Public mental health oct 18 mcmanus uclp


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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

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Public mental health oct 18 mcmanus uclp

  1. 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 k
  2. 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
  3. 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’
  4. 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? k
  5. 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
  6. 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
  7. 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)
  8. 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) k
  9. 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 k
  10. 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) k
  11. 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 k