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Depression in London Borough of Tower Hamlets

Executive summary:

Depression affects adversely people’s thoughts, decision making and mental and physical wellbeing. Tower Hamlets is the London borough that is situated in East London. This report has selected this borough for discussing depression because this borough shows the high prevalence of different mental disorders such as depression, behavioural disorders, anxiety, dementia, schizophrenia and Alzheimer disease. Tower Hamlets shows the high rate of deprivation, that is strongly associated with an ever-increasing number of mental health illness such as depression. Compared to boroughs of London such as Newham, Redbridge and havering, the tower hamlets borough has a higher prevalence of depression among citizen. This is because Tower Hamlets has a high number of unemployment, homelessness, poor housing facilities, health inequalities and deprivation that contribute to developing depression in people. However, the government has developed effective policies and long-term plan that prioritise promoting positive mental health in people. Through implementing these policies into practices, it is possible to reduce the prevalence of depression and other mental illness in Tower Hamlets. This report will discuss the demographic factors, epidemiology, genomics of depression in Tower Hamlets. In this report, the wider determinants of health and wellbeing in relation to depression will be discussed along with the explanation of how these determinants contribute to the prevalence of depression in Tower Hamlets.

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Introduction:

Depression is a mental illness that affects a person's thoughts, mood, feeling, motivation, behaviour and sense of well-being. Mental illness has become a major health concern that leads to an expenditure of £ 26 billion each year to London. This study will present a comprehensive discussion on depression in the Tower Hamlets borough of London. This report will discuss the demographic factors, epidemiology, genomics of depression in this borough. In this report, the wider determinants of health and wellbeing in relation to depression will be discussed along with the explanation of how these determinants contribute to the prevalence of depression in Tower Hamlets. This report will also discuss the JSNA data of Tower Hamlets to discuss the statistics of depression as compared to other London boroughs. This report will also discuss the different national and local mental health policies in Tower Hamlets for promoting positive mental health in this borough. A recommendation will be made which will mention the strategies that can be used by the policymakers and government of Tower Hamlets to reduce the prevalence of depression and mental illness in this borough

Locality:

Tower Hamlets is the London borough that is situated in East London. This report has selected this borough for discussing depression because, in the modern era, this borough shows the high prevalence of different mental disorders such as depression, behavioural disorders, anxiety, dementia, schizophrenia and Alzheimer disease. NHS (2018), reports that Tower Hamlets has the fourth-highest percentage of people suffering from depression and the fourth-highest rate of the patients who visit the first times to GP clinic with the symptoms of psychosis [NHS, 2018]. As mentioned by Kljakovic and Kelly (2019), depression affects adversely people thoughts, decision making and mental and physical wellbeing. Therefore, the ever-increasing number of depressions in this borough pose an overburden of mental illness on the habitants. In this context, the selection of this topic is highly relevant to present the mental health scenario of this borough in front of the policymakers, public and healthcare authority.

Health and social care data of Tower Hamlets: (JSNA 2018 report)

Young people and children in Tower Hamlets have a higher prevalence of depression (10.8 %) than other boroughs of London such as Newham, Redbridge and Havering.

Adults in Tower Hamlets are reported to have severe depression and anxiety (16%) which contribute to making this borough rank fourth-highest mental illness zone among all the other London borough [towerhamlets.gov.uk, 2019).

More than 50000 adults in Tower Hamlets are diagnosed with depression and other serious mental illness in 2018 [towerhamlets.gov.uk, 2019].

Older people in this borough are more likely to have loneliness and depression which make them vulnerable to the risk of serious mental disorders such as dementia and Alzheimer disease.

Determinants, inequalities and barriers to health

Demography and social and economic determinants of mental health:

Tower Hamlets population increases at a faster rate each year due to immigration from other boroughs of London and other countries. The main population groups in Tower Hamlets are Bangladeshi and British therefore showing the high ethnic diversity. As stated by Krause et al. (2020), depression is more likely to be prevalent in the minor ethnic community. The London Borough of Tower Hamlets (LBTH) shows that high population growth rates (29 % from the 2001 census). The population is predicted to be raised by 26% by 2023. As mentioned by Kljakovic and Kelly (2019), an increasing number of populations leads to an increasing number of mental health issues due to limited healthcare resources. In Tower Hamlets, more than 7% of the entire population is above 65 years as compared to 11% of the London population. Here is 32% of the population is Bangladeshi and 31% is the British white community [towerhamlets.gov.uk, 2019].

