This is the best summary of a holistic approach to prevention 

Community empowerment

There is now good evidence that empowering communities through processes like community development has a strong beneficial impact on mental health. The National Policy Forum needs to recommend community development as a routine offering for out of hospital provision across the UK.

Schools

We strongly support the NPF’s paper’s emphasis on schools. There are well-evidenced school interventions such as The Whole School Approach that have been shown to help prevent Mental Health problems. This should be explicitly supported and funded, as should counselling in schools.

Debt

Strongly related to mental illness which improves when debt is relieved. Debt is manageable in a way that many other financial stresses are not, so simple services must be made more readily available, probably through expanding CAB.

Parenting programmes

Good evidence that they improve

  • Parenting efficacy and practice
  • Maternal sensitivity
  • Child emotional and behavioural adjustment
  • Improved behaviour in high risk children and those with conduct problems
  • Improved safety at home
  • Reduced antisocial behaviour
  • Reduced reoffending

Good Employment

Policies that promote good secure employment make a big impact on mental health.

Poverty

Policies that reduce poverty make a big impact on mental health.

Primary care

A valuable document offers practical evidence-based recommendations for primary care to play its part in mental health promotion.

The twelve messages for primary care to achieve improved mental health for all and to save lives:

  1. Mental health promotion and prevention are too important to wait.
  2. Work with your community to map risk factors, resources and assets
  3. Good health care medicine and best practice are biopsychosocial rather than purely physical.
  4. Integrate mental health promotion and prevention into your daily work.
  5. Boost resilience in your community through approaches such as community development.
  6. Identify people at increased risk of mental disorder for support and screening.
  7. Support early intervention for people of all ages with signs of illness.
  8. Maintain your biopsychosocial skills
  9. Ensure good communication, interdisciplinary team working and intersectoral working with other staff, teams and agencies.
  10. Lead by example, taking action to promote the resilience of the general practice workforce.
  11. Ensure mental health is appropriately included in the strategic agenda for your cluster, at the Clinical Commissioning Groups, and the Health and Wellbeing Board
  12. Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development

EARLY DIAGNOSIS AND EARLY INTERVENTION

Early intervention can break down cycles of inequality running through generations of families.

Early intervention for ADHD results in

  • Improved educational and social outcomes

  • Reduced difficulties in later life

Individual parenting intervention programmes for conduct disorder result in

  • Improved child behaviour

  • Improved family relationships

  • Improved educational outcomes

  • Reduced conduct disorder, antisocial behaviour and crime

School based intervention programmes for children at highest risk and those with subthreshold disorders result in:

  • Improved mental health

  • Improved behaviour at school and home

  • Improved social skills and academic skills

Early intervention for psychosis results in

  • Fewer psychotic symptoms and better course of illness

  • Higher employment rates

Early intervention for antisocial personality disorder results in

  • Improved functioning for adults, reduced psychopathy and suicidal behaviour

Training in how mental illness presents for

  • Teachers

  • Police

  • Youth workers

MENTAL HEALTH PROMOTION FOR PEOPLE WITH MENTAL ILLNESS

  • Create inclusive environments that respect and protect the basic rights of everyone, including people with mental health problems.

  • Strengthen community networks and encourage collective responsibility for preventing alcohol/drug abuse, gender discrimination and community and family violence.

  • Develop partnerships with other stakeholders that are involved in promoting mental health and well-being, e.g. working with women’s clubs on gender issues or with a local nongovernmental organization focusing on early interventions with children.

  • Promote positive interactions between parents and their children to enhance childhood development.

  • Promote evidence-based programmes in schools that enhance the social and emotional competencies of students to help prevent substance abuse and violence.

  • Work with the media to change the negative image of people with mental health problems.

TREATMENT OF MENTAL ILLNESS

Community Psychiatric Nurses in CMHTs and in primary care

Many psychiatric conditions and situations can be well supported and treated by Community Psychiatric Nurses. Funding for more, particularly based in primary care, would make a big difference to people with mental illness.

Psychotherapy

There is increasing evidence that psychotherapy is cost-effective and improves outcomes for people with depression and anxiety. There may be benefit for people with psychosis too. We need psychotherapy available as part of IAPT throughout the UK.

Child and adolescent mental health services

Mental Health services for children and young people are suffering huge problems through underfunding. This stokes risks for the future for significant parts of our civic life. The least the Labour Party can do is to reverse the funding gap. But we also need for more emphasis, in addition, to prevention, as outlined above.

Adult services

Again, the funding gaps must be reversed. CMHTs must be boosted and better relationships forged with primary care.

Suicide prevention

  • Coping skills

  • Good relationships

  • Social support

  • Physical activity

  • Resilience

  • Restrict access to suicide hotspots

  • Restrict sale of drugs e.g. Paracetamol

  • Educational programmes for general public

  • Education for health and social care professionals on assessment and management of suicidal risk

  • Intensive support after previous attempt as risk is increased a hundred fold in the following year

  • Support for high risk occupational groups.

  • Most people who kill themselves have recently seen their GP-this is therefore an opportunity for prevention.

Community

There are significant benefits when all community staff feel more confident in preventing, identifying and treating mental illness where appropriate. By linking community health staff with community development workers, it becomes much easier for community clinicians to influence the social determinants of health.

Primary Care

Some 40% of severe and enduring mental illness is treated in primary care, including conditions such as psychosis and bipolar disorder. Primary care needs support from Community Mental Health Teams to support people with mental illness in preventing physical illness – people with mental health problems have a far higher risk of death and disease.

PARITY OF ESTEEM BETWEEN PHYSICAL AND MENTAL ILLNESS

The party needs to specify more clearly what we mean by this concept. Here are some ideas to flesh it out:

Training for Mental Health nurses

One of the problems in managing physical illness in mental illness hospitals is that nurses in mental health wards have no training in simple physical illness interventions. They generally cannot take blood or do ECGs or put up drips.

Colocation

Currently, a psychiatrist who finds a physical problem in a patient in a mental health ward may find it impossible to do any diagnoses or treatment. They may have to refer the patient to A+E which seems like a waste of time and money. Colocation of services may make it easy for physicians to assess people.

Waiting times to be the same between physical and mental illness

This has been promised by the Tories and needs to be continued by Labour.

No refusal of referrals.

It is only in mental health services that patients are refused referrals. 75% of referrals to CAMHS are refused on the basis that they are not serious enough. This has to change, both by changing the principle but also by investing on more staff and training.

Links with Social Care

By improving links to social care, support for families and patients will be improved. In addition, the party needs to commit to a journey towards social care free at the point of use. When that becomes increasingly available, a level playing field will become much more of a reality.

PLANNING MENTAL HEALTH AND ILLNESS SERVICES

Users must be involved in all planning, and from the early stages.

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One Comment

  1. Graham Brack says:

    An excellent summary. I have a particular interest in physical health in mental health, so I was pleased to see that mentioned, but I’d add that the commissioning process is predicated upon the physical health and mental health needs of a population being separable. In fact it’s a Venn diagram with overlapping circles, and around 4.6m people have both mental health problems and a physical long term condition, but the commissioning for these is often done by separate teams with no training in the other discipline. Holistic care can’t easily be delivered by divided commissioning, so Healthwatch organisations need to satisfy themselves that the whole patient is being catered for.

    The problem is, of course, accentuated when the treatment for mental health causes physical health problems (e.g. obesity with antipsychotics) or vice versa (e.g. diabetes causing depression).

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