Public Mental Health: mourning the past and welcoming the new

Public Health England hosted a one day meeting on public mental health on the 6th March at Coin St Neighbourhood Centre, London SE1.

This was a fabulous day of debate and discussion that shaped a new vision for a public mental health and wellbeing service. There was participation from local government, voluntary sector agencies, The UK Faculty of Public Health, The Royal College of Psychiatrists, The Joint Commissioning Panel, The Future Visions Coalition, Time to Change and Big Lottery amongst many other stakeholders. The group discussions were most engaging, especially when questions were raised about the teeth that PHE would have to persuade commissioners to not ignore central guidance as has happened in the past. The Joint Commissioning Panel Guidance on public mental health is a valuable resource that is not being fully exploited and was commended to commissioners. Remarkable epi-genetic and environmental interventions have much to offer and the emerging evidence base promised a revolution in evidence based population interventions. 

The debate continues about the how public mental health initiatives will be inclusive of people with complex mental health needs. Much of this debate is polarised reflecting old conversations that have no place in a future inclusive and high impact public mental health system. We need to let go of these tradition models of mental health focussed on disease categories but rather adopt a person centred approach. Public mental health interventions should apply to all of the public and should not be not rationed or structured on the basis of disease categories or service sectors. Clearly, at a time of financial strain, the transformational potential is far greater than at any other time, and although many hope that existing spending plans and services will continue, it is clear that a new more cost effective approach is needed.

Implementing parity of esteem principles in the US reduced suicide rates and a managed care approached better reduced ethnic inequalities in health care. We need to learn from other countries and sectors the importance of evolving a new approach to delivers better outcomes for patients and public, whilst saving resources and preventing the persistence of symptoms . Disabilities can often be compounded and wellbeing compromised if care systems are insufficiently integrated across different specialities of health and social care. Where there are co-existing illnesses these will require early intervention and integrated pathways to support recovery and well-being in a person centred process. Any new system should always return people to living in their communities of choice and maximising their potential to contribute to and benefit from these communities. Care services are part of a mature and effective public mental health system and must evolve to complement the future plans. 

It is time to mourn old conversations and give life to new forms of partnership and transformational interventions across sectors. Tackling financial planning skills for all age groups, improving well-being by promoting education, nurturing supportive social relationship and networks, enhancing a sense of community, ensuring early return to work for those will illness, taking up well-balanced nutritious foods, and active lifestyles are all essential for the entire population. Some groups will need additional help and assistance, for example, those trying to give up smoking, or those with alcohol and drug related problems; we must do more to tackle obesity earlier in the life-course and violence throughout the life course, especially gender based violence and harm to children and young people. We must not let the existing cultures of care permeate or compromise the public mental health vision, but the public health vision must permeate the culture of care to break down traditional boundaries and improve the interface and care pathways across health economies and specialities. Locating public mental health and mental health care in the community and closely linked with primary care is the only way forward. Young people, parents, children of parents with mental distress, the adult working population and the elderly at risk of memory problems are all priority groups, as are those at risk of premature mortality.

What part can you plan?

Join the Public Mental Health Network by contacting Claire Churchill at the Royal College of Psychiatrists (cchurcill@rcpsych.ac.uk).

We are establishing a special interest group in public mental health and look for your support. Watch out for notices in The Psychiatrist.

The special interest group and the national public mental health network are open to all professionals and service users and leaders and members of the public that wish to shape public mental health.  

Please help us consider priority areas and provide your ongoing commentary on the evolving plans and progress.

Prof Kam Bhui

Public Health Lead Royal College of Psychiatrists.

k.s.bhui@qmul.ac.uk

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