Mental Health
Introduction and key points
The World Health Organisation defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. The Thrive Edinburgh mental health and wellbeing strategy emphasises the importance of supporting and promoting mental health in addition to addressing mental illness.
Mental illness is one of the major health challenges in Scotland. It is estimated that more than 1 in 3 people are affected by mental health problems each year (Scottish Government). The most common mental illnesses are depression and anxiety and together they were estimated to account for a total of 9,733 years of healthy life lost across the City of Edinburgh in 2019 (Scottish Burden of Disease study).
Mental illness is often linked to other long-term conditions and alcohol and substance misuse, which themselves can exacerbate mental health challenges. Higher rates of mental illness are observed in areas of multiple deprivation, and studies have shown that Mental Health is a contributing factor to multimorbidity (Barnett et al., 2012) . As understanding of mental health conditions grows and the stigma attached to them reduces, the number of people being treated for mental health issues will rise.
Additionally, the aging population has led to an increase in the number of people living with dementia, and more people are treated at home shifting care into the community. This often leads to added complexity of care required in the community, putting additional pressure on social care resources. Data in relation to Dementia is covered in our separate Dementia topic paper.
Changes in the broader determinants of population mental health at individual, community and structural levels will influence levels of mental wellbeing and illness in the population. This includes factors such as the proportion living in poverty or in substandard housing, levels of exposure to stigma, discrimination and harassment or poor-quality employment.
This paper contains data on Mental Health indicators, primarily sourced from the Office of National Statistics (ONS) population survey and the Public Health Scotland (PHS) ScotPHO dataset. This includes data sourced from hospital discharge records (SMR01, SMR04), National Record of Scotland (NRS) deaths data, PHS Prescribing data, and the Scottish Health Survey). Throughout this paper we have compared the City of Edinburgh with the Scotland rates and over time.
This paper is intended to provide a high-level overview of mental health in Edinburgh, covering a wide range of data related to mental health. It does not dive deeply into any particular issues but provides an introduction to this topic that can be used to inform and guide the commissioning and delivery of wider health, wellbeing and social care services.
Much of the data on this subject is on service/outcome indicators, which is therefore the focus of this paper. However, it is recognised that, as mentioned above, there are many socio-economic and environmental factors which will be drivers of the state of mental health in any population. Further papers on some of these topics, such as Housing, may be carried out in future, as has already been done for Poverty and Dementia.
The impact of COVID-19 on the data included here is hard to gauge at this time, however should be kept in mind when interpreting recent data. A 2022 publication on the early impacts of the COVID-19 pandemic on Scotland’s mental health (Public Health Scotland), based on survey data and qualitative studies, stated:
“What the evidence also underlines is not just the extent and nature of the mental health impacts of the pandemic, but also the uneven distribution of those impacts, with the potential to worsen and widen mental health inequalities across society. Where people started from, and their social and economic position, may well influence the impacts of the pandemic on their mental health and wellbeing. It may also influence the emotional and financial resources people are able to draw on to recover from the pandemic”.
Key points to note:
- Overall, data on the levels of mental health and wellbeing in Edinburgh, when compared to Scotland as a whole, show a mixed picture
- Mental health prescribing in Edinburgh is lower than the Scottish average, although this could be attributed to differences in access/availability as well as prescribing rates themselves
- In general, rates of mental health related hospitalisations and deaths in Edinburgh, including those that are alcohol and drug related, do not differ greatly from those in the rest of Scotland
- Edinburgh North East is the locality with the highest rates of mental health related hospitalisations and deaths, as well as drug and alcohol related hospitalisations. It is also the locality with the highest levels of deprivation in the city.
Deprivation is a key contributing factor to many aspects of ill-health including mental health. A specific topic paper on Poverty, drawing on the work of the Edinburgh Poverty Commission, has been created, but in this section we summarise some key deprivation figures by locality to provide context to some of the later data.
The following explores the deprivation structure of the City of Edinburgh Localities through the Scottish Index of Multiple Deprivation (SIMD). The SIMD ranks all datazones[1] in Scotland by a number of factors: Access, Crime, Education, Employment, Health, Housing and Income. Based on these ranks, each datazone is then given an overall deprivation rank, which is used to split datazones into Deprivation Quintiles (Quintile 1 being the most deprived, and Quintile 5 the least). The most recent SIMD ranking was carried out in 2020 (though much of the data used in 2020 will be older).
The charts below indicate that, for most of the factors, the North East Locality is most deprived, though the South East locality also has high housing deprivation.
A range of indicators on general levels of wellbeing and mental health are available at Edinburgh level. These indicators present a picture of overall wellbeing and mental health in Edinburgh compared to nationally, though may mask differences within the city.
ONS data (Figure 1), collected through an annual population survey, indicate scores for happiness, life satisfaction and feeling worthwhile are very close to the national level. However, the level of anxiety in the City of Edinburgh is higher than Scotland.
