What can UK governments and others do to tackle anxiety?

Mental health strategies

We call for the development and delivery of 10-year cross-governmental mental health strategies in each of the nations of the UK, with a strong focus on prevention as well as treatment

Good mental health should be the benchmark for a thriving society. We need mental health strategies in each of the four nations of the UK that address all the factors which influence mental health at an individual, family, community, and structural level. This would allow for mental health to be considered across a wide range of local policies, services, systems, and datasets that affect the mental health and well-being of individuals and communities.

These strategies should be wide-ranging, and include action to create safer neighbourhoods, enforce and where necessary pass legislation prohibiting bullying, harassment, and discrimination (including in the online environment), providing well-resourced adult social care and children’s services, providing income supports to reduce financial stress and housing supports to eliminate housing insecurity, investment in community groups that reduce isolation and increase peer support, and promoting good mental health by supporting education settings to increase mental health literacy.

We cannot hope to reduce rates of anxiety and poor mental health without addressing its root causes, including tackling inequality. The illustration below demonstrates how to deliver strategies and tactics at every level to promote good mental health for all.

There is a tendency for governments to focus either on universal campaigns and messages or on targeted interventions for specific at-risk groups. However, both are needed, and they should be adopting a proportionately universal approach. This means ensuring support for everyone, because we all have mental health, but focusing targeted support to address the greater risks that some groups face due to societal inequalities.

Such approaches balance universal action for everyone with targeted action, allocating resources according to levels of need and risk for particular social and economic groups to achieve the greatest gains for the resources available. In our survey, young people, single parents, people who are unemployed and people with long-term conditions emerged as high-risk groups who need targeted action.

What is happening with mental health strategies in each nation?

In England, we are profoundly disappointed that the Government has abandoned its planned 10-year mental health and well-being strategy, in favour of a shorter-term Major Conditions Strategy.^xxvi This loss of an important opportunity to join up work across government to tackle the social determinants of poor mental health must be rectified by the current and future governments.

While it is positive that mental health is included in the Major Conditions Strategy as both a standalone and a cross-cutting theme, it is combining with five other major conditions, so there is a risk it will aim to do too much across too many areas, and will fall short in many of them. It does, however, offer an important opportunity to holistically support people who have both mental health conditions and physical health conditions, such as cancer and heart disease. The government must also ensure that the new Strategy gives mental health - and prevention - equal weight, recognising the increase in demand for mental health support during the pandemic and the pressure that mental health services are under.

In Wales, a review of the current Together for Mental Health Plan is beginning. This needs to be completed as a matter of urgency.

In Scotland, the preparation of a new 10-year mental health strategy is almost complete and due for publication in June 2023. We expect that this new plan will incorporate cross-department action to prevent poor mental health.

In Northern Ireland, a 10-year mental health strategy was published in 2021, and delivery is underway. However, it is currently at risk due to lack of funding.

For all jurisdictions, having robust, cross-departmental delivery and monitoring structures alongside designated funding is important.

Addressing the cost-of-living crisis

Financial strain and anxiety about being able to pay essential bills is prevalent across the UK. We urge governments to take action to mitigate the negative impact on people’s mental health.

For people experiencing poverty and/or financial strain, an important preventative intervention is financial support schemes that alleviate financial stress.

In our survey, 32% of respondents said they had been anxious about being able to pay their bills in the previous two weeks; 40% said that financial security would help prevent anxiety, and this was the highest proportion of any of the solutions offered. Current financial support schemes clearly have not been adequate to prevent financial stress and must be strengthened.

We are backing the Essentials Guarantee campaign being led by The Joseph Rowntree Foundation and The Trussell Trust, which calls for a level of Universal Credit that provides claimants with enough income for life’s essentials. This is at least £120 per week for a single adult and £200 per week for a couple.

Also in our survey, 20% of respondents identified debt as the reason for their anxiety, underscoring the need for adequate debt relief schemes. One study found that having an additional-debt account paid off reduces the likelihood of exhibiting anxiety by 11%.^xxvii We are calling for adequate debt relief schemes for those who need it, as set out in our briefing paper on the cost-of-living crisis and mental health.

Ensure that frontline workers know how to respond effectively to the mental health effects of financial stress and strain.

Frontline workers have regular contact with individuals who may be experiencing mental distress due to financial stress. It is important to ensure that this communication is a supportive experience for people and does not stigmatise or cause distress.

