This presentation seek to approach how one might go about developing a framework for public mental health in a local area, following discussion with DsPH. It was presented at the UCL Partners and Directors of Public Health Meeting on 18th October 2013

1. Public Mental Health (PMH)
Some reflections towards a framework
18th October 2013
Public Mental Health Meeting
Directors of Public Health and UCL Partners Event
Jim McManus
Director of Public Health
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org

2. Suggestion
• Significant amount of policy discourse which
says Local Authorities seem ideally placed to
work on public mental health
• Which tools, which evidence and a framework to
assess these against seem to be the process
priorities we need to focus on
• Lifecourse agenda suggests priorities for PMH
are varied across every stage
www.hertsdirect.org

3. Seeking orientation
•
Speaking to DsPH on public mental health
– “Cinderella” of Public Health
– Language – does anyone know what wellbeing
actually means?
– Laudable policy intent
– Problem with the evidence base – what exactly is it
– A lot of (variable quality) science, any actual practice?
•
DsPH I spoke to fell into several groups
–
–
–
–
‘ I have a desire to do something but no idea what‘
‘I have some idea but no interventions to get there‘
‘ I have some idea/ framework but not joined up'.
I have loads of indicators of how bad it is, but no tools to make it
any better’
www.hertsdirect.org

4. Approaching mental health as a DPH
•
•
Making sense of a complicated and contested
landscape (various players, various agendas)
Is it one, several or all of:
– Promotion of mental good health
– Promotion of resilience? How does that differ from
good mental health?
– Primary and Secondary Prevention of mental illhealth
– Tertiary prevention e.g. Prevention of disability due
to mental ill-health?
– Making sure mental health services work well?
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org

5. Making PMH Opportunities a reality -1
• A Framework for DsPH
– JSNA to Commissioning remains a
challenge
– Domains Model or Prevention Model within
the framework (next slide)
– Menu of interventions likely to work across
domains
– “Plug and play” tools and strategies
http://www.fph.org.uk/better_mental_health_for_all
www.hertsdirect.org

6. Making PMH Opportunities a reality -2
•
Frameworks we might use
– Domains of Public Health Model or Prevention Model?
• Health Improvement – layer, scale and phase
• Health Protection – mentally disordered offenders, etc
• Service Quality – CAMHS, MH Pathways etc
– Prevention Model? – 1ry, 2ry, 3ry, Resilience?
– Levels of Public Health (Dettels et al,2009)
• Biological, behavioural, social, structural, policy, environmental
– An Evidence Base
http://www.fph.org.uk/better_mental_health_for_all
www.hertsdirect.org

7. The domains model applied to public mental health
(a first, partial start at an illustration)
Health Improvement
Health Protection
Service Quality (often
called service public health)
Good JSNA and Equity Audit as a foundational step
Lifecourse approach to
building resilience
Protecting people from
vulnerability factors
(workplace stress)
Best possible evidence
Early intervention
Drugs and alcohol work
Best possible
implementation
Physical activity, social
connectedness as well as
drugs and therapy
Mentally disorderered
offenders work
Best possible evaluation
and audit
Tiered approach (severity)
Layering across the 6 layers of public health: biological, behavioural, social,
political, environmental, structural (Dettels et al 2009)
www.hertsdirect.org

8. Evidence example – the “S” and “R” words
• Growing evidence base for dual impact of
Spirituality and Religion on health
– King et al 2013
– Koenig et al 2012
• Salience of context and outlook
• Important coping and resilience benefits
• Least comfortable of protected characteristics in
NHS (McManus, 2008; Cooke 2010)
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org

9. Making PMH Opportunities a reality - 3
•
Some discrete pieces of work
– PMH and wider determinants (resilience, financial
stress and burden)
– Using research and academic monies to do
knowledge transfer
– Supporting DsPH with knowledge transfer into
implementation
• menus of interventions which work
• the evidence gap – what’s promising and what does good
innovation look like
evaluations
•
– Training
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org

10. Systems thinking on public mental health
The wider determinants of Health and Local Government functions
(Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or
hinder healthy lifestyles (policy, service quality, access,
behavioural economics, behavioural sciences)
The services people access such as primary care
(high quality, easy access, good follow up,
behavioural and lifestyle pathways wrap around)
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org

11. An attempt at a Hertfordshire framework
•
•
Phasing – Lifecourse
Layering of PMH intereventions (the 6 layers)
– Resilience – how to thrive, carers, lgbt, bullying,
community interventions,– physical activity, 5 ways
to wellbeing, bibliotherapy, financial stress etc,
building social movements and norms
– Prevention – menu of interventions, pathway
– Tiering of services – scale, pace, quality,
commissioning, pathways
Jim.mcmanus@hertfordshire.gov.u
k
www.hertsdirect.org