A new year, a new start & wellbeing · A new year, a new start for positive mental health & wellbeing. Sharing evidence and good practice from across the public health community

A new year, a new start for positive mental health & wellbeingSharing evidence and good practice from across the public health community

Wednesday, January 27th, 2010 Stobart Stadium, Widnes

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Flourishing individuals, connected communities:

Implications for local strategic planning

Catherine ReynoldsStrategic Lead: Public Mental Health

Liverpool PCT

4

Flourishing Individuals, Connected Communities

• Perceiving• Articulating• Acting

• New Horizons– Population Mental Health & Wellbeing

• Professional• Organisational• Strategic Partnerships

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A way of looking

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Janus

• the gift to see both future and past

• the god of the home entrance (ianua)

• frequently used to symbolize change and transitions such as the progression of past to future, of one condition to another, of one vision to another

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The Clinical Gaze

• In the 1960s the French philosopher and historian Michel Foucault questioned the wider implications of the methods developed by French physicians to understand disease. His work focused specifically on the social and political changes brought by the Revolution. He argued that doctors’ new powers of diagnosis relied on their ‘gaze’ - a new type of medical perception and experience. Physicians who observed bodies carefully could potentially penetrate the illusions of outdated theories and see the hidden ‘truth’ of disease. In the process, practitioners gained much power and status, because no-one could challenge their stories of illness. The patient’s own experience or perception became less important than the doctor’s judgment. This trend within biomedicine continued until the second half of the 1900s, when efforts began to be made to look at the patient’s perspective on medical care.

• M Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (New York: Pantheon Books, 1973)

Bio-medical

Bio-psycho-social

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A way of articulating

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“To live is the rarest thing in the world. Most people exist, that is all.”Oscar Wilde

(in Flourishing: positive psychology and the life well lived. Keyes and Haidt (eds) 2002.

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Giving meaning. . .

Well- beingWell-being

flourishing

Quality of life

Emotional well-being

Positive mental health

Happiness

Mental well-being

Mental Capital

?

Mental health

So, which of these resonate

with you?nef

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Definitions of well-being

New Horizons

A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment.

Foresight

Mental well-being is a dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relations with other and contribute to their community.It is enhanced when an individual is able to fulfil their personal and social goals and achieve a

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A way of being

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RECESSION

UNEMPLOYMENT

LABOUR MARKETMARGINALISATIONLow pay, job insecurity,Chequered work history,

STRESS POVERTYHEALTH BEHAVIOUR

CHANGESSocial isolation, tobacco,

alcohol, drug abuse,less exercise, etc.

PHYSICAL HEALTHEFFECTS

Bronchitis, Lung cancer, Heart diseaseAccidents, Low birth weight babies

Infant growth retardation:General susceptibility

MENTAL HEALTHEFFECTS

AnxietyDepressionParasuicide

Suicide

SUBNUTRITIONFUEL POVERTYPOOR HOUSING

Work ethicstigma

Source: Smith, R (1987) Unemployment and Health: A disaster and a challenge, New York, OUP.

15

Uncertainty. . .friend or foe?

Without a measureless and perpetual uncertainty, the drama of human life would be destroyed. Winston Churchill

The desperation to maintain as sense of certainty can lead to mental health problems.Dorothy Rowe

We are born into a world we know nothing about, and in which larger forces incessantly buffet us like a

Health Literacy Related Skills

• Cognitive• Behavioural• Advocacy• Existential

– Include the ability to make sense of life, live with uncertainty and avoid descending into depression, self-pity, hopelessness or helplessness.

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Hope

Hope is sitting on a globe representing the world, her eyes are bandaged signifying that what is to be seen is not encouraging. She is playing on a lyre of which all but one of the strings is broken; she leans over it to catch the very small sound that may emerge.It is the hope implied by the expression “hoping against hope”. It is the hope of those who refuse to submit to despair when it beckons.

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A way of responding

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New Horizons: A new vision, a new language, a new focus?

“This is about more than preventing mental illness...it is also about helping individuals and communities to bring the best out of themselves”.

Good mental health is more than just the absence or management of mental health problems; it is about our ability to cope with life’s problems and make the most of life’s opportunities. It’s about feeling connected with people and surroundings and being able to function well.

