The Local Picture

This Chapter will focus on Mental Wellbeing of Children and Young People in Bexley and Mental Wellbeing of Adults in Bexley.

Children and Young People

“Most mental illness begins before adulthood and often continues through life. Improving mental health early in life will reduce inequalities, improve physical health, reduce health risk behaviour and increase life expectancy, economic productivity, social functioning and quality of life”

(The Royal College of Psychiatrists ‘No Health Without Public Mental Health’) [1]

Mental wellbeing is of particular importance in younger age groups as childhood experiences in infancy and the first five years of life have been found to have a lasting impact upon a child’s mental wellbeing. The pre-school years, involve children undertaking a number of important developmental tasks relating to their physical, social and emotional development and language and cognitive development. The other key developmental stage is adolescents. There is a surge of brain development in early adolescence, continuing into the early 20’s, and this brings with it great potential for building lifelong wellbeing and resilience, along with significant risk. Vulnerability to risky behaviours around 14-18 years and choices made in this period heavily determine future life chances. Multiple risky behaviours are associated with a cluster of common factors including deprivation, poor parental connection, loss, violence and low self-esteem. Fifty percent of lifetime mental illness (excluding dementia) starts before the age of fourteen and 75% by the mid-twenties.

Interventions that promote mental health and emotional wellbeing also, usually, prevent mental health problems and produce a broad range of benefits associated with improved wellbeing. A study by Friedla and Parsonage (2009) [2] estimated that promoting mental wellbeing in a single year cohort of children could bring benefits of nearly £24billion for the whole of the UK. These benefits are accrued over a lifetime and it is clear that promoting mental wellbeing in children will provide significantly more economic benefits than promoting mental wellbeing at other ages.

Children and Young People population and population projection

In 2017, there were 57,000 children and young people (under 18 years old) living in Bexley, 23% of the total Bexley population. Whilst the total number of residents aged under 18 is going to increase up to 66,000 by 2047[3], it is estimated, there will be a steady decline in the proportion of children and young people (as a percentage of total Bexley population) to around 21.5% by 2047, mirroring the London trend,(see Figure 2 below for details).

[1] Royal College of Psychiatrists. No health without public mental health. (2010) Available from http://www.rcpsych.ac.uk/pdf/Position%20Statement%204%20website.pdf

[2] Friedli L, Parsonage M, Promoting mental health and preventing mental illness: the economic case for investment in Wales. All Wales Mental Health Promotion Network. 2009.

[3] All population projections in this chapter are based on © GLA 2016-based demographic projections. Borough-based figures are taken from Local authority population projections – Trend projections, Central migration scenario published in 2017.

Figure 2:      Population projections for Bexley and London for years 2017 – 2047, residents under 18 years old

 

The most significant increase in population growth over the next 10 years will be amongst those aged 10-14 and 15-19 years old, (the numbers in these age groups are expected to increase by 18% and 23% respectively by 2027). Figure 3 highlights predicted changes in number of children and young people by age group. 

Figure 3:      Bexley population projections by age group, 2017 – 2047

There are significant differences in the numbers and proportions of children and young people living in Bexley wards. The highest number of children and young people live in North Bexley, especially in Thamesmead East, North End, Erith and Belvedere – all with more than 25% of residents aged under 18. (Figures 4 and 5) [1]. 

[1] Mid-2015 Population Estimates for 2015 Wards in England and Wales by Single Year of Age and Sex – Experimental Statistics. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/wardlevelmidyearpopulationestimatesexperimental

Figure 4:      Children and young people population by locality, 2015

Figure 5:   Children and young people population by ward, 2015

Prevalence of risk factors for mental and emotional wellbeing among Bexley children and young people.

The following section reviews the key factors that influence mental health in children and young people and where possible estimates their prevalence in the Bexley population. It is acknowledged that not every factor that impacts on mental wellbeing is considered in this chapter, as the list is too extensive. A prioritised approach has therefore been adopted to focus on the main risk and protective factors for mental health in children set out in table below.

Table 2:       Risk and Protective Factors for Children and Young People’s Mental Health

	Risk Factors	Protective Factors
Children	•     Genetic influences •     Low IQ and learning disabilities •     Specific development delay or neuro-diversity •     Communication difficulties •     Difficult temperament •     Physical illness •     Academic failure •     Low self-esteem	•     Secure attachment experience •     Sociability •     Humour •     Problem solving skills and a positive attitude •     Experiences of success and achievement •     Faith or spirituality •     Capacity to reflect •     Being female (in younger children)
Family	•     Parental conflict including Domestic Violence •     Family breakdown (including children taken into care/adopted) •     Inconsistent/unclear discipline •     Hostile/rejecting relationships •     Failure to adapt to a child’s changing needs •     Physical, sexual, emotional abuse •     Parental psychiatric illness or personality disorder •     Parental criminality, alcoholism or other substance misuse •     Death and loss	•     At least one good parent-child relationship (or one supportive adult) •     Affection •     Clear, consistent discipline •     Support for education •     Supportive long term relationship or the absence of severe discord
School	•     Bullying •     Discrimination •     Breakdown in or lack of positive friendships •     Deviant peer influences •     Peer pressure •     Poor pupil to teacher relationships	•     Clear policies on behaviour and bullying •     ‘Open-door’ policy for children to raise problems •     A whole-school approach to promoting good mental health •     Positive classroom management •     A sense of belonging •     Positive peer influences
Community	•     Socio-economic disadvantage •     Homelessness •     Disaster, accidents, war or other overwhelming events •     Discrimination •     Other significant life events	•     Wider supportive network •     Good housing •     High standard of living •     High morale school with positive policies for behaviour, attitudes and anti-bullying •     Opportunities for valued social roles •     Range of sport/leisure activities

Source: Department of Health 2014 Mental Health & Behaviour in Schools

The effect of risk factors is cumulative. A child with a single risk factor present in their life is thought to have a 1 – 2% chance of developing a mental health problem, whereas for a child with three risk factors the chance is 8%. With four or more risk factors the chance is 20%.^[1] However, the presence of risk factors can be mitigated by protective factors that build resilience. Early intervention to halt the accumulation of risk is effective and vital. ^{[2] [3]}

[1] https://www.actionforchildren.org.uk/media/145524/emotional_harm_and_well-being_of_children.pdf

[2] Rutter, M., Giller, H. and Hagell, A. (1998) Antisocial behaviour by young people Cambridge: Cambridge University Press.

[3] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284086/early-intervention-next-steps2.pdf

Deprivation and Inequalities 

Poverty has a profound impact on the growing and developing child. A childhood spent in poverty reduces access to positive experiences and opportunities and this is exacerbated by the effects of a suboptimal living environment and often some form of malnutrition.