We are calling for the Government and private sector organisations to ensure all frontline workers in contact with people experiencing financial distress receive relevant training to be able to sensitively respond and signpost to support. This should include frontline workers in health, social care, money and debt advice services, and antipoverty and other community organisations, as well as energy companies, water and telecoms services, and private financial services companies. Our partner Mental Health at Work is an organisation which can provide appropriate training.

Support community social networks, resources, and resilience. We recommend fast-track access to funding to sustain and grow grassroots organisations or initiatives that are likely to support them, and action to make social media and the online environment safer.

Efforts should focus on building up people’s assets, rather than only focusing on their needs and problems. Assets are strengths that are identified as valuable to a community or family and can be used to make positive changes to their lives. Assets can be physical resources (land, money, buildings), but, more often in public health, assets tend to be psychosocial, such as self-esteem, confidence, knowledge, skills, social networks, and collective value.^xxviii There is some evidence that asset-based approaches at the community level can improve mental health outcomes such as self-esteem and social isolation.^xxix

Investing in cost-effective support

We all need support to live well. We urge national governments, local authorities, and others to commit to programmes and interventions that promote improved relationships and better mental health at home, at work, in education settings, and in communities.

Implement at scale programmes and approaches to improve the culture and environment in which people grow, learn, live, and work.

UK Governments should ensure provision at scale of well-evidenced programmes to improve emotional and mental well-being and relationships and help prevent the development of mental health problems, including persistent anxiety. These include cost-effective programmes that can create more positive, supportive cultures in which children, young people and adults are living and working, in the family and in workplaces:^xxx

• Providing evidence-based parenting programmes for the whole population and for those where a specific need for parenting support has been identified.
  Such programmes can help infants, children, young people and their parents to thrive within families.^xxxi In our survey, 23% of respondents cited loneliness as a source of anxiety and 18% cited relationship(s) with family member(s).
• Encouraging employers to provide access to brief psychological support in the workplace for those who need it, alongside actions to change workplace cultures so that they promote and protect mental health, in particular improving the knowledge of line managers and workers risks for mental health.^xxxii
  In our survey, 46% of respondents said they wouldn’t tell their employer about their anxiety, and 33% said they didn’t think their colleagues at work would be sympathetic if they told them they were anxious. Further, 21% said that less pressure at work and 14% said more flexibility at work would help their anxiety.
• Ensuring consistent implementation of the Whole School Approach to mental health and well-being in all primary, secondary, and further education settings.
  This approach should include the provision of well-evidenced anti-bullying programmes.^xxxiii

Uncertain times: Anxiety in the UK and how to tackle it.

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Download the full report (PDF)

xxvi - Written statements - Written questions, answers and statements - UK Parliament. https://questions-statements.parliament.uk/written-statements/detail/20….
xxvii - Ong Q, Theseira W, Ng IYH. Reducing debt improves psychological functioning and changes decision-making in the poor. Proc Natl Acad Sci U S A. 2019 Apr 9;116(15):7244-7249. doi: 10.1073/pnas.1810901116. Epub 2019 Mar 25. PMID: 30910964; PMCID: PMC6462060.
xxviii - Lindström B, Eriksson M. A salutogenic approach to tackling health inequalities. In: Health Assets in a Global Context: Theory, Methods, Action. Springer New York; 2010. p. 17–39.
xxix - NHS Health Scotland. Asset-based approaches to health improvement. NHS Scotland. 2011.
xxx - McDaid, D, Park, A (2022) The economic case for investing in the prevention of mental health conditions in the UK, London: Mental Health Foundation.
xxxi - Doyle O, Hegarty M, Owens C ‘Population-Based System of Parenting Support to Reduce the Prevalence of Child Social, Emotional, and Behavioural Problems: Difference-In-Differences Study’, Prevention Science: the Official Journal of the Society for Prevention Research, 01 Aug 2018, 19(6):772-781.
xxxii - Matrix Insight. Economic analysis of workplace mental health promotion and mental disorder prevention programmes and of their potential contribution to EU health, social and economic policy objectives. Brussels: Executive Agency for Health and Consumers; 2013.
xxxiii - Fraguas D, Díaz-Caneja CM, Ayora M, Durán-Cutilla M, Abregú-Crespo R, Ezquiaga-Bravo I, Martín-Babarro J, Arango C. Assessment of School Anti-Bullying Interventions: A Meta-analysis of Randomized Clinical Trials. JAMA Pediatr. 2021 Jan 1;175(1):44-55. doi: 10.1001/jamapediatrics.2020.3541. PMID: 33136156; PMCID: PMC7607493.