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MIND THE GAPS
Meeting the needs of people with co-occurring substance misuse and mental health problems
ANNEX A
KEY STATISTICS ON ALCOHOL IN SCOTLAND
Alcohol consumption by age and gender
1 in 3 (33%) of men drink over weekly recommended limits. [
Scottish Health Survey 1998].
Although this proportion is less for women (15%), evidence shows that there is an upward trend, particularly in young women, of whom 1 in 4 (24%) drink excessively. [
Scottish Health Survey 1998].
Among current drinkers, 12% of men and 5% of women were identified as possible 'problem drinkers'. [
Scottish Health Survey 1998].
Young people
Excessive drinking is most prevalent in younger adult age groups. [
Scottish Health Survey 1998].
The 2002 survey of Scottish schoolchildren (SALSUS) reveals that nearly 1 in 4 of 13 year olds and almost 1 in 2 of 15 year olds reported drinking alcohol in the previous week. [
SALSUS Interim report December 2002].
Drinking has increased over the past 4 years for 15 year old boys and 13 year old girls. Most (77%) 15 year olds reported they had been drunk at least once. [
SALSUS Interim report December 2002].
Service use
There were over 100,000 GP consultations in 2002 for alcohol related problems. People with alcohol related problems consult their GP twice as often as those who do not. [source: CMR, ISD].
3 in every 100 of all acute admissions (35,194/1,062,038) and more than 1 in 10 of all psychiatric admissions had an alcohol-related diagnosis (2,947/25,258). [source: SMR 1 and 4, ISD].
Deaths
Vulnerable populations
More than half of a sample of homeless people in Greater Glasgow in 1999 were drinking hazardously. [
Health and Well-Being of Homeless People in Glasgow ONS 2000].
A study of substance misuse in prisoners in England and Wales found that 58% of male remand prisoners and 63% of sentenced prisoners reported hazardous drinking in the year before they were imprisoned (30% of each group had severe alcohol problems). Amongst women, 36% of remand and 39% of sentenced prisoners reported hazardous drinking in the year before they were imprisoned with 14% and 11% respectively that had severe alcohol problems. [
Psychiatric Morbidity among Prisoners ONS 1999].
Men living in the most deprived areas (Deprivation Category 7) of Scotland are seven times more likely to die an alcohol related death than those in least deprived areas (Deprivation Category 1) (see Figure 1). [
Plan for Action on Alcohol Problems SE 2002].
People living in the most deprived areas of Scotland are seven times more likely to be admitted to an acute hospital with an alcohol-related diagnosis. Acute hospital inpatient admission rates with an alcohol diagnosis are seven times higher in Deprivation Category 7 than Deprivation Category 1. (1,461.3/100,000 compared with 189.6/100,000) (see Figure 2). [
Plan for Action on Alcohol Problems SE 2002]
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STATISTICS ON DRUG USE IN SCOTLAND
Drug use by age and gender
In the 2000 Scottish Crime Survey, drug use in the last month was reported by 5% of those aged 16-59 (this compares with 6.4% for the UK population as reported by the UK Psychiatric Morbidity Survey). [
Drug Misuse Statistics Scotland 2001].
Drug use is commoner in males (8% of males had taken a drug in the last 12 months compared with 6% of females) and in younger age groups (37% of 16 to 29 year olds said they had ever tried drugs compared with 13% of those aged 30 or over). [
Drug Misuse in Scotland: Findings from the 2000 Scottish Crime Survey 2001].
It estimated the number of problem drug users (opiate/benzodiazepine) in Scotland in 2000 was 55,800 with an approximate male to female ratio of 2:1. [
Hay G, McKeganey, N & Hutchinson S 2001].
Young people
Drug use is higher in younger age groups with 13% of 16-29 year olds reporting this for the last month. Trends from the Scottish Crime Survey suggest that drug misuse has been tailing off since a peak in the mid nineties, particularly in the younger age groups. These figures are however based on relatively small sample sizes. [
Drug Misuse Statistics Scotland 2001]
The 2002 Scottish schoolchildren survey (SALSUS) shows 8% of 13 year olds and 23% of 15 year olds reported using drugs in the last month, with boys more likely to report use than girls in both age groups. Trends from previous surveys show reported drug use in the last month has not changed significantly since 1998 [
SALSUS Interim report December 2002].
Service use
Compared with alcohol misuse, there are proportionally far fewer GP recorded consultations for drug misuse. In 2001 there were just over 10,000 GP consultations with a drug misuse diagnosis. [
Drug Misuse Statistics Scotland 2002].
