Dr James Higgins knew he saw a lot of depressed patients at his surgery in Brinnington in Stockport, Greater Manchester. But it was only upon learning the area had the highest prevalence of depression of anywhere in England (23.6%, compared with an average of 9.8%) that the GP decided to do his own calculations.

He looked back on every consultation in the previous six weeks. Of the 123 adult patients through his door, 24% were actively asking for help with depression, a further 28% were already being treated for the condition and 16% had previously had it. “Only 31% had never been depressed,” he said, slightly surprised at his own findings.

Brinnington’s position at the top of the depression league may be surprising to someone just looking at a map. Situated on a hill just outside Stockport’s rapidly gentrifying town centre, it is sandwiched between the M60 motorway and Reddish Vale country park and is on the railway line into Manchester, with excellent transport links and access to acres of green space.

But for some of the regulars at Brinnington’s community art group for people with anxiety and depression, the statistic hardly raises an eyebrow.

“I can believe it,” said Wendy Dutton, 46, who uses a wheelchair and has arthritis, fibromyalgia, labyrinthitis, hernias, chronic fatigue and irritable bowel syndrome, as well as depression, anxiety and Asperger’s. “This is where you go when you’ve got nowhere else to go. The council put you here. It’s always been that way.”

Just over half of all homes in Brinnington are social housing, with 47.5% of the population living alone. Dutton was given a council house 17 years ago after her former husband kicked her out and she ended up sleeping on a park bench.

Q&A What is the London versus … series? Show Hide London plays a crucial economic, political and cultural role in the UK. It is home to one of the world’s busiest financial centres, the royal family, parliament and some of the best museums on the planet. But that domination has come at a cost. To many living outside it, London has become more of a distant city-state than a capital, increasingly disconnected from the rest of the country. In the devolved nations of Scotland, Wales and Northern Ireland, voters can elect representatives who put their countries first. Londoners sometimes argue they deserve a special deal. After all, London paid an average of £12.7bn a year more in taxes than it received in public spending in the decade up to 2014, subsidising most of the rest of the country. And while life in London might be easy for the oligarchs who have bought up Mayfair, it is a struggle for many. Yet while rail passengers in the north of England and Cornwall still judder to work on 35-year-old Pacer trains, Londoners will soon be able to get around even quicker on the £17.6bn Crossrail. This series explores how the rest of England has been left behind. It will expose how some of the poorest people pay the most for public transport, the north-south divide in health and how cultural institutions have been ravaged by cuts. Finally, it will look at the case for more devolution in England and ask what can be done to bring the country back together at a time when it has never seemed more divided. Helen Pidd



Fourteen per cent of people in Brinnington and Central ward say their day-to-day activities are limited “a lot” because of long-term health problems or disabilities, compared with an average of 8.31% of the English population. The area has the lowest male life expectancy in Stockport at 71.9, compared with 83.7 a few miles away in wealthier Cheadle Hulme South. There is also a disproportionately high number of residents who are long-term sick or disabled (12.1%) and long-term unemployed (4.5%).

Like Dutton, many of Higgins’ patients have multiple physical conditions, which he thinks exacerbates their mental ill health.

Poor bus links on congested roads can stop people seeking specialist help, said Higgins. “Going back at least 10 years, before I joined the practice, patients were referred to mental health services at [the nearest Stockport hospital] Stepping Hill and when we reviewed a whole year of patients, not a single one made it to their appointments,” he said. The solution was to persuade a psychiatrist to come to Brinnington once a month for a satellite clinic.

Shay Ritchie, 44, another participant at the art group, said she had been “so stressed recently” trying to get PIP (personal independence payments) and had recently been transferred to universal credit. “It has been horrendous. I’ve had to go to the food bank because it took five weeks to start the claim. They give you a loan but it doesn’t cover your bills. I had to borrow money off my eldest kids to get by and have been using my Argos store card – it’s like a credit card – to buy food at Sainsbury’s. Sainsbury’s is expensive but it’s the only place I can use the Argos card,” she said.

For Ritchie – who also has fibromyalgia as well as depression and anxiety – poverty and poor health go hand in hand. “I can’t afford to get the healthcare I need. Not everything is available on the NHS. I probably need to go to a chiropractor and an osteopath about my bones, but I can’t afford to go,” she said.

Facebook Twitter Pinterest Higgins says that of his 123 adult patients, 24% were actively asking for help with depression. Photograph: Christopher Thomond/The Guardian

In his nine years at Brinnington health centre, Higgins has also noticed an increase in patients disclosing abuse. “Historic abuse is enormous here – sexual abuse, physical abuse, emotional abuse, neglect,” he said. “Very often when I have patients in their 40s and 50s with chronic pain and depression, they have had terrible upbringing[s], they’ve been horrendously abused in childhood and that is the underlying cause of a lot of the issues … It is no longer surprising when I say ‘tell me about your childhood’ that they report these things. It’s almost the norm,” he said.

There is an oft-quoted statistic that one in four people experience mental ill health, across all income levels and social classes. So why do NHS surgeries in Westminster, one of the wealthiest boroughs in the UK, report such tiny numbers of people with depression? Pride may play a role, thinks Higgins: “If you are very, very rich … you have got to be willing to stand up and say you have a problem. Whereas in Brinnington, where people don’t feel they are perfect anyway, it’s not that big a step to admit that they have got faults. That could partly explain the prevalence here.”

There is also a very strong sense of community, thinks Rachel Glindon, who set up the art group five years ago when she was struggling with depression and realised she had not spoken to anyone outside her house for six months. “There isn’t a stigma up here about being depressed. People help each other,” she said. She doesn’t believe wealthy Londoners are somehow immune from depression. “We just talk about it here.”