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Promoting
Positive Mental Health and Resilience
Children andYoung People’s Mental Health: Promoting integration and early
intervention
Manchester, 8th December2016
LilyMakurah
DeputyNationalLead–PublicMentalHealthandWellbeing
Content
1. The challenge: public mental health in England
2. The response: national action on prevention and partnerships
3. What support PHE is giving to the system
2
1. The public’s mental health in England
Mental health problems in the general population
Mental illnesses account for the largest burden (23%) of diseases in England
23%
• One in four adults experiences at least one diagnosable mental health
problem in any given year
• One in five older people living in the community and 40 per cent of
older people living in care homes are affected by depression
• Up to three quarters of people with mental health problems receive no
support
• People in marginalised groups are at greater risk, including black,
Asian and minority ethnic people, lesbian, gay, bisexual and
transgender people, disabled people, and people who have had contact
with the criminal justice system
Children and young people
Opportunities for prevention and improving outcomes
• One in five mothers has depression, anxiety or in some cases
psychosis during pregnancy or in the first year after childbirth
• One in ten children aged 5-16 has a diagnosable mental health problem
• Children living in poor housing have increased chances of experiencing
stress, anxiety and depression
• Key high risk groups include:
 Looked after children
 People of all ages who have experienced traumatic events, poor
housing or homelessness
 People have multiple needs such as a learning disability or autism
are also at higher risk
10%
One in ten children between the ages of one and 15 has a mental health
disorder.
Inequalities, experiences and impact
While life expectancy has increased overall, there has been little, if any,
improvement in inequalities:
• People living in the most deprived areas are only just approaching the
levels of life expectancy that less deprived groups enjoyed in 1990.
• Inequalities in life expectancy and burden of disease are actually greater
within regions than between them - so largely related to deprivation not
geography.
• People with mental health problems are often overrepresented in high
turnover, low pay and often part time work.
• Common mental health problems are more than twice as high among
people who are homeless compared to the general population, and
psychosis is up to twice as high.
• Poor mental health carries an economic and social cost of £105 billion a
year in England. The economic cost of each death by suicide is estimated
to be £1.67 million.
Understanding the non-communicable
disease (NCD) Challenge
Social and structural determinants matter to children and young
people’s outcomes
• Economic prosperity and a good start to life
• Whilst individuals’ behaviours do matter (e.g. half of health inequalities
between rich and poor are the result of smoking), the reality is that our
health is impacted by a range of wider determinants including:
– good employment
– higher educational attainment
– safe, supported, connected communities
– poor housing and homelessness
– living on a low income
– social isolation, exclusion and loneliness
– stigma and discrimination
Why act early? Impact on childhood life
8
Why act early? Impact on adolescent life
9
Graph sources: Estimates calculated from ONS mid year population (MYE) and prevalence from British Child and
Adolescent Survey
• Mental illness for those aged 14-16 years
carries the highest risk of unhealthy
lifestyle behaviours
• About 50% of children and young people
with conduct disorder smoke, which is
nearly 86,000 children
• About 30% with emotional disorder and
hyperkinetic disorder are regular smokers,
which means provides an estimate of
50,000 children
• About 50,000 children with mental illness
may drink regularly
• About 38, 000 children with mental illness
may be using drugs
2. National action and partnerships
10
An integrated methodology informed by the
WHO approach to public mental health
Everyone, irrespective of where they live, has the
opportunity to achieve good mental health and
wellbeing…especially communities facing the greatest
barriers and those people who have to overcome the most
disadvantages. This includes those living with and
recovering from mental illness.
