Mental health in adults (health and wellbeing needs in South Tyneside)

South Tyneside is around 25 square miles (64 square kilometres) wide, with a population of around 147,800 residents.

It is ranked 26^th most deprived out of 317 local authorities nationally in the latest index of Multiple Deprivation (2019), ranking particularly poorly for employment, income, and health and disability.

The borough is more deprived than its Tyne and Wear neighbours and is 3rd most deprived borough overall in the North East region, after Middlesbrough and Hartlepool.

The health of people in South Tyneside is generally worse than the England average. 

Life expectancy for both men and women is lower than the England average. Life expectancy is 9.3 years lower for men and 8.1 years lower for women in the most deprived areas of South Tyneside. See Projecting Adult Needs and Service Information System (pansi.org.uk) and Projecting Older People Population Information System (poppi.org.uk).

The projected data in Table 1 suggests little changes in the key areas of mental health prevalence in the period 2023 to 2040 however we are expected to see an increase in the older population and any associated mental health need.

In 2022  /23, at 15.70% South Tyneside had a higher proportion of people with depression, which is slightly higher than that of the Northeast (15%) and significantly higher than that of England at 13.2%.

Table 1 suggests that the population (working age adults) will largely remain unchanged in the borough in the period to 2040 and beyond, with changes regionally and nationally mirroring increases and decreases in the population.

However, we are expected to see an increase in the older population with a diagnosis of depression as shown in Table 2.

^{Source for Tables 1- 4 POPPI / PANSI}

In South Tyneside the number of working aged people with a mental health condition is not expected to change (Table 4).

However, in England mental health demand modelling predicts that up to 10 million people will need either new or additional mental health support as a direct consequence of the pandemic.

Depression, post-traumatic stress syndrome and support with bereavement and loss are areas are areas which are projected to increase and demand for services increase.

Table 5 above outlines the prevalence rates of severe mental illness, anxiety and depression are similar to other sub regional areas across the North East and Cumbria.

Prevalence is generally higher amongst 35 to 65 year-olds and strongly linked to areas of deprivation. Depression and anxiety disorder rates are much higher among women.

Adults on the Severe Mental Illness Register (SMI)

As of 9 November 2023, there were 1,448 people on the SMI register. Of these 1,143 people had received all six physical health checks, an 86.4% achievement rate which is above the national average of 65%.

Data quality evidence suggests there should be 1,675 people with SMI on the register. South Tyneside remains the highest performing area in relation to the number of physical health checks undertaken in England. 

Table 6 shows count of people with SMI having had each physical health check in November 2023.

Following each consultation that is completed with a person around their health needs, appropriate advice / signposting or direct intervention is provided around identified needs.

Table 7 shows this further intervention. Whilst there has been some improvement within some areas, particularly around smoking, it is worth noting that further work is to be completed in this area.

In South Tyneside in 2022 / 2023 the smoking prevalence in adults with long term mental health conditions was 26.4%, this was similar to the region (24.2%) and England (25.1%). However, if reviewing those identified on the SMI register, it is noted that prevalence rate is 39.9 %.

Of the 458 people on a GP register meeting the threshold for intervention 421 people are receiving intervention, equating to 91.9%.

Substance missuse

There are 511 people experiencing substance misuse on the GP SMI register meeting the threshold need for intervention.

Of these there are only 5 people receiving intervention, this suggests there is further work with the South Tyneside Mental Health team and primary care needs to be completed to improve the uptake of intervention.

Adults in inpatient beds

In October 2023 there were 10 adults in acute mental health beds for over 60 days, this is slightly above the national target of 8.

Hospital admissions

In terms of hospital admissions during the period 2022 / 2023,  South Tyneside is statistically similar to both England and the region.

The South Tyneside Hospital Admissions Group with representation from South Tyneside Council, the Integrated Care Board (ICB), Cumbria, Northumberland Tyne and Wear NHS Foundation Trust (CNTW), South Tyneside and Sunderland NHS Foundation Trust (STSFT) and a range of third sector representatives reviewed the NHS data from 2019 to 2022 relating to the number of people using emergency department services (ED) broken down by older people and people of working age.

They also explored where people move onto such as into hospital or back into the community.

This review noted that working age adults are more likely to attend the emergency department (ED) than older people, and highlighted people are more likely to be admitted into psychological services if they have attended ED. 

During the timeframe 2019 to 2022 there was no significant increase due to mental health issues but a slight increase due to self-harm.

Access to Talking Therapies

Data around treatment within 6 weeks of referral and 18 weeks of referral is monitored along with the recovery rate of people attending at least two treatment contacts and moving to recovery.

Data at October 2023 shows that the percentage receiving treatment within 6 weeks of referral was 97.9%, and within 18 weeks was at 100%.

Whilst the data being around access to Talking Therapies is clearly demonstrating that people from different ethnic groups, ages, deprivation levels and gender are accessing the service at present, it is below the expected access rate, in respect to prevalence in the borough.

Waiting times

Feedback received from people who use services is that they would like better information on waiting lists which can often be a barrier for people with mental health engaging.

A priority is timely access to mental health crisis services and support.

