How can the NHS promote better mental health and well-being across the population?

Part of our response to the Labour Party Policy consultation June 2012
  1. At the least, ensure that there is good, safe medical cover on psychiatric wards. There is almost none now.
  2. Support more work on services for patients with unexplained medical conditions. If we can get this right, we will reduce Outpatient demand significantly.
  3. As far as possible, put psychiatric and physical health in the same institution.
  4. Alcohol and drug services integrated with physical health and linked with the Local Authority
  5. More private investment in the prevention of illness and disease. This means making workplaces safer, lower stress, more productive and more engaging of front line workers’ ideas for reform.
  6. NHS occupational services need to be aggressively expanded to all small and medium enterprises.
  7. At national level we need to look at how we incentivise volunteering among active older people.  Those who volunteer have lower  mortality rates, greater functional ability, and lower rates of depression later in life than those who do not volunteer.
  8. These are two separate questions. Mental health is established in childhood and young adulthood, so resources should be targeted at parents and children to promote mindfulness, self-efficacy and positive coping strategies; New Labour did this well with Sure Start but there needs to be an extension of this thinking into the teenage years, involving Education as well as the NHS.
  9. Well-being is subjective ‘feel-good’ experience that is distributed across the age span in a U-shaped form, with peaks in childhood and adolescence, and in later life. The trough in well-being is in the 30s and 40s, perhaps earlier for women than men. This is the young parent population, which experiences substantial economic stress and which is also the most critical of the NHS. Rising well-being seems to be associated with consumption (eat, drink and be merry?) that is not necessarily healthy, and with increasing reluctance to prioritise health care. So, at the individual level there is some evidence that those with higher life satisfaction are less likely to act on threatening symptoms, and a social level there may be political resistance to spending on health services.
  10. Public health needs to straddle both local authorities and the NHS, becoming an “owned” resource for both  the opportunity to continue the good work Labour did in government. The teenage pregnancy strategy was an amazing achievement – the lowest rates in 30 years. It’s hard work, it’s well evidenced partnership work and the rates will rise if the work slides. Attractively, Kings Fund figures show every £1 spent on contraceptive services saves £11 – and that’s an in year saving. Ensuring men & women of all ages can have full control of their fertility us something Labour should be wholeheartedly behind.
  11. Risk taking behaviour more generally should be prioritised & linked to mental health & emotional well being. Labour did great work in schools (I think SEAL was one programme) ensuring children & young people were emotionally literate. Labour very nearly made Sex & Relationship Education compulsory – we should continue to promote this so that children & young people are protected from abuse & equipped to meet puberty and the pressures of later life n our very sexualised society.
  12. By having the power to determine policies that affect health – for example alcohol marketing and prices, gambling, employment practices, planning – beyond the traditional sphere of health services.
  13. Restore effective health screening in schools (currently this is now just in reception and year 6, and then only minimalist), and do away with the pernicious over-emphasis on parental choice, both in terms of school choice and in terms of referral – for example for seriously obese children.
  14. Again, however, there needs to be a radical rethink of how our society operates – the NHS within the context of a caring, socially inclusive society rather than as a mitigation of a system that exists for the perpetuation of capital. Transformation of this sort would take a generation and requires investment in community development (more singing for example) linked to new democratic and participative processes and structures – sorry but you can’t deal with these big questions with a narrow focus on the NHS.
  15. Drugs/smoking/alcohol – prohibition is not the answer. Sensible restrictions and policies make a difference – for example plain packaging on cigarettes will make a difference, the new legislation on covering displays of tobacco is making a difference. More policies like this are needed.