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Aspiration & Realisation

A cross-government action programme, produced by the Department of Health and including commitments to action by 11 government departments.

– For the first time it sets out a new approach with the twin aims of

• improving people’s quality of life and well-being, and

• improving the quality and accessibility of services for people with poor mental health.

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New Horizons: A shared vision?

The new strategy covers a number of areas to better address people’s mental health and well-being.

These include:

• making everyone’s mental well-being better • helping everyone to understand mental health problems and not to treat people

with mental health problems unfairly • making it easier for people to find and get the help they need

• spotting mental health problems early • providing services and treatments in ways that meet people’s individual needs • making sure people have a say in the treatment they get.• making it easier for young people to keep getting help after they are 18

• carry on making services better and using resources effectively• working with councils, the NHS and others to make sure people get services

that look after all their needs

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Mental Disorder: 18%

Languishing: 11%

Moderate mh: 54%

Flourishing: 17%

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The gains from improving mental well-being

• Increased quality of life and overall well-being• Improved educational attainment and outcomes• Safer communities with less crime• Reduced health inequalities• Reduced mortality• Improved productivity and employment retention• Reduced sickness absence• Reduced levels of poor mental health and mental

illness

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A way of acting

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Critical Questions: (nef)

1. What are the key levers and opportunities for developing a local response to this well-being survey?

2. How can a case for promoting population mental health and well-being be made, especially in the light of the current recession?

3. How can our knowledge, experience, skills and good practice be built upon?

4. What does this well-being survey mean for local partnership working?

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Strategic implications: The local level• The role of Local Government

– The power of wellbeing– Supporting the development of safe, sustainable, connected communities– Co-production of neighbourhood services

• The role of Strategic Partnerships– Local Area Agreements– Strategic alignment and integration: wellbeing & inequalities– Total Place (Birmingham – Mental Health)– Commissioning for Wellbeing

• The role of Public Health & Stakeholder Engagement– Articulating a strategic population approach– JSNA– Communicating the centrality of well-being ( nef’s Five Ways )– Testing out, innovation, extending the evidence base

• Asset-based approaches: Social Prescribing, Timebanking, Volunteering,

• The role of Mental Health Commissioning– Earlier intervention for child, young people and adults

• IAPT• Suicide Prevention• Physical health of adults with severe mental illness

– Recovery based approaches in secondary care and in community services

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The Joint Strategic Framework for Public Mental Health aims to promote positive mental health and ameliorate mental distress by actions that:

• enhance wellbeing (i.e. increasing flourishing)• prevent mental illness from occurring• treat mental illness when it is present

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Social Prescribing & Community Referral

• Establishment of Social Prescribing Pathway across statutory and third sector providers in the Alt Valley Area as a model for neighbourhood working

• Connect community service providers in primary, secondary care and the third sector to better meet people’s needs– Debt management– Benefit Maximisation– Personalisation– Advocacy– Reading groups– Creativity & Arts– Leisure facilities– Opportunities for

Learning, Volunteering etc

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“Tend to the social and the individual will flourish”

Jonathan Rutherford

Cited in ‘The Joint Strategic Framework for Public Mental Health 2009-12’

Mental wellbeing policy

DH policy – New Horizons 2009 recognises more needs to be done to promote population mental health and wellbeing:

To build resilience in individuals, families and communities;

To create flourishing, connected and sustainable communities;

To prioritise mental health as much as physical health and recognise the links between them;

To work collaboratively across sectors to achieve this.

To identify agreed measures of mental wellbeing to support local improvement.

Mental wellbeing policy

Foresight 2008:improving mental wellbeing could have very high economic and social returns

WHO Mental Health Action Plan 2005:commitment to develop new indicators and data collection methods for mental health promotion. Information needs to be available about the current state of mental health across populations that is standardised and allows comparison locally, nationally and internationally.

Mental wellbeing intelligence..

The NW survey provides new data:

an important new baseline;

comparability & consistency across localities;

better understanding of our mental wellbeing, its determinants and relation to physical health and health inequalities;

recognising mental wellbeing as an asset – to our productivity and resilience;

new intelligence to support commissioning, needs assessment, service development and evaluation of practice.

