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Archive for the ‘Mental Health’ Category

By John Middleton, FPH President

better mental health infographic

Mental health in the workplace is the theme for this year’s World Mental Health Day today. The workplace is a key setting for health as good work is a key determinant of health.

Job control, fair treatment, job security and reward for our efforts are what characterise good work. Those who lack autonomy to do their job, have insecure terms and conditions, are treated unfairly or receive no praise or recognition from their managers will feel their health suffer. This in turn will impact on productivity, staff retention and sickness absence.

Sadly, we too often see workplace mental health action focussed on individual behaviours rather than organisational actions that tackle these determinants of health at work. Workplace wellbeing has become extremely popular but yoga at lunchtimes may do little, if anything, to tackle the causes of stress.

The National Institute for Health and Care Excellence (NICE) guidance for workplace health recognises the organisational commitment needed, the role of good line management and the value of staff participation in decision-making. It also recommends the Health & Safety Executive’s excellent management standards for workplace stress. The public health workplace is not exempt. There are many stressors out of our control but there is also much that we can do. As well as implementing the NICE guidance or management standards we can also look out for one another. Relationships are key for good health and equally so at work.

Being aware of our own mental health and wellbeing is the start of taking any action. This helps us improve our communication with others and create meaningful solutions with others. The revised Faculty of Public Health (FPH) curricula 2015 included a new learning outcome that we could all do more to demonstrate and apply: an understanding of how mental health and wellbeing can be managed and promoted in staff and yourself in a range of situations.

Mental health remains a priority for FPH and for me personally. Last month I pledged FPH’s support by signing the Prevention Concordat for Better Mental Health that we have contributed to through our Public Mental Health Special Interest Group. We will continue to take action, to support our members in their practice and to advocate nationally for the public’s mental health.

As a standard-setter and educator, we will include positive mental health in our education and training programmes, and we will work to become a Mindful Employer.

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By Prof John Middleton, FPH President

John Middleton 2 web

August was a stock-take month for me. I held several meetings which all pointed to the need for public health and the woeful neglect of public health expertise by local, national and international policy makers.

Early in August we held a productive session of the Global Violence Prevention Special Interest Group which resolved to look at training tools for work in conflict and post-conflict areas – how to make rapid needs assessments, how we build alliances with public health resources in conflict areas and how we make sense of prevention and resolution of conflict through working with political scientists, theologians, international lawyers and aid non-governmental organisations. The work is being led by Daniel Flecknoe and Bayad Nozad. We plan to join up this work with that of Brian McCloskey and David Heymann for Chatham House (Royal Institute of International Affairs) looking at emergency responses in conflict zones. Mark Bellis’s work for the Commonwealth will also play a key part. The FPH statement says our unique role is in preventing violence and building and implementing the evidence base – locally, nationally and internationally. Economic inequality and unequal power-sharing are major causes of violence at local, regional and international level, and major challenges for the public health community, whether in relation to violence, childhood obesity or premature mortality. It is clear to me that FPH can play a greater role in violence prevention by harnessing the disparate skills of our members, from the frontline to high-level international policy – in emergency preparedness, health protection and health services organisation and in public mental health and community development.

In August I also met with David Ross from the armed forces public health services. They clearly have much expertise to contribute – in relation to international conflicts and closer to home. We have resolved to have a meeting with forces colleagues in the new year. The root causes of violent behaviour are also often the root causes of accidental violent injury. This was never more demonstrated than with the Grenfell Tower disaster. I am pleased that we could respond to the terms of reference consultation for the inquiry. Sadly our representations were not heeded and a limited range has been set for the inquiry with a junior minister leading consultation on the implications for social housing and some superficial examination of the causes of the causes. Nevertheless, I am extremely grateful to the FPH members who responded rapidly to our request for help on the Grenfell submission and particularly to Ruth Gelletlie who put together our response on the terms of reference. We received a wealth of material on every aspect from health protection and response, public mental health responses, health inequalities and the London housing market, building design, regulation and controls and social issues regarding migration and homelessness. Ruth and colleagues in the revitalised Housing and Health Special Interest Group will be drawing on this material for our formal submission to the inquiry (and for a listening minister…?)

A sustainability and transformation partnership has announced a £2.7million contract with the private sector for a year’s support for an accountable care organisation. It’s a mind-numbing figure and would buy an awful lot of public health health-care expertise and analysis. We will follow this programme carefully and see what it teaches… and in the meantime, continue our work to rebuild training and capacity in healthcare public health.

