No Health Without Mental Health Policy Analysis
The main causes of overall burden of diseases worldwide is mental health (Mental health Foundation (MHF), 2017). Public health England (PHE) (2010) says experts have estimated that dealing with poor mental health could reduce the overall disease burden by nearly a quarter. The Department of Health (DOH, 2011) underscores that mental health is everyone’s responsibility. It also denotes the dangers; inequality constrains and the need to improve and promote quality of life and wellbeing of mental health patients.
Mental health is therefore described by the World Health Organisation (WHO) as “a state of wellbeing in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productivity and fruitfully, and is able to make a contribution to his or her community” (WHO, 2002). This definition prescribes the total holistic wellbeing of mental health patients.
The objective of this report is based on the No Health Without Mental Health policy, which intends to address and improve the mental health and wellbeing of the public on a countywide level linking research and evidence-based outcomes. Using the Bardach (2000) policy analysis approach, this report will critically analyse the policy, suggested amendments to be made and a strategy to address them and make some improvements which might be helpful.
It’s known in the UK that at least 1 in 4 will experience mental health problems in their life, and 1 in 6 adults has a mental health issue (DOH, 2011). 1 in 10 children aged 5 to 16 years suffer with mental health issues and most of them might continue into adulthood (DOH, 2011). According to the centre for mental health (2014), 1-2% of adults experience a severe mental health problem such as bipolar or schizophrenia. However, the DOH (2011) suggests that at least 1 in a 100 people has a severe mental health issue, and that about 60% of prisoners have been diagnosed with a mental health problem.
The centre for mental health (2009/10) highlighted that the economic and social cost of mental health is quite high. There is a significant increase in the cost from £77 billion in 2003 to £105.2 billion as of 2009/10. The No health without mental health policy (NHWMH) shows that £105.2 billion was estimated as the cost in England and expected to doubly rise in the coming twenty years. Approximately £400 million was also invested for four years for the availability of psychological therapies to those in need around the country and is expanded to include children, young, older people, and those with long-term physical health challenges as well as mental illness patients (DOH, 2011). Poor MH can affect all people regardless of age, however, with effective promotion, prevention and early intervention, the effects can be greatly reduced (mentalhealth.org, 2011).
Care quality commission (CQC, 2011/12) report noted MH has a wider range of impact on health, education, criminal justice, and work and connects with health risks behaviour and related premature death. The CQC (2016) report on NHWMH policy asserts that there is need for improvements on the mental health delivery system which concerns the safety of the service. This is however, since one of the main areas of the NHWMH objectives is the reduction of the risk of harm for those using the service and guarantee the provision of services at the same level compared to other public service providers.
It has been highlighted on another key objective that the report seeks to address the impact of stigma and discrimination associated with MH by educating the public which in turn will reduce the negativity attitude and behaviour towards MH patients (DOH, 2011). The CQC has commended that more people are receiving the required treatment and MH care due to the reduction of stigma. However, this high demand on the services has caused a strain to the system in that, accessibility, staffing and unsafe environments in certain MH units have become more of a problem affecting the quality of service provision (CQC, 2016/17).
Another strategy highlighted the need for equality and human rights. This aims at reducing inequality and promote human rights while reducing the risks of MH (DOH, 2011). With the gathered evidence showing MH services do not meet the need of especially the black minority ethnics (BME), hence the priority for improvement (DOH, 2011). However, CQC (2016/17) noted that there is more to be done as people from the BME population in detention are overrepresented in England compared to White population. The reason behind this high rate is, however, not known (CQC, 2016/17).
As identified above, since the implementation of the government’s NHWMH strategy in 2011, there are some achievements. However, there is still more to be done to improve the mental health strategy to achieve its optimum goals.