The NW Mental Wellbeing Survey

Sample 18,500 residents

18 PCTs bought a boost of 500

Face-to-face interviews: April–June 2009

Computer Assisted Personal Interviewing

Validated scale – WEMWBS + 44 other questions

Largest survey of its kind in UK

WEMWB ScaleNone ofthe time

Rarely Some of the time

Often All ofthe time

I’ve been feeling optimistic about the futureI’ve been feeling usefulI’ve been feeling

relaxedI’ve been dealing with problems wellI’ve been thinking clearlyI’ve been feeling close to other peopleI’ve been able to make up my own mind about things

Explored some key determinants of mental wellbeing…

Where people live

Health andLifestyle

Finance

Feelings and relationships

Life events

Warwick and Edinburgh Mental Wellbeing Score (WEMWBS)

0%

2%

4%

6%

8%

10%

12%

14%

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35WEMWBS score

Low wellbeing (16.8%)

Moderate wellbeing (62.8%)High

wellbeing(20.4%)

Mean score (27.70)

NW mean score = 27.7Scotland mean = 25.5England mean = health survey 2010

Mental wellbeing distribution:

Gender – there is no difference between men and women;

Age – high mental wellbeing is highest among 25-39 year olds, but then decreases and is significantly lower among 40-54 year olds;

Deprivation – mental wellbeing reduces as deprivation increases.

Ethnicity – lower amongst white than non- white;

16.8% 62.8% 20.4%

31.7929.97

29.59

28.5828.57

28.37

28.34

27.77

27.70

27.68

27.5926.85

26.70

26.6026.50

26.20

26.17

26.10

25.69

20 25 30 35

WarringtonHalton and St Helens

Stockport

Cheshire WestBlackburn and Darwen

Heywood, Middleton and Rochdale

Central and Eastern Cheshire

Central Lancashire

North West

Wirral

Sefton

East Lancashire

Cumbria

Manchester

Tameside and Glossop North Lancashire

Knowsley

Blackpool Liverpool

Mean WEMWBS score

Locality mean WEMWBS scores

Low, moderate & high wellbeing

30.3%

25.0%

16.8%

21.6%

22.0%

23.2%

24.2%

23.1%

8.4%

11.2%

13.9%

16.8%

10.9%

13.0%

13.7%

11.1%

9.5%

5.0%

5.8%

64.0%

64.7%

76.9%

64.6%

63.6%

61.6%

61.9%

60.2%

82.0%

75.6%

66.2%

62.8%

68.7%

65.3%

61.1%

62.9%

53.9%

59.6%

34.0%

5.7%

10.3%

6.2%

13.8%

14.4%

15.2%

13.9%

16.7%

9.7%

13.2%

19.9%

20.4%

20.5%

21.7%

25.2%

26.0%

36.6%

35.4%

60.2%

Liverpool

Blackpool

Knowsley

North Lancashire

Tameside and Glossop

Manchester

Cumbria

East Lancashire

Sefton

Wirral

Central Lancashire

North West

Cheshire East

Heywood, Middleton and Rochdale

Blackburn with Darwen

Cheshire West

Stockport

Halton and St Helens

Warrington Low Moderate High

Age

Mental wellbeing highest among 25-39 year olds;

Lowest among 40-54 year olds;

Despite them more likely to have job;

40-54, in full-time employment also less likely to report satisfaction with personal relationships; ore likely to have had a recent divorce or separation; less likely to meet with or talk to people from outside their own home;

Age & WEMWBS

16-24

25-39

40-54

55-64

65+ 17.3%

18.2%

18.3%

15.5%

14.3%

63.5%

60.8%

63.1%

61.2%

65.7%

19.2%

21.0%

18.6%

23.3%

20.1% Mean score: 28.07

Mean score: 28.03

Mean score: 27.39

Mean score: 27.57

Mean score: 27.52

Key: Low Moderate High

Deprivation & WEMWBS


Least deprived

Fourth most

deprived

Third most

deprived

Second most

deprived

Most deprived

20.2%

15.7%

19.1%

14.0%

11.4%

62.2%

64.3%

59.1%

63.4%

66.1%

17.6%

20.0%

21.9%

22.7%

22.5% Mean score: 28.39

Mean score: 28.18

Mean score: 27.59

Mean score: 27.71

Mean score: 27.17

Ethnicity & WEMWBS

White

Non-White

13.0%

17.1%

60.4%

62.9%

26.5%

20.0% Mean score: 27.63

Mean score: 28.72


Health

Strong associations between general, physical health, lifestyle and mental wellbeing.