As we return from the summer holidays, FPH will once again get into full swing with major policy-planning days. Our workforce strategy is nearing completion and will be formally signed off in November. We are much exercised by the need to build our membership and would urge you to invite all your colleagues to join us – we have a category for virtually everyone working in public health or associated with our work. I will also be involved in the Academy of Medical Royal Colleges planning days. Our policy team priorities on Brexit and public health funding are taking shape. I will be at the Public Health England conference in Warwick at which we will launch the Public Health Prevention Concordat for good mental health. I will also be speaking at MEDACT’s conference in York with the International Physicians for the Prevention of Nuclear War on the theme of the progressive-health movement. I will also be speaking at the Oxford public health registrars symposium on the theme of partnership in public health. I believe there are still places available at all of these meetings.

As the US President flexes his nuclear options, and our government stumbles over complex imponderables of Brexit, it is clear to me we absolutely need a progressive health movement which addresses inequalities in income, in opportunity, in education and environment, which understands and builds new programmes for public mental health and conflict resolution, which stands strongly for non-violent resolution of problems, which looks at the health impacts of all policies and across future generations, and which believes in partnership, in shared benefits and better outcomes for all.

Can I draw your attention to an exciting event coming up which provides a unique opportunity to share learnings about advocacy. Mike Daube, Professor of Health Policy at Curtin University, Perth, Australia, will be delivering the DARE Lecture entitled ‘Not a Spectator Sport: public health advocacy and the commercial determinants of health’ on 27 September in London.

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By Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England

Public Health England estimates that between 2-5% of the population identify as lesbian, gay, bisexual or other – comparable to many ethnic minority and faith populations. Despite legislative reform many LGBT people continue to experience discrimination, marginalisation and harassment.

  • 38 per cent of trans people have experienced physical intimidation and threats and 81 per cent have experienced silent harassment (e.g. being stared at/whispered about)
  • One in five (19 per cent) lesbian, gay and bi employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years
  • Almost 1 in 4 trans people are made to use an inappropriate toilet in the workplace, or none at all, in the early stages of transition. At work over 10% of trans people experienced being verbally abused and 6% were physically assaulted.

The impact of this discrimination on mental health is easy to understand, however the stark data on suicide and self-harm demonstrates the depth of the impact that this discrimination can have:

  • 52% of young LGBT people reported self-harm either recently or in the past compared to 25% of heterosexual non-trans young people and 44% of young LGBT people have considered suicide compared to 26% of heterosexual non-trans young people
  • Prescription for Change (2008) found that in the last year, 5% of lesbians and bisexual women say they have attempted to take their own life. This increases to 7% of bisexual women, 7% of black and minority ethnic women and 10% of lesbians and bisexual women with a disability
  • The Gay Men’s Health Survey (2013) found that in the last year, 3% of gay men have attempted to take their own life. This increases to 5% of black and minority ethnic men, 5% of bisexual men and 7% of gay and bisexual men with a disability. In the same period, 0.4% of all men attempted to take their own life
  • The Trans Mental Health Study (2012) found that 11% of trans people had thought about ending their lives at some point in the last year and 33% had attempted to take their life more than once in their lifetime, 3% attempting suicide more than 10 times.

The impacts aren’t limited to mental health, and the level of inequalities in lifestyle behaviours such as smoking and substance misuse will almost certainly play out in a great burden of chronic disease and premature mortality over the life course.

The evidence base of inequalities affecting LGBT populations continues to grow as we get better at incorporating sexual orientation and gender identity into the demographics of research and population surveys. Positively, as the NHS rolls out the sexual orientation monitoring information standard this year, this understanding will no doubt continue to grow.

As public health professionals we have a responsibility to advocate for the populations in our care, and this should include advocating for LGBT populations. Lesbian, gay, bisexual and trans communities are diverse, vibrant and varied and have many assets, although the LGBT community sector has faced fiscal challenges due to the economy there remain many small local LGBT organisations that are keen to work with public health teams to address these inequalities.  This is population who clearly need our professional expertise, advocacy and support to co-produce solutions for change and one where we could have a real impact.

So during this lesbian, gay, bisexual and trans Pride season please take up the opportunity to engage, empower and partner with your local LGBT community.

