and probably the NHS Information centre as well however QResearch seems
to be the place for the dataset necessary.
Yhe 1 in 4 figure is the most common used one in mental health yet it
seemed the people using it didn't give a shit where it came from. Few
bothered to work out if it was 1 in 4 in a year or 1 in 4 in a lifetime.
Most of the major mental health organisations wouldn't have know wehich
was the correct figure a year or two ago. Even this year, Sue Baker of
Time to Change misquoted the figure as 1 in 4 in their lifetime.
I remember the strangest conversation with one of the teams where I used
to work. In the pub I'd explained to them where the figure came from and
what it meant. They were annoyed though. They thought it was 1 in 4 in
their life. They explained to me that 1 in 4 in a year didn't sound very
good. They didn't care what the figure meant. They cared how they could
use it. So I explained that 1 in 4 in a year could be written 1 in 4
every year experiences mental illness.
I'd tkane to the time to investigate this figure. I'd established where
it came from originally, the authors thoughts about it a decade on and
the data that confirmed the figure (approximately) almost three decades
after the book from which the figure was taken was published. I'd spoken
to someone on the team who was the statistics expert at the organisation
that first promoted this figure.
There is an academic debate as to what the figure means. This is pretty
interesting if you're interested in accuracy of numbers and I am.
There's a more interesting debate. If it's 1 in 4 every year then what's
the lifetime prevalence?
No one has been able to provide me with that figure or the research that
substantiates any estimate of life prevalence. I searched and found an
American paper which makes a guesstimate. The figure is over 1 in 2 in a
lifetime. This begs the question "What is normal?" but it seems no one
else is particularly interested to find out that over half the
population experience 'abnormal' behaviours or emotions. It sort of
makes the lack of mental disorder the abnormal thing.
Using a bit of mathematical logic, a way to work out fairly easily (once
the counting system has been established) what the snapshot lifetime
prevalence of diagnosed mental illness is to ask the question how many
people at any one time have had a psychiatric diagnosis ever in their
lifetime? A suitable electronic dataset that covers 100 years of
diagnosis information correctly coded would allow this question to be
answered very quickly however I don't think this exists.
There is a second problem as well, a problem somewhat tackled by Huxley
and Goldberg: unrecognised mental disorder. There's lots of it..
Diagnosis is different from illness. What that means is someone who's
never seen a psychiatric can have the same supposed brain illness that
creates the behaviours associated with other people who get diagnosed or
hospitalised. They just get through life without being detected.
There's the problem of how diagnosis has changed over the last hundred
years. So homosexuals or unmarried mothers today wouldn't be diagnosed
as mentally ill. Many, many, many more people would be diagnosed as
mentally ill using modern diagnostic criteria compared to ones from the
mid-20th century and psychiatric thinking about diagnosis would also be
significantly different.
So really this is just a theoretical way to work this out rather than
one that could be used in practice.
The methods used in the US study that estimates the lifetime prevalence
of mental disorder could be used in the UK. That's probably how the
research to find out the lifetime prevalence would be done.
Epidemiological stuff like this is of interest to doctors and provides
value for organisations who campaign for more behavioural modification.
For me it's interesting because it challenges the fundamental idea of
mental illness as something abnormal. It's the start of a thought
process about what is normal and that's really interesting in mental health.
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