public mental health and wellbeing
TRANSCRIPT
The Public’s Mental Health
Sheffield’s Health and Wellbeing Board 25 June 2015
Gregor HendersonNational LeadWellbeing and Mental HealthPublic Health England
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Public Health England‘Protecting and improving the nation’s health
and addressing health inequalities’
A Government Executive Agency. Part of the Department of Health.
Key Functions:
• Health Protection
• Knowledge and Information (CKO)
• Health Improvement (Health and Wellbeing)
5000 staff, £5bn annual budget (subject to continuing efficiencies)
National HQ, 8 Local PHE Centres, Plus London PHE.
Public Mental Health
Mental Health Promotion
Improving lives –
recovery and inclusion
Mental Illness and
suicide Prevention
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Mental Health in PHE• Part of new Equity and Mental Health Division
• Identified as a key underpinning theme, alongside addressing inequalities and adopting community centred and asset based approaches.
• To be included in all PHE’s health improvement priority areas – smoking, obesity, alcohol, children, dementia.
• Includes promotion of mental wellbeing across the life course, prevention of mental illness, suicide prevention and improving the lives of people living with and recovering from mental illness
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Public Mental Health in PHE• National Public Mental Health Team
• Mental Health and Suicide Prevention leads in all PHE Centres
• Health Protection, Psychological Resilience Function and National Team
• National Mental Health, Dementia and Neurology Intelligence Network
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Why Mental Health?• Vital to community, neighbourhood, family and individual health and
wellbeing
• Essential as part of overall approach to addressing inequalities
• Important key component for overall health and wellbeing, going beyond and complementing the treatment of illness (mental and physical)
• Crucial to seeing mind and body links in health, wellbeing and living with illness and long term conditions, disabilities, distress (eg diabetes, cancer, heart disease)
• A key part of the ‘shift to prevention’ agenda – and to reducing demand on acute and community NHS services and sustaining recovery (NHS England 5 Year Forward View)
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Why Mental Illness?• Mental illness / ‘dis’orders account for over a
quarter of the total ‘burden’ of illness
• Significant economic and social costs (national circa £110bn per annum)
• Continuing stigma, discrimination and inequality
• Poorer outcomes in terms of Jobs, Homes, Friends, Income, Health, Quality of life, Mortality
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What Helps? 1. Good Data and IntelligenceNational Mental Health, Dementia and Intelligence Network
• Local mental health profiles
• Local suicide profiles
• Data tools
• Key Topics Briefings
• JSNA Tool – in development
2. Workforce and Leadership
PHE ACTION PLAN calls all partners to take action on:
Applying, and testing, the principles and competencies to different workforces – Competencies and Capabilities
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Aim of the planTo inform and influence the development of public health leadership and workforce development, in order to:
build the capacity and capability of leaders and a workforce that is confident, competent and committed to:
– Promoting good mental heath across the population;
– Preventing mental illness, suicide and self-harm;
– Improving the quality of life and healthy life expectancy of people living with mental illness;
– Tackling inequalities and improving the wider determinants of wellbeing and mental health;
The overall recommendation is for partners responsible for workforce development, including leaders, commissioners, providers, managers and professional bodies, to use the competencies and priorities to guide action within their work plans.
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Core Principles
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3. Community Approaches and Assets
Working with communities – empowerment, evidence and learning
A PHE and NHS England project to draw together and disseminate existing evidence and learning on working with communities and supporting community-centred health and wellbeing interventions.
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VisionA central resource and effective networks on community-centred approaches to health and wellbeing that are used, supported and sustained by individuals and organisations with an interest in improving health and wellbeing.
Good access to evidence and learning through a knowledge portal combined with strong collaborations will help grow and strengthen effective working with communities, within a whole-of-society approach to health.
