Better Health For All

I retired from my main career within the public health system because I had stopped enjoying many elements of it; the benefits were not refuelling the tank that was being drained by the disbenefits I was experiencing.

Since retirement, I have taken two very part time roles. I was asked to stay on as a clinical advisor to the bloodspot screening programme for one day a week. This was complicated since the screening programmes also transitioned to NSHEI when PHE was abolished. It has taken me until now to be able to link in to some of the NHSEI Public Health arrangements and structures – over six months. I have also taken a role as Training Programme Director in the newly established Kent Surrey and Sussex School of Public Health, for half a day a week. This has been way smoother in comparison to the NHSEI role.

Having two part time roles makes it difficult to switch off from work sometimes, and I log in most days to check emails. Both roles are flexibly worked rather than having set times which I greatly prefer but which does allow the time spent on work topics to inexorably increase. I have started to book other things into my diary to keep this under control, and now spend more time catching up with friends, visiting art galleries, going to gigs, reading more and finally sorting the house and garden out. My longer term plans to travel more are starting to feel possible again as the covid situation eases, and meanwhile we have a summer of music festivals booked. My confident expectation that I would exercise more when I no longer had to rush to fit a swim in to an already long day hasn’t happened though. With all day to fritter away I some how haven’t got around to much exercise at all, and have started to book into more classes to make myself get more active.

My next decisions will need to be how long to continue in the part time roles I have. I feel I add less and less value to these roles as my other organisational knowledge becomes more and more out of date, and the effort of keeping up with requirements such as appraisal seems less justified. I suspect I will not be doing any formal work in a few years time, and am greatly looking forward to learning how to make cider from Dilys. My one attempt so far developed a very strange smell – will be trying again this year.

Jane Scarlett

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Could you please tell us a bit about your professional background and how this has led to you working on this series and stories

There has always been a creative seed deep inside me and, over recent years, my professional and creative worlds have become excitingly inter-twined. Professionally, I specialised both in general practice and public health, but the latter has been my mainstay for the past two decades. I have worked as a local director of public health at Camden, in national roles as director of public health strategy and global public health director at HPA/PHE, and am currently based at NHS HQ as clinical director for national clinical policy. I am also senior public health adviser to the Football Association (FA), advise the UK film/TV industry on Covid, and have worked academically at the London School of Hygiene and Tropical Medicine for many years.

As much as I have tried to be imaginative in my professional work, the creative seed has been slowly germinating. Early on, this was reflected by studying philosophy after my medical degree, but through the past decade the impetus has been increasingly expressed in literary form – further inspired by my involvement on the board of the wonderful national charity, BookTrust. In 2013, I published my first children’s book, The Amazing Adventures of Perch the Cat, and my current book, The Five Clues, was published by Crown House last year (https://www.crownhouse.co.uk/publications/the-five-clues).

The Five Clues is a YA detective/adventure book centred on 13-year-old Edie Marble, who discovers that her mother’s death a year earlier may not have been an accident. There is a public health plot (conceived well before the Covid pandemic!) and an important sub-theme around supporting mental health in children and young adults. The book – which is the first in the 4-book ‘Don’t Doubt the Rainbow’ series – has, so far, been short-listed for the Dudley Children’s Book Award 2021, People’s Book Prize 2022, Hampshire Book Awards 2022, and CrimeFest Best Crime Fiction Novel for Children Award 2022.

How do you think children and young people’s mental health has been impacted by the pandemic? And what are your hopes for how your books might be able to offer support to this group?

Today’s mental health challenges for children and young adults are immense. This was the case pre-2019, but since the pandemic the situation has heightened with significant rises in the demand for services for depression, anxiety, phobias, eating disorders, OCD, addictions and the like. In April 2021 the Royal College of Psychiatrists (RCPsych) said “the country is in the grip of a mental health crisis with children worst affected”. On 21 March 2022, the British Medical Journal reported that the RCPsych has now urged the government to fund a recovery plan for specialist mental healthcare due to “unprecedented demand”.

Against this backdrop, I have had a long-standing personal and professional interest in children’s mental health. In recent years, I have become especially interested in a new-ish approach to psychological wellbeing based on an understanding of how the mind works – and thereby an understanding of how we experience life, moment by moment and day by day. Awareness of how we generate our experience of life enables the reduction of psychological distresses (e.g. stress, fear, pressure, discouragement) and the uncovering of our inner well-being. The approach is therefore not just about managing life’s challenges, but also about facilitating the capacity for individuals to thrive and flourish. I have published articles in the Journal of Public Mental Health about this approach as well as a summary on my own Medium site (https://akessel.medium.com/the-three-principles-understanding-of-how-the-mind-works-an-overview-55c03a255296), and I sit on the board of a mental health charity that provides ground-breaking programmes (informed by this approach) to schools in this country and internationally.

In The Five Clues the young protagonist, Edie Marble, learns from her mum about this understanding, which helps Edie in solving clues, bringing criminals to justice, and navigating grief and other emotional challenges. This sub-theme of supporting children’s psychological wellbeing and resilience is threaded through the whole ‘Don’t Doubt the Rainbow’ series. In terms of public health improvement, my intention is to generate mental health benefit in the young using the vehicle of fiction.

How do you think story-telling more generally could be used in public health to reach certain audiences, particularly children and young people?

Story-telling is an incredibly powerful way of sharing ideas, conveying messages and effecting change. Much of what we already do professionally in public health involves telling a story. A well-written board paper tells the story of a new strategy to tackle obesity locally or the story of a proposed organisational re-design. To be successful such papers need a compelling story arc, in the same way as an impactful academic article tells a good tale of why the research is needed, how the authors set about conducting the study, what were the outcomes, and what should be done as a consequence. An annual public health report is, at heart, a chronicle of the health of the population.

If convincing, the narrative of a good story is more likely to capture the audience’s attention, and thereby more likely to be effective. This is just as true for a spoken story as a written one. Telling a story well is therefore a powerful, and somewhat underused, instrument in the public health toolkit. We need to harness this skill in public health, perhaps through first supporting development of the art.

Young people love a good story, perhaps even more than adults, and I hope that my children’s books can provide a touchstone to igniting deeper use of story-telling in the practice of public health.

Finally – are you able to give us any hints about what we can expect from the future books in the series?

Set three months apart, each book in the ‘Don’t Doubt the Rainbow’ series has a new adventure story, with the psychological wellbeing theme continuing throughout. The second book, Outside Chance, will be published in July 2022 and involves eco-terrorism, climate change, stolen dogs and exam fraud – as well as an over-arching discussion of determinism and free will. Plus, of course, Edie containing her journey of self-discovery.

I now spend a lot of time in schools – speaking to children and doing book readings – and at events focused on the relationship between fiction/reading and children’s mental health. It’s wonderfully enjoyable and rewarding, but nothing gives me more pleasure than a single child telling me how much they enjoyed my book and what they got from it. A story is an extraordinary vehicle for joy, entertainment and learning, as well as a potentially vital means to enhancing wellbeing.

Anthony Kessel

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