Prevention and health promotion in mental health – Public Health England
One of the four objectives in the global mental health action plan (2013-20) from WHO is “to implement strategies for promotion and prevention in mental health”. Although many countries aspire to implement this objective at the national scale, challenges abound.
At Public Health England, we have the main responsibility for delivering on this objective in England. Since our creation in 2012 as a national public health agency (part of UK Government), we have mainly focused on three areas - mental health promotion, prevention of mental disorders/suicide prevention and addressing the health inequalities experienced by people living with or recovering from a mental disorder. We seek to identify the best evidence and deliver national programmes and guidance from this. We continue to face many challenges in advocating for a public mental health approach, but there have been some success stories. For instance, our work was a contributory factor to the largest decrease for 20 years in the suicide rate in the UK between 2015 and 2016.
We would welcome the opportunity to partner with organisations in other countries to collaborate on this global objective of mental health promotion and prevention.
PHE Promotional initiatives for Young people
Mental health affects people across the life course. The early years are particularly crucial. Laying the foundations for healthy development and protecting against adverse child experiences can be done through strong early attachment and positive parenting. In England, the Healthy Child Programme: Pregnancy and the first five years of life and Healthy Child Programme: From 5-19 years old identifies mental health as a key area where public health interventions can make a difference. Health visitors and school nurses as leaders of the Healthy Child Programme can provide support for mental health across the 0-19 continuum- starting in pregnancy, and continuing in the early years and throughout the school-age years. These public health clinicians may often be the first contact with children who need early identification, prevention and support (4-5-6 model, Emotional Health and Wellbeing pathway and High Impact Areas). We are also currently working with NHS England on public health areas of England’s Maternity Transformation Plan, improving perinatal mental health.
By engaging and listening to young people to understand the challenges of early adolescence we have identified how they can be better supported through these changes. The first 1001 days of adolescence findings were presented by young people through a short film which explores what health and wellbeing support and prevention at this age could look like.
By reviewing the evidence and working with young people, we developed a public health approach to promoting young people’s resilience. We also actively support education settings to implement whole school approaches to mental health and wellbeing, publishing principles and a toolkit to guide them.
Our social marketing expertise has also helped to develop ‘Rise Above’ - a peer led digital platform for 11-16 year olds. This incorporates inspirational videos from vloggers to get young people talking about the things that matter to them and helps them to deal with diverse life challenges such as cyberbullying, exam stress, body image and self-harm.
PHE promotional initiatives for working populations
If mental health is going to be everyone’s business, then this requires the development of a broad workforce with the knowledge and skills to take action. Following consultation we produced a public mental health leadership and workforce development framework. We followed this up with specific actions including delivery of a national train the trainers programme in mental wellbeing brief intervention (connect 5 training), e-learning modules in community-centred approaches, development of public mental health subject guides to inform the training of public health specialists and the wider workforce and development of local government leadership through a mental health champions programme for elected representatives.
For employers we have also developed a toolkit for them to support the mental health of their employees’ which has been downloaded over 10,000 times. The success of this toolkit was followed up by a similar toolkit for suicide prevention and one for organisations after a suicide of an employee. Over 700 companies have signed the Time to Change employer pledge (led by the NGO’s ‘Mind’ and ‘Rethink Mental Illness’) to take action to reduce the stigma of mental health at work.
Later this year PHE will launch a public facing campaign that seeks to deliver a step change in how people view and engage with their mental health – promoting parity of esteem, highlighting the importance of good mental health and wellbeing and providing practical tips and techniques that enable people to improve their own mental health and that of others.
PHE Prevention Initiatives
Our work on suicide prevention includes guidance to regional and local stakeholders in developing local suicide prevention action plans. We have also provided guidance on responding to suicide clusters, reducing the risk of high risk locations and specific guidance for certain high risk groups such as lesbian, gay and bisexual young people.
Those bereaved by a suicide are at increased risk of mental health and emotional problems so receiving the right support is essential. With this in mind, we promoted support to those bereaved by suicide. This included a support booklet called ‘Help is at Hand’ for anyone affected by a suicide. In some parts of England there are now services to support those bereaved by suicide, following guidance we produced.
One of the key prevention policies we have recently established is a Prevention Concordat for Better Mental Health. This brings together a cross-sectoral range of local and national stakeholders that include traditional mental health sectors, communities, religious groups and businesses to make a strategic commitment to mental health prevention.
Underpinning everything we have done is the use of mental health data. At PHE we have developed the ‘fingertips’ tool which provides users with a rich source of recent data on many aspects of mental health and wellbeing in England. Importantly, this now includes data on social determinants of mental health as well as risk and protective factors for mental disorders.
With the growing importance of improving wellbeing as an ultimate policy objective of governments, PHE was a founding partner of the What Works Centre for Wellbeing and hosted the development team as they established themselves in 2015. Their aim is to understand what governments, communities, businesses and individuals can do to improve wellbeing. They have produced many excellent reports that collate, synthesise and translate evidence on promoting wellbeing on subjects such as housing, work, unemployment, the arts, community wellbeing and using cost-effectiveness analysis.
Other mental health resources that may be of interest are