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Calling all public mental health practitioners!

Are you practising public mental health? Are you developing and delivering evidence based policies and programmes aimed at advancing the public’s mental health and wellbeing?

If yes, then submit your work for the Sarah Stewart Brown Award for Public Mental Health and be in with a chance of winning the £500 cash prize that’s on offer. The award is an opportunity to highlight what you are doing and the impact you are making in enhancing mental health and wellbeing at a population level. It’s also an opportunity to highlight innovation and to share good practice with public health colleagues and with the wider public.

What is public mental health?

Public mental health has been described as the art and science of improving mental health and wellbeing and preventing mental illness through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.

Good mental health and wellbeing are profoundly important to our quality of life and our capacity to cope with life’s ups and downs. They also help protect us against physical illness, social inequalities and unhealthy lifestyles. There are now a large number of evidence-based approaches to promoting mental wellbeing and preventing mental illness, and these are growing daily. They range from programmes to mitigate the impact of Adverse Childhoood Experiences (ACEs) through to tackling social isolation in the elderly.

Who is Sarah Stewart Brown?

For the last 20 years, Professor Sarah Stewart Brown has devoted herself to developing and promoting public mental health at the Faculty of Public Health (FPH) and in other settings. She chaired FPH’s Public Mental Health Committee from inception in 2007 to 2015 and before that worked with various FPH committees including the Mental Health Working Group.

Since 2003 she has been Professor of Public Health at Warwick University where she leads research and development in the fields of mental health and wellbeing and teaches on public mental health to medical and public health students.

As an advocate for public mental health, Sarah has sponsored the award with the aim of encouraging and promoting leadership and innovation in public mental health in the UK.

Now is the time to bring your work into the spotlight.

Who can apply?

If you’re a member of FPH, you work in the UK and you’ve played a significant, but not necessarily lead role in the development or implementation of an innovative approach to promoting mental health and wellbeing, you are eligible to apply.

Criteria for award

Submissions must provide evidence of:

  • Development or implementation of an innovative approach to mental health and wellbeing improvement at population level
  • Use of appropriate research evidence to inform practice
  • A sound plan for monitoring and evaluating the innovation
  • Engagement by appropriate stakeholders including service providers, partners and/or community
  • Potential for sustainability

Exclusions:

  • Projects or programmes addressing secondary or tertiary approaches to prevention are not eligible for this award

The Award recipient will have:

  • Enabled public health mental health work to flourish and grow – either directly or by enabling others to act
  • Demonstrated innovation in the field of public mental health – doing things differently – thinking differently and / or enabling others to do so
  • Shown how their contribution has made a difference to individuals, to communities, to staff or to public policy

What can you win?

A cash prize of £500 which must be spent in a way that either promotes the work that’s already been delivered, or helps to progress the work in some way. For instance, it could fund the design of a discussion paper and associated comms or it could go towards an event.

How do you enter?

To nominate yourself for this award, please submit a proposal (500 words max.) that briefly outlines the work you’ve led, or enabled others to lead, and your plans as to how the award money will be spent. Email your submission to policy@fph.org.uk by 1 March 2019 or for more information, click here.

Written by Dr Mike McHugh, Public Health Consultant at Leicestershire County Council and member of the FPH Public Mental Health Special Interest Group (SIG). Follow Mike on Twitter @hguhcmekim.

 

The fourth international LEPH (Law Enforcement & Public Health) conference was held in October 2018, with an overarching theme of disparities in health and criminal justice. We were delighted to be invited to speak about our work developing a national consensus agreement between policing and health (and not just because the conference was in Toronto!), and humbled by the amount of national and international interest it generated.

Attention to the links between public health and policing is growing at the moment, especially the concept of a “public health approach to…”. The conference showcased both the breadth and depth of work going on in this field internationally. In particular, it demonstrated that “a public health approach” is being applied effectively in law enforcement far beyond violent crime. This blog gives an overview of the different strands of the conference and picks out some highlights for us.

