Part of: Mental Health and Illness
Related to: Anxiety and Depression, Personality Disorders, Postnatal Depression. Wellbeing, Emotional Health and Wellbeing of Children and Young People, Self-Harm, Suicide and Mortality of Undetermined Intent, Safe Places in Health-based Settings , Guardianship under the 1983 Mental Health Act, Dementia, Eating Disorders, Patient Experience, Adult Social Care, People with Multiple Needs, Alcohol, Substance Misuse
- It is estimated that in 2012, about 0.35% (511 people) of people aged 16 years in Bath and North East Somerset had a psychotic disorder.
- In 2012/13 B&NES spent £3,969 on psychosis services per 100,000 of the 18+ population.
- In B&NES in quarter 2 of 2014/15 GPs prescribed 48.02 drugs for psychoses and related disorders per 1,000 of the registered GP population (9,568 items).
Psychosis - is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.
The two main symptoms of psychosis are:
- hallucinations – where a person hears, sees and, in some cases, feels, smells or tastes things that aren't there; a common hallucination is hearing voices
- delusions – where a person believes things that, when examined rationally, are obviously untrue – for example, thinking your next door neighbour is planning to kill you
The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion and behaviour.
Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.
Psychosis isn't a condition in itself – it's triggered by other conditions.
It is sometimes possible to identify the cause of psychosis as a specific mental health condition, such as:
- schizophrenia – a condition that causes a range of psychological symptoms, including hallucinations and delusions
- bipolar disorder – a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs)
- severe depression – some people with depression also have symptoms of psychosis when they're very depressed
Psychosis can also be triggered by traumatic experiences, stress or physical conditions, such as Parkinson's disease, a brain tumour, or as a result of drug misuse or alcohol misuse.
How often a psychotic episode occurs and how long it lasts can depend on the underlying cause. For example, schizophrenia can be long-term, but most people can make a good recovery, and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may reoccur.
What does the data say? 2
Psychosis is more common than most people realise, with schizophrenia being the most commonly associated mental health condition.
Recent research found that in England in any given year, one new case of psychosis is diagnosed for every 2,000 people.
Another study estimated that around 3 in 100 people will have at least one episode of psychosis at some point during their life.
Psychosis can develop at any age, but is rare in children under 15.
Bath and North East Somerset 3
It is estimated that in 2012, about 0.35% (511 people) of people aged 16 years in Bath and North East Somerset had a psychotic disorder, slightly lower than the estimated prevalence for England of 0.40% (17,0753 people). These estimates are based on applying annual prevalence from the Adult Psychiatric Morbidity Survey (APMS) to populations.
In B&NES in 2011 it has been estimated that there were 19.6 new cases of psychosis per 100,000 aged 16-64 (23 new cases), and 24.2 in England (8321 new cases). These estimates are based on a modelling approach which uses data from large research studies to estimate risk across a range of socio-demographic and socio-environmental factors. These risk estimates were then applied to local population factors to estimate the number of new cases in each local authority per year.
Schizophrenic disorders - The Directly age standardised rates of schizophrenic disorders in the PCT are 19 per 10,000 which reflects 389 cases. That is 16 per 10,000 for females and 25.1 per 10,000 for males:
- Rates of schizophrenia in different GP practices vary considerably However, these variations in results do not necessarily mean that there are genuinely higher rates in these practices than in other practices, it can instead reflect differences in coding practice by different GP’s4
- The age specific rates of schizophrenic disorders in B&NES increase with age to a peak at age 45-54 for men (approximately 45 per 10,000 men) and 65-74 for women (45 per 10,000 women) with a dip then a second peak at 85+ (approximately 4.8 per 1,000 women).
- Men and women are equally affected by schizophrenia, but in men it usually begins between the ages of 15 and 30; in women it usually occurs later, beginning between the ages of 25 and 305
Are we meeting the needs?
Treating psychosis 6
Treatment for psychosis involves using a combination of:
- antipsychotic medication – which can help relieve the symptoms of psychosis
- psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with schizophrenia and, in appropriate cases, family therapy has been shown to reduce the need for hospital treatment in people with psychosis
- social support – support with social needs, such as education, employment or accommodation
Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms reoccurring.
If a person's psychotic episodes are severe, they may need to be admitted to a psychiatric hospital.
Intervention and treatment of psychosis in Bath and North East Somerset 7
Spend on psychosis services – In 2012/13 B&NES spent £3,969 on psychosis services per 100,000 of the 18+ population (mapped from PCT), compared to £4,789 per 100,000 of the 18+ population in England as a whole.
Early Intervention teams - In B&NES in 2013/14 there were 21.6 new cases of psychosis per 100,000 of the 18 years and over population served by Early Intervention teams. This was similar to the rate in England of 24.9 new cases per 100,000 of the 18+ population in 2013/14.
Psychological therapy - In 2013/14 in B&NES it is estimated that 6.4%** of psychosis care spells* (40 care spells) received psychological therapy, this is higher than the estimate for England of 3.4%**.
*A care spell - is the period a person spends in contact with a particular provider. One person may have many Adult Mental Health Care Spells during the year. Here ‘psychosis care spells' refer to people who had spent at least three days assigned to a care cluster in the psychosis super class.
** It is important to note that Public Health England have significant concerns over this data as the fields used to identify psychological therapy contacts are poorly recorded, and so this data should be regarded as experimental.
The Care Programme Approach (CPA) - This is the system which coordinates the care of many specialist mental health service patients. CPA requires health and social services to combine their assessments to make sure everybody needing CPA receives properly assessed, planned and coordinated care. It should also ensure that patients get regular contact with a care co-ordinator.
In B&NES in quarter 2 in 2014/15 there were 459 people on the Care Programme Approach per 100,000 of the 18 years and over population (670 people). This is lower than the rate for England (518 per 100,00 of 18+ population).
Drug treatments – In B&NES in quarter 2 of 2014/15 GPs prescribed 48.02 drugs for psychoses and related disorders per 1,000 of the registered GP population (9,568 items). This rate of drug prescribing is higher than that of England (45.7 per 1,000 of the registered GP population).
Early deaths – In 2011/12 in B&NES the ratio of the number of deaths for people aged 18 to 74 in contact with Secondary Mental Health Services to the number that would be expected based on the age and sex specific death rates of the general population was 406.67. This was not statistically significantly higher than the England ratio (337.2).
- 1. NHS Choices (2014) Psychosis, http://www.nhs.uk/conditions/psychosis/pages/introduction.aspx (viewed 28.04.15)
- 2. NHS Choices (2014) Psychosis, http://www.nhs.uk/conditions/psychosis/pages/introduction.aspx (viewed 28.04.15)
- 3. Public Health England (2015) Severe Mental Illness, Psychosis Pathway data, http://fingertips.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness/data#gid/1938132719/pat/44/ati/19/page/0/par/E40000004/are/E38000009 (downloaded 18/03/15)
- 4. Tapson, H. (2010) Mental Health in NHS Bath & North East Somerset GP Practices, NHS B&NES PCT
- 5. NHS Choices (2010) Schizophrenia (downloaded 03/04/2012) http://www.nhs.uk/conditions/schizophrenia/Pages/Introduction.aspx
- 6. NHS Choices (2014) Psychosis, http://www.nhs.uk/conditions/psychosis/pages/introduction.aspx (viewed 28.04.15)
- 7. Public Health England (2015) Severe Mental Illness, Psychosis Pathway data, http://fingertips.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness/data#gid/1938132719/pat/44/ati/19/page/9/par/E40000004/are/E38000009/iid/90574/age/168/sex/4 (downloaded 28/04/15)