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A public mental health approach to promoting emotional well being in children

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Acting Consultant West Sussex PCT and Mental Health Directorate, ... Immigrants and asylum seekers. Older people. Promoting meaning & purpose. Key messages ... – PowerPoint PPT presentation

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Title: A public mental health approach to promoting emotional well being in children


1
A public mental health approach to promoting
emotional well being in children
  • Jo-anne Alner
  • Acting Consultant West Sussex PCT and Mental
    Health Directorate, Department of Health

2
Public Mental Health
  • …a definition
  • …is the art, science and politics of
    preventing mental ill health and inequalities
    through the organised efforts of society
  • By reducing risk and promoting protective
    evidence-based interventions
  • In order to improve physical and mental
    well-being
  • And create flourishing, connected individuals,
    families and communities
  • (National Expert Group for Public Mental Health
    and Well Being, 2008)

3
A public mental health approach
  • Describe the problem prevalence, risk and
    protective factors
  • Come up with solutions evidence-based and
    cost-effective approaches
  • Address root causes upstream thinking,
    wider determinants, inequalities
  • Develop strategies and policy
  • Promote leadership and collaborative working
    to achieve change and implement policy
  • Encourage reflective learning and evaluation
    and sharing of good practice

4
Create flourishing, connected communities A
Public Mental Health Framework for Developing
WellBeing
Promote meaning and purpose
Reduce risk factors
Promote protective factors
Develop sustainable, connected communities
Integrate physical and mental health and
well-being
Build resilience and safe, secure base
Ensure a positive start in life
5
Presentation outline
  • The problem
  • The vision
  • Overview of the Public Mental Health framework
  • Taking this work forward and next steps

6
The problem
  • Poor mental health contributes significantly to
    overall health inequalities and the burden of
    disease
  • Mental health problems have a significant cost
    impact on society

7
Mental health problems are common
  • 1 in 6 the adult population experiences mental
    ill health at any one time
  • 10 of children have a mental health problem,
    many continue to have mental health problems into
    adulthood
  • 10 of new mothers suffer from postnatal
    depression
  • 19 of women and 13.5 of men are affected by
    depression or anxiety at any one time
  • Half of all women and a quarter of men will be
    affected by depression at some time in their life
    and 15 experience a disabling depression
  • 4 of population has a personality disorder
  • 1 of population have a serious mental health
    problem

8
UK Disability Adjusted Life Years - WHO,
2002 www.who.int/healthinfo/bodestimates/en/index
.html
9
UK Disability Adjusted Life Years by mental
illness WHO 2002
  • Total UK DALY due to mental illness is 26.1, of
    which the following are the largest contributors
  • Uni-polar depression 7.8
  • Serious Mental Illness 2.3
  • Alcohol Misuse 3.7
  • Drug Misuse 2.1
  • Dementia 3.7

10
A reflection on life, death and well-being
  • Vision
  • Improve Health
  • Reduce Inequalities

Promote well-being
Positive Outcomes Health well-being Educational
achievement Productivity efficiency Safer
communities Social Inclusion
Integrate Well-Being
Promote Physical Health
Promote Mental Well-Being
Promote Social Well-Being
Public Health Early Prevention
Health Services
Social Health Risk Factors
Mental Health Risk Factors
Physical Health risk factors
Negative Outcomes Inequalities in health Poor
education Reduced productivity Increased
crime Social exclusion
Reduce risk factors
Ill-Health
Death
Nurse J, 2006
11
Impact on society
  • Mental health problems have a significant
  • cost impact on society

12
Impact on society
Cost of mental health problems in England Source
Kings Fund 2008
5.3
13
Mental Health Problems Have a Significant Impact
Upon the Individual
14
Deliberate Self Harm and Suicide
  • Suicide
  • Accounts for 20 of all deaths among young people
    aged 15-24
  • ChildLine received 1,265 calls in 2005-2006 in
    connection with Suicide

15
Deliberate Self Harm and Suicide
  • Deliberate Self Harm
  • lt 24,000 teenagers admitted to AE after self
    harming each year
  • Estimated 1 in 10 Teenagers Self harm
  • ChildLine received 2,012 calls in 2005/06 in
    connection with self harm

