Key Concepts

What you'll learn

• How psychologists define mental health, including the mental health continuum.
• The difference between prevalence and incidence, with current patterns by age, gender and sexual orientation.
• How attitudes to mental health in the UK have changed since the 1959 Mental Health Act.
• How significant mental health problems can affect individuals and wider society.

What is mental health?

Mental health is about more than “not having a disorder”. It includes how you think, feel, cope with stress, form relationships and manage everyday life.

A person can have good mental wellbeing while still facing difficulties, and someone may have a diagnosis but be coping well with support. This is why psychologists often avoid a simple “ill or well” view.

Ways of defining mental health

There are several ways mental health can be defined:

• Absence of mental illness: a person is mentally healthy if they do not meet the criteria for a mental health disorder.
• Positive wellbeing: a person has self-esteem, emotional balance, purpose and satisfying relationships.
• Ability to function: a person can manage everyday demands such as school, work, sleep, hygiene and relationships.
• The mental health continuum: mental health is seen as a range, not a fixed category.

The mental health continuum

The mental health continuum places people somewhere between positive mental wellbeing and severe/significant mental health problems. It is useful because it shows that mental health can change over time.

For example, a student may usually cope well, then move towards “struggling” during exams, then return to better wellbeing after rest, support and reduced pressure.

Prevalence and incidence

You need to understand two key measurement terms.

A simple way to remember it:

• Prevalence = how widespread it is.
• Incidence = how many new cases occur.

Current prevalence of mental health problems

Statistics vary depending on the survey, age group, questions asked and definition used. For GCSE, focus on the overall patterns rather than memorising too many exact numbers.

Useful current patterns include:

• Around 1 in 4 adults in the UK are often estimated to experience a mental health problem in a given year.
• Around 1 in 6 adults in England report symptoms of a common mental health problem, such as anxiety or depression, in a typical week.
• NHS England data for children and young people has shown high levels of probable mental disorder: in 2023, around 1 in 5 children and young people aged 8 to 25 had a probable mental disorder.

Differences by age

Mental health problems can occur at any age, but patterns differ:

• Children and teenagers may show anxiety, low mood, eating difficulties, self-harm or school refusal.
• Young adults often show high rates of anxiety and depression, partly because of transitions such as exams, work, university, relationships and independence.
• Older adults may experience depression, loneliness, bereavement, dementia-related difficulties or anxiety linked to health and isolation.

Differences by gender

Gender patterns are not identical for all disorders.

• Females are generally more likely to report anxiety and depression.
• Young women and teenage girls have shown particularly high rates of emotional problems in recent UK surveys.
• Males are less likely to seek help for some mental health problems and are more likely to die by suicide.

Differences by sexual orientation

People who identify as lesbian, gay, bisexual or another minority sexual orientation often show higher rates of mental health problems than heterosexual people.

This does not mean sexual orientation causes mental illness. A better explanation is often minority stress: extra stress caused by prejudice, bullying, discrimination, fear of rejection or lack of acceptance.

Incidence over time: has mental health changed?

It can look as if mental health problems have increased over time, especially among young people. However, you must be careful: changes in statistics can be caused by several things.

Changing classification

A classification system is a formal system used to organise and diagnose mental health disorders. Two important systems are the DSM and the ICD, though you do not need A-level detail here.

When classification changes, incidence and prevalence figures can change too. This may happen because:

• a disorder is renamed;
• symptoms needed for diagnosis are changed;
• several diagnoses are merged;
• a behaviour is no longer classified as a disorder;
• professionals become better at recognising a problem.

For example, homosexuality used to be treated as a mental disorder in some classification systems, but it is no longer classified that way. This reflects a major change in scientific understanding and social attitudes.

Similarities and differences over time

Some things have stayed similar:

• Anxiety and depression have remained common mental health problems.
• Severe disorders affect a smaller proportion of the population.
• Poverty, trauma, discrimination and social isolation remain risk factors.

Some things have changed:

• People are more likely to talk openly about mental health.
• Children and young people are more often screened and referred.
• Treatment has moved away from long-stay institutions towards support in the community.
• Online life and social media may create new pressures, although they can also provide support.

Changing attitudes since the 1959 Mental Health Act

Before the mid-20th century, people with significant mental health problems were often placed in large psychiatric hospitals, sometimes for long periods. Mental illness was heavily stigmatised, and patients often had limited rights or independence.

The Mental Health Act 1959 was important because it helped shift UK attitudes and services away from “asylum” care and towards treatment as part of ordinary health and social care. It encouraged more voluntary treatment and support outside hospital.

Since then, attitudes have continued to change:

• Mental health is discussed more openly in schools, workplaces and the media.
• Campaigns have challenged stigma and encouraged help-seeking.
• Legal protections, such as equality law, aim to reduce discrimination.
• NHS services include GPs, talking therapies, crisis teams and community mental health teams.

Effects on the individual: stigma and discrimination

Stigma

Stigma can affect people before diagnosis because they may fear being judged. This can stop them telling family, friends, teachers, employers or doctors what is happening.

After diagnosis, stigma can continue. Other people may treat the diagnosis as the person’s whole identity, rather than seeing them as a full person with strengths, preferences and goals.

Effects of stigma may include:

• shame and low self-esteem;
• hiding symptoms;
• delay in seeking help;
• isolation from friends or family;
• self-stigma, where the person starts to believe negative stereotypes about themselves.

Discrimination

Discrimination is the action that can follow stigma.

Before diagnosis, a person may be treated unfairly because their symptoms are misunderstood. For example, depression might be seen as laziness, or anxiety might be seen as being rude or difficult.

After diagnosis, discrimination might include:

• being excluded from social activities;
• being bullied or mocked;
• being treated unfairly at school or work;
• being denied responsibility or opportunities;
• not being taken seriously when reporting physical health symptoms.

Effects on wider society

Significant mental health problems do not only affect the individual. They can affect families, communities, workplaces and public services.

Wider effects may include:

• increased demand for NHS services, including GPs, therapy, medication, crisis support and hospital care;
• pressure on families and unpaid carers;
• absence from school or work;
• reduced productivity;
• increased need for benefits, housing support or social care;
• links with homelessness, substance misuse or contact with the criminal justice system for some vulnerable people.

Care in the community

Care in the community can be positive because it allows people to stay connected to family, education, work and ordinary life. It can support independence and reduce the harms of long-term institutional care.

However, it only works well if services are properly funded and coordinated. If support is too limited, people may experience crisis, repeated hospital admissions, homelessness or pressure on families.

Applying this topic in GCSE answers

For AO1, you should be able to describe key terms such as mental health, continuum, prevalence, incidence, stigma, discrimination and care in the community.

For AO2, you may need to apply these ideas to a scenario. For example, decide whether a person is experiencing stigma or discrimination, or explain where someone might fit on the mental health continuum.

For AO3, you may need to evaluate definitions, statistics or social responses. Strong evaluation often says that statistics are useful but affected by classification changes, reporting differences and social attitudes.