Deprivation:

Tower Hamlets shows the high rate of deprivation, that is strongly associated with the ever-increasing number of mental health illness such as depression (Baucom et al. 2018). Tower Hamlets is the seventh most deprived borough in London, in which 69% of the residents live in the 20% of the most deprived areas of England [JSNA, 2019]. It also shows the high rate of child poverty with a lack of proper nutrition, education, healthcare facilities and a good family environment. The JSNA report of Tower Hamlets shows that 39% of the working-age people (16-64 years) of Tower Hamlets are unemployed. The data also shows that Tower Hamlets is reported to have the second percentages of long-term unemployment.

Deprivation

As mentioned by Robb et al. (2020), unemployment is strongly associated with developing depression in people. The JSNA report 2018 shows that the rates of unemployment in every 1000 working-age people is 107. This rate is predicted to be increased by 12% by 2023. The mental health illness in Tower Hamlets accounts for more than 45% of all the health issues that pose an adverse impact on the economy of London [JSNA, 2018].

As mentioned by Robb et al. (2020)

The above-mentioned graphical representation shows that, after Barking and Dagenham, Tower Hamlets has the highest prevalence of mental health disorders among all the other East London boroughs. Deprivation is one of the potential determinants of depression in Tower Hamlets. The JSNA report (2018) of Tower Hamlets states that this borough has the sixth-largest working-age population that is out of work and this rate of employment will increase in recent years.

Childhood poverty:

Evidence suggests that there is a strong connection between depression and child poverty (Baucom et al. 2018). In Tower Hamlets, children belonging to the poorest families are more likely to be affected by depression, anxiety, behavioural disorders and psychosis than those residing in high-class society.

Childhood poverty

From the graph, it is seen that Tower Hamlets shows the highest percentage of childhood deprivation out of all the other boroughs in London. As mentioned by Robb et al. (2020), depression is more prevalent in young children which reside in deprived families. The author also stated that depression is more prevalent in boys as compared to girls in the derived communities. This is because boys in the poorest families are more likely to face the mental and emotional stress to search for a job, leave their school and feed their family (Shakeel, 2019). In Tower Hamlets depression is 3 times more severe in the case of young children as compared to the other age groups in this borough. The majority of children residing in lower socioeconomic communities in the Tower Hamlets borough of London is more likely to suffer from depression than those residing in higher societies [towerhamlets.gov.uk, 2019].

Unemployment:

The JSNA report of Tower Hamlets presents the fact that in this borough there is an increasing rate of unemployment in the working-age population. The rate of unemployment in the working-age population in 107.4 per 1000 people [JSNA, 2018]. This percentage is worse than the other borough of London such as Newham and Redbridge but better than Hackney. During 2014 more than 39% of the working-age population in Tower Hamlets is considered unemployed. According to Cameron et al. (2021), unemployment is strongly associated with developing depression in people. In Tower Hamlets, the unemployed people belonging to the working-age population are more likely to suffer from depression that leads them to develop unhealthy habits such as, smoking, drug addiction and alcohol consumption.

RR1 Long term unemployment rate per 1000 population time period:2011

The graph shows that in 2011, Tower Hamlets has the seconds highest percentage of unemployment in working-age people. The JSNA report (2018) of this borough predicted that the unemployment in the working-age population will continue to be increased which will pose adverse impacts n the mental health of young people and children.

The graph shows that in 2011, Tower Hamlets has the seconds highest percentage of unemployment in working-age people. The JSNA report (2018) of this borough predicted that the unemployment in the working-age population will continue to be increased which will pose adverse impacts n the mental health of young people and children.