Working with communities – empowerment, evidence and learning
Guide & family published Feb 2015
2015/16 Evidence into action• Embedding across PHE priorities• Application of family to practice• Development of knowledge portal• Asset based approaches• Communication and dissemination
2014/15 PHE and NHS England project to draw together and disseminate existing
evidence and learning on working with communities
System leadership Good access to evidence and learning
combined with strong collaborations will help grow and strengthen effective working with
communities
Community-centred approaches
Building confident and connected communities is an important route to improve health and reduce the health
gap
4. Addressing Inequalities
• Health and health equity in all policies (working with key stakeholders ADPH, LGA)
• Key tools and resources to support local action on health inequalities on range of issues (from parenting to workplace health)
18 Stakeholder Forum 21 January 2015
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5. Evidence of What Works and What looks PromisingPopulation Approaches
• Mental Health and Mental Illness Literacy – improving public understanding, awareness and action
• Reducing stigma and discrimination
• Mental health in all policies – mentally healthy communities, green space
• Actions in primary care – social prescribing, integrated wellness services
• Suicide prevention – local plans, surveillance, audits, multi-agency response, services
• Alcohol – Minimum Unit Pricing
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Evidence ContinuedLife Course
• Early Years – perinatal mental health, family and parenting support
• Children and Young People – schools and education, adolescence, transitions
• Adults – work, working life, employers, culture and recreation
• Older life – reducing social isolation, preventing depression, dementia
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Evidence – people with mental illness• Improved physical health – integrated (ie Diabetes)
• Smoke free mh units – targeted smoking cessation
• Employment
• Housing
• Debt
• Shift from diagnosis to ‘functioning’
• Improved services – access, quality and design
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ChallengesDespite,
• Increased awareness and growing commitment……..
We still see,
• Discussion dominated by mental illness and often pejorative (burden, costs etc)
• Any ‘new’ investments targeted at downstream services (ok, but where is prevention?)
• Low understanding of good ‘mental health’ and its benefits to overall health and wellbeing and other significant public and social outcomes
• Low investment in promotion and prevention
• Poor evidence of real embedding and integration into physical health, public health and vice versa
• Major social determinants remain the biggest challenge (austerity, poverty, housing, employment, education, inequality, discrimination, race, sexuality etc….)
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Going Forward – what might help• Mental Health as an integrated element of local
planning, strategy and action (Data and Intelligence)
• Shift to a social model and a focus on psycho-social health
• Integration of mental and physical health in all aspects of local planning, commissioning and delivery
• Community approaches, building on assets
• Shift to ‘wellness’
• Evaluation and Evidence (What Works for Wellbeing)
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What Works Centre for Wellbeing
www.whatworkswellbeing.org
Employment and learning, Communities, Culture and Sport.
Measurement, data, indicators, definitions
Overarching Mental Health Measures (taken from the NMHIN profiling tools)
Excess under 75 mortality in adults with severe mental illness: SMR
Emergency admissions for intentional self harm: directly aged standardised rate
Depression Data
Children and Young People Data
Wellbeing Data
Self reported wellbeing (ONS measure) within deprivation decile
Suicide Prevention Profile
Suicide data: note – female age group rates are the regional value in which he local authority resides
County Durham
Cost-effective interventions (LSE, 2011)
Health Visiting and reducing post-natal depression - for parental and child mental wellbeing, quality of life and productivity;
Parenting skills and support - for maternal and child mental wellbeing; £8 saved per £1 invested over 25 years; 3:1 public sector;
Healthy schools including social & emotional learning programmes and reducing bullying - for young people’s education, wellbeing and reduced crime and service costs; SEL savings £10,000 per child after 10 years; bullying prevention saves £1000 per pupil;
Debt advice - to increase financial security, reduce mental illness and worklessness; £3.40 savings per £1 invested;
Promoting wellbeing in the workplace - to improve productivity and reduce worklessness; £9 savings per £1 invested;
Befriending for older people - to reduce isolation and service costs;
Timebanking - to increase inclusion, independence, social networks and employment; £3 savings per £1 invested;
Community navigators - to improve service usage and reduce vulnerability; £2 saved per £1 invested;
Alcohol Brief Interventions - to improve health and reduce costs of services and crime; £12 saved per £1 invested;
Health and wellbeing – what influences it? Meta analysis: comparative odds of decreased mortality
Source: Holt-Lundstad et al 2010
Wellbeing Matters…….to health•Wellbeing is associated with a 19% reduction in all cause mortality in healthy populations (29% reduction in CVD mortality)
•Subjective wellbeing can add 4-10 years to life
•Survival of more than 9 years is associated with enjoyment of life in older adults
•Wellbeing can protect against developing illness, aid recovery and survival
•Wellbeing is associated with (and underpins) healthy behaviours
•Staff wellbeing impacts the quality of care delivered
•Associated with wider social outcomes – employment, education, relationships, reduced crime
Department of Health, 2014, Wellbeing: why it matters to health policy
Benefits of improving wellbeing includeHealth Benefits:
reduced mental illness and suicide
improved physical health
Improved and sustained recovery
reduced health care utilisation
reduced mortality.
