The Pursuit of Happiness: A New Ambition for our Mental Health

Make the mental wellbeing of the nation or the ‘pursuit of happiness’ a clear and measurable goal of government. The tools are available to evaluate policy and measure its impact with wellbeing in mind. P7

 

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Every Health and Wellbeing Board (HWB) should appoint a Wellbeing Champion to advocate parity of esteem between mental and physical health and promote wellbeing. P11

 

The Mental Health Foundation argue that reducing the number of people across the UK developing a mental health problem is the only way that mental health services will be able to cope with demand in 20–30 years’ time.11 P15

 

Paul Burstow MP, Chair of the CentreForum Mental Health Commission, said:
“Failure to promote good mental health not only ruins lives, it costs the economy £105 billion every year. There is no single simple change that will deliver better mental health.  But making governments measure and value wellbeing as much as GDP would be an important step in the right direction. We then need bold action across the board so that we can see national wellbeing improving. We know what works in the workplace, in schools, in health services.  Starving mental health services of investment is a massive false economy, building up more costs to the NHS, to social care, to welfare, to businesses and the economy.”

 

“The first signs of life long mental illness can be traced back to childhood for half of those with mental health problems. This is simply not good enough. We would not tolerate a hospital turning away a child with a broken leg or cancer, but that is the experience of children with mental health problems every day. We need to promote good mental health from the earliest opportunity, and make sure that schools, workplaces and the communities that we all live in are supporting us to be mentally well. The cost of doing nothing or simply settling for gradual change runs to billions of pounds, but the real cost is measured in human misery, misery for want of determination to act on the evidence.”  

Prof Sir Simon Wessely, President, Royal College of Psychiatrists, said:
“As someone with a background in public mental health I warmly welcome this report’s focus, and in particular its advocacy for closing the treatment gap, prioritising the good mental health of children and adolescents and securing parity of funding for mental health services. This report recognises that the status quo of undertreatment and underfunding is unsustainable both in terms of the economic costs and more importantly the human misery that it perpetuates, and makes powerful recommendations for cross governmental action to reduce the health inequalities suffered by people with mental illness. I hope that the Government, CCGs and Health and Wellbeing Boards give it careful consideration, as befitting the thorough work that clearly went into it.” 

Prof Sue Bailey, Chair of Children and Young People's Mental Health Coalition and outgoing President of the Royal College of Psychiatrists, said:
“I am delighted that this report points out the current stark reality of lack of resourcing for the well being, resilience and mental health of all children and young people from conception to adulthood. But more importantly the report offers practical steps that move from the rhetoric to the reality of how to best invest in the well being and mental health of children and young people. How to deliver effective early identification, assessment, timely support and treatment because our children simply deserve better.” 

Lord Victor Adebowale, Chief Executive, Turning Point, said:
“This report makes clear that mental health and wellbeing will not be sidelined. No one involved in this report wants words without action - what is key is that individuals and organisations in the health and social care sector work together to make the report’s recommendations a reality.” 

Dr Alison Rose-Quirie, Chair, Independent Mental Health Services Alliance (IMHSA), said:
"The independent sector mental health providers support the essential recommendations clearly set out in this report. To achieve equality between physical and mental health we must set tangible goals and drive momentum to create real change in the system. Closing the funding gap for mental health and investing in our children and young people has real potential to change lives. We now look forward to working with partners across the sector to deliver the report's recommendations and make parity of esteem a reality." 

Sean Duggan, Chief Executive, Centre for Mental Health, said:
“This vital report sets out a clear agenda for the next five years to give mental health and wellbeing the attention they deserve from government, from health services, from schools and from business. The report offers practical recommendations to enhance wellbeing and to tackle high levels of unmet need among children and adults living with mental ill health. By investing in families, schools, workplaces and health services we can prevent problems emerging, respond quickly when people seek help and support recovery.”

 

At the forefront of this agenda, the Commission propose a National Wellbeing Programme, led by Public Health England, to expand the range and access of local wellbeing services and support by 2020. Within this programme, mental health problems are a component rather than a core focus, with a wider remit for public mental health prevention and health promotion. P18

 

That the annual report, which Directors of Public Health are required to produce, should include a statutory obligation to include a record of local progress towards parity of esteem for physical and mental health within public health. A national commitment has been made to ‘close the gap’ between physical and mental health in terms of investment, outcomes, waiting times, quality, research and aspirations, amongst other things.34

The prevention agenda is one in which a particular disparity exists and if this is to be effectively addressed, it will need to be the job of every local Director of Public Health and progress should be monitored at a national level. P23

 

