Better Mental Health for All: Strengthening Public Health Practice Day 2

1. Better Mental Health for All:Strengthening Public Health Practice Day 2 Glasgow 27th & 28th February 2019

2. Objectives Day 2 • Participants will : • consider good practice with regard to public mental health interventions and how to measure them • have the opportunity to share local and organisational experiences. • have the opportunity to learn more about interventions • have the opportunity to increase their knowledge topics highlighted in the Faculty`s competencies including suicide prevention and workplace health • consider other topics to explore in depth • reflect on how to apply their ideas and learning by developing a personal action plan

3. Better Mental Health for All:Strengthening Public Health Practice Introduction to Interventions Mike McHugh and Chris Nield

4. Where • Family: – antenatal visits and classes; health visitors; children’s centres; 3rd sector; schools • Schools • Colleges and Universities • Workplaces • Communities • Primary Care • Social services • Mental health services: - CAMHS; adult; old age • Secondary care • 3rd Sector service providers

5. Where • Family: – antenatal visits and classes; health visitors; children’s centres; 3rd sector; schools • Schools • Colleges and Universities • Workplaces • Communities • Primary Care • Social services • Mental health services: - CAMHS; adult; old age • Secondary care • 3rd Sector service providers Everywhere

6. When Universal • Pregnancy • Infancy • Childhood • Adolescence • Working age • Older age Targeted • Bereavement • Unemployment • Relationship breakdown • Debt • Involvement in violence

7. When Universal • Pregnancy • Infancy • Childhood • Adolescence • Working age • Older age Targeted • Bereavement • Unemployment • Relationship breakdown • Debt • Involvement in violence Any time – All the time

8. How • Policy maker education • Making the economic case • Focus on the positive • Universal approaches • No health without mental health • Service provider education • Doctors • Public education • Engaging in our own mental health and wellbeing • Can’t give what you don’t have • Engaging in mental health and wellbeing of family and friends

9. How • Policy maker education • Making the economic case • Focus on the positive • Universal approaches • No health without mental health • Service provider education • Doctors • Public education • Engaging in our own mental health and wellbeing • Can’t give what you don’t have • Engaging in mental health and wellbeing of family and friends Doesn’t need to cost anything

10. How • Investing in specific interventions • Strong evidence base • Parenting • Schools • Pretty strong evidence base • Workplace • Loneliness • Physical activity • Mindfulness • Some evidence, lots of public support • Complementary and Alternative Medicine • Primary care: social prescribing; wellbeing pledges; • Singing, making music • Engagement in the arts • Gardening • Green spaces

11. How : systems approach Parent Infant Adult Social and fiscal policy Mental health of societies

12. Everything is connected • So can start in many places • Nothing much works on its own • Work on what is possible

13. Need for a Universal Component • Mental health problems are very common; many undiagnosed • Sub-optimal mental health is common and disabling • Risk factors are hard to identify clinically • Screening is ineffective • Targeting is more effective in context of universal • Stigma • People want help • Reduce the number of people causing others problems • Increase number of people who can help

14. percent of population reporting health interfering with work or other regular daily activity (SF-36) % Postal survey of 9332 adults (16-64 yrs) Oxford Region Stewart-Brown S, Layte R. J Epid Comm Health 1997

15. How Engagement Policymakers, practitioners, public, patients

16. New Resources appear every day • On line training for public and professionals • FutureLearn Babies in Mind: Why the Parent's Mind Matters https://www.futurelearn.com/courses/babies-in-mind/1/. • Careif & East London Foundation Trust : MH4L https://Mentalhealthforlife.org launching this week • Personal Apps • Mindfulness • https://www.futurelearn.com/courses/mindfulness-wellbeing-performance • Authentic happiness • www.authentic-happiness.com/home/Discover-Your-Strengths

17. Old ones are still valuable • Better mental health for all • http://www.fph.org.uk/better_mental_health_for_all • Mental Health Impact Assessment • www.apho.org.uk/resource/view.aspx?RID=95836

18. Training and Curricula • Faculty Public Health • LOs 4.11 and 9.4; understanding of own and staff mental wellbeing and how to manage and promote; role in personal competence • Public Mental Health Training Content Guides – Introductory & Specialist Courses • Public Health England • Workforce Development Strategy • Royal Society for Public Health • Short courses for wider workforces • Royal College of Psychiatrists

