Mortality rate three times as high among mental health service users than in general population

February 19, 2013: Mortality among mental health service users aged 19 and over in England was 3.6 times the rate of the general population in 2010/11, new Health and Social Care Information Centre (HSCIC) figures show.

People in contact with specialist mental health services had a higher death rate for most causes of death, especially mental and behavioural disorders and diseases of the nervous system such as Alzheimer's disease, according to new analysis about cause of death released for the first time today.

However a much higher level of mortality (considering people between the ages of 19 and 74) also occurred for lifestyle - related diseases, including:

• Nearly four times the general population rate of deaths from diseases of the respiratory system (at 142.2 per 100,000 service users, compared with 37.3 per 100,000 in the general population).
• Just over four times the general population rate of deaths from diseases of the digestive system (at 126.1 per 100,000, compared with 28.5 per 100,000 in the general population).
• 2.5 times the general population rate of deaths from diseases of the circulatory system (at 254.0 per 100,000 compared with 101.1 per 100,000 in the general population).

Within these disease areas specific conditions that accounted for a high proportion of deaths among service users (under the age of 75) were:

• Diseases of the liver; at 7.6 per cent of deaths (1,430 in total)
• Ischaemic heart diseases; at 9.9 per cent of all deaths (1,880 in total)

The findings are based on extended analysis of linked data from HSCIC's Mental Health Minimum Dataset (MHMDS) to Office of National Statistics (ONS) deaths data. They are released today as part of a the annual Mental Health Bulletin, which provides information about specialist mental health services in England; including the number of people in contact with services and the number who spend time in hospital.

Key findings from the new mortality analysis show that in 2010/11:

• The mortality rate was 4,008 per 100,000 (83,390 deaths in total) for mental health services users, compared to the general population rate of 1,122 per 100,000.
• By age, the difference in mortality rates was largest among people aged 30 to 39; at almost five times that of the general population, 300 per 100,000 service users (520 in total) compared to 63 per 100,000 in the general population.
• By underlying cause of death, the proportionate difference in mortality rates was greatest for mental and behavioural disorders (where the main cause of death was unspecified dementia) at just over twelve times that of the general population at 556 per 100,000 service users (11,570 in total) compared to 46 per 100,000 in the general population.

Key findings from today's annual mental health bulletin provide the most comprehensive picture to date of activity in England. Based on a new, updated version of the MHMDS that includes additional data processing, the 2011/12 information captures even brief contact with services and shows that in 2011/12:

• Just over 1.5 million people were in contact with specialist mental health services, equating to approximately one person in 32 in England.
• A third of service users (530,830) were aged 65 or over. The proportion of the general population who are this age is much lower at just over 16 per cent.
• 99,100 service users spent time in an NHS hospital - continuing the downward trend since 2009/10.

HSCIC chief executive Tim Straughan said: "Today marks the release of the most comprehensive analysis of our mental health data. Not only is the data the most comprehensive it has ever been, but we have also been able to link this information with other data to report about the subject in greater depth.

"We know therefore that the mortality rate among people who are in contact with specialist mental health services is nearly four times that for the general population.

"While it may be assumed that the mortality rate would be higher for diseases like dementia among mental health service users, it is perhaps unexpected that the mortality rate for more lifestyle related conditions is also much higher than for the general population.

"This data is a very valuable starting point for health professionals and the public alike to understand what is happening to people who access specialist mental health services. Its high level of completeness provides compelling evidence as to what is happening within our communities and hospitals."

ENDS

Notes to editors

1. HSCIC was previously known as the NHS Information Centre. It is England's authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The HSCIC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

2. The analysis presented in this report build on the work done to develop Indicator 1.5: Excess under 75 mortality rate in adults with serious mental illness in the NHS Outcomes Framework, published in June 2012. It should be noted that this analysis looks at all deaths aged 19 and over, whereas indicator 1.5 uses only those among people aged 18 to 74.

3. Mortality rates are calculated for people aged 19-75 or 19 and over and are not age and sex standardised.

4. The profile of the population in contact with mental health services differs to that in the general population so these crude mortality rates could be affected by differences in age and sex.

5. Service user numbers in this press release have been rounded to the nearest 10 and rates to the nearest whole number. Percentages and rates are based on exact service user numbers, which can be found in the report, rather than the rounded numbers presented in the press release.

6. For media enquiries please call 0845 257 6990 or email media@hscic.gov.uk