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‘1 in 4’ prevalence for psychiatric disorder…or should that really be ‘1 in 3’? Parity of esteem in statistical headlines

Published online by Cambridge University Press:  26 October 2020

Andrew Moore*
Affiliation:
Consultant Psychiatrist, Devon Partnership Trust, UK. Email: andrew.moore7@nhs.net
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Abstract

Type
Correspondence
Copyright
Copyright © The Royal College of Psychiatrists 2020

Bebbington & McManus are to be thanked and congratulated for keeping this important and popular, but slippery, statistic under regular review and close-examination.Reference Bebbington and McManus1 Their summary is likely to lead most readers to continue using the now well-known and oft-quoted ‘1 in 4’ headline statistic for the overall prevalence of psychiatric disorders. They also rightly point out the twin dangers of over- and under-egging the statistic, risking lack of credibility and lack of impact, respectively.

However, I would suggest that the data presented comfortably allows for a new, revised ‘1 in 3’ headline. This would not be overstating the case, but would simply accurately describe their findings. Their current ‘1 in 4’ summary headline explicitly excludes ‘personality and other disorders’, as well as ‘substance use disorders’ and ‘developmental disorders’ …including them takes the true statistic to (very nearly) ‘1 in 3’ (31.6%, to be precise).

There is now a long history of evidence and campaigning to have personality disorders recognised as ‘bona-fide’ mental disorders, with services developed and provided to match. Calls range from the 2003 National Institute for Mental Health in England ‘Personality Disorder: no longer a diagnosis of exclusion’,2 through to the more recent 2018 consensus statement on personality disorderReference Mind3 and the freshly released 2020 Royal College of Psychiatrists Position statement, ‘Services for People Diagnosable with Personality Disorder’.4 They have always been in the ICD-10. Similar arguments and evidence could be made (ethically, on the grounds of stigma/parity, and scientifically) for the inclusion of the substance use disorders and developmental disorders that bring the final statistic to 1 in 3.

Presenting a new ‘1 in 3’ headline would not be over-egging the evidence, but simply presenting the full findings of carefully conducted up-to-date research, thus promoting accurate, evidence-based societal perceptions of mental disorder, and subsequent policy decision-making. This is especially important given the limited traction so far gained in closing the gap between rhetoric and action with regard to ‘parity of esteem for mental health’.Reference Moore5 The NHS Long Term Plan for Mental Health6 carries the potential for hope, but nothing should be taken for granted until it materialises.

In the meantime, we should advocate not excluding people with personality disorder (or substance use and developmental disorders) from the headline statistics generated by good-quality research; statistical parity of esteem for all those with mental disorders would justify a new, revised, evidence-based and accurate ‘1 in 3’ summary headline, which would be neither under-egged, nor over-egged, but ‘just(-ly) right’.

Declaration of interest

I am an elected member of the Executive Committee of the General Adult Faculty, Royal College of Psychiatrists, and also work in an NHS general adult community mental health team that treats and supports people with a range of mental health problems, including personality disorders.

References

Bebbington, P, McManus, S. Revisiting the one in four: the prevalence of psychiatric disorder in the population of England 2000–2014. Br J Psychiatry 2020; 216: 55–7.CrossRefGoogle ScholarPubMed
National Institute for Mental Health in England. Personality Disorder: No Longer a Diagnosis of Exclusion. Policy Implementation Guidance for the Development of Services for People with Personality Disorder. Department of Health, 2003.Google Scholar
Mind, and others. “Shining lights in dark corners of people's lives” The Consensus Statement for People with Complex Mental Health Difficulties who are diagnosed with a Personality Disorder. Mind, 2018. Availability from: https://www.mind.org.uk/media-a/4408/consensus-statement-final.pdf.Google Scholar
Royal College of Psychiatrists. Services for People Diagnosable with Personality Disorder. PS01/20. Royal College of Psychiatrists, 2020. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps01_20.pdf?sfvrsn=85af7fbc_2Google Scholar
Moore, A. The forgotten foundations: in core mental health services, no one can hear you scream. BJPsych Bull 2018; 42: 225–8.CrossRefGoogle ScholarPubMed
NHS England. NHS Mental Health Implementation Plan 2019/20–2023/24. NHS England, 2019. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-2023-24.pdfGoogle Scholar
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