19. Manifesto: Start Well Live Better • Implement the recommendations of the of the 1001 Critical Days report • Help all children develop essential life skills and make PSHE and S&R education a statutory duty in all schools • Others • Living Wage for all in employment and training • Minimum Unit Price for Alcohol • Promote active lifestyles in schools – 2 hrs of PA per week • Stop marketing of high sugar, salt and fat foods • 20% tax on Sugar Sweetened Beverages

20. How: the art of public health • Start where you are • Invest in your own mental health • Talk about mental health at every opportunity • Make alliances with people who understand public mental health • Work through others – 3rd sector; health visitors; railways • Work where doors are half open • Use the evidence base with intelligence

21. Public Health Roles – Public Mental HealthM McHugh 2018 • Two main areas of focus in order to develop sustainable population approaches - reduce risk factors for mental and physical illness - Strengthen mental health, well-being and therefore physical health Roles – four broad overlapping areas of public health can effect positive change • As leader : directly using resources to commission and implement programmes • As partner: working in partnership can include- joint strategies, commissioning, and sharing of resources including budgets • As advocate: a key role is to champion and advocate for change , tackling mental health inequalities, stigma and discrimination • As evaluator: adopt an evidence approach, including needs assessment & addressing gaps in the evidence base

23. Interventions

24. The mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Moderate mental health Mental disorder Flourishing Languishing Number of symptoms or risk factors

25. The effect of shifting the mean of the mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Flourishing Moderate mental health Mental disorder Languishing Number of symptoms or risk factors

26. Relationship between levels of prevention, intensity of intervention, mental illness, recovery and well-being Mental illness Recovery treatment & tertiary intervention Early signs of illness early intervention & secondary prevention High risk groups including history of mental illness secondary prevention General population Primary prevention Increasing levels of well-being

27. Create flourishing, connected communities A Public Mental Health Framework for Developing Well-Being Meaning from adversity: • Post traumatic growth • Psychological therapies • Positive reflection Promote meaning & purpose Cultivate purposefulness & fulfilment: • In life, work, education and volunteering • By creativity, coherence and flow • With inclusive beliefs and values Enhance: • Community engagement • Ecological intelligence and connectedness Reduce social exclusion: • Address discrimination and stigma • Target high risk groups Develop sustainable, connected communities Integrate physical & mental health & well-being Improve: • Physical activity • Healthy Food • Sexual Health • Health Checks Reduce: • Smoking • Alcohol • Drugs • Obesity Reduce risk factors Promote protective factors Reduce Inequalities: • Unemployment • Fuel Poverty • Homelessness • Violence and Abuse • Impact of Climate Change Promote: • Employment • Benefits Checks • Safe Green Spaces • Insulated & Warm Homes • Partnership Working Build resilience & a safe, secure base Prevent and reduce impact of Adverse Childhood Experiences: • Child abuse • Parental mental illness • Parental substance misuse • Parental Domestic Abuse • Household offender • Childhood bereavement Improve: Parenting & Parental Health • Social and Emotional Literacy in Healthy Schools • Early interventions for conduct & emotional disorders Ensure a positive start in life Nurse J 2008

28. How?

29. What is your sphere of influence?

30. 1. Leader2. Partner3. Advocate4. Evaluator

31. 1. Leader With control over the allocation and implementation of some of the public health grant, and responsibility for assessing the need and evidence base, direct contracting and procuring services..

32. 2. Partner Understanding the health impact of other departments’ and partner’s policies, work with others to develop joint initiatives. This can include joint strategies, commissioning and sharing of resources including budgets.

33. 3. Advocate • When not in a position to have any direct control over an issue or policy, a key role is to champion and advocate for change, tackling mental health inequalities, stigma and discrimination. • This can include raising awareness of mental health and wellbeing with departments unaware of the effects of their decisions, completing health impact assessments, attending relevant boards and committees and engaging with the media, political bodies and individuals.

34. 4. Evaluator • Where possible adopt an evidence based approach in all of the programmes/ activities that you lead on and commission. • Keep abreast of key developments and look to national bodies for guidance on best practice. However, public mental health is an emergent field and as a result there are gaps in the evidence base. • Where there is a strong argument to intervene in an area where promising practice exists it is the public health role to ensure that these interventions are piloted and well evaluated before being implemented at scale. • Also consider if you have responsibility to share what is known to work and for whom in real life situations to influence not just local prioritisation but to help build the wider public mental health evidence base, including publishing findings and disseminating these more widely.

35. Better Mental Health For All: FPHhttps://www.fph.org.uk/media/1644/better-mental-health-for-all-final-low-res.pdf