Appendix Two - Prevalence rates for people with more than one service need
People with psychological and mental health problems
1. Keene (2001) stresses the significance of psychological and mental health related complex needs, pointing to how these affect:
- around one fifth of the GP workload in the UK
- young adults and people with learning and development difficulties (Matson and Bamburg, 1998; Sturmey, 1998)
- men and women who make heavy use of health services
- 90% of those who attempt suicide (DoH, 1996)
- people affected by post traumatic stress disorder and substance misuse
- those with alcohol-related problems with multiple psychological, social and family consequences (MacRae and Cox, 2004 a, b)
- people diagnosed as having Attention Deficit Hyperactivity Disorder ( ADHD) in later life, who have tendency to be involved in substance misuse (Tucker 1999).
People with co-occurring mental health problems and substance misuse
2. The SACDM and SACAM report (2003) identifies that:
- Up to 3 in 4 drug using clients have been reported to have mental health problems
- Up to 1 in 2 clients with alcohol problems may also have a mental health problem
- Up to 2 in 5 people with mental health problems may have a drug/and or alcohol problems
- Co-morbidity in general practice in England has risen by 62% between 1993 and 1998.
(Source: SACDM/ SACAM (p.12), Scottish Executive 2003).
Women who have experienced domestic abuse
3. Seventy percent of women psychiatric in-patients and 80% of those in secure settings have histories of physical or sexual abuse (DoH 2003, quoted in Baron, 2005).
4. A study of 60 women using crack cocaine found that 40% reported being regularly physically assaulted by a current partner and 75% assaulted by a current or previous partner. Much of this was at the extreme end of the spectrum with approx 50% needing hospital treatment in the past year as a result of partner violence. (Bury et al, 1999, quoted in Humphreys, 2005).
Homeless people
5. A Homeless Link survey of service providers to homeless people in 2002 found that:
- 88% of respondent agencies said they worked with clients with multiple needs
- 4458 service users were identified as having multiple needs, almost half (47.8%) of the total population receiving services
- multiple needs were most prevalent among rough sleepers.
(Source: Homeless Link, 2002)
People with learning disabilities
6. A key Scottish Executive report commented that in Scotland:
"research suggests that 15-20,000 people need a lot of help to cope with daily living . Of these about 25% (4,000 to 5,000) are children and young people aged under 16. A further 25% (4,000 to 5,000) have complex needs which need a lot of support. People with learning disabilities are often not as healthy as the rest of the population. They may need more health support than primary care alone can provide. As people's learning disability becomes more severe, so does the likelihood of complex health needs such as epilepsy, mobility and sensory impairment. People with learning disabilities may need support and services because of mental health problems. Around 30% to 42% of children with learning disabilities may need help for emotional and behavioural problems. Older people with learning disabilities have more mental health problems. This is particularly so for people with Down's syndrome who may get early onset dementia"
(Source: Scottish Executive, 2000; see also Scottish Executive, 2006f).
7. Learning disability is often associated with a variety of other disabilities and health problems, the most common of which include:
- Epilepsy (25% people with learning disability and 50% of those with severe learning disabilities)
- Hearing impairments (40%)
- Visual impairments (40%)
- Psychiatric and behavioural disorders (35%)
- Hypothyroidism in people with Down's Syndrome
- Dementia (especially people with Down's Syndrome and those over 50 years of age).
(Source: WHO quoted in Ridley, 2004.)
8. McGrother et al (2001) using the Leicestershire register explored the extent of a range of problems. Overall, they found 43% of people with learning disabilities had a problem with one or more 'significant physical dependency', 42% had a 'significant behaviour problem' and 28% had one or more 'significant psychiatric symptom'. The overlap between problems was said to be "considerable". However they also found that mental illness such as depression in those with learning disabilities is often difficult to identify.
Older people with long term conditions
9. A DOH Report (2006) identified that:
"An estimated 250,000 people with complex needs would benefit from case management, as required by the current Personal Service Agreements ( PSA) target for long-term conditions.
(Source: DOE, 2006, p 116).
Young people with complex needs
10. Ninety-eight per cent of respondents to a Social Exclusion Unit survey said that young people presented to a particular service with multiple problems.
(Source: Social Exclusion Unit, 2005b, p..27).
People with particular communication needs
11. The Social Exclusion Unit identified that:
- one in 20 people have difficulties following straightforward texts accurately and independently
- one in 15 people have a sensory impairment who may require communication support
- around one in 7 people from ethnic minorities need information to be translated into another language (Social Exclusion Unit, 2005a, p.41).
People with challenging behaviour
12. In terms of behaviour that is labelled as 'challenging', Hogg (2001) cited a recent study (Emerson et al, 2001), which found an overall percentage prevalence of 12.1% of the total population of children and adults as exhibiting 'challenging behaviour'. Variation across the age range was also found with the highest prevalence within the 10-19 year age group and those over 70+ years showing very little challenging behaviour. McGrother et al (2001) suggested a far higher estimate - 25% of the adult population with learning disability have a behaviour problem that poses a major challenge to the achievement of an ordinary life.