The effects can be life-long, hard to escape and affect every aspect of the child’s future, from expectation to achievement and associated health outcomes.[1] Socio economic disadvantage is a major risk factor for poor mental health in children. Children living in poor households are three times as likely to have mental health problems as children in well-off households.^[2]

Bexley has lower levels of deprivation than the England average with less than 10% (9.2%) of its population living in the most deprived quintile and approximately 53% living in the two least deprived quintiles (24.3% in least deprived).[3] Based on an average score across indices, the 2015 Indices of Multiple Deprivation (IMD) rank Bexley 191 out of 326 local authorities in England (1=most deprived).[4] However this overall average position masks important areas of deprivation and higher need most notably in the wards situated in the north and south east of the borough.

In 2014 there were 8,925 (19%) children (aged under 16 years) in Bexley living in low-income families, significantly better than the England average (20.1%). Bexley is ranked 126 out of 326 local authorities (with 1 being the worst) for Income Deprivation affecting Children (2015).[5] There are significant differences in child poverty levels across Bexley ranging from 36% of children living in poverty in Thamesmead East down to 11% in Brampton.[6] It is important to highlight that the wards with the highest number of children and young people are also those with the highest percentages that live in poverty. 

[1] ‘Fair Society Healthy Lives’ (The Marmot Review) – IHE

[2]http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard

[3] London Borough of Bexley (2013) Joint Strategic Needs Assessment

[4] Department for Communities and Local Government (2015). English Indices of Deprivation 2015. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015

[5] Department for Communities and Local Government (2015). English Indices of Deprivation 2015. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015

[6] End Child Poverty (2014) Child Poverty Map of the UK (2014) Compilation of child poverty local indicators 2014 update by Donald Hirsch and Laura Valadez, Centre for Research in Social Policy (CRSP), Loughborough University. August 2014.

Figure 6: Child poverty levels across Bexley

In Bexley the level of child poverty is better than the England and London averages. In 2014 18.9% of children aged under 16 (8,925 persons) were classed as living in poverty, compared to the national level of 20.6% and the regional level of 23.4%[1].

[1] Public Health England. Child Health Profile Bexley (2017)

Housing and Homelessness

Good-quality, affordable, safe housing is essential to our wellbeing. Poor housing or homelessness is associated with an increased risk of depression and anxiety, as well as increased risks of physical illness and can make it more difficult to manage an episode of mental distress. Children living in rented accommodation, either social or private sector, are more likely to suffer from a mental health problem than those living in owner-occupier households.^[1]

Data for Bexley (2016) show that the majority of households are privately owned either outright or with a mortgage (74%). Bexley has 13% of housing from socially rented stock, lower than the Outer London (16%) average (Note: that these data are for all households and not just those where there are children and young people). A further 13% of households live in private rented accommodation.[2] Social Housing in Bexley is heavily concentrated in certain wards with the highest being Thamesmead East with 38.4% of residents living in socially rented housing and the second highest is North End at 37.4%. This contrasts with other wards such as Falconwood and Welling, which has only 1.1% of housing being socially rented.[3]

Homelessness is a significant risk factor of and indicator for mental health problems. Adolescents and street youth are likely to present with depression and attempted suicide, alcohol and drug misuse, and are vulnerable to sexually transmitted diseases, including acquired immune deficiency syndrome (AIDS).[4] In March 2017 there were 1,016 households in temporary accommodation. This included 1,808 children.

A study by Shelter found that for children living in temporary accommodation:[5]

• 50% were often unhappy or depressed
• Mental health problems such as anxiety and depression are three times as common among homeless children who have lived in temporary accommodation for more than a year

[1] Mental Health Foundation 2007 Fundamental Facts. The latest facts and figures on mental health

[2] London Data store Tenure of Households borough. https://data.london.gov.uk/dataset/housing-tenure-borough

[3] London Borough of Bexley population profile http://www.bexley.gov.uk/CHttpHandler.ashx?id=13333&p=0

[4] Vostanis, P. (2002) Mental health of homeless children and their families. Advances in Psychiatric Treatment 8 (6), 463-9.

[5] Shelter. What is it like to be homeless? web access http://england.shelter.org.uk/campaigns_/why_we_campaign/tackling_homelessness/what_is_homelessness_like (accessed December 2015)

Ethnicity

There is limited research into mental health problems in children from Black, Asian and Minority Ethnic (BAME) groups. [1] The most complete study [2] found differences in the rates of mental health problems across different ethnic groups.[3] Rates of mental disorder were highest in those categorised as white (10%) with rates of 9% in the black group, 8% in Pakistani/Bangladeshi children and 3% in children categorised as Indian. However the study is over 10 years old, used small sample sizes and had difficulty in ascertaining information from non-English speaking parents.

According to the 2011 Census data, in Bexley 81.9% of the population were classified as white and 18.1% non-white. Of the non-white population 6.5% were Asian and 8.5% Black.[4] In Bexley, between 2001 and 2011, there was a fall in the white population of 9,500, the most significant increase being across the Black/African/Caribbean/Black British with a 13,300 population increase (211.1%).

There is a larger percentage of pupils in Bexley schools from black/ethnic minority groups. In Bexley 41% of the school age population (5-16 years) were from BAME populations. By far the largest ethnic group amongst this were of Black African ethnicity (19%)[5]. With increasing ethnic diversity it is important to better understand the mental health needs across different ethnic groups through research into the prevalence of mental health conditions, access and use of services and whether some communities are more resilient than others.^[6]

[1] www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rpt-ethnicity.html

[3] Green, H., McGinnity, A., Meltzer, H., Ford, T. and Goodman, R. (2004) Mental health of children and young people in Great Britain, 2004. Office for National Statistics. London, HMSO.

[4] ONS (2012) 2011 Key Statistics for local authorities in England and Wales

[5] ONS. Schools, Pupils and their Characteristics: January 2017 – Local Authority Tables. Department for Education 2017

[6] CMO report 2012

Parental Factors

There are 4.5% of households with dependent children in Bexley with no adult in employment, in line with the England average of 4.2% and lower than the outer London average of 5.4%.[1]

The number of children living in all out-of-work benefit claimant households in Bexley in 2016 was 7,030.[2]

Table 3:       Bexley children living in all out-of-work benefit claimant households

Age 0-4	Age 5-10	Age 11-15	Age 16-18
2,380	2,370	1,570	710

[1] ONS (2011) Adults not in employment and dependent children http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rft-table-ks106ew.xls

[2] Department for Work and Pensions 2016 Children in Out of Work benefit household statistics

Domestic Violence

Domestic violence is recognised as a key indicator for child abuse and neglect with young people experiencing family violence being between 2.9 and 4.4 times more likely to have experienced physical violence and neglect from a care giver. [1] Children who have witnessed domestic violence are 2.5 times more likely to develop serious social and behavioural problems[2].