Those with high mental wellbeing 3.5 times more likely to say they were in good health.

Low mental wellbeing 6 times more likely to self report ‘not good health’.

Strong relationship with mobility, self care, pain, anxiety & depression.

Significant proportion who are not anxious or depressed have low levels of mental wellbeing.

Healthy lifestyle

People with high mental wellbeing were

more than twice as likely to be meeting the physical activity target (30%);

People with low levels of mental wellbeing were

four times as likely to be sedentary for more than 8 hours a day;

more likely to smoke (30%)

Significantly more likely to be drinking at harmful levels and significantly less likely to be drinking at sensible levels;

Work is good!

Those who are permanently sick or disabled are significantly more likely than average to have low levels of mental wellbeing.

Those who are in full-time employment or education or who are self-employed are significantly more likely than average to have a high level of mental wellbeing.

Money worries

3 out of 10 adults said they had worried about money quite often or almost all the time during the last few weeks;

Half of all those with poor mental wellbeing had;

Males and those in most deprived most likely to have worried;

People aged 65+ far less likely to have worried;

Money worries

People with high mental wellbeing were 2.4 times more likely to have never worried about money in the last few weeks;

1 in 5 adults were finding it difficult on their present income – and were 5 times more likely to experience this if they had low levels of mental wellbeing;

Over 25% of those in the most deprived areas were finding it difficult on their present income – significantly more non-whites.

Low levels of mental wellbeing by feelings towards income

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Living comfortably onpresent income

Coping on presentincome

Finding it difficult onpresent income

Finding it very difficulton present income

Perc

enta

ge w

ith a

low

leve

l of w

ellb

eing

Place Matters

People with higher levels of mental wellbeing :

More likely to have lived in a local area 10 years or more (3/5 had);

Satisfaction with the local area as a place to live (55yrs +, white);

5% of adults were dissatisfied with their area as a place to live;

Much stronger sense of belonging to their immediate neighbourhood (women, older, less deprived, white);

20% didn’t have a strong sense of belonging;

Place matters

People with higher levels of mental wellbeing :

More likely to feel safe in their local area. (males, younger, less deprived)

97% felt safe when outside during the day, 74% after dark;

Had stronger agreement they can affect decisions about their area (3x definitely agreed);

Those in lower deprivation

Aged 55-64

Over half of adults felt they couldn’t influence decisions in their local area:

Lowest for 65+

white

Relationships matter

Strong relationships and good social networks are strongly associated with high levels of mental wellbeing:

Long-term relationships

High satisfaction with relationships

Social networks and contacts outside home

Contact with neighbours

Relationships: those with low mental wellbeing

Nearly three times more likely to have not spoken to someone outside their household in the last week - 3% hadn’t;

Over 3.5 times more likely to never speak to their neighbours – 3% don’t; those more likely to are female, age 55+, white, 3rd most deprived;

More likely to never meet friends or relatives – 1% don’t;

Health

High mental wellbeing:

3.5 times more likely to report very good health;

Significantly less likely to have mobility problems;

Low mental wellbeing:

3 x more likely to have poor self-care or be moderately anxious or depressed;

Significantly more likely to have problems performing usual activities, have moderate pain or discomfort or feel extremely anxious or depressed;

6/10 were not anxious or depressed;

Lifestyle

High mental wellbeing:

Twice as likely to be meeting physical activity target (men, white, 3rd deprived);

Low mental wellbeing:

Sedentary;

Smoking;

Drinking at harmful levels;

Not drinking alcohol;

Using cannabis;

WEMWBS and EQ5D (NI119)

North West Mental Wellbeing Survey 2009distribution of categories for WEMWBS and EQ5D

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Warwick Endinburgh Mental WellbeingScale

EuroQol EQ5D

high

intermediate

low


General Health

Individual likelihood of reporting health as good or very good health was found to be more strongly associated with EQ5D categories, than with WEMWBS categories.

Healthy Lifestyles

Sensible drinking (amongst those who drink alcohol); and having given up smoking (amongst those who have ever smoked), were both found to be more strongly associated with WEMWBS categories than with EQ5D.


