Presentation at the Faculty of Public Health annual conference 2016

1. Public Mental Health and Wellbeing
Developing and implementing a local
strategy in Warwickshire
June 2016
Dr Charlotte Gath
Consultant in Public Health

2. Why a Public Mental Health Strategy?
• Living in Warwickshire survey, 2014
– “1 in 5 people in Warwickshire either never or rarely
feel relaxed, while 1 in 10 people do not feel close to
other people”

4. PMH strategy – the theory
1. Analyse local public mental health
intelligence to assess risk factors and
need
2. Select appropriate and cost-effective
PMH interventions
3. Evaluate, and measure population
outcomes for PMH interventions

5. Evidence for cost-effective
interventions

7. Evidence for public mental health
interventions to:
• Improve healthy lifestyles, physical health,
life expectancy
• Improve resilience, social functioning and
quality of life
• Reduce burden of mental disorder
• Reduce inequalities
• Reduce associated health risk behaviour,
crime and violence

9. Economic reasons for investment in
public mental health
2011 DH published a report by Knapp et al – for
every £1 invested in public mental health
interventions, the net savings were:
• £84 saved – school based social and
emotional learning programmes
• £44 saved – suicide prevention through GP
training
• £18 saved – early intervention for psychosis
• £14 saved – school-based interventions to
reduce bullying

10. Knapp savings 2
• £12 saved – screening and brief interventions in
primary care for alcohol misuse
• £10 saved – work-based mental health promotion
(after 1 year)
• £10 saved – early intervention for pre-psychosis
• £8 saved – early intervention for parents of
children with conduct disorder
• £5 saved – early diagnosis and treatment of
depression at work
• £4 saved – debt advice services

11. Evaluation and outcomes

12. Public mental health outcomes
• Promotion of population wellbeing –
WEMWBS
• Prevention of mental disorder by addressing
risk factors –measure reduction
• Early and effective treatment of mental
disorder to improve recovery outcomes,
reduce associated health risk behaviour,
reduce associated physical illness and early
mortality, reduce suicide

14. What we did…
• The strategy outlined the reasons –
including economic reasons – for investing
in public mental health
• It included a review of cost-effectiveness
of public health interventions to improve
mental wellbeing
• Outlined a series of priorities linked to
Warwickshire JSNA and national strategy
“No Health Without Mental Health”

15. Tailoring presentation for different
audiences….

16. The three tier approach
Priority areas are given as key aims, laid out
in traditional three tier public health model –
• Level 1 – universal interventions to
improve mental wellbeing
• Level 2 – targeted interventions to prevent
mental ill health
• Level 3 – health improvement for
vulnerable population groups including
people with severe mental illness

18. Key aims for strategy 1
Level 1
• to champion mental health for all, and to
promote and improve public mental health
and wellbeing across the life course, from
childhood to all age, working in partnership
with key stakeholders

19. Key aims for strategy 2
Level 2
• To promote and improve the mental health
and wellbeing of looked after and vulnerable
children and young people in Warwickshire
• To commission evidence-based public health
interventions to prevent mental ill health,
suicide and dementia
• To increase access to, and availability of, low
level support and early intervention services
for people at risk of mental health problems

20. Key aims for strategy 3
Level 3
• To narrow the gap in health inequalities for
people living with severe mental illness
• To increase timely diagnosis rates for
dementia, and improve availability of post-
diagnosis support

21. What have we done so far? Level 1
Champion mental health for all and reduce
stigma: Time to Change Warwickshire
campaign

22. What else have we done? Level 1
• Five Ways to Wellbeing campaign, e-learning
• Mental Health First Aid training and Dementia
Awareness for frontline staff
• Early intervention and mental health
awareness training for schools, school-based
programmes to prevent bullying and conduct
disorder, parenting support through Smart
Start
• Dementia Friends 10,000 target reached
• Older people – befriending schemes and
enhanced physical activity

23. Five ways to wellbeing in
Warwickshire

24. The five ways to wellbeing

25. Background to the campaign
• Campaign uses evidence and guidance developed
by the New Economics Foundation (nef)
• nef commissioned by the Government's Foresight
Project on Mental Capital and Wellbeing to
develop a set of evidence-based actions to
improve personal well-being
• Evidence suggests small improvements in
wellbeing can help to decrease some mental
health problems and also people to flourish.
• Good mental health and resilience are
fundamental to our physical health, our
relationships, our education, our training, our work
and to achieving our potential.

