Marmot recommendations: A - "Give every child the best start in life" ; C - "Create fair employment and good work for all" ; E - "Create and develop healthy sustainable places and communities" ; F - "Strengthen the role and impact of ill health prevention"
This theme of the JSNA is organised into three population groups – children/young people, adults and older people – each group is discussed within the various sections of the theme.
With regard to children and young people, early intervention is at the heart of the Government’s approach to improving outcomes for children and families. This is set out clearly in the public health White Paper Healthy Lives, Healthy People, and the mental health strategy No Health without Mental Health as well as the recommendations of Graham Allen’s review of early intervention.
There is compelling evidence of the cost benefit of early intervention using evidence-based programmes and methods:
Conduct disorder is the most common mental disorder in childhood. By the time they are 28 years old, individuals with persistent antisocial behaviour at age ten have cost society ten times as much as those without the condition. Parent education and training programmes can have good medium to long term effects at relatively low cost.
If services had intervened early for just one in ten of the young people sentenced to prison each year, public services could save over £100 million annually.
The cost to society of adult mental health problems is currently estimated at more than £100 billion.
The savings associated with providing an early intervention service approach rather than standard mental health care for patients with psychosis have been conservatively estimated at £50 million per year in the short term and more than £20 million in the long term. The savings relate to increased work, decreased suicide and decreased homicide.
In terms of adults, mental disordera are responsible for the largest burden of disease in England; 23% of the total burden, compared to 16% for cancer and 16% for heart disease. The annual cost of mental disorder in England is estimated at £105 billion; by comparison the total costs of obesity to the UK economy are £16 billion a year.
People can be more vulnerable to common mental health problems if they have poor physical health, are isolated, in debt or in poor housing. Having a severe mental health problem affects people’s life expectancy. For example people with schizophrenia live on average twelve years less.
Mental wellbeing is associated with a range of important health benefits including:
Improved wellbeing also has important non-health benefits including:
Reduced health risk behaviour, including smoking and harmful levels of drinking
Increased productivity at work
Stronger social relationships
Increased social/community cohesion
No Health without Mental Health, the Government mental health strategy was published in 2011. It states that mental health is everyone’s business – individuals, families, employers, educators and communities all need to play their part.
Be Well, the public mental health and wellbeing strategy for Southampton is at the heart of the Public Mental Health agenda locally. The strategy is for everyone in Southampton, including those with poor mental health. Working with partners ii aims to promote good mental health and wellbeing in the community, reduce the number of people who develop mental health problems and lessen the stigma and discrimination associated with mental ill health.
Turning our attention to older people, in 2008 there were 18.3 million people aged 60 and older in the UK. By 2033 the number of people in the UK aged 75 and over is projected to increase from 4.8 million to 8.7 million (ONS).
Poor mental health in older people does not just mean dementia, but also other disorders such as depression, anxiety, schizophrenia, suicidal feelings, personality disorders and substance misuse.
Psychosocial interventions have been shown to be effective in improving mental wellbeing, as is support for older people before and during difficult times. Walking and physical activity programmes are effective in promoting wellbeing as are learning and volunteering. Anything that reduces loneliness and social isolation can have a profound impact on older peoples mental and physical health.