Isabella Goldie Director of Development and Delivery Isabella Goldie Director of Development & Delivery

Our vision is for a world with good mental health for all Our mission is to help people understand, protect, and sustain their mental health Changing minds, changing lives

HOW WE WORK We connect policy, research and practice in services, communities and workplaces We develop programmes of work with partners across the UK and beyond that to change lives We nurture and amplify the voice of experts by experience, especially those most marginalised We reach the public with eye- catching and evidence informed campaigns and media work

PUBLIC MENTAL HEALTH FRAMEWORK P ROMOTION R ECOVERY /I MPROVED L IVES Prevention Based on WHO mental health framework

WHY PREVENTION? Increase in mental health problems in children and young people: –Increase in emotional problems in girls –Increase in eating disorders 50% of adult mental health problems established by age 14, 75% by early adulthood. Adverse childhood experiences (ACEs) have long known to be linked to mental health problems in childhood and into adult life (eg Chapman et al, 2004). School exclusions both fixed term and permanent have risen by 50% since in 200 Children under the age of 18 are on the child protection register (Jutte et al, 2014) In an average class of year-old pupils will have encountered a range of risk factors: ₋ ten are likely to have witnessed their parents separate ₋ one could have experienced the death of a parent ₋ seven are likely to have been bullied

Lost employment opportunity cost £23.1bn ½ of People aged 75+ live alone Working LifeRelationships Perinatal Maternal Mental Health School (Pre FE) Parenting Health and social care 75% mental health Problems set by age 24 ChildhoodWorking Age Later Life LIFE COURSE APPROACH

WHOLE SYSTEM/SETTING APPROACHES Universal Whole community/setting Selected Recognising and addressing risk Indicated Responding to functional distress People with mental health problems PROPORTIONATELY TARGETED

Mental Health in all Policies (MHIAP) Primary care, school nurses, social work Schools, FE, YOI, Youth services attendance, attainment, offending Education, Criminal Just, welfare Mental Health in all Service Contacts (MHIAC) Mental Health in all Settings (MHIAS) Mental Health in all Impact Measures (MHIAMI) Assumes a Life Course Approach Assumes Proportionality to Address Inequality Assumes Genuine Co-Production with Community The Whole Community Approach to Public Mental Health Model developed by Goldie I & O’Sullivan C Mental Health Foundation (2016) All Rights Reserved

Home based interventions to support maternal mental health and attachment (University of Sheffield, 2011) Creation of effective perinatal pathways (Hogg, 2014; NICE, 2014) Parenting support (including for foster parents) can promote attachment and prosocial behaviour (DH, 2015) and some have found positive impacts for families most at risk (Scott, 2006) –Mellow Parenting, Strengthening Families Strengthening Communities, Triple P, Incredible Years (database of effective approaches can be found at: Family and Schools programmes to support school readiness (NSPCC, 2012) Systemic practice and whole family solutions are recommended (Tavistock Centre for Family Relationships, 2015) ₋ Positive couple relationships can buffer early insecure attachments and lead to the formation of new working models and patterns of interaction ₋ The couple relationship is the early intervention opportunity In a survey of over 4,500 children seen by CAMHS services, ‘Family Relationships Problems’ were the biggest presenting problem (Wolpert and Martin, 2015) The Evidence – Individual Parents and Families

Bullying Programmes ‘a top investment’ (Dretzke et al., 2009; Knapp, 2011) NICE recommend a ‘Whole School Approach’ which has been shown to have positive impacts on – 1. Academic learning, motivation, and sense of commitment and connectedness with learning and with school 2.staff well-being, reduced stress, sickness and absence, improved teaching ability and performance 3.pupil well-being including happiness, a sense of purpose, connectedness and meaning 4.the development of the social and emotional skills and attitudes that promote learning, success, well-being and mental health, in school and throughout life 5.the prevention and reduction of mental health problems such as depression, anxiety and stress 6.improving school behaviour, including reductions in low-level disruption, incidents, fights, bullying, exclusions and absence 7.reductions in risky behaviour – such as impulsiveness, uncontrolled anger, violence, bullying and crime, early sexual experience, alcohol and drug use. Can this approach be transferred to other ‘whole’ settings and systems? Can be applied to other systems and settings such as young offenders institutions, care settings, youth services, FE The Evidence –Schools

WHOLE SCHOOL APPROACH (LAVIS, P AND ROBSON C. FOR PUBLIC HEALTH ENGLAND 2015).

Peer support approaches a component of ‘whole school approaches’ Increasing attention being given to this by DfE (recent ministerial workshops, paper to be produced) Emerging evidence shows young people value peer interventions Evidence base for PS as other universal interventions not strong – some tentative positive evidence around bullying (Scharr paper) Peer Support Initiative in Somerset with emotion coaching (based on Tuning into Kids) an evidence based Australian programme. Monitored outcomes on academic achievement show promise. Peer Community

SELF HELP - ONLINE COMMUNITIES OF SUPPORT

Let us keep our phones on… they can be a lifeline for help or moral support if we feel bad, or scared

MENTALLY HEALTHY WORKPLACE Indicated Recognising and addressing distress Stigma and Discrimination Supporting People into and back to work Selective Recognising the those at additional risk and pressure points and supporting accordingly Bullying Universal Line Manager Training for all Ethos, social and physical environment Policies and procedures

1.Mental Health literacy across the population: –Upskilling the public workforce to ‘make every contact count’ –Co-producing messages alongside communities including tailored support with communities at greater risk (such as BAME, LGBT) –Access to self management and peer support approaches The Mental Health Commission of ‘Australia is currently using an ‘every service is a gateway principle’ which is a progressive model aimed at developing skills amongst non-governmental orgs, GPs and Primary Care. 2.Creating mentally healthy communities –Adopting a whole community/system that is universally proportionate (Marmot, 2010) –Applying an Asset Based Community Development approach (IACD, 2009) –Social prescribing options through primary care professionals (Friedli et al., 2007) ABCD approaches can create place-based solutions that are meaningful to those that live there. They engage local people in their community to address inequalities and build resilience to adversity Whole Community Approaches

Engaging ‘experts’ to create a jointly owned movement for prevention Engaging ‘places/spaces’ neighbourhoods, schools, workplaces, job centres to improve mh Co-producing tailored approaches for those at high risk Working with services/settings to reduce distress Early intervention & Recovery focused integrated care APPLYING AN ASSET BASED APPROACH

EVIDENCE LIMITATIONS Settings Looked after children Pre school Further Education Residential Life Course Adults not in work Later Life Transitions Mental Health Inequalities Social Inequalities Poverty Health inequalities

Promising Approaches Psychologically informed care and residential settings neighbourhoods. Peer support/mentoring approaches for people who are socially/emotionally isolated (older people, young parents, transitions out of care, carers, people with long term mental health problems, refugees). Trauma informed approaches within blue light services and mental health services ( CBT for older people to prevent depression (including pre-emptive). Integrated approaches to health and mental health (liaison psychiatry in A&E, making every contact count) (MHF, 2013; Kings Fund, 2015). Liaison and diversion schemes for offenders (Centre for Mental health, 2014). Digital solutions (Emental Health – online CBT, Mindfulness, self management).