16
The vision
To create flourishing, connected communities
17
Shifting focus from illness to well-being
  • Mental health more than absence of mental illness
  • Shift from treatment to providing greater focus
    on promoting well-being in the whole population
    and early intervention for high risk groups
  • Positive mental health is a key asset which
    benefits physical health, educational outcomes,
    families, community safety and the economy

18
Benefits of flourishing
  • (Keyes 2007)
  • Fewest missed days of work
  • Healthiest psychosocial functioning, i.e. low
    helplessness, clear goals, high resilience
  • Lowest cardiovascular disease
  • Lowest number of physical diseases with age
  • Fewest health limitations of activities of daily
    living
  • Lower health care utilisation

19
The mental health spectrum
From Huppert Ch.12 in Huppert et al. (Eds) The
Science of Well-being
Moderate mental health
Mental disorder
Flourishing
Languishing
Number of symptoms or risk factors
20
The effect of shifting the mean of the mental
health spectrum
From Huppert Ch.12 in Huppert et al. (Eds) The
Science of Well-being
Flourishing
Moderate mental health
Mental disorder
Languishing
Number of symptoms or risk factors
21
  • The Public Mental Health Framework

22
Create flourishing, connected Communities A
Public Mental Health Framework for Developing
WellBeing
  • Meaning from Adversity
  • Post traumatic growth
  • Psychological therapies
  • Positive reflection

Promote meaning purpose
Develop sustainable, connected communities
  • Reduce Social Exclusion
  • Address discrimination and stigma
  • Target high risk groups

Integrate physical mental health well-being
  • Reduce
  • Smoking
  • Alcohol
  • Drugs
  • Obesity

Reduce risk factors
  • Reduce Inequalities
  • Unemployment
  • Fuel Poverty
  • Homelessness
  • Violence and Abuse
  • Impact of Climate Change

Build resilience a safe, secure base
  • Prevent and reduce impact of
  • Adverse Childhood Experiences
  • Child abuse
  • Parental mental illness
  • Parental substance misuse
  • Parental Domestic Abuse
  • Household offender
  • Childhood bereavement

Ensure a positive start in life
Nurse J 2008
23
Ensure a positive start
Risk factors
  • Adverse childhood experiences mean people are
  • 12 times more at risk of attempting suicide
  • 10 times of injecting drug use
  • 7 times of being an alcoholic
  • 4 times of being depressed or using illicit
    drugs
  • Violence and abuse A history of child abuse
    increases the risk of lifetime prevalence of
    depression by 1.8 - 2.7 times for women and 1.6 -
    2.6 times for men

24
Ensure a positive start
Risk factors
  • Looked after children are
  • 8 times more likely to develop conduct disorder
  • 3 times an emotional disorder
  • 7 times a hyperkinetic disorder
  • and up-to 5 times more likely to attempt suicide
  • Poor education Those leaving school who are
    under 15 years of age are 2.5 times more at risk
    of developing a mental health problem

25
Educational Poster for Expectant Mothers
National Child Welfare Association 1919
26
Life Course Benefits
  • crime smoking drugs depression
    suicide no quals
  • Top 50
  • (no conduct
  • problems) 1.00 1.00
    1.00 1.00 1.00 1.00
  • Middle 45
  • (some
  • problems) 1.95 1.24 1.51
    1.24 1.69 1.18
  • Bottom 5
  • (conduct
  • disorder) 4.13 1.59
    2.39 1.57 3.00 1.45

27
Build resilience and a safe secure base
Risk factors
  • Flooding
  • Increases risk of depression four fold
  • Unemployment Economically inactive are up to
    5.5 times more at risk
  • Fuel poverty 2.3 million vulnerable people live
    in fuel poverty in the UK, cold homes increase
    the risk of depression by 50
  • Violence and abuse
  • Levels of community violence have increased
    over last 50 years associated with mental
    health problems