Resilience

people who had been made redundant, now regaining employment

people who had been divorced or separated in the last six months, reporting satisfactory personal relationships

In each case, positive experience was more strongly associated with WEMWBS categories.

Five Ways to Wellbeing

‘Connect’ - regularly meeting friends and neighbours

‘Be Active’ - reporting recommended levels of physical activity

‘Take Notice’ - strong feelings of belonging in the immediate neighbourhood

‘Keep Learning’ - having the time do things you enjoy

‘Give’ - regularly participating in local groups and organisations

All five ways to wellbeing are more strongly associated with the WEMWBS categories.

Recommendations“achieving a small change in the average level of wellbeing across the population would produce a large decrease in the percentage

with mental disorder, and also the percentage who have [low levels of mental wellbeing]”. (Foresight)

Increase the mean baseline score;

Sustainable investment in improving population mental wellbeing;Tackle inequalities in wellbeing;

Address & improve mental health as a determinant of physical health;

Build community resilience and relationships;

Work and income;

Behaviour change – segmentation & five ways to wellbeing;

Recommendations

Inform needs assessment and outcome focussed commissioning;

Align wellbeing policy;

Mental Wellbeing Impact Assessment;

Collaboration;

Further analysis:

Mid-life

Deprived communities that thrive

Physical health & health behaviours

Unemployment

Ethnicity

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2010 Year of Health & Wellbeing

Rob Faulkner 2010 Project Manager

Liverpool Primary Care Trust

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5 Ways to Wellbeing Framework

• Give

• Connect

• Be Active

• Keep Learning

• Take Notice

nef (New Economics Foundation)

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Progress to date

• Website: www.2010healthandwellbeing.org.uk

• Pledges – Organisations and Individuals

• Communications toolkit

• Work streams Include:

• Volunteering

• Design for Health & Wellbeing

• Better Use of Green space and Health

http://www.2010healthandwellbeing.org.uk/

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Expected Outcomes for 2010

• Health on everyone’s agenda – CONNECT

• Quality Partnerships – CONNECT

• Increased Capacity for health - GIVE

• Greater sense of pride in our communities – TAKE NOTICE

• Reduced health inequalities together – KEEP LEARNING

• Better Use of existing good community practice – KEEP LEARNING

• Use of the 5 Ways to wellbeing in people lives (Adding 7 years to life) – BE ACTIVE

• Improved Communications – CONNECT

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Conclusion

• Opportunity to reach a whole new set of organisations and people

• Chance to embed Health into everyone’s agenda

• 5 ways to wellbeing framework is for all

• Badge and Logo design is transferable across the City Region

• 2010 provides us with an opportunity to create a platform on which to build health and wellbeing

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Contact Details

For more information on 2010 contact:Rob Faulkner – Liverpool Primary Care Trust Project Manager for 2010

[email protected]

Tel. 0151 296 7831

Danielle Sharp – Social Marketing Manager

[email protected]

Tel. 0151 8602

Or go to the website: www.2010healthandwellbeing.org.uk

mailto:[email protected]

mailto:[email protected]

http://www.2010healthandwellbeing.org.uk/

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Promoting mental health in a recession: using the evidence on effectiveness and cost

effectiveness

Dr Lynne Friedli

CPD event for Champs Public Health Network

27th January 2010

Champs Public Health Network [email protected]

This being human is a guest house. Every morning a new arrival.

A joy, a depression, a meanness, Some momentary awareness comes

As an unexpected visitor. Welcome and entertain them all.

Even if they’re a crowd of sorrows, Who violently sweep your house

Empty of its furniture. Still treat each guest honourably.

He may be clearing you out for some new delight. The dark thought, the shame, the malice,

Meet them at the door laughing, And invite them in.