That Public Health England’s scrutiny role should be strengthened, allowing them to hold local public health teams to account for their performance against the Public Health Outcomes Framework,35 for which one key indicator is self-reported wellbeing. Public Health England has great potential to support wellbeing promotion. However, there is a gap between these good intentions at a national level and the delivery of wellbeing initiatives locally. The publication of data on self-reported wellbeing by the Office for National Statistics (ONS) is an important first step but the Commission believe that Public Health England should have the authority to use this data to challenge local public health teams and hold them to account. P23

 

That a national wellbeing social marketing campaign should be rolled out should findings from Public Health England’s regional pilot conclude that such a campaign could have a positive impact on wellbeing. The pilot campaign focuses on the ‘five ways to wellbeing’, which includes five evidence-based steps that people can take to improve their own wellbeing.39

An effective national marketing campaign of this type could increase wellbeing, help to tackle stigma around mental health and support local Directors of Public Health by increasing the uptake of local initiatives and services to promote wellbeing. P24

 

Using the new Wellbeing Outcomes framework to set measurable outcomes for CCGs and other NHS bodies in meeting their statutory obligations to reduce health equality; monitoring the commissioning process for effectiveness in meeting community need; ensuring service user and carer leadership are part of evaluating services. P24

 

Despite known means of support and treatment, mental health problems cost UK employers £26 billion each year, averaging £1,035 per employee. This cost comprises £8.4 billion lost through sickness absence, £15.1 billion through lost productivity and 2.4 billion lost through staff turnover.74 So, for business reasons, besides moral imperatives, employers should have a keen interest in ensuring that people with such conditions are supported to recover and retain their jobs and, when they are absent, to enable them to return to work as soon as they can. Employers should take steps to ensure their organisation or business promotes and protects the mental wellbeing of their employees. P37

 

The Commission believe a ‘National Wellbeing Programme’ that focuses on promotion and prevention is a core part of meeting the future needs of the nation. P41

 

Depression and severe anxiety account for the majority of mental health problems diagnosed, yet 75 per cent of these people do not receive any form of treatment.89 P41

METRICS

 

The Children and Young People’s Mental Health Coalition also conducted a review of Joint Strategic Needs Assessments (JSNAs) and JHWSs and found that many were not prioritising children and young people’s mental health. The main findings showed that:

 

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  • Two thirds of JSNAs did not measure levels of children and young people’s mental health locally;
  • One third of JHWS do not prioritise children and young people’s mental health; and the most commonly used data to estimate prevalence was a decade old. P22

 

 

Additionally, there should be a new set of multiple measures of wellbeing that are more sensitive than the current ONS measures (life satisfaction, happiness, worthwhile and anxiety), to include communities. P24

 

The Commission believes that Subjective Wellbeing (SWB) should be adopted by NICE as part of its evaluation methodology. SWB provides a global assessment of life satisfaction but keeps the QALY weighting system. This metric is more appropriate for measuring wellbeing and mental capital. P25

 

Other tools that can be used include the Warwick-Edinburgh Mental Wellbeing Score and the wellbeing and resilience measurement,41 which is being tested in several European cities as a way of achieving a more realistic picture of the state of social capacity in neighbourhoods. Similarly, the Good Childhood Index, which can be used with children from eight years of age, can be valuable.42 P25

 

That all children should receive child development assessments at key stages . . . at the start of primary school and at years 6 and 8. In the early years, tools such as the Ages and Stages Questionnaires (ASQ. When the child is older, simple tools such as the Strengths and Difficulties Questionnaire (SDQ) can be used by nursery staff, teachers and other practitioners to identify children falling outside the normal range of healthy development. This will help to identify those whose families may need support and allow schools and health and wellbeing boards to assess the overall levels of wellbeing in the local population. This data should be shared with schools as well as other local agencies such as public health departments. HWBs, CCGs, and local authority/public health commissioners should use this data to plan and commission relevant services, which may be schools based as well as clinic based. P31

 

That the national curriculum should include the requirement to teach children and young people how to look after their mental health and build emotional resilience through approaches such as mindfulness. They should also provide relationship skills education as standard, given the links between relationship distress and poor mental health.69 The exact nature of the wellbeing programme being offered should be at the discretion of individual schools but every school in England must be able to demonstrate they are providing something of benefit to their students. OFSTED would be charged with monitoring progress towards the goal of at least 80 per cent of primary and secondary schools incorporating wellbeing programmes into school curriculum by 2020. P36

 

That for children experiencing a less severe or emerging mental health problem, there should be greater accessibility to psychological therapies in schools or in the community. This service should be provided by a practitioner with a background in child and adolescent mental health. This should be delivered through different evidence-based modalities such as face-to-face participation and mobile technologies. This could be provided by the voluntary or independent sector or statutory services. For children with moderate to severe mental health problems, all secondary schools should have routine access to a named CAMHS worker, either on site or through an effective referral pathway to CAMHS tier 3 or 4. P36