Social perspectives and drivers influencing the policy
The coalition government in 2010 produced a” White Paper” to tackle public health and mental health in England. It shows serious changes in which public health is dealt with. This highlights that many lifestyle-driven health issues seen today are already at an alarming level as shown by the statistics (Public health England, 2010). It is therefore noted that health public policy involves the creation of a healthy society and recognises for that to be accomplished, it should not focus on the physical only but the “social, cultural and economic aspects of health and wellbeing must be addressed” (Douglas and Jones, 2007)
There is always an oversight of social-economic conditions like employment, housing, transport, and safety when mainly focusing on health services, behaviours, and clinical practice (Ewart et al, 2017). Individuals who have no social network connections suffer more psychosocial health problem than those with great social connections (Levula, Wilson and Harre, 2016). However, Pilgrim (2014) identified that social capital and socio-economic status can affect both rich and poor and that failure of having network connections leads to mental health problems
McAneney et al, 2015 highlighted that people living in deprived areas have a high prevalence of poor mental health. However, the importance of differentiating individuals and population level factors such as environment and social has been raised because they could be linked to MH and well-being. The relationships should be compared differently depending on neighbourhood deprivation levels. Luvela, Wilson and Harre, (2016) postulate that individuals who have less physical and psychological health are most socially isolated and in turn have negative impact on an individuals’ life expectancy. People diagnosed with mental illness live at least 20 years shorter than those without (Ewart et al (2017).
Poverty is identified as one of the leading aspects with a direct mental health impact and that social factors are very relevant in predicting mental health problems in adults (Pilgrim, 2014). The Marmot report also noted poverty as having a negative contributing effect to health inequalities in areas of education, environment, employment, and others (Marmot, 2017)
The estimated cost to the economy of mental health issues in the United Kingdom is very high. It was estimated at £70-100 billion per year as of 2013, which is a 4.5% of the gross domestic product (GDP). The report, however, acknowledged the complexity in the estimated value, £105.2 billion was estimated annually for England alone as of 2009/10 (Mental Health Foundation; 2016, Centre for Mental health, 2018).
Various organisations such as Mind has contributed by campaigning for change years before the no health without mental health policy by framing, “A manifesto for Better Mental Health” (Mind, 2014). The manifesto called for directed and practical changes a future government can make to ensure mental and physical health are equally valued. It demanded fair funding for mental health, giving children a good start in life, improve the lives of people with mental health problems, improve physical health care for mental health patients, and better access to mental health (Mind, 2014).
On the hand Mental Health Foundation (2018) championing in research and practical based studies which help pioneering change in MH. These and other organisations contributed in the establishment of the MH policy. However, MH disparities are known to be unfair differences in access to or value of care according to race and ethnicity, which are very common in MH (McGuire & Miranda, 2008).
Bardach (2000) police analysis framework has six stages namely to define the problem and the context; search for evidence; considering the different policy options and constructing alternatives; project outcomes and applying evaluative criteria.
The first being the policy aim to address the MH problem faced by the entire population and to make improvements on the accessibility of the services for the benefit of those with MH problems (DOH, 2011). The policy also identified the cost associated with MH problems as affecting the education, criminal justice, and homelessness quite considerably. This comes as a result of poor MH which leads to drug and alcohol abuse (DOH, 2011).
The policy identified that everyone is responsible for their MH and others and highlighted the need to fight stigma and discrimination (DOH, 2011). Educating the population will help reduce the impact of stigma and discrimination which in turn improve the and lessens the negativity upon those suffering with MH problems as highlighted in objective 6 (DOH, 2011).The policy aims to achieve this by giving power to people at local level ensuring effective planning and commissioning of services that meet locally agreed needs and having less people experiencing stigma and discrimination while improving public understanding of MH (DOH, 2011).
MH problems are costing to the economy and improving the MH of people will help raise economy outcomes (DOH, 2011). The outcome was measured by using quantitative data to understand the quantity of the economy being affected by poor MH (DHH, 2011). These reasons then justify the need for research-based evidence.
The source of evidence used in this policy is credible as it was derived from organisations such as Mental Health Foundation, Mind, Centre for Mental Health, National Institute for Care Excellence, WHO and other governmental sources which proves that the information contained in the policy is of valuable high quality (DOH, 2011). Furthermore, primary and secondary journals were used providing more evidence on the seriousness of the MH problems, costing and mortality rate. Although some pf the evidence was sourced from articles outside the UK such as the National Association of State Mental Health Program Directors in USA and the European Psychiatric Association (DOH, 2011). The main purpose of the information, however, was to provide evidence on the depth of the MH problem in comparison with other policies or programmes which might have had similar targets (Bardach, 2000).