Wider benefits include:
improved educational outcomes, learning and cognitive ability
reduced health risk behaviour such as smoking, alcohol and substance misuse
increased productivity, employment retention and reduced sickness absence
reduced antisocial behaviour, crime and violence
improved social relationships.
higher levels of social interaction and participation in community life
Inequalities - ‘beyond the individual’
‘………levels of mental distress (ill-being) among communities need to be understood less in terms of individual pathology and more as a response to (poverty) relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological well-being’
Dr Lynne Friedli, ‘Mental Health, Resilience and Inequalities.’ WHO Europe 2009
Five Ways to Wellbeing
Commissioned by the Government’s Foresight Project the brief was to
“build on the findings of the outputs of the Mental Capacity and Wellbeing Project, and develop an evidence-based wellbeing equivalent of the health promotion dictum “five fruit and vegetables a day”.
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Wellbeing and Policy (O’Donnell et al 2014)
MENTAL HEALTH AND CHARACTER BUILDING
Treat mental ill-health as professionally as physical ill-health.
Support parents.
Build character and resilience in schools.
COMMUNITY
Promote volunteering and giving.
Address loneliness.
Create a built environment that is sociable and green.
INCOME AND WORK
Promote economic growth.
Reduce unemployment through active welfare.
More wellbeing at work.
GOVERNANCE
Treat citizens with respect and empower them more.
Measure wellbeing and make it a policy goal.
Give citizens the wellbeing data they need.
Public Mental Health and Wellbeing June 2014
All Party Parliamentary Group (2014)Wellbeing in Four Policy Areas:
Focus on stable jobs over growth: More than half the UK workforce are worried about losing their jobs, with disastrous consequences for their wellbeing and productivity – sickness leave alone costs an estimated £100bn a year. Secure, stable employment should be the primary focus of economic policy.
More green spaces in our cities: Planning processes have lost sight of their original mission to improve community wellbeing. Restoring this would transform local areas, with considerable economic benefits – city liveability is a major consideration for big employers, while encouraging residents to take up walking or cycling could save the NHS £675m a year.
Mindfulness training for doctors and teachers: Mental health problems cost the UK economy an estimated £70bn annually. Training new medical and teaching staff in mindfulness techniques would embed a culture of wellbeing in health and education, and reduce a later burden on the NHS by improving the availability of mindfulness-based therapies.
Invest in arts and culture: Wellbeing evidence gives a robust means of measuring the value of non-market goods. Arts and culture play an important part in all our lives, and wellbeing data will help make the case for spending in these areas.
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Some PHE Web linksPublic mental health leadership and workforce development framework
https://www.gov.uk/government/publications/public-mental-health-leadership-and-workforce-development-framework
A guide to community-centred approaches for health and wellbeing
https://www.gov.uk/government/publications/health-and-wellbeing-a-guide-to-community-centred-approaches
Guidance for developing a local suicide prevention action plan https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/359993/Guidance_for_developing_a_local_suicide_prevention_action_plan__2_.pdf
National Mental Health Intelligence Network Website
http://www.yhpho.org.uk/default.aspx?RID=191242
Local Suicide prevention profile tool.
http://fingertips.phe.org.uk/profile-group/mental-health/profile/suicide