Commissioned Community Mental Health Services

In October 2023 there were 2,590 people had received two or more contacts with community mental health services.

Hospital Admissions Self Harm

In the period 2021 / 2022 there were 380 hospital admissions for self-harm which is significantly higher than the national average but not significantly different to the regional average.

Not everyone who self-harms will have suicidal thoughts and not everyone that dies by suicide will have self-harmed. However, it is known previous serious and escalating self-harm, is a key predictor of completed suicides.

Long term conditions

Having a long-term physical condition can lead to social isolation, low self-esteem, stigma and discrimination.

You may feel tired, frustrated, worried or stressed, especially when dealing with pain, tests, treatments or flare-ups.

All of these things can make someone more likely to develop a mental health problem such as depression or anxiety.

Research shows that people with long-term physical conditions are more than twice as likely to develop mental ill-health.

Mental health problems can then make it harder for individuals to cope with their physical health condition.

Prevalence of long-term conditions (Table 8) therefore need to be considered alongside mental health support being available.

Where people live

Adults in contact with secondary mental health services who live in stable accommodation

South Tyneside is slightly worse than the regional average for people in contact with mental health services who live in stable accommodation (period 2021 to 2022).  

In January 2024 there were 162 adults with an active support plan in receipt of services from adult social care who had a primary support reason relating to mental health.

Table 9 shows a breakdown of services people are receiving.

South Tyneside Council is developing an All-Age Accommodation Strategy with the aim of providing focus and direction to the future provision of accommodation with care and support, this will include reviewing the people who are living out of borough and in need of residential care provision.

Overall trend analysis from the Homelessness and Housing Solutions team (Table 10) shows overall reason of approach to the team.

• Domestic violence cases continue to rise. Many of these cases have complex needs and there is currently limited provision for this type of presentation. However, this is being addressed as part of the Domestic Abuse Strategy.
• There was a total of 22 presentations following prison release.
• Evictions from supported housing has been identified as an issue, although work is ongoing with the Commissioning team, South Tyneside Council Housing Services and local providers to address this.
• There is a rise in the number of privately rented sector tenancies ending. The trend is attributed to landlords choosing to sell properties rather than rent, possibly due to rise in the cost of living and impact on pensions.

Commissioned accommodation and support for adults with mental health in South Tyneside

There are 3 commissioned providers specifically offering accommodation with support, dispersed and outreach currently in South Tyneside to adults 18+ with mental health needs.

The criteria to access this provision is; to have an allocated social worker, present with a range of complex mental health needs (this may include a concurrent mental health, mental health and substance misuse (dual diagnosis) or be subject to certain conditions under the Mental Health Act after discharge from hospital or having had contact with the criminal justice system.

There are two residential mental health care homes in South Tyneside.

Occupancy of provision (Table 11) has remained quite static with low numbers of vacancies.

Work being undertaken within Adult Social Care around the All-Age Accommodation Strategy suggests there is an opportunity for reviewing those in residential care settings to determine if this is the best and least restrictive option for them.

Safe Haven

In November 2021, South Tyneside was successful in its bid to NHS England to support a reduction in the risk of delayed inpatient discharge / risk of inpatient readmissions.

Changing Lives was commissioned to provide 4 Safe Haven beds, consisting of accommodation and on-site support to help people safely transition back into the community.

In total there have been 69 referrals into Safe Haven, 33 of these were accepted as appropriate referrals.

Since January 2023, 28 people who have successfully moved on have either moved back into their primary residence, moved onto supported accommodation, accommodated by family, obtained a property via South Tyneside Council, or moved into a residential setting, while 2 people were readmitted to hospital.

Out of the 33 people who were appropriately referred Safe Haven, 9 were moved on within the 28-day period. From the 33 people accepted into Safe Haven, 11 were referred via the Risk of Admission pathway and 22 via Discharge. 

The average length of stay for people accessing the service is approximately 72 days.

An understanding of why people have experienced delayed discharge from the Safe Haven included:

• Difficulties sourcing appropriate accommodation
• Delays in providing wrap around support
• Delays in assessing move on needs

There has been greater strengthening of relationships between Safe Haven and partners working into the service. For example contact with Bed Management, Community Mental Health teams and Adult Social Care have utilised beds on occasions ensuring move on plans are met.

The present level of need is being met by the service (there is no delay to accessing the service) and Safe Haven is at present able to maintain a proficient level of resilience of referrals to support the risk of the pathway blocking.

Areas for improvement, which have been a theme across both the provider and the people accessing the service, relates to more effective planning around the move on process and thereon, the lack of suitable accommodation options which are being explored further within the Adult Social Care All Age Accommodation Strategy.

The data on the labour market profile informs us South Tyneside has high rates of economic inactivity and gaps in employment.

A working group to explore employment opportunities has been identified through open forum discussions and what reasonable adjustments are needed to support those with lived experience of mental health in the workforce.

Based on the increased number of people claiming out of work benefits (116,008 additional people between March and September 2020 in the North East and Cumbria) the projected demand on mental health services is estimated to be 2,378 for major depression.

However, the full economic impact is yet to be felt.