Figure 1: Wellbeing indicators from the ONS annual population survey, for Edinburgh and Scotland, 2011/12 – 2020/21
Figure 2 shows the mean Mental Wellbeing Score (from ScotPHO) for Edinburgh and Scotland, for males and females separately. The results for both sexes in Edinburgh are very similar to the Scotland level on this score, though Edinburgh females score slightly higher.
Figure 2: Mean score on The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in Edinburgh and Scotland, 2008-2011—2014-2017, for males and females aged 16+, with 95% confidence intervals
Figures 3a and 3b present the trends in prevalence of depression and mental health conditions per 100 population in recent years, from GP data. Figure 3a suggests that prevalence of depression in the City of Edinburgh is lower than the Scottish average, with prevalence having declined since 2016/17. On the other hand, Figure 3b* indicates that prevalence of mental health conditions in the City of Edinburgh is higher than in Scotland as a whole and has increased in recent years. There may be variation in coding of depression and mental health conditions across GP practices, as well as with individual behaviour in seeking/receiving treatment; this data should therefore be interpreted with caution.
* Mental Health conditions as defined in the QOF Business Rules v32
Figure 3: Depression and mental health prevalence in Edinburgh and Scotland, 2017/18—2021/22
Figure 4 shows the trend in the percentage of the population with common mental health problems, defined as a score of 4 of more on the General Health Questionnaire (GHQ12), for Edinburgh and Scotland. The prevalence here is greater than Scotland for males and less for females over several years, although the difference is not statistically significant.
Figure 4: Percentage with common mental health problems, defined as a score of 4 of more on the General Health Questionnaire (GHQ12) in Edinburgh and Scotland, 2008-2011—2014-2017, for males and females aged 16+, with 95% confidence intervals
Source: ScotPHO (2022) – data from SHeS
The Scottish Burden of Disease (SBoD) study is a national, and local, population health surveillance system which monitors how diseases, injuries and risk factors prevent the Scottish population from living longer lives in better health. The data for mental health indicators for the City of Edinburgh show that the rate of Disability Adjusted Life Years (DALYs) for Anxiety, Depression, Schizophrenia, and Other Mental Health Disorders, are lower than the national level.
Figure 5: Age-standardised rate of DALYs per 100,000 in the City of Edinburgh and Scotland: Anxiety disorders
Figure 6: Age-standardised rate of DALYs per 100,000 in the City of Edinburgh and Scotland: Depression
Figure 7: Age-standardised rate of DALYs per 100,000 in the City of Edinburgh and Scotland: Schizophrenia
Figure 8: Age-standardised rate of DALYs per 100,000 in the City of Edinburgh and Scotland: Other Mental Health Disorders
Prescribing data can give insights into the prevalence of illnesses requiring specific prescriptions. This data must be treated with caution as prescribing rates can also differ due to GP and patient behaviour, including the ‘social prescribing’ alternatives available to GPs.
The five main categories of medicines prescribed for mental illness are: antidepressants; hypnotics and anxiolytics; antipsychotics; drugs for dementia; and drugs for attention deficit hyperactivity disorder (ADHD). Figure 9a illustrates steady growth in the percentage of the population prescribed drugs for anxiety, depression, or psychosis across Scotland and in the City of Edinburgh between 2010 and 2019, with a slight decline in 2020. City of Edinburgh prescribing levels are lower than for Scotland as a whole, and the gap has widened slightly over time. This suggests that regardless of different prescribing practices in Edinburgh compared to other areas in Scotland, mental health issues within the city requiring treatment with medication are increasing.
Figure 9b shows that the Edinburgh North East locality has the highest percentage across the localities, potentially linked to the higher levels of deprivation seen in this area.
Figure 9a: Percentage of the population prescribed drugs for anxiety, depression, or psychosis in Edinburgh and Scotland,
2010-11—2020-21
Figure 9b: Percentage of the population prescribed drugs for anxiety, depression, or psychosis in Edinburgh Localities,
2010-11—2020-21
Source: ScotPHO (2022) – data from PHS Prescribing dataset
Figure 10 shows that mental health prescribing is more common in deprived areas but that, while all areas are showing an upward trend, the relative gap between the most and least deprived quintiles is trending downwards and the difference is consistent over time.
Figure 10: Inequality analyses for percentage of the population prescribed drugs for anxiety, depression, or psychosis in Edinburgh, 2014-15—2019-20, using Scotland-level SIMD quintiles
Source: ScotPHO (2022) – data from PHS Prescribing dataset
Data on hospital admissions for psychiatric treatment can also show the level of mental health issues in the city. Again, this data can be reflective of access issues and alternative treatment options as well as changes in mental health levels.
Figures 11 and 12 show that psychiatric hospitalisations in Edinburgh are similar to those in Scotland as a whole, and are highest in North East and South East Edinburgh.
