Incidence over time

1. The recorded incidence of significant mental health problems in the UK has risen steadily since the middle of the twentieth century.
2. Incidence counts new cases in a set period, so the figure moves when either the illness or the counting changes.
3. A rise in recorded cases can come from a change in how cases are found and recorded.
4. Three things changed together: how problems are classified, how readily professionals record them, and how willing people feel to come forward.

Changing classification

1. Mental health problems are classified using the ICD, published by the World Health Organization, and UK doctors diagnose against it.
2. Mental disorders were first given their own section in the ICD in 1949, so before that there was no agreed international list to count against.
3. Each new edition has recognised more separate conditions, so experiences that once had no name now fit a category and get recorded.
4. Thresholds have moved as well, and ICD-10 sorted depression into mild, moderate and severe episodes.
5. ICD-11, in use from 2022, dropped the old subtypes of schizophrenia such as paranoid and catatonic, and replaced them with one diagnosis rated on current symptoms.
6. Categories can also be removed as attitudes change, and homosexuality was taken out of the ICD when the tenth edition was approved in 1990.
7. Widening a category raises the recorded incidence on its own.

Why recorded rates have risen

1. GPs are now trained to ask about mood and anxiety in an ordinary appointment, so problems get picked up that were once missed.
2. Diagnoses go onto electronic patient records and are gathered nationally, whereas mid-century figures came mainly from hospital admissions.
3. NHS talking therapy services can be self-referred, so a person can enter the statistics without a crisis happening first.
4. National surveys such as the Adult Psychiatric Morbidity Survey now ask the public directly about their symptoms.

Changing attitudes since 1959

1. The 1959 Mental Health Act replaced Victorian lunacy law, removed legal terms such as lunatic and asylum, and brought mental illness under a framework closer to that for physical illness.
2. It allowed informal, voluntary admission, so a person could ask for treatment and leave again rather than being certified and detained.
3. It created Mental Health Review Tribunals, giving a detained person a route to challenge that decision for the first time.
4. It also started the move out of the large mental hospitals and towards care in the community.
5. The 1983 Mental Health Act went further on rights, adding rules on consent to treatment and on second opinions.
6. The Equality Act 2010 counts a long-term mental health condition as a disability, so discrimination at work became unlawful.
7. Campaigns changed everyday language, and Time to Change, run by Mind and Rethink Mental Illness from 2007, was set up to get people talking about mental health.
8. Greater openness means more people report a problem, and reporting on its own lifts the recorded incidence.
9. Attitudes have changed unevenly, and surveys still find more public unease about schizophrenia than about depression or anxiety.
10. Recovery is a normal outcome, and many people diagnosed with a significant mental health problem work, study and live independently.

Similarities and differences over time

1. Recorded rates of depression and anxiety have risen sharply across the period.
2. Schizophrenia has stayed at roughly one person in a hundred over the same decades.
3. Women have consistently been diagnosed with depression about twice as often as men, and that gap has held throughout.
4. Men have consistently accounted for around three quarters of deaths by suicide in the UK.

Evaluating the trend in recorded cases

1. Part of the rise may be real, if pressures such as insecure work, exam stress and social media make more people unwell.
2. Part of it comes from better recording, through broader classification, routine questions from GPs and greater openness.
3. The two cannot be pulled apart from the figures alone, because the same rising graph fits either explanation.
4. The rise is best treated as a combination of real change and improved recording.

Turning this into marks

1. When two reasons for the rise are asked for, make them genuinely separate rather than one reason rephrased.
2. Name the specific change, such as the 1959 Mental Health Act or the move from ICD-10 to ICD-11, because a general reference to changing attitudes does not secure the knowledge mark.
3. The mark most often lost is treating a rise in recorded cases as proof that more people have become unwell.