2. So far..
• Both mental health and mental ill health
unequally distributed
• Socioeconomic inequality strongly associated
but not shown to have causal relationship with
illness
• Options to intervene to improve chances of
mental health & wellbeing at population and
targeted levels
• No specific primary preventive interventions for
mental ill health but early intervention important
• Positive mental health valuable for all sorts of
reasons & in its own right
3. Mental ill health and inequality
• Psychotic disorder: Prevalence = 0.1% adults in the
highest 1/5 of household income vs 0.9% in the lowest
1/5. The trend more noticeable in men than women
• Significantly higher levels of psychosis in black men
(3.1%) than other ethnic groups (0.2% white men) but no
significant variation in women by ethnicity
• Common Mental Disorder (CMD): people from low
income households more likely to have CMD than those
in highest income households. Most marked for men: in
the lowest household income group men are three times
more likely to have a CMD than those in the highest
income households (23.5% vs 8.8%)
• Of individual CMDs, depressive episodes show the
largest difference across income groups, especially
among men (0.2% of men in the highest 1/5 of household
income vs 6.9% in the lowest 1/5)
(ONS 2007)
4. 0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Mental Disorders
Circulatory
Neoplasm's
Respiratory
Digestive
Musculoskeletal
External causes
Nervous System
Ear
YLL
Endocrine
YLD
Infectious
The Costs
Lambeth BoD 2005 (England)
Genito-urinary
Perinatal
Congenital
malformations
Blood
Eye
Symptoms
Pregnancy
Disability Adjusted Life Years Lambeth 2005
Skin
7. Where jobs and Where people
education are share a sense of
rewarding, belonging and
challenging and are respectful of
foster personal each other
development
Where people
find it rewarding
and worthwhile
to engage in
local
governance and
are satisfied
Where activities with local
and environments services
are designed to be
fun and interesting
Source: new economics foundation
8. One perspective
The mental health continuum - Keyes and Huppert
The population approach to health improvement - Rose
10. A dynamic model of wellbeing
Experience of
life
Functioning well
& satisfaction of
needs
Enabling Psychological
conditions resources
Source: new economics foundation
11. Psychological model of wellbeing
Lyubormisky & Schkade
• Parents and upbringing – 50%
– Genetic inheritance
– Parenting; especially in the early years
• Intentional activities – 40%
– Home
– School or work
– Friends and community
– Hobbies
• Life circumstances – 10%
– Age, gender, income
– Things that happen; new job, relationships
12. The Lambeth story so far…
• 2004 – 05: HAZ & NRF (short term money) to scope,
develop & launch Lambeth’s first mental health
promotion strategy
– Inclusive process: Open Space
• 2005 – 08: some NRF to implement strategy
– Develop measuring wellbeing toolkit
– Assess LAA capacity to measure wellbeing
– Small implementation group to work on joint small projects
– Continuing activity by mental health provider
– Annual arts & wellbeing festival ‘Springforward’
• 2008-10: mainstream (PCT) funding to evaluate,
update & implement refreshed programme
13. In Lambeth
‘To experience good mental health and
wellbeing is to feel positive about today
and to have hope about the future; to feel
reasonably confident about being able to
handle life’s stresses and problems and
that mostly life is fulfilled and rewarding’
14. External evaluation
Successes 2005- 08
• Perceived as innovative and ambitious
• Positive focus on wellbeing rather than illness
– ‘Upstream’ approach
– Building resilient communities
– Arts/creativity
– Tackling stigma and discrimination,
• Partnership working on implementation
– Coordinating group
– Measuring wellbeing work eg; local measuring wellbeing
handbook, mental wellbeing impact assessment (MWIA)
• Emotional wellbeing of children & young people –
eg; stretch target under LAA
17. Evaluation
• Less successful 2005 - 08
– Embedding strategic messages and gaining
commitment & action at senior level
– Partnership action to
• Improve employment practice
• Develop the role of staff in promoting wellbeing
– Specific action to reduce suicide & self
harm
18. Next steps
2009 -12
• Raise profile & make the case
• Focus on the enabling environment
• Develop visible leadership
• Sustainable resource to coordinate
delivery
• Build on success
• Develop accountability processes
across the partnership
20. Promoting the benefits:
the business case
• Improved educational achievement and outcomes
• Increased productivity and employment
• Reduced sickness absence
• Lower rates of crime and disorder
• Better standards of health/reduced mental illness
• Reduced costs of public services
• Increased quality of life
• Higher levels of tolerance, trust and participation
21. Using the evidence:
mental wellbeing ‘best buys’
• Support parents and early years: parenting skills
training/pre-school education