Witnessing domestic violence during childhood is not uncommon, with one study finding that 12% of under 11 year olds, 17.5 % of 11-17 year olds and have been exposed to domestic violence between adults in their homes during childhood[3]. If we applied these rates to the Bexley population (2016 mid-year estimates) this would mean that 3,867 under 11 year olds, 5,122 11-18 year olds have witnessed domestic violence in the last year.

Data from the Office for Policing and Crime shows that in the year to September 2017 there were 3,565 domestic incidents reported of which 1,902 were domestic abuse incidents 588 were for domestic violence with injury.[1]      

[1] Radford, L. et al. (2011) Child abuse and neglect in the UK today

[2] Wolfe, D.A., Zak, L. Wilson, S & Jaffe, P. (1986) Child witnesses to violence between parents: critical issues in behavioural and social adjustment. Journal of abnormal child psychology 14, 95-104.

[3] Radford, L. et al. (2011) Child abuse and neglect in the UK today

⁶⁰ May London Office for Policing and Crime (2015) https://www.london.gov.uk/priorities/policing-crime/data-information/vawg-dashboard

Parental Mental Health Problems 

Parental mental health problems have been shown to impact upon a child’s emotional and mental wellbeing. Research has shown that some children of parents with a severe and enduring mental illness experience greater levels of emotional, psychological and behavioural problems than children and young people in the rest of the population. Additionally, research has shown that children who have a parent with schizophrenia are more likely to experience psychiatric disturbance themselves, more likely to be socially isolated and can experience stress about their parents’ symptoms. Parents at increased risk of mental health problems include lone parents, those living in poverty, those who have chronic health problems and those who are unemployed.

Estimates suggest that 68% of women and 57% of men with a mental illness are parents.[1] However local data on numbers of children living in households with a parent who has a mental health problem are not available. Nationally about a quarter of children aged 5–16 years has a mother at risk from a common mental health problem such as depression or anxiety. Applying this to the Bexley population would man that 9,103 children aged 5-16 are living with a mother at risk from a common mental health problem.

Parental substance misuse

Parental Substance misuse may have an impact on a child’s emotional wellbeing as a result of their emotional needs not being met. There are a number of risks to children as a result of parental substance misuse:

• Abuse or neglect.
• The development of behavioural and long-term developmental problems.
• Separation from parents, including removal to local authority care, which is estimated to occur in around 60% of cases.
• An increased risk of eviction or housing in temporary or unsuitable accommodation.
• Responsibility for caring for a parent with substance misuse problems, which has been shown to lead to a higher incidence of educational difficulties.
• A greater risk of experiencing domestic violence or foetal alcohol syndrome.
• Inter-generational transmission of harms where the children of substance misusers will also go on to misuse substances.

The Hidden Harm Report 2003, estimates that between 2-3% of children under the age of 16 years are the children of problem dug users. [1] In Bexley this would equate to between 987 and 1,480 children.

[1] Hidden Harm – Responding to the needs of children of problem drug users https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/120620/hidden-harm-full.pdf

Teenage Mothers

It is widely understood that teenage pregnancy and early motherhood can be associated with poor educational achievement, poor physical and mental health, social isolation, poverty and related factors. There is also a growing recognition that socio-economic disadvantage can be both a cause and a consequence of teenage motherhood.[1]

There has been a steady downward trend in the conception rate for women aged under 20 since, from 61.4 (in 2007) to 40.5 conceptions per thousand women aged 15 to 19 in 2013. In 2013 conceptions to women aged under 18 accounted for 36% of all conceptions to women aged under 20, falling from 37% in 2012.[2]

In 2016 there were 56 live births to mothers under the age of 20 in Bexley.[3] In 2013 there were 108 conceptions amongst under 18’s in Bexley, a rate of 23.3 per 1,000 population, which is slightly lower than the England level of 24.3 per 1,000.[4]

[1] Swann C, Bowe K, McCormick G and Kosmin M (2003) Teenage pregnancy and parenthood: a review of reviews, Health Development Agency.

[2] ONS (2015) Conceptions in England and Wales, 2013http://www.ons.gov.uk/ons/rel/vsob1/conception-statistics–england-and-wales/2013/stb-conceptions-in-england-and-wales-2013.html?format=print

[3] Office of National Statistics. (2013) Live births (numbers and rates): age of mother and administrative area of usual residence, England and Wales, 2012

[4] Office of National Statistics (2015) : Under 18 conceptions (numbers and rates) 1,2 and outcome, 1998-2013

Education

Education plays a significant role in both risk and resilience factors for mental health. Low achievement in school is a known risk factor for a range of problems such as drug use, teenage pregnancy, behaviour problems and crime.[1] Conversely, poor mental health depresses educational attainment. Having a ‘sense of connectedness’ with school is a recognised protective factor for mental health.[2]

There is increasing awareness of the growing number of children and young people identified with mental health and emotional wellbeing problems in school. A 2015 consultation on Children’s Mental Health and Emotional Wellbeing in Bexley[3] found that across the 55 schools completing the survey:

• 55% of schools ‘frequently’ or ‘very frequently’ were presented with issues relating to children’s mental health,
• 78% of schools ‘frequently’ or ‘very frequently’ were presented with issues relating to children’s anxiety
• 46% of schools ‘frequently’ or ‘very frequently’ were presented with issues relating to mental health exhibiting in disruptive behavior
• 44% of schools ‘frequently’ or ‘very frequently’ were presented with issues relating to family/domestic violence
• 20% of schools ‘frequently’ or ‘very frequently’ were presented with issues relating to self-harm/risk of suicide
• 27% of schools reported that self-harm/suicide issues had increased over the past two years
• 61% reported that anxiety (amongst children) had increased over the past 2 years
• 44% reported that mental health exhibiting in disruptive behavior had increased
• 50% reported other concerns about children’s mental health had increased over the last two years.

Across 38 Bexley schools responding to the question on the estimated number of children and young people (with mental health and emotional wellbeing issues) that their staff are supporting, the total number was between 2,452 and 2,682. Additionally, 2 schools reported that around 30% of their pupils needed support for mental health and emotional problems.

[1] Rutter M, Hagel A, and Giller H. 1998. Anti-social Behaviour and Young People. Cambridge: Cambridge University Press.

[2] Catalano RF, Mazza JJ, Harachi TW, Abbott RD, Haggerty KP, and Fleming CB. 2003. Raising healthy children through enhancing social development in elementary school: Results after 1.5 Years. Journal of School Psychology. 41(2):143-164.

