Political leadership for prevention science
Just how immersed are the hearts of our political leaders in the quest to transform the mental state of the nation after 8 June 2017? After all, this opportunity to influence the nation’s mental health and wellbeing is arguably unprecedented on at least two counts. First, in terms of indicators of being a nation in distress, the UK is at a particularly low ebb. The UK female suicide rate has increased to its highest rate in a decade, and, also of deep concern is the increase in suicides for males under age 30 as well as for middle-aged men. Also with a focus on young people, whilst the Organisation for Economic Co-operation and Development (OECD) data show that - based on 53 countries - the average is 34% feeling very satisfied with life, in the UK in 2015 only 28% of students feel this same way. More generally, across the breadth of the human lifespan, in the UK currently around one in four people experience a mental health problem each year. Now add into the picture, an economic slant. The current estimated cost of mental health issues (at least as applied to UK employees of working age) amounts to around 4.5% gross domestic product.
Taken together, these trends collectively point to a strong ethical, social and economic case for raising our national game in provision for mental health and wellbeing. A comparison is warranted across General Election 2017 manifestos of the three largest parties in terms of the highlights of their ambitions for mental health and wellbeing:
• Labour - this manifesto proposes to invest in support for children and young people. They will introduce a new Index of Child Health to include four primary indicators of which one is mental health. They will also ensure that access to counselling service is available for all children in secondary schools, and keep mental health care local. Labour will also ask the National Institute for Health and Care Excellence to evaluate the potential for increasing the range of evidence-based psychological therapies on offer.
• Conservatives - this manifesto is the pledge to address the need for better treatments across the spectrum of mental health conditions. They aspire to make the UK the leading research and technology economy in the world for mental health, meshing public, private and charitable investment. In terms of legal terrain, they transform mental health in the workplace using the findings of the Stevenson-Farmer Review into workplace mental health support.
• Liberal Democrats - includes a pledge to drive equal care for mental health through changes in access – namely, waiting time standards of six weeks for depression and anxiety and clinically effective and cost-effective talking therapies, with no out of area placements. Specifically named groups included children and young people with scope to adopt the Australian ‘headspace’ model; pregnant/new mothers (including those who experienced miscarriage or still birth) and LGBT+ needs.
A litmus comparison across manifestos shows the large preoccupation with reducing mental health problems only after they have arisen. Whilst solutions are vital, so too are narratives which reflect a role for prevention. The incoming government has an unprecedented opportunity at this point in science to prioritise prevention.
Significantly, the start of a new five-year period of government term coincides with the advent of a new era in prevention science. Whilst globally, prevention science in mental health is only in its infancy, the approach offers renewed hope for leadership. As already pointed out by psychological scientists no data on implementation of universal mental health care provision yet exists. However, at national level, Norway (incidentally, Norway is the top country in the 2017 World Happiness Rankings) have partnerships who have successfully implemented mental health programmes at national scale through children’s mental health clinics. Through the tools of translational science, it becomes possible to quantify the economic and social impact of such mental health prevention efforts within relevant time-frames. The lead political party has unprecedented opportunity to determine the potential economic and social impact of programmes and associated policies.
Imagine in the UK a scenario where the relevant policy agendas of poverty, housing and employment were entirely conducive to optimising both individual, family, community and organisational mental health and wellbeing. What is needed within the next five-year government term is access to information about the extent to which preventive strategies in mental health have the most chance of social and emotional wealth whilst reducing public costs without substantially increasing spending. Tomorrow’s government have the unprecedented opportunity to support the generation of and to exploit the evidence base of mental health prevention strategies. In the spirit, there needs to be targeted dialogue involving users, academic research leaders, practitioners, NHS, learned societies and policy-makers to unite voices around a quest for sustainable, and intergenerational gain in mental health and wellbeing.
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