Housing:

As mentioned by Robb et al. (2020), good housing facilities are associated with having good mental health and wellbeing. In Tower Hamlets majority of the people suffering from depression and other mental illness, generally have unstable housing environment, lack of rooms and unhygienic housing condition. The ever-increasing number of populations of Tower Hamlets is the reason behind the lack of rooms and spaces in the houses that are provided to the majority of the people (). The JSNA report shows that most of the people in Tower Hamlets are more likely to experience depression due to the lack of fresh air and hygiene in the room, the poor behaviour of homeowners and high rates of rent. Insufficient numbers of rooms as compared to the number of households makes it difficult for them to maintain a healthy and hygienic environment inside the house (Ulhaq et al. 2017). In Tower Hamlets, more than 34% of the households are reported to have poor housing facilities and insufficient numbers of rooms that contribute develop depression in them.

Homelessness:

Homelessness is considered a significant aspect of developing depression in the people of Tower Hamlets. Homeless people are vulnerable to depression, anxiety and psychosis as compared to people having housing facilities (Martin, 2020). In Tower Hamlets, the rates of homelessness are worse than that in the Newham and Red bridge boroughs of London. In Lower Hamlets the rate of homelessness is 5.77% per 1000 people [JSNA, 2018]. However, this percentage is lower than the rates of homelessness in Barking and Dagenham borough of London (nearly 6% per 1000). A huge number of people suffering from severe depression in this borough due to not having any housing facilities, therefore, have to experience severe difficulties in having a normal living standard [towerhamlets.gov.uk, 2019]

Health inequalities:

Health inequalities in the social condition in which there is the disparity in availing health and social care facilities in relation to the socio-economic condition of people (Butt et al. 2019). In the London Borough of Tower Hamlets (LBTH), there are high rates of health inequalities that is considers as the major reason behind increasing numbers of depression in young children and adults. The JSNA report of Tower Hamlets shows that more than 30000 adults in this borough are diagnosed with severe depression and anxiety which is related to the poorest healthcare facilities and social care, they receive from the NHS professionals. The recent NHS report shows that health inequality contributes to developing depression dementia and psychosis in people residing in the lower economic class of Tower Hamlets borough. The JSNA report shows that more than 15,900 people are diagnosed with depression at their first visit to the GP’s clinic (towerhamlets.gov.uk, 2019).

JSNA report shows that as compared to the other boroughs of London such as Newham, and Redbridge, Tower Hamlets is reported to have a higher number of cases of health inequalities, this is because there is a high number of unemployment, ethnicity, homelessness, poor housing facilities, poverty, child labour and social classification. The JSNA report of Tower Hamlets shows that more than 69% of the people of Tower Hamlets reside in 20% of the most deprived areas of England and Wales [JSNA, 2018]. People belonging to deprived and poorest communities in the Tower Hamlets are reported to have below standard mental health services from NHS hospitals and social care organisations as compared to the services provided to high society people. For example, in Tower Hamlets people belonging to poor ethnic communities are more likely to face several issues such as long waiting for GP’s appointments, lack of modern healthcare facilities and negligence of nurses and care professionals (Abbott et al. 2019). This severe disparity in healthcare services in the case of poor people makes them highly vulnerable to poor mental and physical health. In Tower Hamlets, people suffering from severe depression are more likely to lose their right decision making and cognitive skill due to a lack of healthcare facilitates and social support.

Review of the provision of the current service:

Child and adolescent mental health services: (CAMHS)

Under CAMHS, all the children and young people will be provided with equal and high-quality primary care, social facilities and school. As mentioned by Randhawa et al. (2020) depression can be reduced in society through providing proper healthcare facilities, educational facilities and social support. This provision is useful; in assessing the children and family needs thereby meeting these needs accordingly to improve the quality of living in Tower Hamlets. Under CAMHS, children and adolescent will be protected from the bully, harm, abuse and social malpractices that can cause severe depression in them. As stated by Serfaty et al. (2020), children who are exposed to social malpractices are more likely to suffer from depression.

This provision is useful in providing different facilities to children and young people such as educational training, professional and career development training, multidisciplinary team working, the group working and professional development program. By providing these facilities, it is possible to reduce the rate of depression in Tower Hamlets.

