Public Health England, in collaboration with the LGA, held their annual Public Mental Health Summit last Wednesday, on the theme of Maintaining Momentum. With keynotes and workshops delivered by a range of prominent people working in the sector, including Norman Lamb MP, councillors and mental health professionals, the day was packed with inspiring stories and practical advice.
Lots of progress has been made in the UK over the last few years in the field of mental health. The recognition of ‘parity of esteem’ between mental and physical health services has been one of the major breakthroughs. But there is still much further to go. NHS funding constraints, difficulty measuring outcomes and attributing success to specific interventions, and a lack of joined-up thinking are among the challenges still to be surmounted.
In the context of an uncertain funding environment for health and social care, with obvious consequences for mental health in particular, Norman Lamb called for a ‘Beveridge Report for 21st century’ – a cross-party investigation into the future of the NHS and social care. There was also talk of the opportunities afforded by data – to track outcomes, identify risk factors, and assess local need – with the National Mental Health Intelligence Network (NMHIN) leading on much of this work.
1.36% of the public health budget goes to mental health – Mind
23% of the disease burden relates to mental health – Government
MRC spends 3% of its budget on mental health research – Department of Health
1 in 4 people experience a mental health problem each year – Mind
People with severe mental health problems die on average 20 years younger than the rest of the population – Mind
62% of people approaching the Citizen’s Advice Bureau with debt issues have mental health problems – CAB
68% of people suffering domestic violence present with clinical depression – Corporate Alliance Against Domestic Violence
What can local government do?
Become a Mental Health champion.
There was a call for local authorities to sign up to the Time to Change pledge to end mental health discrimination, as well as to designate a Mental Health Champion in every council. Similarly, those working in local government were asked to encourage their council as well as businesses in their area to sign up to the Workplace Wellbeing Charter.
Recognise the importance of employment.
Having a stable job that you enjoy means you feel financially secure and that your work is valued. This usually correlates with better mental wellbeing. But getting into employment is not always easy for those who have been out of work due to mental health problems, and employers often struggle to know how to support them once they’re there. Breaking down misconceptions, and training line managers in mental health first aid, signposting and back-to-work plans, are areas in which local authorities can provide assistance. David Caldwell from Barclays discussed an employee-led mental health awareness campaign within Barclays, called This Is Me, that has reduced the stigma around admitting you are struggling with mental health problems.
Adopt a ‘whole system’ approach.
It is important not to leave mental health service provision purely within the remit of the health authorities. There should be ongoing collaboration between and referrals across all local authority departments – jobs, criminal justice, housing, education, etc. – as part of a preventative strategy. Providing practical support on issues like housing and personal finance can contribute to better mental health outcomes indirectly by reducing stress. Jenny Edwards, CEO of the Mental Health Foundation, advocated a lifecycle approach to planning, ensuring the risk factors at every stage of life are addressed, from perinatal support, through school and workplace, to elderly care.
Acknowledge the link between physical and mental health.
Poor mental health has been proved to hinder recovery from a physical illness, whether the mental illness was caused by or unrelated to the physical condition. Equally, poor mental health often leads to below average physical health and fitness, and consequently lower life expectancy and higher morbidity. Recognising this link is important if we want to design a joined up system of physical and mental health care.
Know your patch.
Which organisations are working in your area? Where are the gaps in provision? What specific needs do people in your area have? Engage all organisations working in the space – social carers, voluntary sector, primary care workers, emergency services, etc. Make use of data to inform your activities, find out where the need is greatest, profile risk factors, and see where your interventions are working. Cllr Jacqui Dyer, Co-Chair of Lambeth’s Black Health and Wellbeing Board, spoke of the need to know your area. In her work, the first challenge she must address is that people often don’t realise they have a problem, so before any practical support can be given, they must help to improve ‘emotional literacy’.
Provide a range of services, not just clinical.
Having adequate medical pathways for mental health is essential, but we must recognise that many non-clinical interventions can also be effective, both for prevention and treatment. As such, things like arts and culture organisations (see Julia Slay’s blog The Art of Commissioning) and the ability to signpost to other local authority departments are important tools as well. Helping to build the link between clinical and community-based support is also key – for instance, informing GPs where they can refer people, if not to a psychiatrist or psychologist. Councils can also leverage their commissioning position to write contracts supporting mental health outcomes across a range of services. Speakers at the conference were keen to point out that lots of people are interested in working within mental health, so councils can make the most of this enthusiasm.