[3] LB Bexley Council. Children’s Mental Health and Emotional Wellbeing – School consultation Bexley (2015)

Educational Attainment 

Educational attainment is one of the most important determinants of future health outcomes and is a protective factor for mental health in children and adults. Conversely having a mental health disorder as a child can have a considerable negative impact on educational achievement, especially for those with conduct and emotional disorders. Some of this difference may be accounted for by the co-existence of learning disabilities and the high correlation between having a mental disorder and missing school, which occurs in approximately 25-30% of depressed and anxious children and 20% of children with conduct disorders (Green et al, 2005).

Achieving five A* to C GCSEs is used as a measure of educational attainment in 16 year olds. In Bexley GCSE achievement was slightly better than the England average. The 2016/17 percentage of Bexley pupils achieving good GCSE standards in English and Maths was 9% higher than the national out-turns. Bexley’s rate was 1% higher than London and CYP comparators’ average achievement levels. (More information on educational attainment from preschool to post 16 can be found in the children and young people’s chapter)

Children with Special Educational Needs (SEN)

Children with Special Educational Needs (SEN) have learning difficulties or disabilities that make it more difficult for them to learn or access education than most children of the same age. This could include: Difficulties in thinking or understanding, physical or sensory difficulties, emotional and behavioural difficulties or difficulties with speech and language. These children may need extra or additional help.

14.0% of pupils in Bexley schools have identified special educational needs (equating to 6,205). This is in line with the national data. 2.6% of pupils in Bexley have a statement or EHC Plan compared with 2.8% nationally[1].

As of 07^th March 2018 there wee 1,631 children in Bexley with a SEN or EHCP. This figure has been steadily rising over the past 3 years from 1,458 in 2015/16[2]. It is forecast that this will continue to rise to over 1,700 by 2022. Bexley schools’ percentages of pupils with SEN support or statements/EHC plans do not differ drastically from statistical neighbours, outer London boroughs and national. (more data on SEN can be found in the children and young people’s chapter)

[1] Commissioning Plan for Education. Provision Planning for Growth. London Borough of Bexley 2017-2019

[2] London Borough of Bexley. Statuttory Assesment and Disabled Childrens Services. Freeddom of Information Request 4975696

Autistic Spectrum Disorder (ASD)

Autistic Spectrum Disorder (ASD) is an umbrella term that covers everyone with conditions within the spectrum of autism. ASD is thought to affect around one in 200 children and adults, although this is likely to be an under-estimate. [1] The European Commission (2005) highlights the problems associated with establishing prevalence rates for Autistic Spectrum Disorders. However a study by Baird et al (2006)[2] estimated the prevalence of Autism in children aged nine to ten years at 38.9 per 10,000 and that other ASDs at 77.2 per 10,000. A later survey of autism-spectrum conditions by Baron-Cohen et al (2009)[3] using the Special Educational Needs (SEN) register alongside a survey of children in schools aged 5 to 9 years produced prevalence estimates of 157 per 10,000 (including previously undiagnosed cases). If these figures were applied to the Bexley population there would be 250 five to nine year olds suffering from Autism spectrum disorders in 2014. [4]

[1] Mental Health Foundation. Autistic Spectrum Disorder. Web access http://www.mentalhealth.org.uk/help-information/mental-health-a-z/A/autistic-spectrum-disorder/

[2] Baird, G., Simonoff, E., Pickles, A., Chandlert, S., Loucas, T., Meldrum, D. and Charman, T. (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet, 368 (9531), 210-5.

[3] Baron-Cohen, S., Scott, F.J., Allison, C., Williams, J., Bolton, P., Matthews, F.E. and Brayne, C. (2009) Prevalence of autism-spectrum conditions: UK school-based population study. The British Journal of Psychiatry, 194 (6), 500-9.

[4] National Child and Maternal Health Intelligence Network. CAMHS Needs Assessment: Bexley. Web access http://atlas.chimat.org.uk/IAS/profiles/profile?profileId=34&geoTypeId= (accessed 02/12/15)

Children and Young People with Learning Disabilities

A review by the University of London (TCRU 2007)[1] on the evidence on the emotional wellbeing of young people found the following links between learning disability and mental health:

• Children with learning disabilities were three to four times more likely to have behavioural problems than peers without a disability
• There is a 40% prevalence of diagnosable mental disorder within the learning disabled population. For children and young people with severe learning difficulties, the incidence rate is three to four times higher than in the general population
• Children and young people with a learning disability living in urban and deprived communities are at particular risk of emotional wellbeing and mental health problems
• One in ten of all children with referred mental health problems had a learning disability, and 50% of those lived in poverty
• 25-30% of the increased risk of emotional and behavioural problems among children with learning difficulties was related to households with very low income
• The presence of intellectual disabilities should be considered a highly significant risk factor for the development of some specific forms of psychiatric disorders (conduct disorders, anxiety disorders, attention deficit and hyperactivity disorder/hyperkinesis and pervasive developmental disorders)

Emerson et al (2011, p.i)[2] estimates that in 2011 there were 286,000 children and young people (180,000 boys and 106,000 girls) aged 0 to 17 in England with learning disabilities. Emerson et al (2011, p.3) estimates that 2.46% of girls and 4.01% of boys, aged 7 to 15 years in 2011, were identified at School Action Plus or with a Statement of Special Educational Need (SEN) with a primary SEN associated with learning disabilities. In addition, Emerson et al (2004)[3] calculated prevalence in children and young people with learning disabilities for different age groups as follows: 5 to 9 years: 0.97%; 10 to 14 years: 2.26%; and 15 to 19 years: 2.67%. The National Child and maternal Mental Health Intelligence Network applied these estimates to the Bexley population. This shows that an estimated 890 children aged between 5-19 years in Bexley has a learning disability of which, 365 will have mental health problems.

[1] TCRU (2007) Young London Matters: The emotional well-being and mental health of young Londoners: A focused review of evidence. Thomas Coram Research Unit, University of London. http://tinyurl.com/947vxek

[2] Emerson, E. Hatton, C. Robertson, J. Roberts, H. Baines, S. Evison, F. and Glover, G. (2011) People with learning disabilities in England 2011. Available at: www.improvinghealthandlives.org.uk/publications/1063/People_with_Learning_Disabilities_in_England_2011

[3] Emerson, E. and Hatton, C. (2004) Estimating current need/demand for supports for people with learning disabilities in England. Institute for Health Research, Lancaster University, Lancaster.