26. An engaging and eye catching brand

27. Resources developed for Mental Health
Awareness Week:
Five ways website
publichealth.warwickshire.gov.uk/5ways
Business cards with inspiring quotes
Badges
Banners
Wellbeing Hub prompt sheet for staff
Happy cards ‘What made you feel happy
in the last few days?’
Pledge for wellbeing cards ‘My pledge for
my wellbeing is to’:
Branding and Resources

28. My pledge for my
wellbeing is to:
• To take more notice & look around while walking
• Be active, do something rewarding
• Get a new radio fitted in my car next week
• To go to lunchtime meditation this week
• Carry on going to my social groups
• To talk to people more
• Take time to observe my environment & take
pleasure in those things that we take for granted
– time to reflect

29. • Encouraged to build wellbeing into daily life
• Wellbeing goodies
• Visit five ways website:
publichealth.warwickshire.gov.uk/5ways
• Follow us on twitter: @WCCPublicHealth
• Tweet how you got on with your pledge
• Come back to wellbeing service
• Support from Hubs
• Signposting to other services
Support for wellbeing

30. Evaluation
• Website hits / tweets / facebook likes etc
• Living in Warwickshire survey, 2014
– 1 in 5 people in Warwickshire either never or rarely
feel relaxed, while 1 in 10 people do not feel close to
other people
– 2016 new version just launched, results awaited
• Wellbeing Hubs evaluation - uptake of low
level mental health and wellbeing services,
WEMWBS

31. Mental Health First Aid
• Accredited course and provider (Rethink)
• 5 x 2 day sessions across Warwickshire
2015-16
• 23 external organisations, 14 different
county council departments
• Cost £12k
• Roll-out continuing

33. What have we done so far? Level 2
• Big White Wall
• Books on Prescription scheme
• Commissioned three cross-county Wellbeing Hubs
aligned with CCGs
• Criminal Justice Strategic Group and Youth Justice
mental health needs assessment
• School nurses – YP emotional resilience training
• Programmes aimed at improving emotional
wellbeing of looked after children and other
vulnerable groups of children and young people

35. Level 2 cont’d
• Improving working lives - workplace
mental resilience and early intervention
• Suicide prevention education programmes
specifically for GPs, ASIST
• Effective signposting to wellbeing support
for people with long term physical health
conditions
• Veterans’ mental health

37. What have we done so far? Level 3
• Enhanced smoking cessation support for
people using mental health services in all
settings, and use of MECC (Making Every
Contact Count)
• Enhanced role for Wellbeing Hubs with
greater emphasis on physical health and
activity, weight management and smoking
cessation – eg FCH Dance Programme
• Supported development of integrated
physical health pathways for people with
serious mental illness

38. Level 3 cont’d
• Mental Health and Employment Service –
commissioned IPS-based model
• Co-production and user involvement, WREP
recommendations
• Development of dementia community support
(Dementia Navigators)
• Improved service access and care for people
with dual diagnosis – drug and alcohol
service review
• Suicide audit 2015

39. Next steps
• 5WTW e-learning roll-out
• Suicide Prevention strategy
• Young people and preventing self-harm
• Mental health and employment service launch
• Smart Start early years, infant and maternal
mental health
• Crisis Response, Crisis Care Concordat
• Primary care MH development, mental health
prevention for STP
• Dementia risk factor reduction campaign

40. Contact us…
• Email: charlottegath@warwickshire.gov.uk
• Web: www.warwickshire.gov.uk/publichealth
Huge thanks to:
Paula Mawson, Claire Taylor, Mike Jackson