The importance of mental health is finally beginning to be recognised

Seeking some consensus on mental health

01 March 2012

The importance of mental health is finally beginning to be recognised – but we still have a long way to go, says Paul Jenkins, who will chair Public Service Events’ A New Approach to Mental Health conference

An issue that affects one in four of the population and costs society an estimated £101bn every year ought to be pretty prominent in the minds of the public and policy makers. But mental health has struggled to capture the attention and priority it deserves.

There are signs of change. Sportspeople and other celebrities have shown welcome candour in talking about their own experiences of mental ill health and politicians from across the political spectrum are showing greater recognition of the importance of the issue. Attention is focusing not only on debates about health and social care but also other areas of public policy such as criminal justice, welfare reform and education.

There is still, however, a long way to go to deliver genuine parity of esteem between physical and mental health and an appropriate level of response to tackle the burden of mental illness.

The coalition government published its mental health strategy No Health Without Mental Health last year. While the controversies around the Health and Social Care Bill have distracted attention, the strategy sets out some clear principles.

The first is that as with physical health, prevention is better than cure. Growing interest in mental health makes us more aware of the risk factors, often concentrated in early years, which can lead to mental health problems in adulthood. So we know that the one in 20 individuals with a serious conduct disorder in childhood go on to to commit 30 per cent of crime, at a cost £22bn.

Relatively simple interventions to tackle conduct disorder can reduce future offending by 50 per cent. Many other examples exist of interventions targeted on specific at-risk groups, or on the first presentations of mental illness, which can significantly improve outcomes and reduce costs.

The second principle relates to recovery. Historically, mental illnesses have been seen as a life-sentence and an end to ambitions the rest of society takes for granted. The focus on recovery, a movement in which people with direct experience of mental ill health have taken the leading role, aims to stand this paradigm on its head. Recovery-focused services should be built on a realistic message of hope and deliver care and support around goals that the service-user wants to achieve. Professional are “on tap” not “on top”. Such an approach resonates with similar approaches to many long-term conditions, where the focus is on enabling someone to live with a condition and on preventing or reducing disability. They require a significant cultural shift by service providers and greater emphasis on social care and other interventions rather than an exclusively medical approach. This resonates strongly with calls for greater choice and control and for the personalisation of services.

The third principle is a major challenge to the validity of the dichotomy between physical and mental illnesses. This has two manifestations. First, it is not acceptable to tolerate the appallingly poor outcomes that people with a mental illness experience in relation to physical health. How can it be right for someone with schizophrenia to die, on average, 20 years younger than someone in the general population? The second element is the interconnection between the physical and mental in any therapeutic process. This has highlighted the value of talking therapies, not just for people with mental health problems, but also for some people with long-term physical conditions.

The final principle relates to attitudes and stigma. For many people experiencing a mental illness, the hardest thing to deal with is a sense of rejection from family, friends and the rest of society. In a major survey 90 per cent of people with mental health problems and 60 per cent of their carers reported stigma or discrimination. Such stigma is borne out by the difficulty many people with mental health problems experience in finding work, in reduced social networks and in institutional discrimination, such as not being able to serve as a juror. Stigma affects people already experiencing mental health problems but also has a devastating impact on how people with emerging problems seek help.

Things are changing. It’s been a great privilege over the past four years for Rethink Mental Illness to be a partner with Mind in Time to Change, the largest programme in England to challenge stigma and discrimination in mental health. The programme has had some demonstrable impact on attitudes and behaviour and the government and Comic Relief have recently confirmed support for a further four years.

I face the future with a mixture of optimism and anxiety. There is greater recognition of the importance of mental health and greater consensus around what needs to be done. There is, however, a long way to go. But £101bn and thousands of wasted lives seems a high price to pay for not grasping the nettle of improving outcomes in mental health.

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