Figure 13 shows that there are higher rates of psychiatric hospitalisations in deprived areas but the absolute gap has decreased over time.
Figure 11: Psychiatric hospitalisations in Edinburgh and Scotland, 2002—2021, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – data from SMR04
Figure 12: Psychiatric hospitalisations comparing each Edinburgh locality with Edinburgh as a whole, 2002—2021, as an age-sex standardised rate, with 95% confidence intervals
Source: SMR04 data
Figure 13: Inequality analyses for psychiatric hospitalisations in Edinburgh, 2002—2021, using Scotland-level SIMD quintiles
Source: ScotPHO (2022) – data from SMR04
While suicide is not a mental health problem itself, it is linked to mental distress and mental illness is a major risk factor for suicide. It is therefore important to understand trends and distribution of suicides as part of the wider mental health data.
Figures 14 and 15 show that deaths by suicide in Edinburgh are similar to those in Scotland as a whole, and that there are no statistically significant differences between the Edinburgh localities.
Figure 14: Suicides in Edinburgh and Scotland, 2002—2020, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – data from NRS deaths
Figure 15: Suicides comparing each Edinburgh locality with Edinburgh as a whole, 2002—2020, as an age-sex standardised rate, with 95% confidence intervals
Source: NRS deaths data
Alcohol and mental ill health are closely linked. Alcohol can be used by many people as an attempt to cope with symptoms of anxiety and depression or other mental health issues, but excessive alcohol use can also have negative impacts on mental health, regardless of existing conditions.
Figures 16 and 17 show that alcohol-related hospitalisations in Edinburgh have been lower than in Scotland as a whole for some time. Edinburgh North East has statistically significantly higher alcohol-related hospitalisations than the whole of Edinburgh whereas Edinburgh North West has statistically significantly lower rates.
Figure 18 shows that there are higher rates of alcohol-related hospitalisations in deprived areas, but the gap has decreased slightly over time.
Figure 16: Alcohol-related hospitalisations in Edinburgh and Scotland, 2002—2021, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – SMR01 data
Figure 17: Alcohol-related hospitalisations comparing each Edinburgh locality with Edinburgh as a whole, 2002—2021, as an age-sex standardised rate, with 95% confidence intervals
Source: SMR01 data
Figure 18: Inequality analyses for alcohol-related hospitalisations in Edinburgh, 2002—2021, using Scotland-level SIMD quintiles
Source: ScotPHO (2022) – data from SMR01
Figures 19 and 20 show that alcohol-related deaths in Edinburgh are not statistically significantly different from those in Scotland as a whole. Similarly to alcohol-related hospitalisations, Edinburgh North East has higher alcohol-related deaths than the whole of Edinburgh whereas Edinburgh North West has lower rates.
Figure 21 shows that there are higher rates of alcohol-related hospitalisations in deprived areas, but the gap has decreased slightly over time.
Figure 19: Alcohol-related deaths in Edinburgh and Scotland, 2002—2020, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – data from NRS deaths
Figure 20: Alcohol-related deaths comparing each Edinburgh locality with Edinburgh as a whole, 2002—2020, as an age-sex standardised rate, with 95% confidence intervals
Source: NRS deaths
Figure 21: Inequality analyses for alcohol-related deaths in Edinburgh, 2002—2020, using Scotland-level SIMD quintiles
Source: ScotPHO (2022) – data from NRS deaths
Similarly to alcohol, drug use can both result from and have negative impacts on mental health issues. Figures 22 and 23 show that drug-related hospitalisations in Edinburgh have been similar to those in Scotland as a whole for some time. The trend in Scotland has been upwards, whereas in Edinburgh it has fluctuated and for the most recent years has been statistically significantly lower than Scotland. Similarly to the alcohol picture, Edinburgh North East has statistically significantly higher drug-related hospitalisations than the whole of Edinburgh whereas Edinburgh North West has statistically significantly lower rates.
Figure 22: Drug-related hospitalisations in Edinburgh and Scotland, 2002—2019, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – data from SMR01
Figure 23: Drug-related hospitalisations comparing each Edinburgh locality with Edinburgh as a whole, 2002—2019, as an age-sex standardised rate, with 95% confidence intervals
Source: SMR01 data
Figure 24 shows that the drug-related death rate in Edinburgh was similar to that in Scotland as a whole for some time but has diverged in recent years. The trend in Scotland has continued upwards, but in Edinburgh it has risen less steeply and for the most recent years has been statistically significantly lower than Scotland.
Figure 25 shows that there are higher rates of drug-related deaths in deprived areas, and the absolute gap has increased over time (although the relative gap has not).
Figure 24: Drug-related deaths in Edinburgh and Scotland, 2002—2020, as an age-sex standardised rate, with 95% confidence intervals
Source: ScotPHO (2022) – data from NRS deaths
Figure 25: Inequality analyses for drug-related deaths in Edinburgh, 2006—2019, using Scotland-level SIMD quintiles
