Working together on prevention public mental health

Working together for
Prevention
mental health, physical health, money and
wellbeing
Stevenage CAB AGM
Jim McManus, Director of Public Health
October 2017

www.hertfordshire.gov.uk
What’s happening?
• Too many people getting complex
preventable problems, not just illness and
disability
• Too many variations in care quality and
outcomes
• Not enough focus on preventing things
happening or worsening
• Unsustainable, unaffordable, undeliverable

Success is possible: Steve Atwell

That’s the physical…imagine if we
could capture every mental health,
debt and stress success like that…

• Over the next 20 years,
the shape of the
population will change
• By 2022, people aged 65+
(highlighted in orange) will
represent a greater
proportion of the overall
population…
1
How the STP
population will age

• By 2027, this change will
be more noticeable (note
the widening of the lines at
the top)…
1
How the STP
population will age
© Copyright, 2017
Hertfordshire County
Council Public Health

• By 2037, the change will
be much more dramatic
• There will be c.23,000
more residents aged 90+
across the STP footprint
by 2037 than in 2017
1
How the STP
population will age

And we could tell the same story
• For children and young people
• For working age adults , especially those not
coping with their financial or employment or
debt or housing circumstances

Money and Mental Health Policy Institute
https://www.moneyandmentalhealth.org/

Implied impact on ill-health recovery
• Source: Money and
Mental Health Policy
Institute
• Caveats around the
data but indicates
an issue of
importance

So what?
• The work done by projects like CAB, Money
Advice Unit and local communities may not turn
into money from the NHS in the short term
• But it puts down a significant marker that you
are part of the health and wellbeing system and
you and your funders make a strong, positive,
tangible and measurable impact on health

Avoidable mental ill-health
• Significant burden of ill-health
• 25% of adults at some stage
• 7-9% at any given time of population
• Significant amounts of it preventable
• Focus on suicide prevention is good, now what
about the determinants?
– Debt, Poor workplaces, significant stress
levels, inability to cope

Money and Mental Health – 2ndary
Prevention
• “…… our health research demonstrated the
‘drag’ on recovery rates in mental health
services presented by financial difficulty, and
found that very few local areas are
systematically tackling the issue, at the cost of
both the patient and the NHS
• Money and Mental Health Project
• Annual Report

Demand outpacing resource
• We can no longer afford to put all our energies
into responding after adverse events
• System never designed for this level of
need/demand
• We need to prevent, reverse or mitigate need
for services
• Significant avoidable and preventable burden of
ill health and inequality
BUT ALSO………

But also….
• There is a strong and significant burden of
avoidable mental ill-health which is in principle
preventable through a range of actions

What do we do?
• A population shift to prevention – mindset
• Primary
• Secondary
• Tertiary
• Everyone’s business
• Making it the day job

What is Prevention?
• The avoidance, whether permanent or temporary, of
demand or need for public service or an adverse
event/hazard or exposure leading to need for public
service
– SHORT TERM (eg up to 24 months)
– MEDIUM TERM (eg 2-5years)
– LONGER TERM (eg 5 years plus)
• Prevention is NOT rationing or restricting eligibility

Levels of Prevention
• three levels. Preventative activities may be delivered by any
agency.
• Primary Prevention – ‘prevent’ or stop harm or need for
service arising in first place – physical activity, recycling
• Secondary Prevention – ‘reverse’ harm or need for
service – rehabilitation
• Tertiary Prevention – ‘reduce’ or mitigate harm/need for
service – an Anti Social Behaviour Order? A wheelchair
for a diabetic foot amputation

So what are our ambitions? The Three
building Blocks of Prevention
People looking
after themselves
• Cultural shift
• Most difficult to
do
Making prevention
the day job
• Mixture of
• Business
Process
• Culture Shift
• Prevention Know
How
The Big Return
Programmes
• Bespoke projects
we could use to
transform
demand and
need

The Enablers and Governance
People looking
after themselves
• Cultural shift
• Most difficult to
do
Making prevention
the day job
• Mixture of
• Business
Process
• Culture Shift
• Prevention Know
How
The Big Return
Programmes
• Bespoke projects
we could use to
transform
demand and
need
Enablers: Comminication (Internal, External), Programme Management,
Logic Tools, Directorate Worshops, Business Benefit Mapping

Block 1: People looking after themselves
• Individual level motivation and challenge
• Societal Level – policies which reinforce this
• Lots of talk on this, little action
• We are working on a framework to help you
address this

Block 2: Making Prevention the day job
• What is it your services do to encourage
dependence and demand?
• What is it they could do to reduce and avoid
demand?

Mainstreaming Prevention
Consider
impact of
everything you
do on
prevention
Consider what
you can do
individually and
together
Population
needing fewer
specialist
resources

Its BOTH business Know How and Science

Block 3: The Big Ticket Opportunities
• What are the big things we could do to make a
radical shift in areas of high cost avoidable
need?
– Family Safeguarding
– Adults with mental health needs and
employment

Phasing and Layering
• You don’t approach this like a blunderbuss
• Use scientific and business principles to identify
what will have greatest impact in what timescale
• Phasing the interventions across time to produce
results and yield
• Layering the interventions across populations to
produce results and yield
• Still need to do primary prevention, but that’s
long term

How?
• Mindset
• Establish clear priorities
• Timescales – short, medium, longer term
• Everyone’s business
• Pathways
• Redesign
• Population Approach

So what could be done? Examples
Levels of
Prevention
Crime and
Disorder
Mental Health Cancer
Prevent/Stop
harm or need
Reduce alcohol
related injuries
and violence
Reduce drug
related crime
Prevent lost
productivity by
workplace ill-
health
Routine physical
activity for
everyone to
retain balance
and mobility
Reverse harm
or need
Physical activity
for rehabilitation
Reduce/Mitigate
harm of need
Cheaper
alternatives?
(social groups for
lonelines)

What can the science do
• Science of behaviour change
– Behaviour insights “nudge” on council tax
payment and recycling behaviour
– Behaviour change backed
• Much better clinician push on prevention, self
care and responsibility

Quick wins in the system - 1
• Drug testing on arrest and early referral in
• Using “behavioural insights” on council tax notices and
letters and on recycling
• Leisure centres and services
• Early intervention to prevent slips, trips and falls
• Using “behavioural insights” in recycling
• Resilience in employment

Quick wins in the system - 2
• Night time economy work on alcohol with retailers
• Routine, universal, physical activity
• Physical activity and social contact for people isolated
• Behavioural contracts with offenders
• Mental Health First Aid
• Getting people temporarily sick back into work
• Getting people with one long term condition doing physical
activity

Hertfordshire and West Essex
Sustainability and Transformation PlanPrioritising Prevention – the Decision Cycle
What population?
What issue/need?
What outcomes do
we want?
Which
interventions fit
best?
How do we know
it’s working?
(Evaluation)
1. Service cost and
demand
2. Needs (JSNA)
Define the outcomes clearly
so you can really assess
feasibility
1. Financial Assessment
2. Evidence Assessment
3. Logic mode where
evidence silent
1. Financial Assessment
2. Outcome Assessment
Questions to ask Tools for HCC

Desired Outcome
• An appropriate prevention plan which models
savings achievable from prevention
• A plan underpinned by evidence and a logic
model
• Clear articulation of who needs to deliver what to
achieve it
• System wide expectations

For your sector
• What could it look like?
• Improve physical health?
• Social referrals to health shop?
• Get more GPs referring in?

Working together on prevention public mental health

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Working together on prevention public mental health