Young People not in Education, Employment or Training

The term ‘NEET’ refers to young people aged 16 to 24 years who are Not in Education, Employment or Training. The NEET population is diverse and continually changing and includes many young people who face barriers to participation. Those at risk of being NEET include young people from disadvantaged backgrounds, those who have underachieved in school, teenage parents, young people who are in care, and young people with learning difficulties and disabilities or mental health problems. Young NEET’s are more likely to suffer from poor mental health and depression.[1] Those with depression often withdraw from social activities and relationships, decreasing the size of their social networks and severing relationships that may offer support and enhance occupational functioning. Conversely, disengagement is also likely to lead to worse mood. Being NEET may exacerbate depressive symptoms, leading to greater social isolation and diminished role functioning[2]

In Bexley (at the end of 2016) there were 220 (3.7%) 16-17 year olds registered as NEET, a 0.9% fall since 2015. This is lower than the London averages (5.3%) and lower than all the Bexley CYP comparator areas. (More NEET data can be found in the children and young people’s chapter)

[1] Eurofound (2012), NEETs – Young people not in employment, education or training: Characteristics costs and policy responses in Europe, Publications Office of the European Union, Luxembourg.

[2] B O’Dea Et al (2014) A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare. BMJ Open 2014;4:e006378 doi:10.1136/bmjopen-2014-006378

Looked After Children (LAC) 

Looked after Children (LAC) are a particularly vulnerable population and a high proportion experience poor health, educational and social outcomes after leaving care.   They have higher rates of adverse childhood experiences, including physical, sexual and emotional abuse or neglect, compared to children in the general population and are significantly more likely to experience mental health problems. ^[1] A large national survey in 2003^[2] found that compared to all children:

• Looked After Children were about 5 times more likely to have a mental disorder
• Looked After Children had a 6-7 fold risk of conduct disorder
• Looked After Children were 4-5 times more likely to self-harm
• Children in residential care were far more likely to have conduct disorders than those in foster care or living with their natural parents
• Children living with their natural parents or in residential care were about twice as likely as those in foster care to have emotional disorders

Around 60% of looked after children (and 72% of those in residential care) have some level of emotional and mental health problem. Among looked after children aged 5-17 Meltzer found that 37% had clinically significant conduct disorders, 12% had emotional disorders, such as anxiety or depression, and 7% had a hyperkinetic disorder. Looked after Children and care leavers are between four and five times more likely to attempt suicide in adulthood.^[3] Nationally 66.6% of looked after children for whom data were available had a special educational need (SEN), which consists of 29% with a statement of SEN and 37.6% without a statement. These figures are much higher than the total population with SEN (looked after and non-looked after children). [4]

As of 31^st March 2017 there were 236 children looked after in Bexley excluding those in agreed short break respite placements and those children that come in and out of care up to and including 18yrs. This is a provisional rate of 42.2 per 10,000 children aged 0-17 years. This figure is lower than the total of 259 children for the previous reporting year. Unaccompanied asylum seeking children accounted for 12.7% of children looked after in the borough. This is a significant increase on last year (4%). The breakdowns of age bands included are 10 to 15 accounting for 42% of Looked After Children in Bexley. This was followed by 16+ at 37%, 5-9 at 12%, 1-4 at 6% and Under 1 at 3%. The gender split in March 2016 was 60% male and 40% female[5].

[1] Ford, T. et al, Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. The British Journal of Psychiatry (2007) 190: 319-325 2007

[2] Meltzer H, Gatward R, Corbin T, Goodman R, Ford T ‘The mental health of young people looked after by local authorities in England. Office of National Statistics.

[3] Children & Young People’s Health Outcomes Forum, 2012

[4] Department for Education (2014) Outcomes for Children Looked after by Local Authorities in England as at March 2014.

[5] Bexley CCG. Annual Report. The Health of Children Looked After 2016/17. Published July 2017.

Young Offenders 

Research suggests that prevalence of mental health problems for young people in contact with the criminal justice system range from 25% to 81%, being highest for those in custody. The most common disorders amongst the population of young offenders are: conduct disorders, emotional disorders and attentional disorders (The Mental Health Foundation 2002). Girls and young women in custody have greater mental health needs than boys, particularly in the areas of depression, post-traumatic stress disorder and self-harm. Rates of self-harm are notably high among young women in custody.

Young offenders are at risk of having higher than usual rates of mental health problems for three main reasons:[1]

• Because the original risk factors that led to their offending also predict, in the general population, a disposition towards mental health problems. These factors include inconsistent or erratic parenting, over-harsh discipline, hyperactivity as a child, and various other types of stressors on families and neighbourhoods.
• Because various aspects of the offending itself may cause mental health problems and the characteristically risky behaviour of young offenders may itself cause stresses.
• Because interactions with the criminal justice system are stressful and may on their own lead to anxiety and depression, particularly those associated with custody.

The most recent age related data for the London Borough of Bexley (March 2017), shows there was a total of 125 CYP in Youth Justice System receiving a youth caution or court conviction. 21.5% wee from BAME populations. 15% were female and 85% male[2].

[1] The Mental Health Foudation (2002). The Mental Health Needs of Young Offenders. Volume 3. Issue 18

[2] Ministary of Justice and the Youth Justice Board for England and Wales. Youth Justice Annual Statistics 2016-17

Children and Young People using Drugs, Alcohol and Smoking

All children and young people are potentially at risk of misusing alcohol and or drugs. However, evidence suggests that young people in certain vulnerable groups are more at risk of misusing substances. Every Child Matters identified the following groups being at greatest risk: [1]

• Children in care; are four times more likely to use substances than children raised in a household (Care Matters, 2007)
• Persistent absentees and excludes from school; evidence tells us that children who fall into this category are much more likely to be involved with substances and so suitable provision should be put in place to support this cohort.
• Young offenders; evidence tells us that this cohort reports more substance use than any other vulnerable group.
• Homeless people
• Children affected by parental substance misuse.
• Other groups, involved in prostitution, teenage mothers and those not in education, employment or training (NEET); all of these and the above groups are potentially linked with other factors, such as living within the most deprived communities also being a factor.

Substance misuse has implications for physical and mental health. There are immediate health risks such as vomiting, poisoning, memory loss, dehydration and slower reaction times. There are also longer-term risks including liver disease, cognitive defects, anxiety and depression. Recreational drugs are associated with increased risk of suicide, depression and behavioural disorders. Regular use of cannabis has been associated with psychotic symptoms (e.g. hallucinations, anxiety, and paranoia) in about 1 in 10 cannabis users. [2] Associations between substance misuse and mental health disorders are complex. The substances themselves affect mental health, but it is also argued that those with developing symptoms of, for example, schizophrenia or depression, may use drugs or alcohol as a form of ‘self-medication.’