An opening presentation from Dr Eileen de Villa, Toronto’s Medical Officer of Health, set the scene, outlining the health needs of her communities, the inequalities and challenges and her hopes for their future. The crisis of opioid overdose is not at the same scale for us in the UK (and we hope never will be) – but the rest of her words felt very familiar, a reminder of shared values and challenges and the necessity of taking a shared approach to evidence, research and practice in order to meet common goals.

Wellbeing of law enforcement staff was a key theme at the conference, with powerful personal stories and evidence about the impact of trauma on emergency service workers. Work to develop a national emergency services wellbeing service, starting with the National Police Wellbeing Service in England and Wales was highlighted, along with Oscar Kilo (a joint Public Health England and police evidence-based wellbeing initiative). There was a real recognition that this is world-leading, and should be common practice across the international community. Not only is this essential to support and protect the protectors; but it also links to our own understanding of trauma and adversity as a cause of poor health and wellbeing.

The emerging discipline of epidemiological criminology, or ‘epicrim’, was explored. At its most basic this is the study of crime as a form of disease, but also more broadly involves merging the techniques and theories of epidemiology and criminology. Examples of studies were from the US and South Africa focussed mainly on gun crime. Many more examples of innovative inter-disciplinary policing and health research were presented throughout the conference. In particular, we were really excited by the work colleagues in Scotland are doing to develop the law enforcement and public health evidence base, with workstreams around vulnerability, better partnership working, information and data sharing, peer support and organisational wellbeing; and mental health crisis.

Violent crime is of increasing concern in London and other cities in the UK – and there were several sessions discussing public health approaches to violence. The Cure Violence approach began in the USA, and is part of a movement to recast violence as a health issue. Other examples included a data sharing, surveillance and analysis system in Wales enabling targeted early intervention. Traumatic brain injury was highlighted as a vastly under-recognised issue.

Mental health was another theme, with presentations focussing on evidence-based partnership approaches. The question of unintended consequences and fragile intersections between policing and mental health services was also raised many times: for example concerns that efforts to upskill police staff to better support people in mental health distress can lead to a scaling back of mental health services – and/or that scaling back of mental health services leaves police supporting individuals who need crisis treatment. This was a reminder that problems we are struggling with here in the UK are also being experienced internationally.

Colleagues from Public Health Wales presented on their Early Action Together programme which marries an academic and a practical intervention-focussed approach to Adverse Childhood Experiences (ACEs) and trauma informed services. ACEs were discussed in many of the presentations throughout the conference, and there was a strong commitment to early intervention and prevention.

There were many other strands of law enforcement and public health being explored – prison health featured strongly, with presentations ranging from the impact of austerity in English prisons to needle exchange programmes. Other sessions explored the role of public health and law enforcement collaborations to address alcohol; drugs; race; particular needs of indigenous and other marginalised communities; and the role of technology.

The oration was given by Professor Sir Michael Marmot and was a definite highlight of the conference. He spoke with clarity and energy about inequalities in a way that brought together the potentially quite disparate audience of academics and practitioners, from across law enforcement and public health. The intersection of evidence base and passion for social justice is always music to the ears of public health people – but to witness it also being shared equally by a conference hall of law enforcement professionals was a special moment.

Our focus as we presented the work that we’ve done to develop, agree and implement the policing and health consensus is also very upstream, and it was a privilege to be able to share that with colleagues from around the world. One of our main strengths so far in England has been our partnership approach, and we hope that as we collaborate with our colleagues internationally with their strong academic, evaluation and intervention skills we can together grow and embed a holistic approach to public health and policing that will demonstrably improve outcomes for the most vulnerable in society that we are all here to serve. We look forward to sharing our progress at LEPH 2019 in Edinburgh.

Written by Helen Christmas, Specialty Registrar in Public Health at PHE, and Supt Justin Srivastava, Lancashire Constabulary. You can follow Helen on Twitter @helen_christmas and you can follow Justin @SuptSrivastava. If you’re interested in policing and public health, you can also follow @police_health.

bronte 10kOctober 2018 and I flew 10,000 miles to Sydney to start my final year of training in a different system. It requires a very different ‘winter’ wardrobe!

