with mental illness. A reason for this widening gap is the high prevalence of chronic diseases such as cardiovascular disease, cancer and diabetes, and the often poor access and quality of treatment across Europe for such conditions for people with mental illness. Similarly, across Europe people diagnosed with chronic physical health conditions suffer from high rates of depression, often remaining undiagnosed, and this is also associated with higher mortality.

There are now good treatments for many mental disorders and co-morbidities. Suicide can be reduced. However, across Europe the majority of people with mental health problems do not receive treatment, the so-called treatment gap, or experience long delays. It is estimated that even in countries with the most developed mental health systems many people are not diagnosed and do not receive treatment. That is not the case in Scotland and closing this treatment gap has been a key objective of the Scottish Government’s work on depression and alcohol misuse – the two conditions least likely to be diagnosed and treated in other countries.