Archive for October, 2018

Just TalkIt’s a really short sentence isn’t it? Probably something that most men have said or thought at some point in their lives, but definitely something that cuts right to the heart of what we were trying to change through our #JustTalk campaign in Hertfordshire.

I won’t talk in detail about the evidence because that’s already out there. But what was important was that research shows young people – boys in particular – struggle to identify coping strategies when things are worrying them, and fear of judgement is a significant barrier to them speaking to someone about their worries. As a result they can become isolated and vulnerable and unchecked, these behaviours can escalate into adulthood, where we know men are significantly more likely to go missing (73% of adults who go missing are men), or take their own lives. We also know that most existing mental health campaigns have failed to successfully reach out to young men.

#JustTalk was our response to this. The premise is simple, we want to challenge stigma and normalise conversations about mental health and make sure that more young men are using healthy coping strategies. We developed the campaign in partnership with agencies from across Hertfordshire and most importantly with young people themselves. We created a range of resources for schools, including lesson plans and assembly outlines, as well as engaging online content, featuring inspirational role models (premiership footballers, comedians, and journalists) modelling everyday discussion around mental health. Our campaign ambassadors included Jack Wilshire, Jonny Benjamin and Neil Laybourn (the Strangers on the Bridge), Iain Lee and Marcus Brigstocke. The impact of our social media push was huge – our twitter posts alone reach 4.4million people and 25,000 local youngsters heard about the campaign in school assemblies.

Alongside this we ran a competition for young people to submit a film storyboard to promote the campaign, in order to encourage other young people to open up and to understand that it’s ok, not to be ok. The entries we received were both creative, impactful and thought provoking. The title above is a part quote from one of the winners, 13 year-old Alex, who goes to school in St Albans. The rest of it is telling ‘But there’s no need for that, if you share your problems then it will help everything.’ The storyboards have been worked up into films, which we are launching to tie in with World Mental Health day on 10 October. The other winner, Louis, who attends a school in Hertford, entered the competition because he ‘thought it was important everyone knew what mental health is and that it’s important to speak to people if you are feeling a little bit down.’

Both films are great and I would thoroughly recommend taking some time out of your day today to watch. While there’s no simple solution to this problem, if we can share Alex and Louis’ messages with all our young people, then that’s a fantastic start.
If you want to find out more about our ongoing campaign, which launched earlier this year, visit https://www.healthyyoungmindsinherts.org.uk/justtalk.

The films are available on YouTube via the following links:

Written by Jim McManus, Director of Public Health, Hertfordshire County Council . You can follow Jim on twitter @jimmcmanusph.

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Inequalities in Health have always been a concern for epidemiologists. In situations where premature mortality seems preventable, social justice makes inequality a concern for all public health professionals. Before the traumas of World War I revealed that anyone might develop a mental illness, a common clinical belief was that psychiatric disorders were mainly hereditary or the result of some congenital, constitutional weakness – as depicted by Charlotte Bronte in Jane Eyre and the “bad blood” of the first Mrs. Rochester.

Few people were surprised in 1913 that people with mental illness often died at a younger age than their neighbours living in the same community. At that time most British adults died before they reached a pensionable age. But after the Armistice of 1918, hundreds of thousands of young adults who had left Britain reasonably sane, now had mental illnesses that interested the Ministry of Pensions. Factors that determined the severity of illness, recovery of function and inclusion in work became of public interest.

In 2018 the Centre for Mental Health estimates there are 15-20 ‘stolen’ years lost for people living with severe mental illness, compared to other people in the same community. Even for people living with ‘common’ mental illnesses like depression or alcoholism, life is generally shorter. Most former patients are not dying of exceptional incidents (like the fire started by the fictional Mrs. Rochester). The precursors to premature mortality in populations with both severe and common mental illness are in fact physical. They include: smoking, diabetes, heart disease and cancer. Since my days as research co-ordinator for the Bethlem Royal & Maudsley Hospitals I have also been concerned about related, aggravating factors observed alongside mental illness – poverty , bad housing, unemployment and loneliness. 

When I was a member of the Department of Health Steering Group for No Health Without Mental Health in 2010 – 2011, we all agreed on the radical proposal for policy-makers and service commissioners to have a Parity of Esteem (valuing mental health equally with physical health), for physical and mental health needs across the English population. I have been waiting a long time to see much joined-up planning but the Health and Social Care Act 2012 did include the Secretary of State’s duty to promote a more comprehensive service. It stated that:

“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.”

Based on the 2012 Act, the Mental Health Foundation considered the importance of Parity of Esteem. They also offered advice on measuring the parity gap.

They said that while there is not a unanimously accepted method for measuring parity, there are three common concepts in this area that are good indicators. They are:

  • Excess mortality – the negative impact mental health has on life expectancy
  • Burden of disease – mental health is the single largest cause of disability in the UK, however is not reflected in NHS budget
  • Treatment gap – the difference between the number of people thought to have a particular condition, and those receiving treatment for it.

There followed an NHS report called, ‘A Call to Action: Achieving Parity of Esteem; Transformative Ideas For Commissioners’. However, sustainability and transformation plans did not deliver an answer to the “stolen” years with mental illness.

Equally Well

Equally Well is a concept that began in New Zealand “to support the physical health of people with a mental illness“.

Helen Lockett from Equally Well New Zealand welcomed participants to the launch event for Equally Well UK, hosted in London by the Royal College of Nursing on 13 September 2018.

The UK collaboration is led by the Centre for Mental Health and involves about 50 organisations, including Professional bodies (like the Faculty of Public Health), NHS England, Public Health England and a number of not-for-profit organisations. A clear summary of the intentions for this collaboration were given in the BMJ. Personally, I felt there was a lot of goodwill at the launch and I hope there will be a commitment to long-term collaboration, between all of those organisations.

I’m a member of FPH’s Public Mental Health Special Interest group (SIG) and we support the Equally Well “Charter for Equal Health” which I highly recommend everyone reads. We share their belief that “if you have a mental health problem, it shouldn’t mean you have any less right to good physical health”.

Written by Woody Caan FFPH, Editor of the Journal of Public Mental Health and member of FPH’s Public Mental Health SIG. To find out more about the SIG, click here.

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