Improving Population Mental Health and Well-being: Living Well with Mental Health

1. Improving Population Mental Health and Well-being: Living Well with Mental Health Gregor Henderson National Mental Health Development Unit www.nmhdu.org.uk

2. Some questions • Where have we come from and what has been achieved? • The new national policy context and what this may mean for mental well-being? • What are some of things we are learning? • What might we need to keep in mind as we go forward from here?

3. Some Context • POVERTY - 13.5m, 22% of people in UK live below the low income threshold. 4m children, 13% of all older people, 33% of all people with a disability and 20% of bme population, with 5% of people living in overcrowded housing….. • INEQUALITY – over the last 10 years – the poorest 10% have got poorer whilst the richest 10% have got richer. Inequalities persist in educational attainment, employment, health, participation and living standards……. • WELL-BEING? – rising GDP, rising material wealth and living standards for the majority, but life satisfaction and measures of wellbeing flat or declining…………….. • ECONOMIC DOWNTURN– reduced job prospects, higher level of redundancies and unemployment, house repossessions, less infrastructural development, public sector spending cuts, low paid and low skilled at greatest risk, increased uncertainty, distress, stress and anxiety, higher frequency of physical and mental illness……. lower levels of mental well-being

4. Some definitions……… • Poor mental health or poor mental well-being leads to poorer physical health, higher rates of health care use, harmful behaviours (excessive drinking, drugs) increased mortality and reduced life expectancy, poorer educational performance, increases in crime, anti-social behaviour, lower levels of employability and productivity ‘levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological well-being’ (WHO 2008)

5. The recent past • National ‘service’ framework for mental health – ‘better but not well’ • Focus on individually focused service solutions, important but not the whole picture • Low levels of investment in promotion and prevention • Lack of attention to wider social determinants • Insufficient engagement with the wider ‘system’ – public health and well-being, community life, education, employment and working life, culture, arts, sport, leisure

6. The emerging new policy picture • Twin and complementary aims of New Horizons • Guiding values and principles • Providing a vision and direction of travel • Authorising and supporting a broader agenda, including but going beyond mental illness, to a wider partnership agenda with greater local determination

7. www • FORESIGHT REPORT ‘Mental Capital and Well-being’ www.foresight.gov.uk • NEW HORIZONS ‘Towards a shared vision for mental health’ www.dh.gov.uk/mentalhealth

8. What are we learning? - strategically • Importance of ‘population’ approaches to health and well-being for ALL • Importance of integrated thinking and acting – benefits ALL • Different levels of ‘population’ focus • Universal and targeted approaches • Pushing for the next ‘stage of development’ – small steps towards a ‘cultural shift’ or ‘social movement’

9. What are we learning? - practically • The developing evidence base • Wider health improvement gains (physical activity, food and nutrition, behaviour change) • Early years, schools, youth work, employment, later life • Community approaches work • Wider contributions to health and well-being • Health, social, community and economic benefits (your work)

10. More learning • There is good enough evidence of benefit • Importance of local data, indicators, measures • Evaluation, review, monitoring and learning - adjusting, adapting • Local partnership approach – local shared development, ownership, leadership, commitment, building on early action……….

11. Commissioning • Joint assessment of need - physical and mental health • Continual community engagement, ‘case making’ and local learning • Balancing investments towards health and well-being (using the evidence) • Going further upstream, towards longer term returns • Engaging with providers and the importance of well-being outcomes

12. Challenges • Is the evidence good enough? • Who will do the commissioning for mental well-being? • What will happen to mental health services and the most severely ill? • How can we find the resources? • How will we know we are making a difference?

13. Some things to keep in mind? • QuIPP or QP? – demonstrating the case • Local Authority ‘Powers of Well-being’ – community health and well-being • Innovation at a time of reducing funding • Part of something bigger, and guarding against exceptionalism • The ‘upside’ of down • The power of relationships and co-creation

14. Co-creating our future ‘The future is not some place we are going, but one we are creating.The paths to it are not found but made, and the activity of making them changes both the maker and the destination.’ John Schaar, Science Advisor to President Richard Nixon

15. THANK YOUNational Mental Health Development Unitgregor.henderson@nmhdu.org.uk www.nmhdu.org.uk

16. Kotter’s Eight Steps to Achieving ‘Transformational’ Change • Phase One: 1.Establishing a sense of Urgency and Making the case 2.Forming a guiding coalition 3.Creating a Vision

17. Eight Steps to Achieving ‘Transformational’ Change • Phase Two: 4.Communicating the Vision 5.Empowering Others to Act on the Vision 6.Planning for and Achieving Short Term Wins

18. Eight Steps to Achieving ‘Transformational’ Change • Phase Three: 7.Consolidating Improvements and Producing Still more Change. (implementing, acting, visible change) 8.Institutionalising New Approaches (sustaining and mainstreaming)