1. A Public Health perspective on personality disorder
Dr Ian Cameron Director of Public Health Leeds City Council 4th March 2015
The Office of the Director of Public Health Live well, live longer – changing lives in Leeds

5. What is Public Health?
“The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”.
Sir Donald Acheson
Chief Medical Officer, 1988
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6. Health Inequalities Model of Vulnerability
How people treat you
Who you are
Where you live
More factors:
increased vulnerability to poor health outcomes
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7. Public Health Health Protection Vaccination & immunisation
Infection control
Health Protection
Emergency
Planning
Screening programmes
Violence
Environmental hazards
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8. Public Health Health Protection Health improvement Drugs Sexual Health
Alcohol
Obesity
Nutrition
Smoking
Physical Activity
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9. Health Care Public Health
Protection
Health Improvement
Health Care Public Health
Access to effective services including those for causes of early death and major causes of ill health
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10. Health Care Public Health
Protection
Health Improvement
Health Care Public Health
Wider determinants of health and inequalities
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11. The Public Health Model of Leeds
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12. “ Clinicians who provide therapy to people with personality difficulties and disorders….aim to identify patterns which connect childhood development and adult personality”
“ Nearly everyone agrees that early experiences in childhood play a large part in determining personality disorder”
Meeting the Challenge, Department of Health 2014
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13. Brain reaches 80% adult weight by Day 1001
Birth
15 months
2 years

14. Understanding the infant brain
Works via neurons (brain cells) and synapses (connections)
At birth, 10 trillion synapses – 200 trillion by age 3
Too many to be specified by genes: formed by experience
Sculpted: repeated use hard wired – superfluous eliminated
Implies very rapid learning via early life experience
More than one million new connections per second
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15. Neural networks in different areas of the brain associated with specific functions proliferate rapidly and then begin pruning in the earliest years of life.
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16. Language development
Language development at age 2 is strongly associated with school readiness.
Early communication environment in the home provides the strongest influence on language at age 2 – stronger than social background.
Books available; number of visits to library; being read to by a parent; number of toys; parents teaching a range of activities; attendance at pre-school.
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17. At age 3:
Children from poor families have heard 200,000 discouragements and 75,000 encouragements
Children from professional families have heard 80,000 discouragements and 500,000 encouragements
The Office of the Director of Public Health
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18. Best Start
Preparing for Birth and Beyond
The first 1001 days

19. WAVE TOP 10 RECOMMENDATIONS
Increase breastfeeding and good antenatal nutrition
Promote language development
Reduce domestic violence and stress in pregnancy
Achieve a major reduction in abuse and neglect
Set up an effective and comprehensive perinatal mental health service
Assess and identify where help is needed
Focus on improving attunement
Promote secure attachment
Ensure good health-led multi-agency work
Ensure early years workforce has requisite skills
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20. Best Start Will achieve: Healthy mothers and healthy babies
Well prepared parents
Reduce infant deaths
Good attunement and attachment and early development
Longer term social & emotional capacity and cognitive growth
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22. Implication for optimum investment
Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic Prospects

23. Personality Disorder Is this viewed as a current priority?
Who cares and why?
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24. Health & Well Being Boards
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25. What drives priorities?
Outcomes
Public Health
NHS
Adult Social Care
Children’s
Current context
Finance
Quality & Safety
Growth & Innovation
Expectations incl. political
Alignment with other priorities & plans
Local needs & priorities – Joint Strategic Needs Assessment
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26. What is the government interested in?
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27. Contributing to reducing health inequalities
Tackling the gradient
Reduce differences in socio-economic position
Enhancing individuals control of health
Reducing the negative impact of ill health on income, education, social networks, etc.
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28. What’s your story? The Office of the Director of Public Health
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29. “For many years, people given the diagnosis of personality disorder were regarded as ‘untreatable’ and were either excluded from services or severely marginalised within them. By the 1990’s, evidence was beginning to emerge….that some psychological treatments were effective” Meeting the Challenge, Department of Health 2014
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30. Public Health
Locally, Public Health (responsibilities, money, staff) has moved to the Council
Opportunity to work on wider determinants across the whole of the Council
Director of Public Health a member of the Health and Wellbeing Board
Mandatory role to provide advice and help to Clinical Commissioning Groups
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31. How can Public Health help?
Needs assessment – Joint Strategic Needs Assessment
Support the commissioning of services
Earlier interventions, e.g. children & young people, schools
Treatment and support
Effectiveness, evaluation, return on investment
Tackling stigma and discrimination
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32. Recap! Rethink!

33. Only Connect! Howards End E. M. Forster
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Live well live longer – changing lives in Leeds