Mental health
promotion
Improving
lives,
supporting
recovery and
inclusion
Mental illness
prevention
and suicide
prevention
Key themes:
• Reducing health inequalities
• Community centred approaches
• Embedding and integrating mental health
• Improving workforce capacity and competency
Independent Mental Health Taskforce Report
(February 2016)
Recommendations include……… implement Future in Mind and
building on the 2015/16 Local Transformation Plans and going further to
drive system-wide transformation
Cross system action and tools
Opportunities for Better Mental Health for Everyone
• Increased attention and ambition for mental health reflected in the Five
Year Forward View for Mental Health recommendations. Including:
• Increased access to timely, high quality intelligence and data enabling
local needs and assets analysis by life course and/or pathway
• Increased emphasis on early intervention and providing people with
timely access to evidence-based care through the life-course
• Implementation of Future in Mind in full
• Prevention focussed action to create a ‘Prevention Concordat for
Better Mental Health programme
• A new reinvigorated Suicide Prevention Strategy for England
• Increased emphasis on the multi-sectoral partnerships required, with
actions for all across the Voluntary and Community Sector, CCGs, LAs
and private sector businesses
Flourishing People
14
3. What support PHE is giving to the system
15
APublic Health approach
Strategic
• Life course, place and settings-based approaches
• Evidence and data
• Health inequalities - ensuring those at highest risk receive the greatest levels of
support
• Addressing the wider social determinants
Tactical
• Prevention and early intervention – evidence based
• Asset based and holistic approach – families and building resilience
• Integrated responses – whole-systems, multi agency
1616
Children and young people’s health
PHE, alcohol and drug prevention17
Six key principles
• Putting relationships at the centre
• Focusing on what helps young
people feel well and able to cope
• Reducing health inequalities
• Championing integrated services
• Understanding changing health
needs as young people develop
• Delivering accessible, youth
friendly services
(You’re welcome quality criteria)
Snapshot of key activity 2016/2017 in addition to Five Year Forward View for Mental Health delivery support
1. Working across the lifecourse - with specific strands on children, young people and families
– Public Mental Health JNSA toolkit;
– Return on investment toolkit
– Prevention Concordat
2. Children and young people’s lifecourse
– Perinatal and infant mental health competency framework capacity building
– Increasing profile of prevention in NHSE funded activity
– Anna Freud supported mental health in schools toolkit
– Adolescence Resilience Framework
– ‘You’re Welcome’ refresh
– Health Behaviour of School Aged Children
3. Specific products
– New ‘Sleep in Adolescence’ Minded resource
– Rise Above online resource for young people (key content on stress embedded throughout )
– Time to Change for young people (DH led)
– Shelf Help ‘books on prescription’ library initiative for young people (Arts Council led)
4. Bespoke activity
– Suicide Prevention and self harm
– Reviewing work contributing Trauma informed practice and violence
– Universities
– Vulnerable persons and Syrian refugees health assessment guidance
Snapshot: children and young people
Prevention: It’s never to soon
• Mental health problems in the perinatal period are very common, affecting up to 20% of
women. Examples of these illnesses include antenatal and postnatal depression,
obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and postpartum
psychosis.
• Almost a quarter of women who died between six weeks and one year after pregnancy
died from mental-health related causes. 1 in 7 women died by suicide.
• Perinatal mental illnesses cost the NHS and social services around £1.2 billion for each
annual cohort of births. A significant proportion of this cost relates to adverse impacts on
the child.
* LSE and Centre for Mental Health, The Costs of Perinatal Health Problems (2014)
*MBRRACE-UK, Confidential Enquiries, 2015
19
Improving access to good quality, timely
mental health intelligence and data
20
Health intelligence products and tools to enable every local area to improve
their emphasis on prevention and early intervention – primary, secondary and
tertiary
• Joint Strategic Needs Assessment tool for public mental health
• Suite of health economics return on investment tools
• New fingertips tools for perinatal and infant mental health
• Updated fingertips tools for suicide prevention
• Refreshed and extended tools for children and young people
Perinatal and Infant Mental Health Key data
21
Key risk factors - perinatal mental health
 Previous or current history of mental health problems
 Traumatic childbirth, stillbirth, infant death - Data indicator: Stillbirth rate, infant mortality
 Domestic violence and abuse - Incidents of domestic abuse reported to police
 Poor social support - Proportion of sole registration births
Key risk factors - Infant and early years mental health
1. Maternal mental health
Drug and alcohol misuse - Parents receiving drug treatment who live with their children, Parents
receiving alcohol treatment who live with their children
Teenage parents – Births where the mother is aged under 18 years
 Looked after children - Looked after children aged under five years
 Child maltreatment - Children subject to a child protection plan
 Homelessness - Family homelessness: households containing children or a pregnant women
22
http://www.chimat.org.uk/PIMH_Needs_Assessment
A key knowledge hub
‘How to’ guide
23
A short guide to how to make the most of the report can be downloaded
from our website. We recommend you read this before using the report.
