Prevention is the only way lasting change can be achieved

17 February 2016

Prevention was the public’s number one priority for NHS England’s Mental Health Taskforce in its public engagement stage. In this and a series of blogs, I will be analysing how far the Taskforce report – The Five Year Forward View for Mental Health – delivers, and where there are opportunities to drive prevention over the next five years. 

In our first response to the report, we have highlighted recommendations for: 

  • a prevention concordat and local mental health prevention plans
  • a 10-year mental health research strategy
  • an equalities champion across health and social care systems and government
  • strategic leadership for people with lived experience through co-production.

Concordats and alliances

Public Health England is to lead the development of a prevention concordat. This will draw on learning from the Mental Health Crisis Care Concordat, but needs to have a different approach. Concordats bring together a range of stakeholders to agree what change needs to be achieved and then gets the main players to sign up to deliver specific actions.

Often, we look to the health sector to resource and have all the solutions around mental health. However, as the Taskforce makes clear, 75% of people experiencing mental health problems are not using health services. This may be due to stigma, inadequate provision and people using their own resources to manage their mental health. 

The causes, impacts and solutions around mental health issues are to be found outside of the health sector: in schools, workplaces, communities and housing. Prevention in these settings can support people who are struggling, and support them earlier. The Prevention Alliance was convened by Public Health England last year. Its membership embodies the diverse range of organisations we need to work together to advance prevention – most of whom are outside of the traditional mental health sector. Involving people with lived experience of mental health problems and communities is crucial as they often know what will make a real difference. We look forward to contributing to the development of the Prevention Concordat and the evolution of the Prevention Alliance.

The focus on creating mentally healthy communities could be ground breaking. Health and wellbeing boards will address mental health in their Joint strategic needs assessments (JSNAs) using locally sourced information (advanced through a five-year data plan) so that they tailor prevention to the mental health priorities and assets of their communities. The JSNAs will be used to develop local mental health prevention plans to drive commissioning for prevention. 

Innovation in devolution areas, particularly those that are prioritising mental health, will be crucial. Likewise, the innovation of voluntary and communities groups needs to be at the heart of this prevention agenda, resourced to scale within health and social care. The work of the Mental Health Providers Forum illustrates the scope of contribution. There is a focus on digital innovation to deliver effective mental health interventions and increase accessibility and choice, which I’m particularly interested in given the Mental Health Foundation’s early adoption of e-mental health through Be Mindful

The forthcoming mental health summit organised by the Local Government Association and Public Health England in March will be an important moment to advance local action on prevention. Public Health England commissioned the Mental Health Foundation to draw together evidence of what works in prevention, which we will publish at the summit.

10-year research strategy

The intention to develop a 10-year mental health research strategy by next year is an exciting prospect. I’m pleased that the credible Roadmap for Mental Health Research in Europe study (ROAMER) will underpin the strategy. I’ll be advocating for public mental health research to be a discrete and substantial component, and prevention a cross-cutting theme. 

Maternal mental health

As a member of the Maternal Mental Health Alliance, supporting the Everyone’s Business campaign, the investment in evidence-based specialist maternal mental health services is a huge win. Let’s take a moment to celebrate!

But as well as specialist clinical services we need to innovate peer support and self-management approaches for mothers and their families such as the Mental Health Foundation’s Mums and Babies in Mind, Young Mums Together and Creating Connections programmes.

Challenging mental health inequalities

Likewise, we have long campaigned for inequalities, discrimination and stigma to be addressed. Commitments to promote equality and equity run throughout the Taskforce report. There is a welcome recognition that mental health problems disproportionately affect people living in poverty, those who are unemployed and who already face discrimination.

Given the Mental Health Foundation’s work on later life, dementia and learning disability we are disappointed that these equality issues are amongst the weakest aspects of the report. There must be an early appointment of the new equalities champion by the Department of Health and a clear programme of work with measurable deliverables.

We want this champion to not only to address the populations that are covered by the Equality Act 2010, but also people experiencing poverty and people who have complex needs such as homeless people. 

Physical health needs

The physical health needs of people with mental health problems, particularly those diagnosed with serious mental illness receive substantial attention. The scandal of early death due to so-called co- and multiple-morbidities will finally be addressed.

Likewise the mental health needs of people with long-term conditions are a welcome focus in the Taskforce report. Both of these are major prevention agendas and so I will be keeping an eye on how prevention is integrated into the new care pathways (timetabled in the report). 

Employment

A lot of the Taskforce’s employment focus is on supporting people with mental health problems into sustained work. This includes investment in individual placement and support services, psychological therapies; and recognition of the need to address the many failings of the work programme for claimants with mental health problems within the next tendering process.

However, I’m particularly interested in the Taskforce’s comments on supporting people who are already employed to remain in work and return to work after sick leave.

Creating a mentally healthy workplace for all staff working across the NHS is on the table with plans to support and measure progress. These plans must be drawn together to develop psychologically informed environments using a whole workplace approach.

Healthy relationships

The Mental Health Foundation has outlined a clear agenda for prevention in our strategy, A New Way Forward. There is a strong evidence base for preventing mental health problems as illustrated by our overview of the public mental health research landscape.

There are promising approaches at all stages of the life course: family formation, children and young people, working age and later life. Like us, the Taskforce recognises that mentally healthy relationships across the life course are what we all want: in our families, communities, schools, workplaces and services. This will be the theme of the next Mental Health Awareness Week running 16-22 May

The Taskforce describes its work as the start of a 10-year agenda. After many months waiting for publication, it is great to have the report published. I am keen to get going on implementation and in the coming weeks I will be blogging on key aspects of the Taskforce report.

I believe in the transformative power of prevention for people with mental health problems and our whole society. We all need to advocate for prevention to be fully integrated into The Five Year Forward View for Mental Health.

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