The same is seen for hospital admissions. During 2001/02, there were 4736 admissions for drug misuse to acute general hospitals and 1134 admissions to psychiatric hospitals (3.3 per cent of total) with a main diagnosis of drugs misuse, making it the 9
th most common condition. [
Scottish Drug Misuse Statistics 2002].
Over 10,000 new individuals were reported to the Scottish Drug Misuse Database as entering drug treatment. [
Scottish Drug Misuse Statistics 2002].
Deaths
Vulnerable populations
Although the majority (72%) of prisoners do not report drug use in the last month, 28% do, a much higher proportion than the general population. [
Fifth Scottish Prison Survey 2002].
1 in 5 of those reporting drug misuse in the last year in the general population were unemployed. [
Scottish Crime Survey 2000].
Again as for alcohol, a deprivation effect can be seen for drug misuse with higher rates in more deprived areas. For example, there is an association with deprivation on GP contact rates for patients with a diagnosis of drug misuse. [
Drug Misuse Stats 2002]. There is also a marked deprivation association seen for hospital discharges with a diagnosis of drug misuse, particularly notable for males (see Figure 3).
Lifetime experience of victimisation (bullying/violence in home/being homeless/sexual abuse) is higher for those who are drug dependent. [
Psych Morbidity Survey].
STATISTICS ON MENTAL HEALTH IN SCOTLAND
Mental health problems by age and gender
The Scottish Health Survey assesses psychosocial health using the General Health Questionnaire (GHQ 12). Scores of over 4 indicate possible psychiatric morbidity. 18% of women and 13% of men had scores over four. The highest scores were seen in the middle years for both sexes. [
Scottish Health Survey 1998].
The UK wide Psychiatric Morbidity Survey found that 16 per cent of the population were assessed as having a neurotic disorder with women having higher rates than men. The most common of these disorders, experienced by 9% of people, was mixed anxiety and depressive disorder. [Singleton et al 2001].
Young people
For children aged 13-15, 5% of boys and 8% of girls had GHQ scores of over 4. [
Scottish Health Survey 1998].
Mental well-being of boys is better than that of girls and overall, children in primary school have better mental well-being than those in secondary school. [Currie and Todd 2003]
Service use
Estimates from general practice in Scotland suggest that 10% of consultations are for a mental health problem. [
CMR 1998, ISD].
There were over 25,000 admissions to psychiatric hospitals in 2001, a 16% fall from the previous year. However, this is more likely to reflect changes in service from hospital based to community delivery rather than a real drop in prevalence. [SMR4, ISD].
Deaths
Death rates due to suicide or undetermined cause for men have risen steadily over the last 25 years with particularly high rates for young men. Rates for women are much lower and have fallen over the same period. In 2000, 75% of deaths recorded as suicide or undetermined cause were for men. [GRO website].
Vulnerable populations
For both men and women, the Scottish Health Survey found that those who were unemployed had an increased risk of higher GHQ score (i.e. possible psychiatric morbidity) compared to those in employment. [
Scottish Health Survey 1998].
The 2002 Scottish Prison Survey asks a series of questions relating to anxiety and depression. A majority of prisoners did report problems, with a significant minority experiencing problems on a daily basis. Although a standard instrument was not used, the questions were based on the GHQ. [
Scottish Prison Survey 2002].
The survey of homeless people in Glasgow found that 6% had a psychotic disorder, 44% a psychological disorder and 22% reported a long-standing mental illness. [
Health and Well-Being of Homeless People in Glasgow ONS 2000].
Qualitative local research in Edinburgh has shown that childhood sexual abuse trauma is perceived to be an important contributor to both mental health and addiction problems. [
Nelson S. 2001].
STATISTICS ON SUBSTANCE MISUSE AND MENTAL HEALTH PROBLEMS
Current prevalence in general population (US)
1 in 10 (13%) have a mental health problem
1 in 40 (2.8%) have an alcohol disorder
1 in 100 (1.3%) have a drug disorder
Lifetime prevalence in general population (US)
1 in 5 (22.5%) will have a mental health disorder
1 in 10 (13.5%) will have an alcohol disorder
1 in 20 (6.1%) will have a drug disorder
Current prevalence of co-morbidity in those with mental health/substance misuse problems in service settings (US)
1 in 5 (20%) of mental health patients have a substance misuse problem
1 in 2 (55%) of alcohol patients have a mental health problem
2 in 3 of drug clients (64%) have a mental health problem
Lifetime prevalence of co-morbidity in those with mental health/substance misuse problems (US)
of those with a mental disorder, just under 1 in 3 (29%) will have a substance misuse disorder
of those with an alcohol disorder, just over 1 in 3 (37%) will have a mental health disorder
of those with a drug disorder, 1 in 2 (53%) will have a mental health disorder
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