24
July August September October November December January February
March/
April
2016 2017
Rapid review
of evidence of
what works
Local Prevention
Planning Guidance
Training for local authority elected
members MH Champions to support
them as prevention focused leaders
Prevention Concordat for Better Mental Health
Mental Health
Joint Strategic
Needs
Assessment
toolkit
Mental Health Promotion
and Prevention Return
on Investment Tool
24
Resources snapshot: Suicide prevention
25
– Updated guidance for developing a local suicide
prevention action plan
e.g. young people in contact with justice are recognised
as a priority group of younger people
– Responding to potential suicide clusters
– Preventing suicide among key groups of young people
e.g. lesbian, gay and bisexual young people; trans
young people
– Help is at Hand’ bereavement support after suicide
e.g. improved responses to children and young people’s
experience of bereavement
– ‘Support after a suicide: a guide to providing local
services (publication imminent)
– Suicide prevention masterclasses
Thank you
lily.makurah@phe.gov.uk
Acknowledgements: Public Mental Health Team

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Lily Makurah

  • 1. Promoting Positive Mental Health and Resilience Children andYoung People’s Mental Health: Promoting integration and early intervention Manchester, 8th December2016 LilyMakurah DeputyNationalLead–PublicMentalHealthandWellbeing
  • 2. Content 1. The challenge: public mental health in England 2. The response: national action on prevention and partnerships 3. What support PHE is giving to the system 2
  • 3. 1. The public’s mental health in England
  • 4. Mental health problems in the general population Mental illnesses account for the largest burden (23%) of diseases in England 23% • One in four adults experiences at least one diagnosable mental health problem in any given year • One in five older people living in the community and 40 per cent of older people living in care homes are affected by depression • Up to three quarters of people with mental health problems receive no support • People in marginalised groups are at greater risk, including black, Asian and minority ethnic people, lesbian, gay, bisexual and transgender people, disabled people, and people who have had contact with the criminal justice system
  • 5. Children and young people Opportunities for prevention and improving outcomes • One in five mothers has depression, anxiety or in some cases psychosis during pregnancy or in the first year after childbirth • One in ten children aged 5-16 has a diagnosable mental health problem • Children living in poor housing have increased chances of experiencing stress, anxiety and depression • Key high risk groups include:  Looked after children  People of all ages who have experienced traumatic events, poor housing or homelessness  People have multiple needs such as a learning disability or autism are also at higher risk 10% One in ten children between the ages of one and 15 has a mental health disorder.
  • 6. Inequalities, experiences and impact While life expectancy has increased overall, there has been little, if any, improvement in inequalities: • People living in the most deprived areas are only just approaching the levels of life expectancy that less deprived groups enjoyed in 1990. • Inequalities in life expectancy and burden of disease are actually greater within regions than between them - so largely related to deprivation not geography. • People with mental health problems are often overrepresented in high turnover, low pay and often part time work. • Common mental health problems are more than twice as high among people who are homeless compared to the general population, and psychosis is up to twice as high. • Poor mental health carries an economic and social cost of £105 billion a year in England. The economic cost of each death by suicide is estimated to be £1.67 million.
  • 7. Understanding the non-communicable disease (NCD) Challenge Social and structural determinants matter to children and young people’s outcomes • Economic prosperity and a good start to life • Whilst individuals’ behaviours do matter (e.g. half of health inequalities between rich and poor are the result of smoking), the reality is that our health is impacted by a range of wider determinants including: – good employment – higher educational attainment – safe, supported, connected communities – poor housing and homelessness – living on a low income – social isolation, exclusion and loneliness – stigma and discrimination
  • 8. Why act early? Impact on childhood life 8
  • 9. Why act early? Impact on adolescent life 9 Graph sources: Estimates calculated from ONS mid year population (MYE) and prevalence from British Child and Adolescent Survey • Mental illness for those aged 14-16 years carries the highest risk of unhealthy lifestyle behaviours • About 50% of children and young people with conduct disorder smoke, which is nearly 86,000 children • About 30% with emotional disorder and hyperkinetic disorder are regular smokers, which means provides an estimate of 50,000 children • About 50,000 children with mental illness may drink regularly • About 38, 000 children with mental illness may be using drugs
  • 10. 2. National action and partnerships 10
  • 11. An integrated methodology informed by the WHO approach to public mental health Everyone, irrespective of where they live, has the opportunity to achieve good mental health and wellbeing…especially communities facing the greatest barriers and those people who have to overcome the most disadvantages. This includes those living with and recovering from mental illness. Mental health promotion Improving lives, supporting recovery and inclusion Mental illness prevention and suicide prevention Key themes: • Reducing health inequalities • Community centred approaches • Embedding and integrating mental health • Improving workforce capacity and competency
  • 12. Independent Mental Health Taskforce Report (February 2016) Recommendations include……… implement Future in Mind and building on the 2015/16 Local Transformation Plans and going further to drive system-wide transformation
