To Level Up or Not Level Up

25th Mar 2022
Influencing policies
Public mental health

How the Levelling Up white paper affects public mental health and what needs to happen next

Here, Michael Hough, the Foundation's Public and Policy Affairs Officer, talks about the effects on mental health and what needs to happen next.

Given the current state of world events, it would be understandable if you had already forgotten about the government’s levelling up white paper. News has certainly moved on quickly since the government published its 332-page document last month.

However, the white paper contains important concepts and policies which will be at the forefront of the debate around public mental health and prevention over the coming months and years and needs further consideration.

What is public mental health?

Before considering the white paper, it's useful to set out what we mean by ‘public mental health.’ As a concept, this can sound quite academic, but, simply put it concerns the prevention of poor mental health through preventive work involving communities, organisations, wider society and individuals, and the promotion of mental health across the course of all our lives.

What is in the white paper?

The white paper centres on 12 national missions, all to be achieved by 2030. These include missions directly aimed at the health sector, such as improving well-being in every area of the country and reducing the gap in healthy life expectancy between different areas and regions. These are the missions that would appear to be the ones of most relevance from a public mental health perspective. Several other missions have the potential to affect public mental health, as preventive action is needed across a range of areas. These include commitments to enhancing broadband capacity and developing 'pride in place'.

The white paper also touches on the concept of travel. The importance of transport and subsidised travel cannot be understated. This has been demonstrated to improve social connectedness, reduce the risk of loneliness - our theme for this year's Mental Health Awareness Week, and allow those from all age groups and backgrounds to be positively involved with society, thereby enhancing their mental health and well-being. This is particularly true for those in later life. To benefit those most at risk of poor mental health, subsidised travel on public transport is just as important as improved transport links. There is still a need for further government thinking in this area.

At the moment, the white paper does not include any additional or new funding commitments but instead brings together several schemes announced in previous spending reviews.

How have prominent stakeholders responded?

Reaction to the white paper has been mixed. Labour spokesperson, Lisa Nandy, described the white paper as “smoke and mirrors” and SNP spokesperson Tommy Shepperd suggested it was “frankly insulting.” But not all reaction has been negative. The white paper was tentatively welcomed by several mayors including Labour Mayors Tracy Brabin and Andy Burnham. This support wasn't without some warnings, with both Brabin and Burnham keen to see more detail.

Away from our leading politicians, some in the health sector expressed frustration that the white paper does not go far enough to tackle the health disparities that currently exist in the country. The Health Foundation argued the white paper “has failed to grasp the enormity of the challenge.” It would be fair to say at present there is cautious optimism about some aspects of this white paper, but also a sense that there are areas where it can and should be improved.

What this means for public mental health.

What this all means is that there is no specific mention of public mental health in the white paper, which is disappointing. While there are discussions about policies and issues that directly affect public mental health, this is restricted to schemes that have been previously announced, with limited evidence of new thinking or policies.

This partial focus on mental health is notable, especially given that mental health is a critical factor for realising all the aims of the paper. To achieve its aim of levelling up the country and reducing health inequalities and disparities, the government needs to prioritise mental health at the community level in a way that is sadly absent from this white paper. Instead, the government is putting lots of emphasis on its forthcoming white paper on health disparities, which is due in the next couple of months.

Time will tell whether this will address this omission. To do so, it must include specific proposals for improving public mental health by addressing the structural social and economic inequalities that need to be tackled to genuinely ‘level up’ the circumstances of those living in the most disadvantaged communities, which increase their risk of poor mental health.

What needs to happen next?

For many still facing significant health and social disparities and poor mental health, the need to improve outcomes not just in the health sector but also across other sectors is imperative. While this white paper sets out some notable and creditable intentions, it does not include any real detail on prevention or on public mental health generally.

There is still time for this to change

Over the coming months, the Mental Health Foundation will be working to influence the next stages of this levelling-up white paper and the important white paper on Health Disparities. The work will focus on demonstrating that prevention of poor mental health is not only possible but is also urgently needed, as highlighted in the Mental Health Foundation’s latest report setting out the economic case for investing in prevention. This shows that poor mental health costs the UK economy at least £118 billion per year and sets out the case for all parts of government to invest in well-evidenced and cost-effective prevention programmes.

The Foundation will also be responding to the forthcoming mental health and well-being plan discussion paper. The development of the mental health policy tool, a commitment made in the government’s COVID-19 mental health and well-being recovery action plan, will be crucial in supporting long-overdue mental health in all policies approach across all government departments. Additionally, this work will also be enhanced by an active engagement to convince the government of the importance of considering the impact of all their policies on mental health.

To achieve the necessary improvements in people’s mental health, it is important these various policy strands are brought together in a coherent cross-government programme for prevention and early intervention. But the early signs aren't promising. The Chancellor’s recent Spring Statement failed to announce any new measures for those on Universal Credit or who are reliant on the safety net of the benefits system, meaning that they will not rise in line with inflation. This will have serious and long-lasting effects on many vulnerable people. The government still has a chance to put this right and needs to seize the opportunities of its forthcoming Disparities white paper and mental health and well-being plan to genuinely level up and in doing so deliver the changes that are desperately needed to current policy and resource allocation.

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