The social determinants of mental illness

Key points from my contribution to a session at PHE 2018 conference on mental health. I use the term mental health advisedly.

The session was titled the social determinants of mental illness. I tried to frame it precisely to the question (unusual for me)

Slides here

My key points were

1. We under invest in mental illness services compared to size of burden of illness.

c13% of the budget for NHS (programme budget), 17% of the burden of illness (GBD). I recognise there is an awful lot of caveats in that data.

Don’t necessarily interpret this as a straightforward call for more specialist mental illness services. Parity of esteem could mean an awful lot of other things.

2. Just as “health” ≠ “NHS”, “mental well being” influenced by everything.

Most of those responsible for good or bad outcomes around mental health wouldn’t consider mental health as their core goal.

3. Upstream matters a lot more.

Downstream interventions still matter, a lot.

Consider the best way to improve outcomes in a population (nb who may or may not be service users). Do we invest more in EIP & IAPT, or, social prescribing, or CAB & debt services, or a range of initiatives around addressing low or no wage, or ensuring safe warm homes for all, or focusing on poverty & employment.

All is, of course, the answer. What if choices need to be made.

4. We want specificity and clear actionable interventions & ROI

Tough, in many respects.

You may not see it, be able to measure it in ways that are meaningful.

5. All the rules of complex adaptive systems are in play.

You can’t address this in silos, but that will be the default. Complex adaptive systems may imply no single idea, no single leader

The plan” will never be written down. Distinguish between “a programme” vs building a culture.

There is some tricky issues around countable and measurable stuff vs having faith in a course of action. Yes, of course focus on the visible and short term but DONT FORGET the long term and less tangible. 1 yr plan, 5 yr strategy, 10yr mission.

the “but it’s invisible, there’s nothing going on” issue.

We quickly default to the policy or service area we are closest to.

There is a great deal going on, that we as individuals might not know about.

Ideological prejudice is common. The answer you give is always based on your worldview. Ask a bunch of DPW, sustainability, economist types and they give you an answer based on that worldview. Similar here.

6. Inequalities matter……..

at the heart of it poverty is the key determinant and ongoing austerity is almost certainly making it worse


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