28
The cycle of violence and abuse across the
life-course
Inequalities Poor Environment
I N C R E A S I N G A G E
Negative Parenting
Adverse Childhood Experiences
Conduct Emotional Disorders
Risk Behaviours
Violence Abuse
Poor Mental Health
Poor Physical Health Socio-Economic Outcomes
Nurse J, 2008
29
Integrate physical and mental health and
well-being
Risk factors
  • A meta-analysis found that depression at age 65
    was linked with a 70 increased risk of dying
    early
  • Having a physical Illness increases your risk of
    developing a mental health problem by 6.4 times
  • Following a myocardial infarction
  • A depressed/anxious person with myocardial
    infarction is up to three times more likely to
    die within two years
  • An anxious person is up to six times more likely
    to die of coronary heart disease

30
Integrate physical and mental health and
well-being
Risk factors
  • Obesity and depression The 20-25 of the
    population who are obese and smoke are
    concentrated in among the 26 of the population
    living in poverty, who also have the highest
    prevalence of depression and anxiety
  • Smoking Having a mental health problem is
    associated with a two-fold increased risk of
    smoking, compared to the non smoking population

31
Integrate physical and mental health and
well-being
Risk factors
  • Hazardous drinking A longitudinal study found
    that in adulthood, especially for women, the risk
    of developing hazardous drinking increased
    following two or more stressful life events
  • Alcohol dependency People with a common mental
    disorder were twice as likely to have dependency
    on alcohol than those without a mental health
    problem and for those with a serious mental
    health problem, it was three times the rate

32
Develop sustainable connected communities
Risk factors
  • Recently released prisoners 35 times more likely
    to commit suicide if they are female and 8 times
    if they are male, young offenders 18 times more
    likely
  • Urban environment Lack of social support
    increases the risk by two-fold, and a lack of
    green spaces by 80
  • Disconnected societies enhance social exclusion
  • Groups who experience discrimination generally
    experience higher levels of mental health
    problems

33
Create flourishing, connected communities A
Public Mental Health Framework for Developing
WellBeing
Promote meaning purpose
  • Cultivate purposefulness fulfilment
  • In life, work, education and volunteering
  • By creativity, coherence and flow
  • With inclusive beliefs and values

Develop sustainable, connected communities
  • Enhance
  • Community engagement
  • Ecological intelligence and
  • connectedness
  • Improve
  • Physical
  • activity
  • Healthy food
  • Sexual health
  • Health checks

Integrate physical mental health well-being
Promote protective factors
  • Promote
  • Employment
  • Benefits checks
  • Safe green spaces
  • Insulated and warm homes
  • Partnership working

Build resilience a safe, secure base
  • Improve
  • Parenting and parental health
  • Social and emotional literacy in healthy schools
  • Violence abuse prevention skills
  • Early interventions for conduct emotional
    disorders

Ensure a positive start in life
Nurse J 2008
34
Ensure a positive start in life Key messages
  • Majority of mental health problems start in
    childhood Up to three quarters of adult mental
    health problems start in childhood
  • Pre-natal and early life factors are important in
    influencing well-being
  • Adverse childhood experiences can have long-term
    negative effects on both physical and mental
    health
  • Interventions
  • Positive parenting skills for the whole
    population and targeted at high risk groups
    treat parental mental illness
  • Develop social and emotional literacy skills
  • Develop violence and abuse prevention skills
  • Intervene early with conduct and emotional
    disorders

35
Build resilience and a safe secure base Key
messages - interventions
  • Reduce socio-economic inequalities, unemployment
    and homelessness
  • Reduce community based violence share
    information and reduce alcohol
  • Promote resilience against climate change
  • Create safe, green spaces to increase resilience
    to climate change (aides flood management,
    reduces heat, improves air quality) and reduces
    mental health problems
  • Address fuel poverty insulate homes to increase
    resilience from heat and cold and reduce CO2
    emissions. Warmer homes decrease the risk of
    depression by 50

36
Integrate physical and mental health and
well-being Key messages - interventions
  • Target interventions to risk factors for those
    with mental health problems
  • Ensure health promotion activities target those
    with mental health problems
  • Promote mental health in those with physical
    health problems
  • Develop integrated clinical pathways to the
    prevention and treatment of physical and mental
    ill health