Education Psychology Service: [EPS]/

Under the provision of this service, more than 124 families in the Tower Hamlets are supported economically and socially thereby reducing their vulnerability to depression and other mental illness (towerhamlets.gov.uk, 2019). Under this provision, health and social care staffs visit different families in this borough, thereby analysing the behaviour, psychology and activities of the children and adults in the families. Under this provision, every household will be covered under the basic health and social care facilities such as primary care, education, training, economic support and social support (Malaeb et al. 2020). This service is proved to be useful in reducing the vulnerability of ethnic community as well as deprived people residing on lower social class to depression

NHS long terms plan (2019):

NHS long term plan prioritises promoting good mental health and develop a set of strategies to reduce health inequalities and mental illness in Tower Hamlets

Key strategies:

Improving the access to the perinatal health service till 24 months after the birth

Increasing the access to the CAMHS services thereby promoting good mental health support in the school (towerhamlets.gov.uk, 2019)

Providing positive mental health support to the transition from childhood to adulthood by following a systematic THRIVE model such as person-centred as well as the need-based framework

Increasing investment in adult mental health such as depression, anxiety and psychosis.

The NHS long term plan is highly useful in providing high-quality mental health support to adults and children suffering from depression. Under this long-term plan, PHE has conducted the mental health campaign, “Every mind matters". This campaign is conducted to promote emotional, social and psychological support to the people suffering from depression (towerhamlets.gov.uk, 2019).

Local policy context: Tower Hamlets

The local mental health policies under NICE guidelines is refreshed in 2018 with the development of three themes:

Building resilience

High-quality mental health treatment and support

Living well with mental health disorders.

Tower Hamlets Mental Health Crisis Care Concordat has been developed in 2015 to check whether all children and young people are protected from harassment, harm and abuse that can cause depression and other meta; disturbance (towerhamlets.gov.uk, 2019).

Tower Hamlets Suicide Prevention Strategy 2018-2021 is proved to be one of the most effective provisions that reinforce positive thought and good decision making in depressed and anxious people to protect them from the feeling of suicide (towerhamlets.gov.uk, 2019)

Tower Hamlets Together (THT) partnership with CCG ad the local authority is highly useful in improving positives mental health in people by providing them with proper training, psychotherapies and counselling facilities.

NICE guidelines:

NICE has the Mental Health and Wellbeing Guidelines for Tower Hamlets that is proved to be highly useful in reducing the rate of depression in this borough [NICE, 2018]. under these guidelines, health and social care staffs will support the mental health of every citizen irrespective of their race, ethnicity, age caste, social class and religion.

This guideline is effective in providing the proper emotional and mental support to older people to protect them from depression and promote their independence.

Under these guideless children and young people with depressive and psychotic behaviour such as half harm, bipolar disorders and addition will be provided with proper emotional support counselling facilities and behavioural therapy (Firth and Haith-Cooper, 2018).

Nurses’ roles in health promotion and screening:

Nurses in Tower Hamlets work under the above-mentioned guidelines to promote positives metal health in citizen. Nurses are well-trained and highly skilled in carrying out technology-based mental health assessment of people with mental illness. this health assessment includes Mental health screening, Cognitive behavioural therapy and psychotherapies (Butt et al. 2019).

Mental health screening is a highly effective psychotherapeutic process though which nurses can access the current mental condition, psychological needs and thoughts of mentally ill patients. in Tower Hamlets, nurses conduct the screening test of mental health of people suffer from depression and other mental condition (Jabri et al. 2020).

Nurses in Tower Hamlets follows the NHS long term plan in terms of providing emotional social and psychological support thereby reinforcing positive mental health in children and young people.

Nurses act as mentors and trainer who train the children and young people with depression about how to cope with the negative and harmful thought. as mentioned by Baucom et al. (2018), nurses need to improve the self-management skill of people with mental illness such as depression.

In Tower Hamlets nurses plays crucial roles to adhere to al the above-mentioned mental health policies thereby promote their professional integrity as well as their accountability to provide safe mental health support to the citizen of this borough

Nurses also provide proper health education, to improve the health literacy in families residing in the deprived areas of Tower Hamlets. Through the process, nurses improve the knowledge of children and young people about their rifts to healthcare, information on different mental condition and ways to self-manage this mental health condition by performing healthy systematic life.