• Support children & yp: health promoting schools
and continuing education
• Improve working lives: employment/workplace
• Positive steps for mh: lifestyle (diet, exercise,
social support, sensible drinking)
• Support communities: environmental
improvements (noise, housing, green space,
safety)
Friedli & Parsonage (2007) Mental Health promotion: building an
economic case, Northern Ireland Association for Mental Health
22. Wellbeing and Happiness in
Lambeth programme
Launched
November 2009
Copies available from:
http://www.lambethfirst.org.uk/mentalwellbeing
Things to do to improve
your wellbeing in Lambeth:
http://www.nhs.uk/lambeth/Pages/Lambethhome.aspx
23. Agreed principles
• No health without mental health
• Focus on what people can do, not what they can’t
• Decision makers must share power
• The cornerstones of wellbeing:
– Kindness and respect: self & others
– Fairness and social justice especially in service
provision
– Being able to take part in community activities &
decision making
• Communicating means listening first
• Measure progress by measuring what matters to people
24. Statements of Intent
• Public spaces and other public assets in Lambeth will be
accessible, attractive and safe, and increasingly used by
everyone
• Lambeth will be a vibrant and creative place to live, work
and learn
Lambeth will be known as a place where people care
about each other
Lambeth will be an exceptionally cohesive place to live,
learn and work
• Lambeth will be a recognised leader in the provision of
sustainable and effective services which enable local
people to achieve, maintain and regain mental wellbeing
25. Delivery
• Work with the strategic partnership
arrangements (Lambeth First)
• High level sponsorship
• Task Group to drive
• Prioritise
• Milestones & timescales
• Success measures
• Targets for theme partnerships
• Wellbeing Network to promote delivery
27. Something for everyone:
Five Ways to Wellbeing
Social relationships are critical
to our wellbeing
Exercise improves mood and can
Thoughts and feelings
lowersimprove self-knowledge and
depression and anxiety
Encourages social interaction
andwellbeing and positive social
Builds trust self esteem
increases
relationships
28. From an incoming
government?
• Commitment to promote mental wellbeing
• Invest in the physical, emotional, social
and cognitive development of children
• Action to promote equity and mental
wellbeing across all sections of society:
school, workplace, community
• Design out poverty & ill health
• Beware of unintended consequences
Editor's Notes
So far we have learned (amongst other things)
Go back a little because when one starts to talk about mental health most people do not think of mental health at all they think of mental illness In Lambeth we are very concerned indeed about levels of mental ill health. We have psychiatrists shroud waving about the highest levels of psychosis in the world, and epidemics of schizophrenia in black people. According to GP records we have about 3x the average SMI which although outside 2SD does not equate to the psychiatrist’s view of the world. Note: In the ONS study no cases of psychotic illness were observed among either south Asian men or men in ‘other’ ethnic groups
This is not a side issue! Has a very substantial impact on the population and on services
From the 1 st London Mayor’s inequality strategy So very strong case for focusing on mental illness. And we do… £100m+ out of c.£800m annual spend. On average people with SMI die many years earlier than people who are not mentally ill because of both their comorbid health problems as well as their risk of suicide which is about 10%
But the inequality is of huge concern – lots of wringing of hands. What can be done? Investment already very extensive and sometimes feels like pouring it down the drain. Chasing our own tail and now against the buffers economically. Its actually unsustainable as things stand although society could afford more we do not choose to pay more. People in Lambeth would love to do something preventive and lots happening but as shown – no one thing so a need to look for another approach that LSPs can take to reduce the risks
Now the other end of the telescope away from mental illness… From a local govt/ local partnership perspective – Lambeth does aspire to this I would say. What people need as summarised from nef: Perhaps summarised as a society that is Productive – people fulfilling their potential Cohesive – people getting on, trusting one another, feeling safe, included, able to participate Healthy (individuals & communities) Fair – a sense of justice and fair treatment by others, services, society at large Sustainable – works for the long term
If we had the sustainable community as described perhaps we might do this & reduce chances of mental disorder and push the population towards flourishing This is a reasonable theory and makes more sense than just trying to identify who is at risk and intervening with individuals (can’t precisely tot up the risk to make it a viable option, NNT ridiculously high and probably leave more people out than get targeted)