The latest report on smoking drinking and drug use among young people in England (2014) [3] found the following:

• 38% of 11-15 year olds had tried alcohol at least once
• 8% had drunk alcohol in the last week
• 22% of those who had drunk alcohol in the last week had drunk 15 units or more
• 15% of pupils had ever taken drugs
• 10% taken drugs in last year
• 6% taken drugs in last month
• 7% reported taking cannabis in the last year
• 9% of pupils had inhaled glue, gas aerosols or solvents in the last year

Table 4:       Applying national prevalence data to the Bexley 11-15 year old population.

11-15 year olds	National Prevalence	Number of 11-15 year olds in Bexley
Tried alcohol at least once	38%	5,588
·            Drunk alcohol in the last week	8%	1,176
·            Of those who had drunk alcohol in the last week had drunk 15 units or more	22%	259
·            Had ever taken drugs	15%	2,206
Taken drugs in last year	10%	1,471
Taken drugs in last month	6%	882
Taken cannabis in the last year	6.7%	985
Inhaled glue, gas aerosols or solvents in the last year	2.9	426

 Between 2011/12 and 2013/14 there were 31 hospital admissions for substance misuse amongst 15 – 24 year olds in Bexley, giving a Directly standardised rate of 101.7 per 100,000 population (age 15-24 years) which is significantly worse than the England average of 81.3 per 100,000. In 2012/13 there were 60.5 (per 100,000) young people in specialist substance misuse services.

Smoking rates amongst 15 year olds in Bexley are high (9%) compared to 6.1 in London and 8.2% nationally.

[1] The Department for Education and Skills, The Home Office and The Department for Health. Every Child Matters: Change for Children. Young People and Drugs (2005)

[2] Royal College of Psychiatrists. Cannabis and mental health.

[3] Health and social Care Information Centre (2014) Smoking, Drinking and Drug use among young people in England in 2014.

Young Carers

Young carers are children and young people under 18 who provide personal care, assistance or support to another family member on a regular basis. They carry out significant or substantial caring tasks including the provision of physical and emotional care. The impacts on young people through taking on this caring role can include underachievement or absenteeism at school, mental or physical ill health, and poverty.[1]

Young carers who care for parents who have mental health needs can have more complex emotional support needs of their own. 29% of young carers care for someone with a mental health problem. Research by the Princess Royal Carers Trust and the University of Nottingham found that almost a third of young carers surveyed (29%), reported that their own physical health was ‘just OK’, and 38% reported having a mental health problem.[2]

The 2011 Census found that in Bexley there were the following numbers of young carers:

• 0-15 years: 506 carers, of this category 53 children provide over 50 hours care per week
• 16-24 years: 1,337 carers, of this category 161 provide more than 50 hours care per week

It is likely that these figures are an underestimate due to the nature of the census. In 2010, a BBC and University of Nottingham survey suggested there could be four times more young carers than the official census figures in 2001 showed.^[3]The table below applies the national estimates to the Bexley population.

Table 5: National Young Careers estimates applied to Bexley

	2011 Census Estimate	Young Carers estimate
Number of Young Carers (0-24 years) in Bexley	1,843	7,372
Young Carer with mental health problem (38%)	700	2,801
Caring for an adult with a mental health problem (29%)	534	2,138

A report by the Children’s Society [4] found that:

• Young carers are 1.5 times more likely than their peers to have a special educational need or a disability.
• The average annual income for families with a young carer is £5000 less than families who do not have a young carer.
• There is no strong evidence that young carers are more likely than their peers to come into contact with support agencies, despite government recognition that this needs to happen.
• Young carers have significantly lower educational attainment at GCSE level, the equivalent to nine grades lower than their peers e.g. the difference between nine B’s and nine C’s.
• Young carers are more likely than the national average to be not in education, employment or training (NEET) between the ages of 16 and 19.

 [1] Royal College of Psychiatrists. Emotional Support for Young Carers. Web access http://www.rcpsych.ac.uk/healthadvice/parentsandyouthinfo/youngpeople/emotionalsupport.aspx

[2] Sempik. J and Becker. S. Young Adult Carers at School: Experiences and Perceptions of Caring and Education. Carers Trust 2013

[3] BBC (2010) Young carers are ‘four times’ the official UK number www.bbc.co.uk/newsbeat/11758368

[4] The Children’s Society (2013) Hidden from View: The experiences of young carers in England.

Adult Mental Wellbeing

As with Children and Young People, adult Mental and Emotional wellbeing depends both on environmental factors and the mental capital or resilience built up throughout the early years of life and into adulthood. The main factors associated with wellbeing include relationships with friends and family, good health and community, civic participation, level of education, relative income and beliefs. The resilient individual can be viewed as having a good level of self-esteem and confidence. By identifying what makes adults resilient, it is possible to help them to develop the fundamental life skills needed[1]. Those who are most disadvantaged are most likely to experience both mental illness and poorer mental wellbeing. So, mental health is both a consequence and a cause of inequalities.

Key determinants for Adult Mental Wellbeing in Bexley are outlined in the headings below.

[1] Marmot, M. Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010. 2010. http://www.marmot-review.org.uk/

Economic Deprivation

Having a very low income, or experiencing economic deprivation, is associated with low wellbeing. Based on analyses of the European Quality of Life Survey, Eurofound reported that someone who suffers severe material deprivation (not being able to afford a range of expenses such as buying new clothes, having guests over for a drink or meal, or a week’s annual holiday) scores 2.1 points lower on life satisfaction than someone who can afford all expenses (holding all other variables constant). Their material deprivation index was the single strongest predictor of both life satisfaction and happiness in the survey.

Local Bexley data shows that 26% of Bexley residents (people in work who responded to survey) earned less than the London Living Wage in 2015. This is the 13^th lowest of all London boroughs and is lower than the outer London average of 29%. The rates in Bexley have risen steadily from a low of 20% in 2012[1].

This map shows the proportion of jobs in workplaces in each London borough that are low paid (2015-16). The overall proportion of jobs in workplaces paid below the London Living Wage in London is 19%. We should note that jobs based in London are less likely to be low paid than the jobs worked by people living in London.

Bexley (32%) is the fifth highest percentage of all London Boroughs for low paid jobs.

[1] https://data.london.gov.uk/dataset/percentage-people-low-income-borough

Figure 7: Proportion of jobs paid below the London Living Wage

However, the map below shows the proportion of residents in each London borough who are low paid. The overall proportion of jobs held by people living in London that were low paid was 21% and 23% in Outer London. Local Bexley data shows that 23% of Bexley residents earned less than the London Living Wage in 2015-2016[1], in line with the outer London average. The rates in Bexley have risen steadily from a low of 20% in 2012[2].

