Mental Health
A Public Health Perspective
Dr Andrea Atherton
Director of Public Health
20th June 2013
A Definition of Public Health
Public Health is the science and art of
preventing disease, prolonging life and
promoting health through the organised efforts
of society.
Sir Donald Acheson
A Definition of Health
Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity.
World Health Organization 1948
A Definition of Mental Health
Mental health is not just the absence of mental
disorder. It is defined as a state of well-being in
which every individual realizes his or her own
potential, can cope with the normal stresses of
life, can work productively and fruitfully, and is
able to make a contribution to her or his
community.
World Health Organization
The Determinants of Health
……and the determinants of mental health
NHS Reforms and Opportunities
for Public Health
Health and Social Care Act 2012
• From 1st April – PCTs and SHAs abolished
• Clinical Commissioning Groups - local commissioning
bodies (Southend CCG)
• NHS England:28 area teams (Essex Area Team)
New public health system
• Public health in upper tier/ unitary authorities
• Public Health England
NHS Reforms (2)
• Focus on outcomes – 3 outcomes frameworks
• Public Health Outcomes Framework
• Requirement for CCGs and Local Authorities to
prepare a Joint Strategic Needs Assessment
and Health & Wellbeing Strategy
• Local authorities are required to have a Health
& Wellbeing Board – membership to include
local authorities, NHS, Healthwatch
Southend Health& Wellbeing Strategy
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A positive start in life
Promoting healthy lifestyles
Improving mental wellbeing
A safer population
Living independently
Active and healthy ageing
Protecting health
Housing
Maximising opportunity
Why prevention of mental health
problems is a public health priority
• At least one in four people will experience a mental
health problem
• One in ten children 5-16 yrs has a mental health
problem
• Self harming in young people: 10-13% of 15-16 year
olds has self harmed
• Almost half of all adults will experience at least one
episode of depression
• One in ten new mothers experiences post natal
depression
Why prevention of mental health
problems is a public health priority (2)
Economic impact
• Cost to the economy in England : £105 billion
Effectiveness of treatment modalities
• Current limitations in effectiveness of
treatment modalities
The evidence
• Preventative interventions: risk factors and
protective factors
A Positive
Start to Life…..
Risk factors for mental disorder in
children and young people
• Use of alcohol, tobacco or drugs during
pregnancy
• Maternal stress during pregnancy
• Low birth weight
• Poor maternal mental health
• Unemployed parent / no qualifications
• Poor parenting skills
• Deprivation
Neurological Development
• Brain development depends
on both genes and
experiences
• Rapid brain development
takes place in the first year
of life
• Early interactions directly
affect the way the brain is
wired
• Early relationships set the
thermostat for later control
of stress response
Family Nurse Partnership Programme
• A structured intensive home
visiting programme
delivered by family nurses &
family nurse supervisors
• A preventative programme
• First time parents under 20
• Nurses visits parents from
pregnancy until child age two
• Each visit uses materials
and activities to build selfefficacy, change behaviour
and promote attachment
FNP in Southend
• Higher deprivation
compared to England
• Higher levels of long term
unemployment
• Relatively high levels of the
adult working population
with no qualifications
• High levels of mental ill
health
• High levels of drug misuse
• High numbers of hospital
stays for alcohol related
harm
• I in 4 children live in poverty
• Number of children on the
child protection register and
Looked After Children
• Southend has a high
teenage pregnancy rate
Outcomes of FNP
• Rigorously tested – 3 scientific trials in USA
and in UK since 2007
• Improvements in women’s antenatal health
and behaviours
• Better parenting
• Better outcomes for children:
• Higher IQs, better language development,
better school readiness in maths, fewer
behaviour/ mental problems reported
Alcohol and
mental health
Impacts of Alcohol
• UK is among the heaviest alcohol consuming
countries in Europe
• Over 1.1 million alcohol related hospital
admissions per year
• 3% of deaths in UK attributed to alcohol
• Alcohol-related harm costs society around £21
billion per year
Health Effects of Alcohol
Acute
• Acute toxic effects of
alcohol poisoning
• Impaired judgement leading
to unintentional injuries and
accidents
• Risky sexual behaviour
• Self harm and suicide:
alcohol is implicated in up
to 65% of suicides in the UK
Chronic
• Neurological problems
• Cardiovascular problems
• Psychiatric problems:
depression, anxiety, and
suicide
• Cancer: mouth, throat,
oesophagus, liver, colon,
and breast
• Liver diseases: alcoholic
hepatitis and cirrhosis
Wider Impacts of Alcohol
“Passive Drinking”
• Antisocial behaviour
• Crime
- violence
- vandalism
• Domestic abuse
• Family breakdown
• Child protection
• Road traffic accidents
Defining Drinking Patterns
• 1 unit of alcohol = 10ml or
8gms of pure alcohol
• Guidelines:
men 3-4 units /day
women 2- 3 units/day
Defining Drinking Patterns
• Binge drinking:> 2x daily guidelines in one day
• Moderate – heavy (hazardous)
22-50 units /week for men
15 -35 units /week for women
• Very heavy: (harmful) - 6% of men, 4% of women
51+ units /week for men
36+ units /week for women
• Alcohol dependency - 6% of men, 2% of women
Interventions to Reduce Harm
from Alcohol
• Media
• Regulation, including age restriction
• Taxation – minimum pricing
Harmful drinkers buy 15 x more alcohol than
moderate drinkers, yet pay 40% less per unit.
MUP of 50p per unit would reduce total
alcohol consumption by 6.7% in the first year
• Multi -buy discounts – restricting to 10% is
equal to MUP of 40p per unit
Interventions to Reduce Harm
from Alcohol
• Business sector sign up to Public Health
Responsibility Deal Pledge to ‘foster a culture
of responsible drinking, which will help people
to drink within guidelines’
• Product labelling on unit content
• Unit messaging in the on-trade and off-trade
• Combatting under age sales: Challenge 21 &25
• Actions on advertising – including not putting
adverts near schools
Identification and Brief Interventions
• Use of AUDIT tool to identify hazardous and
harmful drinking
• Brief interventions constitute a variety of
activities characterised by their low intensity
and short duration
• Highly cost effective – numbers needed to
treat is 8-10
• Now included as part of NHS Health Check
Look After Your Mental Health…
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Talk about your feelings
Eat Well
Drink sensibly
Keep in touch
Take a break
Accept who you are
Keep active
Ask for help
Do something your good at
Care for others
THANK YOU
Any questions?