(Jelaluddin

Rumi, 1207-73)

Summary

•

Mental wellbeing : contributes to the money economy, the core economy and health equity

•

How do we achieve wellbeing: interventions that make a difference:

•

Resources –

equitable access to valued assets•

Relationships –

social solutions/social outcomes

•

Meaning –

valued roles/occupations/contribution

[email protected] Public Health Network

Respectfulresponses to misfortune

Meeting PSA targets: a healthy economy, sustainable communities, reduced health inequalities


Dimensions of mental health

Mental health

Emotional resources e.g.

coping style, mood, emotional

intelligence

Cognitive resources e.g. learning style,

knowledge, flexibility,

innovation, creativity

Social

skills e.g. listening, relating, communicating, co operation, empathy

Meaning

and purpose e.g. vision, goals, coherence, connectedness

If I am not for myself, who will be for me? And if I am only for myself, what am I?

If not now, when?

Mental wellbeing and a healthy (money) economy


‘It’s better to be roughly right than precisely wrong’

Invest to save ..... a lot!

Outcomes associated with positive mental health

A worthwhile goal in itself and

leads to better outcomes:

• reduces prevalence of mental illness

• physical health: mortality/morbidity

• health behaviour

• employability, productivity, earnings

• educational performance

• crime / violence reduction

• pro-social behaviour/social integration/relationships

• quality of life


Life course benefits

crime smoking drugs depression suicide no quals

•

top 50%(no conduct problems)

1.00 1.00

1.00

1.00

1.00

1.00

•

middle 45% (some problems) 1.95 1.24 1.51 1.24 1.69 1.18

•

bottom 5%(conduct disorder) 4.13 1.59 2.39 1.57 3.00

1.45


Reducing behavioural problems: life course savings

per case total for 1-year

Scotlandcohort in UK

£

£

million £

million

•

Prevention (move bottom 5% to middle 45% ) 150,000 5,250

4.2

•

Promotion(move middle 45% to top 50%) 75,000 23,625

18.9

(Friedli & Parsonage 2007)Champs Public Health Network [email protected]

Annual UK birth cohort =700,000

Cost of interventions

Typical cost of parenting programmes (2003 )

•

Group programme: community £1,350

•

Individual programme: home £6,000

Success rate needed: 1 in 25 and 1 in 55

(effect size of 2-4%)


Cost of programme(one year UK birth cohort)

Benefits

Disorder £210 million £5.25 billion

Problem £425 million £23.6 billion

Cost benefits: other examples

Health promoting schools (life skills, social skills):• $25 -

$45 return per dollar invested

Adult education: increase education of women from no qualifications to basic qualifications:

• £230m per year saving in cost of depression

•

Access to green open spaces = 50% reduction in health gap (all cause and circulatory disease mortality )

(US DHHS 2007; Chevalier & Feinstein 2006; Mitchell & Popham 2008)



Equalities Review 2007 Crown Copyright

Contribution of mental health to inequalities

Key domains: education/employment/behaviour /health/ consequences of illness /services

(Whitehead & Dahlgren 2006)

Mental health is a significant determinant in each case, influencing:

•readiness for school/learning•employability•capacity, motivation and rationale for healthy behaviours•risk for physical health (e.g. coronary heart disease), •chronic disease outcomes (e.g. diabetes) •relationship to health services, including uptake/treatment


Adverse childhood

experiences

Health-risk behaviours

SmokingObesityPhysical inactivityDepressionAlcoholismIllicit/injected drug useSexual promiscuity

Morbidity

Ischemic heart diseaseDiabetesStrokeCancerSuicideSkeletal fracturesChronic bronchitis/

emphysemaSTDsHepatitis Source: Felitti

et al 1998

Adverse childhood experiences predict health-risk behaviour and morbidity

Social, emotional, cognitive damage


Mental wellbeing and the core economy


“It gets so lonely around here that I phone myself seven or eight times a day, just to see how I am”

Phantom Tolbooth)


Economic policy, sustainability and wellbeing

environmental instability

psycho-socialinstability

Social recession

Economic/fiscal policy

If “being poor”

once derived its meaning from being unemployed, today it draws its meaning primarily from the plight of a flawed

consumer.Zygmunt

Bauman

Return to the social....


To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded

Edgar Cahn

I am, because we are...

(the ecology of)Relationships

matter

• Mental health is produced socially• Quality of social relationships is key factor in

resilience • Social integration buffers effects of low SES• Re-building the core economy: home, family,

community, neighbourhood, civil society• Social as well as individual solutions


We do not have to be a Gandhi, or a Martin Luther King, or a Nelson Mandela or a Desmond Tutu or an Aung

San Suu

Kyi, to

recognise that we can have aims or priorities that differ from the single minded pursuit of our own well being only.