Figure 8:      Proportion of residents that are low paid

[1] https://www.trustforlondon.org.uk/data/low-paid-residents-borough/

[2] https://data.london.gov.uk/dataset/percentage-people-low-income-borough

Unemployment

One of the strongest and most consistent findings in the wellbeing literature is that being unemployed has a negative impact on subjective wellbeing (regardless of how subjective wellbeing is measured) and mental health. The decline in wellbeing is beyond what would be expected from a decline in income from not having a job. It appears that unemployment affects wellbeing by diminishing our sense of purpose and by reducing our social connections as well. Furthermore, the negative effects of unemployment are lasting. Unlike many life changes, we do not adapt to becoming unemployed, and indeed a period of unemployment reduces wellbeing even after a job has been found[1].

4.5% of Bexley (5,700 people) working age population are unemployed (December 2017). This is in line with the national average of 4.6% and lower than the London average of 5.3%. In December 2016 there were 11.8% of Bexley households that were workless, significantly lower than the 12.8% London average.

At December 2017, 21.3% of the Bexley working age population were economically inactive in line with UK and London averages. A breakdown f this group can be seen in the table below.

[1] Clark A, Georgellis Y & Sanfey P (2001) ‘Scarring: The psychological impact of past unemployment’ Economica 68(270):221-241.

Table 6:       Economic Inactivity in Bexley

Job quality

Almost any job is better than no job, but job quality has a very strong effect on subjective wellbeing. There have been several reviews identifying key determinants of job quality, identifying a large number of important factors[1]. The following factors as most important: work-life balance, fair pay, job security, clarity, management systems, work environment, sense of purpose, sense of progress, sense of control, and relationships.

Work-life balance consistently emerges as one of the biggest factors in predicting life satisfaction. Work-life balance is linked to working hours, and very long working hours (over about 40-50 hours a week) has been found to have a detrimental effect on wellbeing and mental health. Temporary work contracts, particularly when they are for less than 12 months, are also associated with lower levels of wellbeing, when they are only accepted because a permanent work contract is not available.

There is no local data on numbers of Bexley residents on temporary or zero hours contacts. In 2014 – 16 in London, 10% of working-age employees were at risk of being in insecure employment, compared with 9% in the rest of England. In both London and the rest of England, young adult employees (aged 16 to 24) are much more likely to be in insecure employment at 22% and 21% in London and the rest of England respectively, double the proportion overall. In London each age group has a slightly higher proportion of insecure workers than in the rest of the country apart from those aged 25 to 29 and those aged 60 to 64.

Those from a minority ethnic background are more at risk but their risk is lower in London than the rest of England. In London those of Black British, African or Caribbean ethnicity fared the worst, with 17% of people of these ethnicities being in insecure employment. This is 7 percentage points higher than the overall proportion of 10%. The risk of insecure employment was lowest for Chinese, Indian, White and Bangladeshi groups[2].

[1] Jeffrey K, Mahony S, Michaelson J & Abdallah S (2014) Well-being at work: A review of the literature (London: NEF)

[2] Labour Force Survey ONS https://www.trustforlondon.org.uk/data/insecure-work-age/

Health 

Alongside unemployment, health is one of the most regularly identified determinants of subjective wellbeing. Self-assessed health is often found to be one of the strongest predictors of life satisfaction, but when a more objective measure (for example, the number of diagnosed conditions) is used, the effect size for physical health goes down to just over a third of the size of the effect of unemployment[1].

In terms of mental wellbeing health is often measured using a three-indicator domains: physical activity, healthy life expectancy and estimated prevalence of mental health disorders as these are considered the most representative and balanced portfolio of measures[2].

Physical activity levels amongst Adults (aged 19+) in Bexley are significantly worse than the regional or England average. In 2016/17, only 61.5% of Bexley adult population were active at the CMO recommended levels compared to 64.6% in London and 66% England average.

Healthy Life expectancy in Bexley (2014-16) was 65.8 for both males and females compared to 63.5 and 64.4 at a London regional level for males and females respectively.

Estimated prevalence of Common Mental Health Disorders for the Bexley population aged 16-74 was 14.8% (2014-15) compared to 16.4% and 15.6% for London and England averages respectively.

[1] Clark A, Flèche A, Layard R, Powdthavee N & Ward G (in press) The Origins of Happiness: How new science can transform our priorities

[2] Brown H, Abdallah S Townsley R. Understanding local needs for wellbeing data measures and

Indicators. Happy City and what Works Wellbeing

Close relationships

People who have good social relationships have higher wellbeing and better mental health. This, includes the number of friends we have, how often we meet friends socially, and whether we’re married. People who have frequent social contact with family or neighbours have subjective wellbeing scores of almost a full point higher on the 0-10 scale, than those who never have contact[1]. It is also clear that relationships make people happy, and being happy makes one more likely to maintain good relationships, and to interact socially with people. Moreover, the wellbeing of adults who are in a relationship has been associated with the wellbeing of their partner, as well as the quality of their relationship. Wellbeing is also related to relationships with other people in the household and with family outside the household.

Local data is not available for this measure

[1] Eurofound (2013) Third European Quality of Life Survey – Quality of life in Europe: Subjective well-being (Luxembourg: Publications Office of the European Union)

Social capital

Broader social capital has also been found to be related to subjective wellbeing, General social trust in others is a key cross-national predictor of subjective wellbeing. Membership of organisations predicts average life satisfaction at the national level[1] And one study suggests that the absence of any rise in wellbeing in the USA over the twentieth century, in spite of improvements in economic conditions, can be largely attributed to declining social capital (as measured in terms of trust and participation in membership groups)[2].

Average rating of Life satisfaction in Bexley was 7.55 out of 10, in line with the average London Rating of 7.5 and the England average of 7.6. The same survey shows that happiness of Bexley residents was rated as 7.39 (out of 10) in Bexley, slightly lower compared to 7.45 England (7.45), and in line with London Happiness ratings of 7.38[3].

[1] Helliwell J & Putnam R (2004) ‘The social context of well-being’ Phil Trans R Soc Lond 359:1435–1446.

[2] Bartolini S & Bilancini E (2010) ‘If not GDP, what else? Using relational goods to predict the trends of subjective well-being’

International Review of Economics 57:199-213.

[3] Estimates of personal well-being from the Annual Population Survey (APS) Personal Well-being dataset: by UK, country, region, UA/ County in England, LADs in England, UAs in Wales, LAs in Scotland, LGDs in Northern Ireland, April 2014 to March 2015

Giving and volunteering 

‘Give’ was identified as one of the Five Ways to Wellbeing based on the Foresight review of mental wellbeing and capital in 2008. Most evidence on this is related to volunteering, with clear evidence of a positive effect. However, more recent research suggests that volunteering only improves the wellbeing of certain demographic groups, with no significant effect amongst those aged under 40. 

Volunteering work by adults in the borough of Bexley indicates that 22% of adults (aged 16+) have volunteered in the last 12 months compared to 30% in London and 26% in England (2012/13)[1].