I’m spending eight months hosted by South Eastern Sydney Local Health District and based at the oldest working hospital in Australia. Having been here almost two months I’m getting used to a host of new acronyms and a healthcare system which includes a combination of Public Health responsibilities at commonwealth, state and district level and a bigger role for fee paying services than in the UK.

What was clear from my first day here however was not the differences but the similarities. Discussions around an ageing population and a desire to integrate care and risk-stratify the population made me feel very much at home straight away. A stereotypical image of Australia is that it is universally active and ‘healthy’ but rises in obesity, diabetes and mental health are huge challenges here, just as in the UK. In addition the impact of climate change is becoming, albeit slowly, a big issue in a country that has already seen the impacts of increasingly adverse weather events, especially droughts, heatwaves and bushfires.

The health and wellbeing of the Indigenous population, aboriginal and Torres Strait islanders, is something that shouldn’t and cannot be ignored. Prior to colonisation the Indigenous population had a 60,000 year history here but have only been counted as part of the population (via the census) for the last 50 years.

Aboriginal people can expect to live at least 10 years fewer than everyone else in Australia. Virtually all health indicators show vast inequalities between the Indigenous and non-Indigenous populations. Despite making up only 3 per cent of the general population they constitute 28 per cent of the prison population. Rates of smoking are more than two and a half times that of the rest of the population. Indigenous children are more than 10 times as likely to be removed from their families and placed into state care as non-Indigenous children. The list goes on and on.

The term ’aboriginal people’ suggests a single homogenous group. In fact, the map below illustrates how Indigenous communities see the boundaries within their land rather than the states and territories which have emerged in the last couple of hundred years. Hundreds of separate regions with separate languages, customs and traditions.

Australia map image.png

During my placement in Sydney I’ll be based within the Eora nation and on the lands of the Gadigal people.

I’m placed with SESLHD (South East Sydney Local Health District). SESLHD is an organisation responsible for the health of almost a million people. It covers urban areas in some of Australia’s most prestigious neighbourhoods as well as areas of high deprivation and has the world’s second oldest national park within its boundaries. SESLHD covers nine hospitals with commissioning and management responsibilities for a range of community services and everything from pre-birth to palliative care. I guess Clinical Commissioning Groups are the closest ‘fit’ with local health districts.

I’ll be leading on a couple of work areas. Firstly, the development of an Environmental Sustainability Plan for SESLHD. Secondly, I’ll be investigating patient pathways looking for opportunities to reduce variation and integrate services across a number of areas, including paediatrics and Child and Adolescent Mental Health Services.

I’ve also been fortunate to be awarded a scholarship with the Deeble Institute, a research unit within the Australian Healthcare and Hospitals Association (AHHA), and I’ll be working with them to produce an evidence review around the role of accreditation in healthcare. This has already involved spending time in the national Capital, Canberra. I was part of a delegation from the AHHA who met with the Minister and Shadow Minister for Health in Parliament.

Finally a word on the Public Health training here. I’m discovering there are both similarities and differences with training in the UK. The Australasian Faculty of Public Health Medicine is responsible for a three-year public health training scheme for medics. Some of the states also run additional Public Health Officer training programmes for medical and non-medical staff – the largest of which is here in New South Wales. As part of my placement I’m spending time with trainees from both schemes and attending some of their training – and they’re social events of course!

Trainee xmas night out

So in summary, so far it is a great placement with great people and lots to learn. It doesn’t feel like Christmas as I write this in my shorts looking at the beach but the conversations about the Coca Cola truck confirm that it’s that time of the year and that some things in Public Health are universal!

I’ll be writing more about my time in Australia towards the end of my placement. I’m keen to reflect on what lessons I can bring back to the UK and consider what new opportunities there could be for registrars across the commonwealth in a post-Brexit world. In the meantime, I’ll be making an effort to tweet more about my time in Sydney so please feel free to follow me on Twitter and ask any questions @RyanSwiers.

Written by Ryan Swiers, Specialty Registrar in Public Health

Today we’ve published FPH’s first major contribution to the national discussion about the role of the NHS in prevention.

Our discussion paper – the first of three we’ll be publishing – reflects many months of thinking and engagement with key NHS and public health stakeholders and the conclusions of an evidence review of prevention initiatives in the NHS.