Amartya

Sen

Mental wellbeing and achieving health equity


The importance of mental health is directly and indirectly related at every level to human responses to inequalities

All in the caravan may move forward, but how far behind do those at the back have to fall, before they cease to be part of the same caravan?

Polly Toynbee


Not ‘every family in the land’

Findings from 9 large scale population based studies:

•

Material and relative deprivation•

Childhood socio-economic position

•

Low educational attainment•

Unemployment

•

Environment: poor housing, poor resources, violence

•

Adverse life events•

Poor support networks

(Melzer

et al 2004; Rogers & Pilgrim 2003; Stansfeld

et al 2008; APMS 2007)

Cycle of invisible barriers:•

Poverty of hope, self-worth, aspirations

Mental health and deprivation

Untangling the determinants

• Individual skills and attributes

• Social relationships, support and networks

• Material resources

• Inequalities in distribution

of resourcesChamps Public Health Network [email protected]

I do worry about this emphasis on individual psychology; You can’t separate thoughts, feelings, self esteem, motivation fromthe material circumstances of people’s lives. Is it great to be positive? Maybe people are right to be pissed off.”

Positive steps interviews


“...the Greeks and Romans lived, I suppose, very comfortably though they had no linen. But in the present times, through the greater part of Europe, a creditable day labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can fall into without extreme bad conduct. Custom in the same manner has rendered leather shoes a necessary of life in England. The poorest creditable person of either sex would be ashamed to appear in pubic without them”

(Adam Smith Wealth of Nations 1776 cited in Zaveleta 2008)

CMD, by household income and sex

8.8 8.6 10.1

16.2

23.5

18.1

13.1

20.124 25.1

0

5

10

15

20

25

30

Highestquintile

Secondhighest

Middle Secondlowest

Lowestquintile

Equivalised household income

perc

ent

MenWomen

Source: APMS 2007, all adults, age-standardised


0%

5%

10%

15%

20%

25%

under£100

£100-£199 £200-£299 £300-£399 £400-£499 £500-£599 £600-£770 Over £770

Gross weekly household income

Per

cent

age

of c

hild

ren

with

a m

enta

l dis

orde

r

Source: Meltzer et al 2000 Mental health of children and adolescents in Great Britain

Mental health of children by parental income

Rates of poor social/emotional adjustment


(Graham & Power 2004)


Equalities Review 2007 Crown Copyright

Effective interventions: responding to the

determinants of mental health

“resources, relationships, meaning, respect”


I have a deep conviction: we will not change our behaviour until we change our performance measures. And our behaviour absolutely must change. President Nicolas Sarkozy


Scope of public mental health

Relationships and Respect

Social support, collectivity, respect for people experiencing

misfortune

Material resourcesIncreasing equitable access

to assets that support mental wellbeing Interventio

ns to promote mental

wellbeing Inner resourcesStrengthening

psycho-social, life skills and resilience

Meaningful activity

Opportunities to contribute

Social and material outcomes

Responding to the determinants of mental health and well-being

•

Reduce economic inequalities i.e. Mind the gap

•

Include social outcomes: the quality of relationships matters

•

Strengthen opportunities for meaningful activity e.g. volunteering, community participation, timebanks

•

Treat people experiencing problems with respect: vulnerability and dependency are part of the human condition, not a mark of moral failureChamps Public Health Network [email protected]

Resources, relationships, meaning, respect

Developing social and material solutions

• Maximize Income: debt; credit; social enterprise; asset transfer, benefits; pay; training; co production

• Optimize Space: green; blue; public; landshare

•Expand opportunities to contribute: social prescribing; time banks; volunteering, value those who contribute to core economy

•Social Contact: social prescribing; reduce barriers –

think ‘social impact’

(bureaucracy, MVT, street level incivilities;

transport)

•Imagination: arts, culture and creativity

•Think children: parenting support; play; contact with nature



•

Valuing yourself and others•

Talking about your feelings

•

Keeping physically active•

Eating well

•

Drinking in moderation•

Keeping in touch with friends/loved ones

•

Caring for others•

Getting involved/making a contribution

•

Learning new skills•

Doing something creative

•

Getting in touch with your spiritual side•

Contact with nature

•

Seeking Help

Individuals

Communities

Policy

“the delicate tracery of human spirituality in all its fragility

and persistence”Seamus Heaney


http://www.neweconomics.org.uk/gen/uploads/42a0d345snadwj45d uze0iim22102008153312.pdf

