Public Mental Health and Policy: Optimism and Pessimism Firstly, some personal reflections… - by disposition are you an optimist or a pessimist (or a realist?) Then, in the public realm…. - are you an optimist or a pessimist (or a realist?)

Public Mental Health and Policy (1) MH, PH providers and LAs before 2012 (?) Every Child Matters 2003 Children`s Act 2004 (Trusts and Plans) JSNAs 2008/09 Equalities Act 2010 – Public Sector Equalities Duty

PMH and Policy (2) Coalition Government 2010/15 No Health without Mental Health 2011 NHS and Social Care Act 2012: - Health and Wellbeing Boards, - CCGs, Transfer of PH functions to LAs - PHE and NHE England - H and Wellbeing Strategies CMOs Annual Report Sept 2014 Better Care Fund 2015

Public Mental Health and Policy cont NHS 5 Year Forward View 2014 - Community Engagement , Mental Health including workforce development , MH Concordat Sustainable Transformation Plans published 2017 Suicide Prevention & Postvention PHE - Local Suicide Prevention Planning 2014 - Local suicide prevention planning - A guide for LA 2016 Identifying & Responding to Suicide Clusters & Contagion 2015 Preventing Suicide in Public Places Support After a suicide : A guide to providing local services 2016

Public Mental Health Policy (3) (2016) Reductions in PH budgets and pressures on the NHS/Social Care Retrenchments in CCGs Sustainability and Transformation Plans Devo-Manchester…. Launch of work-stream on Child Health Green Paper FPH`s Better Mental Health for ALL

Public Mental Health Policy (4) 2017 National Prevention Alliance for Mental Health/PHE: Prevention Concordat for Better Mental Health JSNAs and mental health Return on Investment tool and local informatics Local Champions Green Paper on Child Health

NHS Long Term Plan 2019 Mental Health Services To deliver timely, high quality mental health support, the NHS Long Term Plan will: This Long Term Plan sets out new commitments for action that the NHS itself will take to improve prevention Action by the NHS is a complement to, but cannot be a substitute for, the important role for local government Increase funding for mental health Provide a single point of access through NHS 111 to timely, age-appropriate mental health crisis care for everyone. Continue investment in perinatal mental health care for mothers and their partners Roll out new and established services in the community and hospitals, including talking therapies and liaison teams reducing suicides will remain an NHS priority Mental health support for children and young people will be embedded in schools and colleges

Includes 5 ways to well being Prevention is better than cure: Our vision to help you live well for longer : Secretary of State for health vision Developing Green Paper 2019 Health and social care secretary Matt Hancock published his vision in Nov 2018 for how he plans to revolutionise the government’s approach to prevention and announces a Green Paper in 2019. The approach will see a shift in focus towards primary and community care services and the value they can bring in offering early support. 50% Mental Health Includes 5 ways to well being

Scotland Mental Health Policy 1.Better Mental Health for All: NHS Scotland 2016 improve population mental health through the promotion of mental wellbeing, prevention of mental health problems improving the quality of life of those experiencing mental ill health reduce inequalities in mental health • reduce the health inequalities of those experiencing mental health problems. 2. NHS Scotland 2016 Mental Health Strategy: 2017-2027 Prevention and early intervention; • Access to treatment, and joined up accessible services • The physical wellbeing of people with mental health problems • Rights, information use, and planning 3. Tackling the attainment gap by preventing and responding to Adverse Childhood Experiences (ACEs) 2017 The Scottish Adverse Childhood Experiences Hub 4. A CONNECTED SCOTLAND Our strategy for tackling social isolation and loneliness and building stronger social connections 2018 we want a Scotland where individuals and communities are more connected, and that everyone has the opportunity to develop meaningful relationships regardless of age, status, circumstances or identity – see framework

HEALTHY LIVES, FAIRER FUTURES: Call to Action Faculty of Public Health in Scotland. Includes: Health in all policies To use the Community Empowerment Act to improve population mental health To reduce child poverty and mitigate the damage to our children Make taxation more progressive To prevent the impact of adverse childhood experiences and help the children of Scotland Actions to mitigate against the impact of the UK welfare reforms

Making the jigsaw fit at local level - the Health and Wellbeing Board, CCG and STPs - other partners and providers - individuals, families and communities

Health and Wellbeing: Boards, Strategies and JSNAs What are the opportunities for Public Mental Health?: 1.JSNAs 2.Health and Wellbeing Strategies 3.Better Care Fund 4. Equalities Act

What should be in your Strategies and JSNAs? Group 1: JSNAs, Public Sector Equalities Duty Group 2: Health and Wellbeing Strategies, Better Care Fund Plans, STPs

What should be in your JSNA`s and Strategies? Group 1: Health and Wellbeing Strategies, Better Care Fund Group2; JSNA`s, Public Health Equalities Duty

Manchester City Council STRATEGIC PRIORITY 6 Improving people’s mental health and wellbeing Background For too long, mental health and wellbeing has not received the attention that physical health has been given. However, with the JSNA demonstrating the very high levels of mental ill health and low levels of wellbeing in the city, and the impact this has on our health, social and economic aspirations, it is time for this to take centre stage in our local strategies.

Wigan Joint Strategic Needs Assessment 2011 Mental Health and Wellbeing 3.1 Introduction 3.2 Start Well 3.3 Develop Well Personality Disorder Learning Disability 3.5 Work Well 3.6 Age Well Dementia End-of-life 3.4 Living Well Physical health of people with severe mental illness Stigma Psychological Trauma Suicide and self-harm Homes and Fuel Poverty Homelessness

Hertfordshire`s Approach “In Hertfordshire, our priority is to improve access to mental health services, to raise awareness of mental ill-health and available support across services for all ages and to prevent mental health problems and intervene at the earliest opportunity”.

Social determinants (Hert`s illustration) “It is therefore important to tackle the social determinants of mental ill health such as bullying, housing issues, drug and alcohol abuse, social deprivation, domestic violence and poor physical health.”

Analysis (Hert`s illustration) Groups currently disproportionately affected by mental health and emotional wellbeing concerns or who are currently facing barriers to accessing services should be targeted. It is estimated that 23 per cent of lesbian, gay and bisexual young people have tried to take their own life at some point. In comparison Samaritans say seven per cent of all young people in general ever attempt to take their own life.

Roles and expectations (Hert`s illustration) What is your role? • Use the Five Ways to Wellbeing recommended by the New Economics Foundation to prevent mental health problems. • Take individual responsibility to look after your own mental health, including managing triggers to stress and other factors which affect your emotional wellbeing. • Outline appropriate work related goals to reduce stigma and prevailing culture of low expectations. • Use the information available to you to exercise your right to take control of the services you receive and improve your experience of care.

Your services should aim to: • Improve inter-agency working, coherence of pathways and raise awareness of services. • Be proactive in identifying those who are at risk of having mental health problems and put in place preventative measures. • Work with all partners to ensure that there is a supportive, stable and safe environment to aid recovery. This means good quality

What is the role of your community? • Raise awareness of mental health and challenge the associated stigma and discrimination. • Raise awareness in the community of local services and support which are available such as Child and Adolescent Mental Health Services (CAMHS). • Help hold public bodies to account, lobby for change and provide advocacy. • Provide services and support to those with mental health issues and promote emotional wellbeing. • Employers to promote mentally healthy workplaces.

Conclusions 1.Two Distinct Strands need to be incorporated within the JSNA and Health and Wellbeing Strategy - positive mental health and wellbeing for whole population, and appropriate support for people with a serious mental illness 2. The Prevention Concordat, due in April, will provide an important opportunity to shift the local focus towards population mental health