If take this approach and it succeeds for individuals How might people describe it for themselves? No pain, Opening up, Taking action, Socialising, Making the most of who you are, Having enough money, Getting things done and being assertive People are surprisingly consistent in this regard; some people emphasis how they feel, some on how they can achieve or function but tend to cover similar aspects
Chicken and egg tho; to get the society we want people have to feel good and function well and to feel good and function well people need a conducive environment to thrive Feeling good and functioning well individually and societally says nef is based on 2 broad groups of resources: Enabling conditions: - opportunities & obstacles, inequalities, social norms, culture Psychological resources: - resilience, optimism, self esteem Functioning well & satisfaction of needs: - eg autonomy, competence, connected to others Experience of life: - eg happiness, satisfaction, interest, boredom & distress Noone would argue but where does this come from and how can it be realised practically – what is an LSP to do? Their traditional approach
Another way of looking at things – Some leading researchers in positive psychology look at the origins of wellbeing If you accept that people function better when they feel ok and that people feel ok if they are functioning well and they can do that if certain things are there for them where does local govt and LSPs go with this? The traditional what shall we do is providing services more and better all the time and the stock response about wellbeing when you start to explain it and how LSPs can promote it is ‘but we do that already’. But a bit like ‘we don’t discriminate’ the question is more how much wellbeing do you have confidence you are delivering, to whom and are you maximising the wellbeing you could deliver with the resources you have? What we are trying to do is find a way of explaining that a focus on wellbeing in itself helps to realise the sustainable community that we need so that people fulfil their potential and are fully productive etc If we accept at a basic level from this perspective – for a successful, productive, cohesive society where talents are realised & people contribute fully Adequate resources; of course – people have to live Nb means of exchange: not just money but people have to be able to earn adequate resources in one way or another but in the real world people also exchange time and energy, love – people have transactions that mean something to them Settings, frameworks, policies, arrangements that bring out the best in people; education, safety, etc Although you can say that wellbeing and positive mental health is a product of this set up, in fact in chicken & egg fashion also to make this go round and work population wellbeing is also needed.
Started very small and without a particularly fair wind with a group of people who thought there was an opportunity with Standard 1 of the MH NSF to look more broadly at mental health outside MH services and the role of health and social care
Lambeth definition
As part of gauging what people felt was important and ensuring a legitimate process worked on getting maximum involvement in a short time; Interviews of key stakeholders, people involved to date Wider events particularly an Open Space with >100 people to gather ideas on what to focus on and how to move forward Open Space – theme is set and people bring their own topics for discussion. Prioritised and written up on the day
Added value of a wellbeing approach – not about doing more but doing differently: maximising the opportunities for people to feel good and function well as a result of LSP action, strategically as well as in service terms
And what gets us there?
The programme is for everybody
Big ambitions and a bit overwhelming so
This is the vehicle – so working within existing arrangements Every LSP looks like this Very specific activities underneath the statements Our input is to develop a MWIA approach, develop better ways of communicating with one another and local people Adding value to activities and emphasising where to focus to get the most benefit eg policing – anti prostitution strategy, investment in the arts etc, importance of attention to built envt. And measuring progress – how to we demonstrate that this makes a difference?
Comms including what everyone can do A balance between state and individual/ community. Lots of people on the bottom of the heap are not dependent, they are fighting hard and don’t want patronising
Support parents/ carers Living wage, appropriate policies to enable more fairness, transparent government and business, opportunities for people to participate and influence Design out poverty and ill health – built environment, transport, taxation, education, health and care services
