Every mind matters?

Ella Rhodes on the government's prevention plan.

New teachers will now be trained in identifying early signs of mental health problems in students, as part of a push towards prevention. The government’s prevention plan also includes measures to give social workers, local authorities and healthcare workers more support in promoting the idea of treating good mental health in the same way as good physical health.

Prime Minister (at time of writing) Theresa May launched the plans in June stating: ‘I believe the next great revolution in mental health should be in prevention’. The government also plans to train more than one million NHS staff in suicide prevention, provide funding to local authorities to deliver suicide prevention plans, and update standards for social workers to increase their knowledge in helping people with mental health problems. An awareness-raising campaign named Every Mind Matters will also be launched in October and from next year parents will be provided with advice on dealing with self-harm, online bullying and stress.

Writing for The Guardian Clinical Psychologist Dr Masuma Rahim suggested that, while teachers are in a good position to support young people who may be struggling, the policy in itself was not sustainable for a number of reasons, including the issue of CAMHS under-funding and problems accessing services once problems are identified. Rahim wrote that mental health problems are often the result of the society a person inhabits and suggested taking a public health approach.

‘You can’t separate mental health from the reality of people’s lives. If you live in substandard housing and haven’t enough food to eat you are extremely likely to have difficulties with your mental health. You can’t give people therapy for being poor, vulnerable, or marginalised. You need to tackle the poverty and the vulnerability and the marginalisation.’

She pointed to the irony of this announcement coming just a fortnight following a report on Sure Start centres which found healthcare outcomes had been improved in deprived areas. However, funding for such early years services has been cut by more than 60 per cent in the last 19 years. ‘If you want to improve population-based outcomes you have to invest in your population… But the policies of the last 10 years have shown very clearly that ringfencing funding to improve the health and social outcomes for poor and deprived people is seen as unimportant by the government.’

While Rahim said she agreed more people should learn how to spot mental health issues early she said these ideas sounded like ‘empty words and policies’. ‘If she [May] really believed in championing mental health she would be looking at tackling the root causes and she would be acknowledging the impact of her own party’s policies on the mental health of those who have borne the brunt of them.’

This move by May comes ahead of publication of a government green paper on prevention which is due out over the next few months. In November Matt Hancock, Secretary of State for Health and Social Care, outlined some of the directions the government is expected to take in its prevention agenda in the Prevention is better than cure document pointing to priority areas such as healthy eating, not smoking, alcohol overuse and mental health.

The British Psychological Society has been consulting with members ahead of the publication of the government’s prevention green paper and has plans to release a public briefing document in response. A recent roundtable meeting brought together a group of Society members to discuss their thoughts on the topic. Professor Jim McManus, Director of Public Health (Hertfordshire County Council) and Vice President of the Association of Directors of Public Health was among them. He told me in an interview that from conversations with those working in the Department of Health and Social Care he was glad to hear that the government had recognised the importance of developing strong prevention policy and the good economic and moral case for prevention, but many areas he felt were lacking.

McManus said all he had read and heard about the government’s prevention strategy was heavily influenced by biomedical and individualist models of behaviour change. ‘I think what they’ve done is taken a clinical paradigm to prevention that is just not going to deliver and never has. It will be the fifth time that a national government policy has tried that and it hasn’t worked, ever... For example John Reid’s plan in 2004 called Choosing Health was all about drinking alcohol more sensibly, eating sugar more sensibly, not smoking, and it hasn’t worked.

‘Alcohol consumption, in everything other than the millennial generation, has stayed stubbornly the same. Smoking prevalence, although it’s declining, is not declining primarily because of smoking cessation services, it’s declining because of a whole range of other policy measures. We’re a fatter society than we’ve ever been, weight is going up, type 2 diabetes is going up, the number of obese children in year six is going up.’

McManus also pointed out that while the government’s ideas so far had made a nod towards wider determinants of health, including social determinants, this thinking had not gone far enough. ‘The problem with the social determinants narrative is it can sound a bit woolly and vague. How is improving someone’s housing going to improve someone’s health? Of course, in and of itself, it’s not a magic bullet but it is important. We have to get into very sharp, very focused thinking on explaining why social determinants are important and articulating the role of complexity alongside social, and wider, determinants. The debate at the minute is government saying “we can’t afford to be an ill society so we’re going to tell people to change their behaviour and they’re going to change their behaviour”.’

Three other areas of concern for McManus are the government’s focus on using apps to tackle prevention, the use of genomics, the evidence for which he said had been overstated, and predictive prevention, which he feels is vaguely articulated and unproven in terms of evidence. ‘To my mind one of the single biggest things you could do if you were going to have a really good prevention policy, for the long term or medium term, is ask what does it look like for a child to have reached adulthood successfully – there’s no joined-up policy narrative around that in this country.’

Psychological evidence, and the potential for psychologists in tackling prevention, has so far been entirely absent from prevention plans. Tackling a problem as large as prevention, McManus said, requires complex thinking and looking beyond the individual and at the full life-course of a person. ‘I think the other thing psychologists could do is make a contribution about healthy organisations and how organisations have a role in either making people less well or making people healthier. The next thing psychology could’ve done is brought some models of behaviour change that actually have a grounding in evidence and balance the individual with the social.’

I asked McManus what he would most like to see from any response to the government’s prevention plans from the BPS. ‘My ask of the BPS would be to do several things. One is to say that the individual behaviour change paradigm is dead and ineffective and won’t work by itself, the second thing would be to talk about the importance of social determinants and individual models held in tension, and actually say how that could make a difference. The third thing would be for the BPS to really focus on childhood, we have to get childhood right, and the fact that we aren’t is storing up an awful lot of avoidable and wasted costs. Also I think if the BPS would counter some of the pseudoscience about genomics and predictive prevention that would be a major step forward.’  

Are you a psychologist working in prevention research or practice? We would love to hear your views on prevention and psychology's role in it - from both physical and mental health perspectives.
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