It is also the first major ‘output’ from our Role of the NHS in Prevention project, which has been funded via an award from the Health Foundation.

We explore three main themes in the discussion paper:

1. What does the evidence tell us about what works?

We’ve discovered that there is lots of good evidence about what helps or hinders prevention in the NHS. But there are still far too many evidence gaps and there’s a very long way to go to make the evidence we do have as useful as possible for NHS leaders, local commissioners and providers. In the meantime they are all having to make ‘best guess’ decisions about which NHS prevention initiatives are likely to provide the most ‘bang for buck’ in their local area.

2. What are the different roles the NHS plays in support of the prevention agenda?

We heard that although NHS organisations are doing a lot of prevention, there is a sense that the NHS responsibility for and capacity to do prevention is poorly defined and poorly understood. This confusion can sometimes impact on service delivery. Based on our evidence-gathering about what prevention in the NHS currently looks like, we’ve come up with five descriptors that we think do a good job of summarising distinct NHS prevention activity:

i. Leader – e.g. commissioning services, providing governance and management, setting the national agenda, role-modelling.

ii. Partner – e.g. providing services, hosting services, working in collaboration to deliver services with local authority, statutory, or other voluntary sector entities.

iii. Employer – e.g. initiatives aimed at improving NHS staff health and wellbeing; NHS as a community employer and ‘anchor institution.’

iv. Advocate – e.g. lobbying governments on public health agenda, lobbying for prevention within individual institutions.

v. Researcher – e.g. funder and driver of new research.

It’s important to stress that we know these categories often overlap and are imperfect descriptors of a diverse range of activity. We’ll be looking to refine these as the project continues.

3. Where should the NHS focus its prevention efforts, now and in the future? In October FPH held our first NHS prevention stakeholder workshop. Over 40 healthcare leaders from across the UK came together to share their knowledge and ideas. Our discussion document sets out a shortlist of 11 prevention interventions that they said should be the focus of the NHS’s prevention efforts. But the majority of experts agreed that a collection of individual interventions alone will not deliver the kind of change we need to support the long-term sustainability of the NHS. A systems approach was identified as a crucial way of achieving change at a population level. We think the NHS should focus some of its effort towards this longer-term goal without losing sight of the fact that delivering more cost-effective prevention interventions could still be very impactful now if implemented in a place-based way and integrated into regular services.

As we set out the themes we will be exploring in more detail in future discussion papers, what’s already clear is that ill-health prevention is a significantly under-exploited way for the NHS to keep people healthy and better manage demand on services. The forthcoming NHS England long-term plan and the UK Government’s prevention green paper offer ‘once-in-a-generation’ opportunities to further promote prevention and make the step-changes we need to integrate prevention into the day-job of every healthcare professional. We hope these opportunities will be grabbed with both hands.

The whole point of a discussion document is to encourage more people to build on the ideas we’ve set out, to challenge them (please be nice!), and to inspire new thinking. We would be very interested to hear your comments and answers to the various questions we pose. You can do this in three ways:

  • By tweeting us @FPH
  • By emailing us via policy@fph.org.uk
  • If you’re an FPH member, by joining our Public Health Funding Campaign ‘sounding board’ and getting involved in the further development of our thinking. Email policy@fph.org.uk to find out more

The final thing to say is a huge thank you to everyone who has contributed to the Public Health Funding project so far. We are extremely grateful for all your help and please do continue to get involved. Click here to read the discussion paper. 

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group, and Lisa Plotkin, Senior Policy Officer and FPH’s Public Health Funding Project Group Lead.

I first read George Orwell’s 1984 when I was fifteen and it terrified me. Never had I experienced such an acute realisation of the importance of human freedoms and civil rights. This never left me during my first career working for ‘the state’ as a psychiatric nurse within the National Health Service, and it has become ever more salient during my current career working for ‘the state’ in public health.

Public health is first and foremost a belief that a better world is available to us through planning, organising, collaboration and action. A world with less disease, fewer premature deaths, and greater equity in the achievement of human flourishing and wellbeing.

