The National Health Service (NHS) serves the UK through four devolved organisations for England, Scotland, Wales and Northern Ireland. It is one of the largest public healthcare systems in the world, universal and free at the point of delivery. Its key challenge is to maintain this approach within tight financial constraints, while embracing new technologies, treatments and styles of service delivery, as well as meeting the health needs of an ageing population.

The population of the UK was 61 792 000 in mid-2009. Children aged under 16 represented approximately one in five of the total population, around the same proportion as those of retirement age (over 65). In mid- 2009 the average age of the population was 39.5 years, up from 37.3 in 1999. Population growth is greatest in the over-85s, who currently number around 1.4 million, a figure which is estimated to reach 3.5 million by 2034, which will represent 5% of the population.

Mental health in the UK

Mental illness contributes 22.8% of the total burden of disability- adjusted life years (DALYs) in the UK (World Health Organization, 2008). One in six adults has a mental health problem at any one time (World Health Organization, 2004).

Half of those with a long-term mental illness have it by the age of 14 (Kim-Cohen et al, 2003) and three-quarters by their mid-20s (Kessler & Wang, 2007). The most deprived communities in the UK have the poorest mental health and physical health (McManus et al, 2009). People with severe mental illness die on average 20 years earlier than the general population. Mental health problems cost England approximately £105 billion each year, including costs of lost productivity and the wider impacts on well-being (Centre for Mental Health, 2010), and represent the largest single cost to the NHS, accounting for 11% of the secondary care budget (Department of Health, 2009).

Further key statistics are presented in Box 1.

Mental health service policy development and delivery

When it was created in 1948, the NHS took over a large number of old mental asylums. The movement towards community care for people with severe mental illness started in the 1950s with the advent of phenothiazines and the exploration of rehabilitation methods in community settings.