  • 13. Cross system action and tools Opportunities for Better Mental Health for Everyone • Increased attention and ambition for mental health reflected in the Five Year Forward View for Mental Health recommendations. Including: • Increased access to timely, high quality intelligence and data enabling local needs and assets analysis by life course and/or pathway • Increased emphasis on early intervention and providing people with timely access to evidence-based care through the life-course • Implementation of Future in Mind in full • Prevention focussed action to create a ‘Prevention Concordat for Better Mental Health programme • A new reinvigorated Suicide Prevention Strategy for England • Increased emphasis on the multi-sectoral partnerships required, with actions for all across the Voluntary and Community Sector, CCGs, LAs and private sector businesses
  • 15. 3. What support PHE is giving to the system 15
  • 16. APublic Health approach Strategic • Life course, place and settings-based approaches • Evidence and data • Health inequalities - ensuring those at highest risk receive the greatest levels of support • Addressing the wider social determinants Tactical • Prevention and early intervention – evidence based • Asset based and holistic approach – families and building resilience • Integrated responses – whole-systems, multi agency 1616
  • 17. Children and young people’s health PHE, alcohol and drug prevention17 Six key principles • Putting relationships at the centre • Focusing on what helps young people feel well and able to cope • Reducing health inequalities • Championing integrated services • Understanding changing health needs as young people develop • Delivering accessible, youth friendly services (You’re welcome quality criteria)
  • 18. Snapshot of key activity 2016/2017 in addition to Five Year Forward View for Mental Health delivery support 1. Working across the lifecourse - with specific strands on children, young people and families – Public Mental Health JNSA toolkit; – Return on investment toolkit – Prevention Concordat 2. Children and young people’s lifecourse – Perinatal and infant mental health competency framework capacity building – Increasing profile of prevention in NHSE funded activity – Anna Freud supported mental health in schools toolkit – Adolescence Resilience Framework – ‘You’re Welcome’ refresh – Health Behaviour of School Aged Children 3. Specific products – New ‘Sleep in Adolescence’ Minded resource – Rise Above online resource for young people (key content on stress embedded throughout ) – Time to Change for young people (DH led) – Shelf Help ‘books on prescription’ library initiative for young people (Arts Council led) 4. Bespoke activity – Suicide Prevention and self harm – Reviewing work contributing Trauma informed practice and violence – Universities – Vulnerable persons and Syrian refugees health assessment guidance Snapshot: children and young people
  • 19. Prevention: It’s never to soon • Mental health problems in the perinatal period are very common, affecting up to 20% of women. Examples of these illnesses include antenatal and postnatal depression, obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and postpartum psychosis. • Almost a quarter of women who died between six weeks and one year after pregnancy died from mental-health related causes. 1 in 7 women died by suicide. • Perinatal mental illnesses cost the NHS and social services around £1.2 billion for each annual cohort of births. A significant proportion of this cost relates to adverse impacts on the child. * LSE and Centre for Mental Health, The Costs of Perinatal Health Problems (2014) *MBRRACE-UK, Confidential Enquiries, 2015 19
  • 20. Improving access to good quality, timely mental health intelligence and data 20 Health intelligence products and tools to enable every local area to improve their emphasis on prevention and early intervention – primary, secondary and tertiary • Joint Strategic Needs Assessment tool for public mental health • Suite of health economics return on investment tools • New fingertips tools for perinatal and infant mental health • Updated fingertips tools for suicide prevention • Refreshed and extended tools for children and young people
  • 21. Perinatal and Infant Mental Health Key data 21 Key risk factors - perinatal mental health  Previous or current history of mental health problems  Traumatic childbirth, stillbirth, infant death - Data indicator: Stillbirth rate, infant mortality  Domestic violence and abuse - Incidents of domestic abuse reported to police  Poor social support - Proportion of sole registration births Key risk factors - Infant and early years mental health 1. Maternal mental health Drug and alcohol misuse - Parents receiving drug treatment who live with their children, Parents receiving alcohol treatment who live with their children Teenage parents – Births where the mother is aged under 18 years  Looked after children - Looked after children aged under five years  Child maltreatment - Children subject to a child protection plan  Homelessness - Family homelessness: households containing children or a pregnant women
  • 23. ‘How to’ guide 23 A short guide to how to make the most of the report can be downloaded from our website. We recommend you read this before using the report.
  • 24. 24 July August September October November December January February March/ April 2016 2017 Rapid review of evidence of what works Local Prevention Planning Guidance Training for local authority elected members MH Champions to support them as prevention focused leaders Prevention Concordat for Better Mental Health Mental Health Joint Strategic Needs Assessment toolkit Mental Health Promotion and Prevention Return on Investment Tool 24
  • 25. Resources snapshot: Suicide prevention 25 – Updated guidance for developing a local suicide prevention action plan e.g. young people in contact with justice are recognised as a priority group of younger people – Responding to potential suicide clusters – Preventing suicide among key groups of young people e.g. lesbian, gay and bisexual young people; trans young people – Help is at Hand’ bereavement support after suicide e.g. improved responses to children and young people’s experience of bereavement – ‘Support after a suicide: a guide to providing local services (publication imminent) – Suicide prevention masterclasses