Measuring inequalities in mental health
Sally McManus is a Research Associate at NatCen
Before the early 1990s, the prevalence of mental illness in England was unknown. The data simply didn’t exist, especially in relation to undiagnosed or untreated conditions.
To address this gap, the Department of Health commissioned social researchers, psychiatrists and epidemiologists to design the first survey to rigorously assess mental illness in a random sample of the general population. It was catchily named the Adult Psychiatric Morbidity Survey (APMS), though nowadays also goes by the more user-friendly moniker ‘Mental Health and Wellbeing Survey’.
Soon after, surveys of the mental health of other populations were also set-up: offenders, the homeless, and people living in institutions. Those surveys have never been repeated, despite changes in these populations and an urgent need to understand their current mental health and circumstances. The general population surveys of adults, however, have been conducted every seven years.
The recent completion of the fourth survey makes this the longest-running series in the world to monitor a nation’s mental health using consistent methods. In 2014/15, interviewers went into the homes of a random sample of 7,500 people aged from 16 to over a hundred, including some with no contact with health services and many with conditions that hadn’t previously been identified.
Datasets from the series are made freely and publicly available to non-commercial organisations through the UK Data Service’s archive. Researchers, epidemiologists, policy makers, clinicians and others have collaborated on more than 300 reports and papers.
Alongside assessing mental disorder, the APMS questionnaire collects data on the wider circumstances of people’s lives. Many of the publications provide evidence on inequalities in mental illness by a range of demographic, social and economic factors, including:
- age and generation
- religious discrimination
- learning impairment
- chronic physical conditions
- poor housing conditions and neighbourhood deprivation
- work stress and job quality
- job insecurity
- unemployment and welfare receipt
- childhood sexual abuse
- sexual violence in adulthood
- domestic violence
- caring responsibilities
The 2007 APMS was one of the first government-funded surveys to ask about sexual identity and the first to combine data on this with assessments of mental illness. Analyses of the data showed that being lesbian, gay or bisexual (defined by both identity and sexual partnership) was associated with depression; generalised anxiety disorder; obsessive compulsive disorder; phobic disorder; probable psychosis; suicidal thoughts and acts; self-harm; and alcohol and drug dependence. Being discriminated against on the grounds of sexual identity was also found to be linked to mental illness, suggesting that discrimination acts as a social stressor contributing to mental health problems in this population.
The report for the latest survey published last week sets out the study’s methods and describes trends and prevalence of disorders, treatment rates, and some associations. It highlighted, for example, that black people with a common mental disorder are far less likely than white British people to get treatment.
However, it’s when the full dataset launches with the UK Data Service in the next few months that the real work for analysts up and down the country begins. We really hope you’ll be a part of that important work.