FPH is committed to improving the health and well-being of the LGBT population. If you would like to join us in our work please consider joining our Equality & Diversity Special Interest Group or our LGBT Health Special Interest Group. To express an interest in joining please email policy@fph.org.uk and we can help you get started!

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By Woody Caan, Editor, Journal of Public Mental Health

The impact of parental drinking on the health and development of children (e.g. Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17) has been recognised for decades but has never produced government policy that reduces harm. For example, in its final days, the National Institute for Social Work profiled a representative, national caseload of children and families. By far the most common characteristic of families assessed by social services (for any concern) was a parent dependent on alcohol. On behalf of the old UK Public Health Association alcohol group, I met with the British Association of Social Workers to discuss policies that would span public health and social work, but even when we identified quick wins (such as better care and assessment in emergency care for those young people with a history of abuse, who self harm when intoxicated) we failed to change policy.

It is not surprising that the 2003 government genetics & health strategy, Our Inheritance, Our Future, failed to address the common observation that many families with a pedigree of alcohol-use disorders repeat the same history across generations. There have never been official UK guidelines on effective child-health interventions after parental alcoholism is identified, although there are many recommendations from NGOs on both sides of the Atlantic.

The US company Kaiser Permanente first studied Adverse Childhood Experiences (ACEs) and their cumulative, long-term impact on adult health. From the beginning, having one or more adults with an alcohol use disorder within a child’s home environment was seen as a serious adversity. (Note: diverse studies have sometimes explored either parental addiction or shorter-term ‘alcohol abuse’, while the grown-up recollection of parenting in childhood tends to be fragmented and not like a clinical assessment.) In 2016, the Public Mental Health Network hosted by the Royal College of Psychiatrists decided to make ACEs our priority. In 2016, Public Health Wales produced a large-scale report on childhood adversity that includes parental drinking as a cause of both mental and physical harm.

What gives me hope for change in 2017? In February, three Members of Parliament (Jon Ashworth, Caroline Flint and Liam Byrne), supported by the Archbishop of Canterbury, all described their own experience of parental alcoholism and issued a manifesto for action. Subsequently, I sent the current Under Secretary of State for Public Health a letter in support of those MPs, with a little public health evidence. On 15 March that minister, Nicola Blackwood, replied to me that she was “committed to developing a strategy to help alleviate this serious issue”. The Public Health Minister also wants professionals like us to share our knowledge “as the new strategy is being developed”.

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Health protection is a global issue – and there are lessons to learn and share from all incidents, wherever they occur. That was the message from the global health protection workshop at FPH’s annual conference in Cardiff on 19 July.

Delegates heard how the Health Protection Agency (HPA) has built a worldwide reputation for its work, in part because the global nature of health protection means that planning needs to go beyond national borders. The World Health Organisation has 10 collaborating centres in the UK, while the HPA has sent teams on international secondments to South Africa, India and Australia. One of the speakers talked about how the HPA had been involved in giving high-level advice to government agencies after the earthquake and nuclear power failure in Fukushima.

Closer to home, the delegates heard from Dr Sarah Finlay about how she and her colleagues from the charity Festival Medical Services dealt with an outbreak of H1N1 at the Glastonbury festival in 2009. The festival had a population of 135,000 ticket holders, and 35,000 artists and staff, many of whom were the kind of healthy, young people most likely to contract the virus. The infrastructure of the event meant that living conditions were poor. People’s behaviour, as would be expected at a music festival, was not typical. The combined circumstances meant that it was easy for communicable diseases to transfer.

Risk was mitigated by following the protocols for managing H1N1, having immediate access to antiviral stocks and good transport to the onsite medical facilities, despite the mud. Good advice was given to festival goers before, during and after the festival, stressing the ‘Catch It. Kill It. Bin It.’ message and the importance of using the hand gels that were available across the site.

Information was circulated via the Glastonbury festival website, music press and general media. Just as the HPA team working on Fukushima had regular updates throughout each day to share information, so the Glastonbury health team relied on situation updates three times each day.

There were six cases of swine ‘flu at Glastonbury in 2009, all of which were confirmed by laboratory test results and each of whom left the site for further treatment. One of these cases was a 16-year old girl who had been sharing a tepee with 12 other people, each of whom had to be tracked down in the chaos of festival life.

In the circumstances, the team felt the outbreak had been well managed, and the lessons learnt from this example of mass gathering medicine were shared with the organisers of the Berlin World Athletics and the Hadj.

