The proportion of people in England with poor mental health has risen sharply over the past 30 years, according to England's most robust national mental health survey. While in 1993 15% of 16- to 64-year-olds surveyed were found to have an anxiety disorder or depression, this reached 23% in 2024.

The Adult Psychiatric Morbidity Survey (APMS) is the longest running mental health survey series in the world. It began in 1993 and has published five waves of data since. The survey series is commissioned by NHS England and conducted by the National Centre for Social Research, alongside the University of Leicester and City St George's, University of London.

The findings from this series are our best barometer of trends in the nation's mental health because of the quality of the survey samples and the rigour of the mental health assessments. Each wave, a random sample of addresses are invited to take part. By drawing from the whole population, and not just those in contact with health services, we can examine population change.

Around 7,000 adults aged 16 to 100 took part in the most recent survey. The detailed, at-home interviews asked participants questions from the Revised Clinical Interview Schedule (CIS-R) - a detailed mental health assessment tool with over 130 questions.

This recent survey revealed many things about the state of mental health in England. While it's clear the prevalence of several mental health conditions have risen this century, there are also signs that access to mental healthcare has also increased.

A quarter of 16- to 24-year-olds in this latest survey had a common mental health condition - the highest level observed since the APMS series began. An upward trajectory was also evident for rates of self-harm.

Evidence from a sister survey we conducted suggests that for young people, the Covid pandemic had a sustained effect on mental health. However, both surveys show the upward trend in young people's poor mental health predated the pandemic.

Although concerns have been linked to social media, evidence for this as a key causal factor is weak. There's likely multiple causes: environmental, social, economic, technological and political changes may all play a part.

Generalised anxiety disorder is now one of the most prevalent types of mental health condition in England - present in one in 12 adults. The condition is characterised by feelings of stress or worry that affects daily life, are difficult to control and which have persisted longer than six months.

The proportion of 16- to 64-year-olds meeting generalised anxiety disorder criteria also doubled since the series began - from 4.4% in 1993 to 8.5% in 2023-2024. The steepest increase was seen in 16- to 24-year-olds - with prevalence rising from just over 2% in 1993 to nearly 8% in 2024.

The survey also confirmed that people struggling financially and those with a limiting physical health condition (such as asthma, cancer or diabetes), were particularly at risk of experiencing poor mental health. About 40% of people who were unemployed had depression or an anxiety disorder.

The survey also revealed area-level disparities, with common mental health conditions being more prevalent among those living in the most deprived fifth of neighbourhoods. In these areas, 26% of people had a common mental health condition - compared with 16% of those living in the least deprived areas.

Regional disparities emerged as well - with people living in more deprived regions of England experiencing worse mental health. Around 25% of adults in the East Midlands and the north-east had a common mental health condition - compared with around 19% of people living in the south-west and 16% of those in the south-east.

Likelihood of receiving mental health treatment varied between groups. People aged 75 and over were the least likely to receive treatment compared to people from other age groups. This could partly stem from lack of help-seeking.

Ethnic inequalities were also observed, with people from Asian or black backgrounds less likely to receive treatment compared to people from white backgrounds. Ethnic disparities in treatment access have also been noted in linked primary care data - disparities which may also have worsened during the pandemic.

Persistent treatment inequalities have been attributed to problems with recognition and diagnosis of symptoms in people from ethnic minority backgrounds by healthcare workers. Cultural variations in expressions of distress may also be missed in consultation processes - affecting whether or not treatments are offered.

A decade ago, the survey found that among people with a common mental health condition, women were around 1.58 times more likely than men to get treatment.

This difference was no longer evident in the latest results. It may be that mental health services have become better at recognising and responding to mental health need in men, or that reduced stigma around mental health has meant more men are seeking help.

The proportion of people with depression or an anxiety disorder receiving mental health treatment - either in the form of prescription medication or psychological therapy - has increased substantially since the survey began.

Between 2000 and 2007, one in four people with a common mental health condition received treatment. This increased to 39% in 2014 - and nearly half in the latest survey. The increase was evident for both psychological therapies (rising from 10% in 2007 to 18% in 2024) and prescription medication (rising from 20% in 2007 to 38% in 2024).

The APMS has been conducted with consistent methods over decades, using the same robust mental health assessments with large, random samples of the population. This means the results are largely not affected by changes in levels of mental health awareness or stigma, and changes in levels of diagnosis or service contact.

As such, this gives us confidence in the figures: that mental health in England really is getting worse, and that access to mental health treatment among people with a condition has increased.

It will now be important for future research to consider what are the drivers of change in population mental health, and how we can improve mental health care for all.