It goes without saying that all potential actions can provoke debate and the voicing of concerns. Such concerns can be sincere or cynical, and it is helpful to be able to differentiate them in order to inform one’s best response.

This is where FPH’s Special Interest Group (SIG) on public health ethics comes into its own. Having secured the invaluable involvement of professional philosophers, ethicists and legal scholars, the SIG works to strengthen our understanding of relevant issues in political philosophy, ethics and law, and how to deploy these in our everyday practice. Leading the case for change requires engagement with such issues, as much as it requires engagement with the empirical epidemiological and healthcare evidence base.

Of particular relevance here is the recent report on the Nanny State Debate authored by Professor John Coggon Hon MFPH, Professor of Law at the University of Bristol. This resource, in which Professor Coggon generously makes the breadth and depth of his scholarship accessible to the public health workforce, provides the key facts one needs to know to be able to classify voiced concerns of ‘nanny statism’ and respond appropriately.

People can have heartfelt concerns about human autonomy and proposed restrictions on freedom of choice. I relate to this in light of my early experience of reading Orwell. Professor Coggon’s report reassures me that it is entirely appropriate to recognise and acknowledges these concerns. Dialogue is worthwhile, making use of empirical evidence to set out the issues and the benefits of action, while other relevant values can be introduced for consideration alongside freedom, such as fairness, equality, and solidarity. In this way, progress can be made.

Alternatively, vested interests whether financial or power-based or both, can cynically seek to prevent action to protect or improve population health. I suspect we will each have had our own experience of this in one form or another. Professor Coggon clarifies how claims of ‘nanny statism’ can be deployed to shut down debate and block action. Direct attempts to engage and persuade, through evidence and appeals to justice, are unlikely to be effective. As public health professionals we need to know how to craft public responses to constructively maintain debate and momentum for action.

In summary, I found The Nanny State Debate to be concise but hugely thought-provoking, and a valuable addition to my public health ‘toolkit’.

At a time of ecological crisis, growing inequalities, and stalling life expectancy we need evidence-based and values-based planning, organising, collaboration and action more than ever before. As a practitioner on the public health front line may I commend Professor Coggon’s report to you, and urge you to read it and put it in to action.

Written by Christopher Littlejohn FFPH, Deputy Director of Public Health, NHS Grampian. 

Jonathan ShepherdSince its foundation, the Faculty of Public Health (FPH) and the organisations from which it was built have advanced public health standards, which is done on the basis of continuously evolving knowledge of what constitutes best practice and policy. In turn, this knowledge is based on the best quantitative and qualitative evidence available. The nature of this evidence has also evolved. Controlled, and, where feasible, randomised trials are now the source of a great deal of the best evidence about what works, what doesn’t and what represents good value for money. The health of the public now relies on such evidence.

Perhaps the main role of FPH and of its parent Royal Colleges with regard to evidence is to make sure it is infused into the professional lives of their members and fellows and is applied – through the curriculum, through career advancing membership and fellowship examinations and assessments, through courses, training standards and wider CPD, through journals and policy statements, and through their networks of advisors. This function is often called evidence mobilisation.

Importantly, FPH also provides powerful incentives to excel – prestigious and eponymous prizes for example. These are often awarded for excellence in evaluation and development and then, through personal example, for pioneering and promoting better practice and policy based on this.

FPH and RCP (The Royal Colleges of Physicians) also provide welcoming professional homes – attractive environments in which practitioners and policy makers engage with the latest evidence and guidance and decide how it might inform and change their practice.

But this Royal College model of continuous improvement was not adopted by some other professions until very recently. It seems astonishing that until 2014 there was no such institution for the police, and until 2016, no professional body for teachers in primary and secondary education.

Since evidence has come a long way in the last few decades across all of these policy areas, it seemed to me that a declaration on evidence, signed by the relevant professional bodies, would strengthen a culture of evidence-informed policy and practice in these institutions and in the professional lives of their members and fellows.