Dr Finlay summed up by saying that the success of the festival’s approach to H1N1 was due to having a well thought-through approach, early detection, awareness of the issue and by sharing the lessons learnt.

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by Camila Batmanghelidjh

Founder and Director, Kids Company

I watched a young man biting his arm who believed that, as a bird, he was pulling out feathers. There was no parent to care for him; for a long time he had coped alone. Let me evidence the invisibility of children like him who, at best, survive on leftovers of other people’s care and, at worst, shut down hope to avoid disappointment.

Kids Company supports 17,000 children and young people with psychosocial care. Recently, our work with 668 disadvantaged 16- to 23-year-olds highlighted dark statistics.

Just under 560 were not registered or connected with a GP; 411 required mental health interventions; 87% had experienced multiple trauma; 394 required housing; 365 needed sexual health interventions; 436 had to be registered with a dentist; 363 required an optician’s assessment.

These are citizens of the underbelly whose needs remain invisible and unmet. Young people have little faith in civil society’s ability to reach out to them. As one put it: “The government hates us.”

Young people believe this because the narrative emanating from politicians is often unwittingly derogatory. Tuition fees have increased, the EMA grant has been stopped, housing benefits have been cut. No-one will rent a room to a young man for fear that he may trash their house, and yet he cannot live in his own flat or bedsit, because £70 a week is the maximum allowance for his rent.

During the [2011] summer riots the TV cameras didn’t follow all those children who stole food. Instead they focused on those who took plasma TVs and trainers.  Forty-two per cent of the young people brought before the courts were in receipt of free school meals. But we are too frightened to see need. Instead, we see greed.

So what brought these desperate young people to such extremes of rage? Don’t go looking for big answers. The truth resides somewhere smaller: in that insidious space where human dignity is systematically eroded. The kids describe it as “stress”: the door of possibility slamming in their faces.

They’re told to have aspirations, but noone will pay their college fees. They’re told to get fit, but no-one will give them money for the gym. They’re told to eat well, but they have no more than £10 a week to buy food while on benefits. They’re told to see their doctors but don’t have enough phone credit or patience for the booking queue.

With 1.1 million children and young people having mental health difficulties in the UK, you’d be forgiven for thinking we were organising a nationwide famine in therapeutic support. Children need an integrated approach to wellbeing, taking into account their range of psychosocial needs in the context of sustained care relationships – not this lucky-dipping for healthcare.

Proximity would yield mutual solutions – healing the wounds of the banned age with a  bandage. Bandages support, hold and promote self-recovery. If a piece of cloth can do it, why can’t we?

This article first appeared in the December issue of Public Health Today, FPH’s quarterly magazine.

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Here I am, enjoying a little summer frivolity up at the Edinburgh Fringe, and it seems to me there isn’t a stand-up standing who hasn’t made some play with swine flu or obesity or the crack-down on binge drinking. From Rhod Gilbert to Rich Hall, from Jason Byrne to Stewart Lee, they’ve all had a go at public health one way or another.

Meanwhile quite a few of the musical cabarets are getting in on the act too. The Oompah Band are sending up the credit crunch with lots of brassy references to redundancy, repossessed homes and the horrors of being down-and-out. Fascinating Aida do a hilarious song about health and safety on children’s outings and a wonderful calypso about the impact of climate change in the Shetlands. And yes, the comedy group I’m singing in, Instant Sunshine, can’t resist joining in with a number about the perils of the demon drink.

But what a strange time I’m having. One minute I’m talking seriously on the radio, down the line from the BBC’s Edinburgh studio, about ham sandwiches, candle wax and the risk of cancer, and the next I’m up on stage singing a silly song about a showjumper who’s lost his horse. One minute I’m on Sky News debating the joys of the NHS versus the inequities of the US healthcare system, and the next I’m impersonating the Queen opening a desperately unfinished Olympic site in 2012.

But hey, that’s showbiz for you. Instant Sunshine’s stuff is gently humorous, utterly inoffensive and, let’s face it, a little dated. We first came here in 1975 and have been back every other year since, thanks to a small but faithful following. There have been thousands of acts on the Fringe, but we are probably the longest-serving. Certainly our queue has by far the most zimmer frames.

 It’s all great fun and utterly frivolous. And I suppose, if it makes people happy for a while, it’s public health – kind of – isn’t it?

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