The University of Birmingham (UK) has launched a Policy Commission report calling for increased investment in the prevention of poor mental health. The report comes at a time when half of life-long mental health problems show their first signs by the age of 15, and three quarters by the age of 25, and evidence that the rates of mental health problems amongst young people are increasing. The Commission Report, therefore, identifies childhood and adolescence as a critical opportunity to prevent and promote better mental health. In this post, Karen Newbigging discusses the report and implications from this work.
The Commission was established in 2016 to look into the treatment gap in mental health. Over an eighteen month period, the Commission reviewed a diverse range of literature, held an open call for evidence, and heard from national and international experts, including people with lived experience. Commission members heard that access to appropriate support and treatment remains a lottery for young people – with long waiting lists and services that do not address the current range of challenges they are facing. Although NHS England is committed to increasing access to services by 2021, at best only a third of young people in England facing mental health difficulties are likely to have access to the support and treatment they need. The Commission asked the NHS Benchmarking Network (NHSBN) to estimate the resources needed to ensure that every young person requiring mental health support is able to access specialist mental health services. The NHSBN estimated that this would require an additional 23,800 staff at a cost of £1.77billion. It is, therefore, clear that focusing on prevention, as well as investment in effective services and support, and is urgently needed to make a substantial impact on better mental health for children and young people. At the launch of the Commission’s Report, Professor Paul Burstow, former Minister of State for the Department of Health, and Chair of the University of Birmingham’s Mental Health Policy Commission, argued that “We need to increase access to mental health treatment and care for young people. But the scale of the workforce challenge makes it essential that we get serious about prevention too”.
The Commission adopts a twin track focus to addressing this prevention gap: maximising resilience and minimising vulnerabilities and identifies four building blocks for focusing on prevention: facilitating positive family, peer, and community relationships; minimising adverse experiences and exclusions; providing mentally friendly education and employment; and responding early and responding well to first signs of distress. The report draws attention to a range of interventions for which the evidence is well rehearsed, interventions in the perinatal period and social and emotional learning in schools for example, as well as emerging evidence on the need to reduce adverse childhood experiences.
A major challenge in adopting a preventative focus in mental health is that the impact and potential cost reductions are often seen in another sector. For example, the benefits of investing in programmes to reduce bullying by the educational sector will be realised by the health sector in terms of reduced demand for services. The Commission, therefore, strongly advocates the need for a whole system approach to mental health prevention and promotion. This requires a refocusing of effort from a sole focus on individuals to families, peers, communities, schools and employment; from reactive treatment to upstream prevention and from single interventions to whole system change. This requires different government departments to work together under clear leadership and ensuring that the impact of government proposals on the population’s mental health and wellbeing are considered. At a local level, strong leadership is also required to bring together the different players including those from health, the local authority, education, employment, the voluntary sector and young people to develop a local strategy and identify investment in prevention.
The Commission believes that this seismic shift in our approach has the potential to halve the number of people living with life-long mental health problems. Whilst this sounds ambitious, the Commission have laid out a clear plan for realising this. With the forthcoming Comprehensive Spending review on the horizon, the Commission calls for the funding and creation of a 10-year Government Strategy and a Resilient Generation Challenge Fund – shaped by Public Health England, local government and Innovate UK - to close the prevention gap and recognise that mental illness is the single largest global health challenge. This investment would provide the context for local systems to focus on implementing those interventions for which there is a good evidence as a start and explore promising practice that is now emerging. This whole system approach is underpinned by a recognition of the complexity and inter-relationship of the factors that shape the mental health of young people and in doing so demands an approach to research that moves beyond traditional paradigms to those that are grounded in an appreciation of complexity.
The University of Birmingham Policy Commission report can be found at:
An animation making the case to address the prevention gap is here:
For more information on the Commission, please visit:
“There is already sufficient evidence of what works to increase resilience and reduce the risks of poor mental health amongst our young. It is time to act. By addressing the causes of poor mental health, not just treating the consequences, it is within our grasp to halve the number of people living with life-long mental health problems”.
Other media related to the Commission
· Times Higher Education, ‘We must tackle the ‘prevention gap’ to combat mental health crisis’, 16 July 2018
· Health Service Journal (HSJ), 'Why investing in a resilient generation is the NHS's business', 06 July 2018
· The Independent, 'Mental Health First Aid has the power to save lives', 05 July 2018
· Science|Business, '£1.77B mental health treatment gap for young people', 04 July 2018
· Early Intervention Foundation, 'The Rules of the Game: Why Does Government Struggle to Invest in a Preventative Approach?', 03 July 2018
· The Big Issue, 'The £1.7bn youth mental health treatment gap shows the need for prevention', 03 July 2018
· Institute of Health Visiting (iHV), 'iHV welcomes Mental Health Policy Commission: Investing in a Resilient Generation report', 02 July 2018
· Universities UK (UUK), 'Mental Health Policy Commission: Investing in a Resilient Generation', 02 July 2018