Declaration of evidence

As an honorary fellow of FPH and a member of FPH’s Academic & Research Committee, I drafted this declaration and then took it through the boards of the Academy of Medical Royal Colleges, the Chartered College of Teaching and the College of Policing. It was signed by leaders of all the Royal Colleges and police and teaching institutions at the Royal Society on 7 November 2017. This event was facilitated by the Alliance for Useful Evidence and chaired by the former Cabinet Secretary, Lord O’Donnell. The Faculty president, Professor John Middleton, signed for FPH.

Blog 1

The signing ceremony at the Royal Society*

This declaration signals FPH expectations of all its members and fellows with regard to evidence and also signals its commitment to support high quality evaluation.

At the signing event at the Royal Society I introduced the declaration and commented that:

This is a unique meeting of leaders of professional bodies in healthcare, teaching and policing. Teachers, police officers, doctors and dentists make up a sizable proportion of the UK workforce. The influence of the institutions represented here extends to more than one million professionals across the UK and more widely. This event is testament to the great importance of evidence for our professions and for the public we all serve.

*The people featured in the photo are:

Front row, left to right, Chief Constable Ian Hopkins, director, College of Policing; Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges; Dame Alison Peacock, chief executive, Chartered College of Teaching. Back row, left to right, Lord O’Donnell, former Cabinet Secretary; Professor Jonathan Shepherd, declaration author; Jonathan Breckon, director, Alliance for Useful Evidence.


Written by Jonathan Shepherd, professor of oral and maxillofacial surgery at Cardiff University. Jonathan is a fellow of the Royal College of Surgeons of England and the Academy of Medical Sciences, and is an honorary fellow of the Royal College of Psychiatrists and the Royal College of Emergency Medicine. He is a member of the Home Office Science Advisory Council and the What Works Council at the UK Cabinet Office.

The Public Health Dashboard is an online, easy to use tool providing information at your fingertips on a number of indicators related to local activity to improve the public’s health and wellbeing. You can learn more about the tool, the data it presents, and how to use it here.

Tools like this one are aimed at local decision-makers, such as senior council officers, to help inform their investment decisions. This will be especially useful when, at some future date, the public health grant fence is removed. At the moment, the tool includes the following local authority service areas:

  • Best start in life
  • Child obesity
  • Drug treatment
  • Alcohol treatment
  • NHS Health Checks
  • Sexual and reproductive health
  • Tobacco control
  • Air quality (interim indicator)

Based on feedback, PHE (Public Health England) and the Faculty of Public Health (FPH) have embarked on a partnership to consider the inclusion of wider determinants of health indicators in the tool and ensure that the voice of the public health workforce is reflected in the final outcome. Our members believe that if this tool is really going to help them make the case in their local authority for more investment for the interventions or services that keep us healthy and well, then indicators that speak to places, sustainability, good jobs, and community cohesion need to be included alongside the mandated services.

However, there are potentially hundreds of ‘wider determinants of health’ (WDOH) indicators that could be included in the tool. To come up with a manageable list of indicators to consider in more detail, we surveyed FPH members about influence and impact. Here is a summary of what they told us:

The Top 5 indicators that councils can influence

  • Active transport
  • Number of premises licensed to sell alcohol per square kilometre
  • Density of fast food outlets within 400 metres of schools
  • Density of fast food outlets
  • Access to parks and recreation spaces

The Top 5 indicators that impact health and wellbeing of local residents

  • Overcrowded households
  • Social isolation in adult social care users
  • Fuel poverty
  • Statutory homelessness
  • Active transport

The survey findings provided us with a wealth of information about influence, impact, and future priorities for our members in terms of the work that they are currently doing locally and also what they think will become more important over the next 2-3 years.

We then used our survey findings to inform two workshops held in London and Birmingham in early November. The workshops were attended by FPH members working in local authorities. Over the course of two afternoons, we had lively and interesting debates about the indicators and how a simple tool like the dashboard could best represent a complex area, such as the wider determinants.

The PHE team is still considering the next steps in terms of how – or indeed if – to incorporate the WDOH indicators into the tool. We hope to use the findings from this work to do a larger project, examining how our members and others working public health can better influence spending in their local authority to tackle the wider determinants of health.

If you would like to get involved in our work or learn more about this project, please email policy@fph.org.uk or click here.

Written by Lisa Plotkin, Senior Policy Officer, FPH