37
Historically, mental and physical health have
been seen as separate and non- interacting
domains, resulting in separate treatment
approaches and policies
Mental Health
Physical Health
38
In reality, there is considerable overlap and
interaction between physical and mental
health Poor mental health is probably a larger
contributor to health risk behaviours and poor
physical health than the other way round
Physical Health
Mental Health
39
Develop sustainable connected communities Key
messages
  • Target groups that experience discrimination for
    interventions to reduce risk factors and promote
    mental health
  • Apply ecological principles as they potentially
    help to increase wider sustainability and a sense
    of being connected to a community
  • Multiple health benefits of green spaces exist,
    including mental well-being, reduced violence,
    increased physical activity, reduced obesity and
    greater social capital

40
Target groups
  • Target socially excluded and discriminated
    groups
  • Those with mental health problems
  • Lesbian, gay, bisexual and transgender
  • Black and minority ethnic groups
  • Looked after children
  • Offenders and ex-offenders
  • Travellers
  • Immigrants and asylum seekers
  • Older people

41
Promoting meaning purpose Key messages
  • Work in partnership to create a vision of
    well-being
  • Improve access to psychological therapies to help
    develop meaning from adverse circumstances
  • Promote meaning and purpose within education,
    work and voluntary community activity
  • Organisations to develop and adopt inclusive
    beliefs and values
  • Promote activities that develop creativity,
    coherence and flow

42
Create flourishing, connected communities A
Public Mental Health Framework for Developing
Well-Being
  • Meaning from adversity
  • Post traumatic growth
  • Psychological therapies
  • Positive reflection

Promote meaning purpose
  • Cultivate purposefulness fulfilment
  • In life, work, education and volunteering
  • By creativity, coherence and flow
  • With inclusive beliefs and values
  • Enhance
  • Community engagement
  • Ecological intelligence and
  • connectedness

Develop sustainable, connected communities
  • Reduce social exclusion
  • Address discrimination
  • and stigma
  • Target high risk
  • groups

Integrate physical mental health well-being
  • Improve
  • Physical
  • activity
  • Healthy Food
  • Sexual Health
  • Health Checks
  • Reduce
  • Smoking
  • Alcohol
  • Drugs
  • Obesity

Reduce risk factors
Promote protective factors
  • Reduce Inequalities
  • Unemployment
  • Fuel Poverty
  • Homelessness
  • Violence and Abuse
  • Impact of Climate Change
  • Promote
  • Employment
  • Benefits Checks
  • Safe Green Spaces
  • Insulated Warm Homes
  • Partnership Working

Build resilience a safe, secure base
  • Prevent and reduce impact of
  • Adverse Childhood Experiences
  • Child abuse
  • Parental mental illness
  • Parental substance misuse
  • Parental Domestic Abuse
  • Household offender
  • Childhood bereavement
  • Improve
  • Parenting Parental Health
  • Social and Emotional
  • Literacy in Healthy Schools
  • Early interventions for conduct emotional
  • disorders

Ensure a positive start in life
Nurse J 2008
43
(No Transcript)
44
Taking this work forward
  • …and next steps
  • Summary to be developed and circulated in the New
    Year for wider consultation DH, OGDs and
    National Experts
  • Draft report to be circulated for comments
  • National launch event of final report Spring 2009
  • Key messages to inform New Horizons work
  • Comments to Jo.Nurse_at_dh.gsi.gov.uk

45
Key messages a reminder
  • The problem
  • Poor mental health contributes significantly to
    overall health inequalities and burden of disease
  • The vision
  • To create flourishing, connected communities
  • Aim of the report
  • To provide an evidence-based public mental health
    framework for generating well-being and
    flourishing within individuals, families,
    communities and society

46
Key messages a reminder
  • Ensure a positive start in life The majority of
    mental health problems start in childhood and
    early interventions to promote well-being have a
    potentially bigger impact upon overall population
    well-being.
  • Build resilience and a safe secure base Everyone
    needs a home, sufficient income, freedom from
    violence and a need to develop resilience.
  • Integrate physical and mental health and
    well-being Lessons from neuro-science will help
    transform the way we approach and treat physical
    and mental health.
  • Develop sustainable connected communities
    Socially excluded groups experience more mental
    health problems and need targeting. Ecological
    principles can help to increase the feeling of
    being connected.
  • Promoting meaning and purpose If we do this in
    all that we do, we can help people overcome
    adversity and promote a greater sense of
    well-being.
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