[1] Department for Culture, Media and Sport. Volunteering work amongst adults, borough. https://data.london.gov.uk/dataset/volunteering-work-among-adults-borough

Pollution 

Two aspects of pollution have fairly consistently been found to detrimentally affect subjective wellbeing, as well as physical health. For example, one study found that a small increase in nitrogen dioxide concentration corresponds to a drop of nearly half a point of life satisfaction (on a 0-10 scale)[1].

London suffers from traffic related pollution in a similar way to most UK cities, but its sheer size, along with a dense road network and high buildings means that the London boroughs tend to be some of the most polluted in the UK. The worst locations tend to be enclosed streets with large amounts of traffic. Comparing London boroughs is very difficult to do as each has a large variation

The Public Health Outcomes Framework includes a benchmark tool which enables the comparison of the fraction (%) of mortality attributable to long term exposure to PM2.5 in each local authority in the UK. Across England 5.2% of mortality is attributable to long term exposure to PM2.5. across the London region the figure is 6.7%, whilst Bexley has the 6^th lowest rates of all London boroughs at 6.1%[2].

[1] MacKerron G & Mourato S (2009) ‘Life satisfaction and air quality in London’ Ecological Economics 68:1441–1453.

[2] https://www.lbbd.gov.uk/wp-content/uploads/2017/01/5.11-Levels-of-Air-Environmental-Pollution-2016.pdf

Crime and personal security 

The fear of crime is a regular predictor of subjective wellbeing, with studies often assessing respondents’ fears of walking alone at night. Other studies, including the OECD analysis, have shown a negative effect of actual experience of crime. Furthermore, crime rates in a locality predict the wellbeing of people who live in that area.

Bexley has a relatively low fear of crime with 29% of Bexley residents very or fairly worried about crime compared to a London average of 31% placing Bexley as the 14^th lowest London Borough in terms of fear of crime (2016-17)[1]

[1] sourced from the Metropolitan Police Service Public Attitude Survey

Physical activity & green space

There is considerable evidence of the impact of Physical activity on mental wellbeing As well as being associated with higher wellbeing, physical activity has also been found to reduce anxiety and depression. Provision of green space and protection of natural landscapes is one way that local areas can increase opportunities for physical activity. Evidence shows that such contexts have an additional wellbeing benefit, and that people are happier when they are in green (or indeed blue) spaces[1]. 

Physical activity levels amongst Adults (aged 19+) are significantly worse than the regional or England average. In 2016/17, only 61.5% of Bexley adult population were active at the CMO recommended levels compared to 64.6% in London and 66% England average.

32% of the borough surface has green space. 1% higher than the London average. However within Bexley 40% of households within 4 out of 21 wards have deficient access to nature[2].

[1] MacKerron G & Mourato S (2013) ‘Happiness is greater in natural environments’ Global Environmental Change

[2] Better Environment, Better Health. A GLA guide for London Boroughs. London Borough of Bexley 2013

Figure 9:      Areas of Green Space in Bexley

Lesbian Gay Bisexual or Transgender (LGBT)

Lesbian, gay, bisexual or transgender (LGBT) people experience discrimination on a wide range of levels, not least in being treated differently by professionals in the healthcare sector. Often in society, they are subject to violence, verbal abuse and bullying and experience social isolation. This can lead to a range of health problems, such as alcohol and drug abuse, depression, suicide and self-harm, as well as problems around housing and employment.[1]

Research carried out by the University of Cambridge (2012)[2] found that 55% of LGBT pupils in Britain’s secondary schools experience homophobic bullying and the majority have symptoms consistent with depression. Young people said that they often or always experienced negative comments or conduct at school – the highest rate from surveyed European Union (EU) countries. The research, based on a national survey of 1,614 young people, also found that nearly a quarter (23%) of gay young people have attempted to take their own life, and more than half (56%) have deliberately harmed themselves.

LGBT populations are at particular risk of mental ill health.[3]

• Over half of LGB young people, and three quarters of transgender people have deliberately self-harmed themselves.
• 2 in 5 lesbian women, 1 in 3 gay men and 1 in 4 bisexual men have experienced negative or mixed reactions from mental health professionals.
• Nearly a third of transgender people who accessed mental health services felt their transgender status was regarded as a symptom of mental illness.
• There is a two fold increase in suicide attempts amongst LGB people and 5% of lesbians, bisexual women and men have attempted in the last year and 3% of gay men.
• 84% of transgender people have considered suicide with over half making an attempt. 

We have no local data on the numbers of LGBT people in Bexley.

[1] Fish, J. Reducing health inequalities for lesbian, gay, bisexual and trans people – briefings for health and social care staff. Department of Health. 2007 http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_078347

[2] Stonewall. The school report: the experiences of gay young people in Britain’s schools in 2012. 2012 http://www.stonewall.org.uk/documents/school_report_8a_low.pdf

[3] Dr Justin Varney. The health and wellbeing of lesbian, gay, bisexual and trans Londoners https://www.london.gov.uk/sites/default/files/The%20Health%20and%20Wellbeing%20of%20LGBT%20London%20FINAL.pdf

Asylum Seekers, Refugees and Immigrants

Asylum seekers arriving in the UK or any other host nation may have a very limited knowledge of the health care and welfare systems of that nation (Crawley, 2010). They are likely to experience poverty, dependence and a lack of cohesive social support. Children and young people could be living with adults that are unfamiliar to them. They may have experienced the death of a close family member or friend, or be unaware of their current circumstances leading to an increased sense of vulnerability (Connelly et al. 2006). Such factors can undermine both physical and mental health. Studies of refugees of all ages have found that one in six has significant physical health problems and over two thirds have suffered from anxiety or depression (Carey-Wood et al. 1995).

The government mental health strategy noted that the rates of mental health problems in particular migrant groups, and subsequent generations, can be higher than in the general population. For example, migrant groups and their children are at two to eight times greater risk of psychosis. More recent arrivals, such as some asylum seekers and refugees, may also require mental health support following their experiences in their home countries (DH, 2011a).

We have no local data on the numbers of people in Bexley who are asylum seekers, refugees and immigrants.

Other factors that influence wellbeing and resilience

Housing: The strongest housing-related predictor of life satisfaction is housing insecurity. Additionally relevant measures of material deprivation such as keeping the house warm enough and in a decent state of repair.

Personal debt: Unmanageable debt (typically credit card debt and consumer loans) are associated with lower wellbeing, depression and anxiety,

Informal care: People who have informal care duties, particularly caring for elderly or disabled people, have significantly lower wellbeing.

It is worth noting that some of the above factors – for example housing, personal debt and informal care – are particularly likely to be influenced by cuts to government budgets.

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