With Prevention in Mind

19^th February 2016

Announcing £1 billion increase in funding to mental health, David Cameron rightly said that there needs to be a ‘revolution’ in mental health care. Much of the money the Prime Minister is pledging is to flow into acute mental health services; £250 million for emergency mental health in A&E and £400 million for investment in crisis resolution. Welcome though this increase in spending on pressured mental health services is, the ‘revolution’ he calls for must not only be focussed on acute services. As Gregor Henderson, Director of Wellbeing and Mental Health at Public Health England, says there needs to be a full scale ‘prevention revolution’ in our thinking about mental health services. This revolution needs to take place in schools, work places, community centres, as well as acute wards and psychiatric hospitals.

We know that 50% of mental health conditions have their roots before the age of 14, and as a result schools need to be at the forefront of the ‘prevention revolution’. Programmes should be put in place to identify and help those most at risk; troubled families, young careers and victims of bullying. Projects that increase mental health literacy and awareness among all pupils will also be vitally important. Places like London, Birmingham and Blackburn, where around a quarter of the population is under 20 would be great areas to pilot these schemes.

It is well known that people with troubled childhoods can suffer from mental health problems later in life, but it doesn’t have to be that way. There is nothing deterministic about a troubled childhood damaging the rest of a person’s life. There has been good progress in breaking the perceived necessity of this link already. Future in Mind highlighted the paucity of information regarding meaningful outcomes and outputs of children’s mental health services. Mapping this information can allow us to see what works and how best prevention strategies can be employed. Breaking the link between a troubled upbringing and poor mental health later in life requires knowledge of what successful prevention strategies look like.

In addition to schools developing early prevention strategies, we need to focus our efforts on other times in life we know people are vulnerable to mental ill health. 10-15% of women experience depression or anxiety during their pregnancies and measures to prevent poor mental health in pregnancy will be vitally important. Promoting good practice from employers to reduce employment related stress will be another important part of the prevention revolution. It is estimated that 10.4 million working days are lost to the UK economy each year due to stress, anxiety or depression. Many report a lack of support from management and bullying at work as the cause of this stress and countering poor employment practice will, therefore, also be vital to this prevention revolution.

Ensuring people who are released from hospitals receive adequate follow up is another key part of the prevention revolution. At the moment people can go through an entire stay at hospital, even for serious conditions such as cancer, without much thought being paid to their mental health. Rightly the focus is on curing them physically, but another part of the treatment should be informing them where they can go to seek help afterwards and letting them know that it would be quite normal and acceptable. These are all areas where the prevention revolution can and should be making more progress.

In making his pledge to increase spending on mental health, Cameron became the first British Prime Minister to address mental health in a public speech. Recently there has also been an increase in questions to the Prime Minister about mental health in the Commons. This is encouraging and shows how far we have come in addressing topics often thought shameful and embarrassing. More remains to be done, and in this climate of squeezed public spending and increased pressures on our acute services, it is vital to make the case that we need to look at prevention also. The strategies outlined above need not cost large sums of money, but their benefit to the acute services, as well improving people’s lives, will be substantial.