Conclusion:

From the above-mentioned discussion, it can be stated that as compared to boroughs of London such as Newham, Redbridge and Havering, the Tower Hamlets borough has a higher prevalence of depression among citizen. This is because Tower Hamlet has a high number of unemployment, homelessness, poor housing facilities, health inequalities and deprivation that contribute to developing depression in people. However, the government has developed effective policies and; long term plan that prioritises promoting positive mental health in people. Through implementing these policies into practices, it is possible to reduce the prevalence of depression and other mental illness in Tower Hamlets.

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Recommendation:

Based on the discussion following recommendation can be done:

Local and national government need to emphasize on effective implementation of all the mental health policies and practices that will ensure the delivery of equal and fair mental health support to all the household irrespective of their demographics and social condition.

Effective resources management in the mental health sector in Tower Hamlet is needed to ensure the health and social care staffs are provided with the technologies, modern equipment and life course approaches to provide high-quality mental health service to people with depression

Professional and skill development training needs to provide to all the health and social care staffs in Tower Hamlets to enable them to better assess the mental health of patients thereby providing the appropriate care to them.

The government needs to focus on improving the socio-economic condition of the people of Tower Hamlets by providing them with proper housing facilities, employment, education and career development training. Improvement of living standard with contributing to good mental health of people

Reference list:

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Baucom, D.H., Fischer, M.S., Worrell, M., Corrie, S., Belus, J.M., Molyva, E. and Boeding, S.E., 2018. Couple‐based intervention for depression: An effectiveness study in the National Health Service in England. Family Process, 57(2), pp.275-292.

Butt, M.F., Walls, D. and Bhattacharya, R., 2019. Do patients get better? A review of outcomes from a crisis house and home treatment team partnership. BJPsych bulletin, 43(3), pp.106-111.

Cameron, C., Hauari, H., Hollingworth, K., O'Brien, M. and Whitaker, L., 2021. Interim Briefing Report. The First 500: The impact of Covid-19 on families, children aged 0-4 and pregnant women in Tower Hamlets.

Firth, A.D. and Haith-Cooper, M., 2018. Vulnerable migrant women and postnatal depression: A case of invisibility in maternity services?. British Journal of Midwifery, 26(2), pp.78-84.

Halvorsrud, K., Nazroo, J., Otis, M., Hajdukova, E.B., Bhui, K. and London, E., Ethnic inequalities in the incidence of diagnosis of severe mental illness in England.

Jabri, L., Rosenthal, D.M., Benton, L. and Lakhanpaul, M., 2020. Complementary feeding practices and nutrient intakes of children aged 6–24 months from Bangladeshi background living in Tower Hamlets, East London: a feasibility study. Journal of Health, Population and Nutrition, 39(1), pp.1-15.

Kljakovic, M. and Kelly, A., 2019. Working with school-refusing young people in Tower Hamlets, London. Clinical child psychology and psychiatry, 24(4), pp.921-933.

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Malaeb, D., Awad, E., Haddad, C., Salameh, P., Sacre, H., Akel, M., Soufia, M., Hallit, R., Obeid, S. and Hallit, S., 2020. Bullying victimization among Lebanese adolescents: The role of child abuse, Internet addiction, social phobia and depression and validation of the Illinois Bully Scale. BMC pediatrics, 20(1), pp.1-11.

Martin, J.S., 2020. The challenges of translating the women's group Participatory Learning and Action Cycle from multiple low-income countries to the UK NHS context, using nutrition in infants of Bangladeshi origin in Tower Hamlets as an exemplar (Doctoral dissertation, UCL (University College London)).

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Serfaty, M., Aspden, T., Satchell, J., Kessel, A., Laycock, G., Brewin, C.R., Buszewicz, M., O’Keeffe, A., Hunter, R., Leavey, G. and Cuming-Higgs, J., 2020. The clinical and cost-effectiveness of a Victim Improvement Package (VIP) for the reduction of chronic symptoms of depression or anxiety in older victims of common crime (the VIP trial): study protocol for a randomised controlled trial. Trials, 21, pp.1-11.

Shakeel, N., 2019. Depressive symptoms in pregnant and postpartum women. The role of ethnicity, level of integration, and physical activity—the STORK–Groruddalen population-based cohort study.

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