Making prevention a priority in mental health

Nearly three years ago to the day, I was trawling through Freedom of Information requests from local authorities, looking at the proportion of their prevention budgets that was spent on mental health. I was working at Mind, and the responses to our enquiries made for fairly bleak reading. We found that, on average, local authorities spent just over 1% of their budgets for prevention in health on mental health. While spending isn’t the only way to measure success, it seemed clear that mental health was far from having ‘parity of esteem’ in the world of prevention – it was barely on the radar.

Three years on, Public Health England have just published the Public Mental Health Concordat, bringing together key parties to commit to making prevention a priority in mental health – and a suite of tools to help them do it. Could this be what makes the difference?

Prevention in health is a combination of two things: reducing risk factors, and increasing our ability to cope with those risks. In physical health terms, this could be reducing our risk of infection, and increasing our ability to fight the infection if we get it. Mental health is no different. While the recent trend to focus on mental resilience and our personal coping skills is not without merit, it can’t be successful without real attention also being paid to the risk factors we face that increase our chances of poor mental health – like financial difficulty, relationship breakdown, poor housing or social isolation.

That’s why I’m particularly encouraged that this new prevention toolkit places its focus squarely on those risk factors. There has sometimes been an assumption that prevention in mental health is soft and fluffy – that it’s all ‘motherhood and apple pie’; largely common sense, hard to measure and not very serious. We’ve been working hard to build the evidence base to counter this, and today’s toolkit certainly adds weight to that argument.

Last autumn we published a report setting out the links between financial difficulty and mental health, and the lack of systematic focus on tackling the issue within the health system. We called for local needs assessments to consider financial difficulty as a key risk factor for poor mental health, and we’re delighted that today’s official toolkit endorses this:

But understanding the level of need is one thing – the next step is to effectively commission services or support to meet that need.

We believe that good debt advice is part of the solution. Last autumn we called for integrated debt advice to be provided in healthcare settings – to help prevent mental health problems and improve recovery. Today Public Health England and the Personal Social Services Research Unit at LSE set out just how much money that would save to the public purse. For adults, provision of debt advice in primary care settings was shown to bring a greater return on investment than any other intervention tested, bar suicide prevention – with a conservative estimate finding £2.60 returned for every £1 invested.

This is great progress. We’re delighted to see this ambitious approach to prevention in mental health and our research having an impact as part of that. But strategies and toolkits are nothing without implementation on the ground. We hope that local areas will take this toolkit and use it to build local prevention strategies that really change lives.

And it’s not just local authorities and the health system who can benefit – the Concordat applies to employers too. There has been an increasing focus on mental health at work over recent years, but until now this has been primarily about building resilience and promoting wellbeing, or about training managers to support people with existing mental health issues at work. We hope that future work in this area, including the forthcoming report from the Government review of mental health in the workplace, will take note of the Prevention Concordat, and also consider what might be done to tackle the risk factors for poor mental health in the workplace. It’s rarely the easy option, but as today’s evidence shows, the return on investment can be significant.