Mental health (feeling good and functioning well) is a fundamental determinant of physiological functioning. Mental health is more than the absence of disease (hence mental wellbeing): two key points from Professor Sarah Stewart-Brown's presentation to the SHOEs conference in Sandwell on March 28 2104.

1. Public Mental Health and People’s
Rights
Sarah Stewart-Brown
Professor of Public Health, Warwick Medical School
Co-Chair Faculty of Public Health’s, Mental Health Committee
SHOES 12

2. OR
How to stay (more or less) sane
over 30 years in public health

3. OR
How to stay (more or less) sane
over 30 years in public health

4. OR
How to stay (more or less) sane
over 30 years in public health
•Social Inequalities
•Human Rights

5. Where are we?
Where do we want to get to?

6. How do we get there ?

7. How do we get there ?
What underpins our present situation ?

8. How do we get there ?
What underpins our present situation?
What are we not getting?

9. Mental,
emotional and psychological
health and wellbeing

10. Descartes

11. Descartes’ writings were
misleading
The mind and body work
as one system

12. Descartes made a mistake

13. Key things about mental health
• Mental health (feeling good and functioning
well) is a fundamental determinant of
physiological functioning

14. Key things about mental health
• Mental health (feeling good and functioning
well) is a fundamental determinant of
physiological functioning
• Mental health is more than the absence of
disease (hence mental wellbeing)

15. Distribution of Mental Health
Poor mental health/
mental illness
Good mental health/
mental well being
No of
People

16. Distribution of Mental Health
Poor mental health/
mental illness
Good mental health/
mental well being
No of
People

17. Distribution of Mental Health
Poor mental health/
mental illness
Good mental health/
mental wellbeing
No of
People

18. Social determinants of mental wellbeing
adjusted for age sex, employment status, marital status, ethnicity religion
Odds of Mental Illness
relative to highest category of
income or education
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
*
*
Odds of Mental Wellbeing
relative to highest category of
income or education
0
0.5
1
1.5
2
2.5
Income Education
*

19. Life Satisfaction and GDP in the UK 1973-2011
By Kind Permission of Ewen Mckinnon Cabinet Office Nov 2012

20. Gudmundsdottir D.G.
The impact of economic downturn on happiness
Social Indicators Research 2013;110:1083-1101
Iceland Banking Crisis:
Happiness scores declined marginally, but almost as many people
had an increase in happiness as a decrease
Decline in happiness
Not predicted by education, unemployment, income or
financial difficulties
Increase in happiness
Predicted by education and social relationships

21. Mental illness
Educational success
Wealth
Employment
Mental wellbeing
Educational failure
Poverty
Unemployment

22. Key things about mental health
• Mental health (feeling good and functioning
well) is a fundamental determinant of
physiological functioning and thus physical
health
• Mental health is more than the absence of
disease (hence mental wellbeing)
• Mental health has its origins in childhood

23. Life Course Influences
By 14 years By 20 years Rest of Life
50% of all mental illness has
emerged by 14 years of age

24. Parenting shapes the
emotional and social brain
• Neuroscience
•Animal studies
•Human studies
•Stress response
•Gene expression
• Epidemiological/ sociological studies
• ‘Attachment’ based studies
•

25. Findings from Animal Models
•Stress due to neglectful care-giving disturbs the
higher and mid brain circuits that regulate
response to psychosocial threat
•Neglectful care-giving produces offspring who
as adults are more fearful and exhibit persistent
physiological abnormalities
•As a consequence they have difficulties learning
and problems trusting others and making health-
enhancing relationships throughout life
•They lack resilience to mental illness

26. Mechanisms
Mirror Neurons
Epigenetic phenomena
• DNA Methylation
• Modification of
transcriptome

27. Dr Stephen Suomi
and team
University of
Maryland

30. Genes involved in the HPA axis that are significantly differentially
methylated between mother and nursery reared rhesus monkey
Genes T cells PFC
NR3C1
NR3C2
AVPI1
AVPR1A
AVPR2
AVPR1B
CRH
CRF1_MACMU
CRHR2
IL1A_MACMU
IL1B_MACMU
IL1R1
IL1RL1
IL2_MACMU
IL6_MACMU
TNFA_MACMU
TNFC_MACMU
INFG_MACMU
INFA14
INFA16
INFA8
INFAR1
INFAR2
NKKB1
Hypermethylated in mother-reared
Hypermethylated in nursery-reared

32. MR.31
MR.44
MR.43
MR.41
MR.55
PR.47
PR.40
PR.37
PR.35
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Regulation of Genetic Activity in Mother
Reared (MR) and Peer Reared (PR)Macaques
Up-regulated
Down - regulated
Abusive

33. Mother reared
Peer reared
717521
Inflammation
Cell growth/differentiation
Transcription control
Immunoglobulin production
Type I interferon antiviral response
Early life social conditions
S. Suomi
Up-regulated
Down - regulated

34. The risk factors for poor parenting are:
– Parental mental illness
– Parental drug and alcohol misuse
– Parents who were in care or abused as children
– ?? Teenage parenting
– ?? Poverty
– ?? Educational underachievement

35. Hostility, depression,
anxiety, anger
fear
Distress, crying,
withdrawal
Sets thermostat on
HPA stress response
Adult who is
prone to
fight, flight
or freeze
responses
Parent
Infant

36. A systems approach
community
Parent
Mental health
of societies
Social and fiscal
policy
Parent
Infant
Adult

37. Systems Thinking: Complexity
Unpredictable Outcomes
Emergent Phenomena
Everything is connected

38. Determinants of Mental Health
Parenting and
Genes
Social
Environment
Self

39. A Right to Mental Health ?

40. Settings and approaches in which mental
health promotion is ‘evidence- based’
Very well
• Parenting
• Schools
Quite well
• Workplaces
• Communities
– Asset based approaches
– Physical activity promotion
– Debt management
– Time banks
• Elderly
– Physical activity, social engagement, new learning
• Adults
– Meditation/mindfulness, bodywork practices, relaxation, fruit and veg
– Creative endeavour, music,
– 5 ways to wellbeing: volunteer, take interest, physical activity
– Laughter sleep, natural environment

41. You can’t make people healthy
You can’t give someone health

42. You can’t make people healthy
You can’t give someone health
You can help them find it

43. How do we get there ?
What underpins our present situation ?
• Unconscious processes and beliefs
What is the next step ?
• Understanding ourselves

44. Understanding of others and thus
understanding mental health
come from understanding self

45. How do we get there ?
What underpins our present situation ?
• Unconscious processes
What is the next step ?
• Understanding ourselves
What is needed to take that step ?

46.  We are part of the
problem and part of the
solution
 Exploring and improving
our own mental
wellbeing is the best way
to enable mental health
in others
 Head banging doesn’t
work

47. Resources
FPH : Better Mental Health for All Website
http://www.fph.org.uk/better_mental_health_for_
all
FPH: Special Interest Group http://www.fph-
groups.org.uk/members/members_registration.php
DH Wellbeing : why it matters to health policy
https://www.gov.uk/government/publications/well
being-and-health-policy