Editorial

Citation

Caan, W. (2015), "Editorial", Journal of Public Mental Health, Vol. 14 No. 4. https://doi.org/10.1108/JPMH-08-2015-0040

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 14, Issue 4.

Woody Caan

At this time of the year, as Commissioners of healthcare are midway through their planning cycle and carefully checking their budgets for "variances", my reflections turn to the separate worlds of Policy and of Practice. In this issue of JPMH, Stansfield gives us insight into policy at Public Health England, beginning with an ambition that: "our leaders advocate for the mental health of citizens as a valuable resource for thriving communities and economies".

Some evidence for this ambition comes from a recent policy statement for Commissioners from the Minister for Community and Social Care:

More of the same is simply not an option. We need to make changes across the whole system by creating opportunities to build resilience, promoting good mental health and intervening early when problems continue to arise. This is why children and young people's mental health is so important (Burt, 2015).

The National Clinical Director for Mental Health has a target for changes, in practice:

Mental ill-health is a major public health issue, so it's time for a public health focus on the prevention of mental ill-health, aiming for 30 per cent prevention (Strathdee, 2015).

In the UK, there are major barriers to succeeding in these ambitions

First, policy makers have not understood the powerful social determinants of mental health and their implications for health in all policies. For example, after leaving school almost a million young people are not in education, employment or training (NEETs): this population has multiple risk factors for mental illness (Caan, 2015a). But the policy response now is to force NEETs into militaristic boot camps that are unlikely to address mental health problems ("The cabinet office minister, Matt Hancock, has denied that a government plan to send young unemployed people to boot camps to prepare them for work is a form of punishment", Mason and Perraudin, 2015). If we look upstream, school policies ignore rising levels of mental illness in children (Boffey, 2015) and the Government has scrapped its target for ending child poverty, to bury its failure (News, 2015). On the International level, children here are now unhappier than in most other countries (The Children's Society, 2015) with low levels of life satisfaction growing from 2.4 per cent of children at age 10 to 8.2 per cent at age 16.

Second, policy makers seem to miss the links between inequality and poor mental health throughout the lifecourse. For example, adverse experiences early in childhood leave a long shadow over mental health (UCL Institute of Health Equity, 2015). One group of with childhood adversity about whom we know a lot are the vulnerable children "looked after" in statutory local authority care (Caan, 2002). Sadly, the Government is neglecting their long-term mental wellbeing (Caan, 2015b) in ways that predict grim problems in the future for both individuals and our society. Multiple adverse life events are not just an issue for children, in Britain. In distant, rural Kenya Jenkins et al. (2015) show that accumulated events predict thoughts of suicide and suicide attempts. Thanks to painstaking work by the National Confidential Inquiry into suicide (University of Manchester, 2015) we have known a huge amount about the paths leading to suicide. Despite this evidence, during the current policy of economic "austerity", suicide among middle aged Englishmen known to mental health services has increased dramatically. Meanwhile, more and more vulnerable people on benefits are being punished by loss of this economic support, as if Government policy was a "plan to blame and shame people for having disease" (McCartney, 2015)!

Implications for population mental health

Perhaps it is not surprising that, across Europe, participation in political organisations is associated with an increase in depressive symptoms (Croezen et al., 2015). However, the Nobel Laureate Amartya Sen (2007) noted that people usually have plural identities. Depressive symptoms in Europeans are reduced if they are involved in a religious organisation such as a church (Croezen et al., 2015). Feeling valued and listened to is probably a positive experience in many settings. The broadcaster Victoria Derbyshire (2015) showed a promising, democratic model in her recent programme on mental health. Participants shared very diverse experiences of both policy and practice.

Participation and diversity are strengths of a public health "family" (Caan, 2015b). Geraldine Strathdee is a very experienced clinician. She has identified a National need to address multiple co-existing conditions, "particularly among people from the most deprived population groups" (Strathdee, 2015).

Last year the Commission on Wellbeing and Policy helped launch the What Works Centre for Wellbeing. I plan to attend one of their coming discussions on behalf of the JPMH. The Centre invites practitioners to share their local experiences. The chair of the group bringing evidence together about what works to improve Wellbeing (Lord Gus O'Donnell) invites you all:

[...] to put that evidence into the hands of those that need it to make decisions.

Multiple co-existing conditions

Biological, psychological, social, spiritual, economic

and ecological –

Vulcan Spock thought the Human condition

should be more logical.

He Boldly Went, through time and space, and after all that trekking

Left barely one ripple -

Poor old Spock forgot Human dimensions

Are always multiple.

References

Boffey, D. (2015), "Michael Gove's school reforms 'ignored' rise in pupils' mental illness", The Observer, 5 July, p.19, available at: www.theguardian.com/education/2015/jul/04/michael-gove-ignored-school-pupils-mental-illness (accessed 19 August 2015)

Burt, A. (2015), "Introducing the new minister of state for community and social care", Commissioning, Vol. 2 No. 6, pp. 6-7

Caan, W. (2015a), "Helping young people feeling the strain", The Guardian, 21 May, p. 38

Caan, W. (2015b), "Strong links for public mental health", Community Practitioner, Vol. 88 No. 8, pp. 44-5

Caan, W. (2002), "Your shout", Mental Health Promotion Update, Vol. 1 No. 3, pp. 16-17

Croezen, S., Avendano, M., Burdorf, A. and van Lenthe, F.J. (2015), "Social participation and depression in old age: a fixed-effects analysis in 10 European countries", American Journal of Epidemiology, Vol. 182 No. 2, pp. 168-76

Derbyshire, V. (2015), "Mental Health debate broadcast 20 July on BBC News", available at: www.youtube.com/watch?v=TMSPkM-fKA4 (accessed 20 August 2015)

Jenkins, R., Othieno, C., Omollo, R., Ongen, L., Sifuna, P., Ongecha, M., Mboroki, J.K., Kiima, D. and Bernhards, O. (2015), "Tedium vitae, death wishes, suicidal ideation and attempts in Kenya – prevalence and risk factors", BMC Public Health, Vol. 15 No. 759, pp. 1-11

McCartney, M. (2015), "The government's plan to blame and shame people for having disease", BMJ, Vol. 351 No. 8022, p. 23, available at: www.bmj.com/content/bmj/351/bmj.h4368.full.pdf (accessed 18 August 2015)

Mason, R. and Perraudin, F. (2015), "Work boot camp will help young people – minister", The Guardian, 18 August, p. 5

News (2015), "Government is 'burying its failure' to bring down child poverty levels", British Journal of School Nursing, Vol. 10 No. 6, p. 266

Sen, A. (2007), Identity and Violence: The Illusion of Destiny, Penguin, London

Strathdee, G. (2015), "Integrating mental and physical health: ending the national scandal", Health+Care, No. 14, pp. 11-12

The Children's Society (2015), The Good Childhood Report 2015 Summary, The Children's Society, London

UCL Institute of Health Equity (2015), "The impact of adverse experiences in the home on the health of children and young people, and inequalities in prevalence and effects", Report for the Department of Health, London

University of Manchester (2015), "Large rise in suicide among male patients in mental health care", National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Press Release, 22 July