Public mental health and PSA targets

•

Fairness and Opportunity: educational achievement

•

Quality of life: health and wellbeing

•

Stronger communities: cohesive, empowered, active

•

Help people through downturn: productivity, employment


[email protected]

A (wider) framework for effective action

Opportunities for meaningful

activity: education,training, volunteering

Mental health and

Mental Capital

Reduce povertyand the impact of

poverty

Respectful policy responses to misfortune

Quality of social

relationships(family, schools,

workplace, communities)

Reduce material inequalities

And what I shall endure, you shall endureFor every atom belonging to me as good belongs to you......

Walt Whitman

Build capacity for collective action

(collective efficacy)Champs Public Health Network


Landshare: 3620 Landowners; 28452 Growers; 4335 Helpers

‘To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded’

Edgar Cahn

http://landshare.channel4.com/


Lincolnshire Partnership [email protected]

http://www.what- if.info/SIT_IN_part1.html

What if?

http://www.what-if.info/SIT_IN_part1.html

http://www.what-if.info/SIT_IN_part1.html

Lincolnshire Partnership [email protected]

110

Working for HealthBuilding a sustainable workforce

111

Workplace Support• Workplace Wellbeing Charter

– Health is wealth commission recommendation

– Inclusive: all organisations of all sizes

– City Region

– Set of standards

– Compelling arguments for workplace health and wellbeing intervention:

• Stress alone costs the economy £3.7 Billion compared to 0.5 Billion from accidents

• 1 in 5 over 65 compared to 1 in 6 under 19.

112

Mental Wellbeing @ work– the case

• Work is good for you – if you are there!

Broad diagnostic category of work-related ill-health

Estimated number of

new diagnoses of work-

related ill-health

made by THOR-GPs (average

of 245 per month)

% of total diagnoses

Incidence rate per

100,000 of working

population

% of diagnoses

issued with

sickness certificatio

n

Number of days

sickness absence certified

Average length of sickness absence

(number of days

sickness absence certified per case)

% of total days

sickness absence

certified by broad

diagnostic category

Estimate of no. of GB days certified sickness absence

Musculoskeletal 2191 52.60% 830 43.00% 21231 9.7 35.00% 2258560Mental ill-health 1288 30.90% 488 79.70% 34506 26.8 56.80% 3670759

Skin 406 9.70% 154 16.50% 1531 3.8 2.50% 162868

Respiratory 102 2.40% 39 28.40% 1044 10.2 1.70% 111061

Audiological 18 0.40% 7 11.10% 154 8.6 0.30% 16383

Other diagnoses 161 3.90% 61 44.70% 2255 14 3.70% 239888

Total diagnoses 4166 100.00% 1578 - 60721 14.6 100.00% 6459519

Total cases 4096 - 1551 51.40% 59526 14.5 - 6332394 Sou

rce:

HS

E

113

Mental wellbeing @ work– the case

• ‘Poor mental health significantly increases the risk of poor physical health…’ Liverpool Public Health Observatory (2008)

• ‘Work is generally good for health and well-being’ Waddell & Burton (2006)

• … 530,000 people in Britain … suffering from stress, depression or anxiety due to work… NICE (2009)

• ‘Several diseases and disorders … are

114

• In your groups, discuss and suggest your top 3 workplace interventions that would be most effective in supporting or reducing the number of employees with stress/work related anxiety.

• Choose 1 Category:– Small enterprise– Medium enterprise– Large enterprise

Question

You can decide whether to choose public, private or third sector.

115

Suggestions

• Liverpool Public Health Observatory/CHAMPS:– Promote mental health in the work environment– Effective stress prevention and management– Domestic violence– Employer wellbeing or occupational health policy– Supporting employees with mental health problems– Integrate psychological ill-health and health & safety

systems– Workplace bullying

116

Documents

A new year, a new start & wellbeing · A new year, a new start for positive mental health & wellbeing. Sharing evidence and good practice from across the public health community