The NHWMH policy does not seem to show or have any alternatives in order to help tackle the mental health problem. However, the previously used top down approach doe not seem to have worked for the benefit of the patients and is now being rejected by the new outcomes approach, which in turn mainly focuses at empowering people to lead their lives in their own ways while maintaining their families healthy and also how best health practitioners can be supported to be able to deliver the best for the service users with dignity and respect (DOH, 2011).
Mind in conjunction with Rethink Mental illness, have been campaigning for change in people’s attitude towards MH and have seen an 8.3% improvement since 2007 in public attitude (Mind, 2018). The “Time to Change” programme is a multi-faceted campaign which includes “high-profile anti-stigma campaign” working with organisations, young people, African and Caribbean communities, and other networks to reduce stigma and discrimination (Mind, 2018).
Crinson (2009) says policies are ongoing and they revolve, therefore are subject to change anytime especially in response to the issues arising out of execution of the resolution. Earle (2007) suggests that a health policy are the actions of governments relating directly to health and the healthcare service.
In trying to resolve the issue of MH problems, the policy has six projected outcomes as indicated below:
? To promote recovery for more mental health patients.
? Promoting good MH and wellbeing.
? High quality services to all wherever they are and easily accessible.
? The reduction of stigma and discrimination among MH patients.
? Reducing death rate by improving mental and physical health for people with MH problems.
? Increase the experience of having good care and support services.
To counter these problems, accountability has been cited as one of key elements to the current MH reforms, narrating that Public health sector, National Health Services, and other public health and social care organisations have a great responsibility to the public and those using the services and how services are provided (DOH, 2011.
The government’s approach intends to put the service user first. This principle is deemed “No decision about me without me”. The approach personalises care provision to reflect the individuals needs rather than the professional offering the service and that people should have access to information and support required so can exercise choice of provider and treatment being offered (DOH, 2011). It also aims at empowering the local organisations and practitioners of having the freedom to innovation and drive for improvements in services and provide high quality support for all (DOH, 2011). The policy emphasise is mainly to be user friendly.
However, according to Closing the gap: priorities essential for change in MH report, has noted admittance that the quality and amount of information concerning MH has been lagging in comparison to that of physical health. Therefore, an information revolution in mental health and wellbeing is a priority (DOH, 2011).
Amendment to the policy
The policy has identified its outcomes and how they will implement them to work for the benefit of the service users. However, the Mental Health Taskforce (2016) noted of improvements still need to match the policy outcome successful. The recommendations highlighted by the Mental health taskforce were acknowledged and various health sections such as Public Health England, NHS, and the Department of Health would work in conjunction to see that they are applied for mental health sustainability as noted in the Implementation Plan (Parkin and Powell 2017).
The public health white paper highlights the need to change the approach used to empower individuals, so they can make health choices and providing communities with tools to address their needs (PHE, 2010. It also plans to put local communities at the heart of public health by ending the centralisation control by allowing local governments the freedom of responsibility and funds to innovate and develop their ways of improving public health in their areas (PHE, 2010).
There is need for investing in effective MH interventions which would see improvements in health and fight the great inequalities in the society. However, there are wide differences in the availability and overall spending is quite low. Some councils are, however, being very innovative in promoting good MH, improving MH illness, and improving life changes of MH sufferers (Mental Health Foundation, 2015).
The United Kingdom government is said to have showed an increased dedication in tackling health inequalities by the development of public policy and partnership working (Douglas and Jones, 2007). Stronks and Mackenbach (2015) discovered the possible strategies to tackling inequalities by targeting and reducing the effects of MH, improving the accessibility and the quality provision of health care services to those of lower socio-economic disadvantaged groups. The focus of the policy should be to improve access to and quality of mental healthcare for all different people because the disparities of MH are rooted entirely in mental healthcare (McGuire & Miranda 2008).
Stigma has been highlighted as one of the main barriers why people avoid help-seeking (DOH, 2011). Therefore, a strategic stigma change is a five-step principle and corresponding practices constructed as a practice to eradicate prejudice and discrimination associated with MH and affirming behaviours and social inclusion (Corrigan, 2011). Awareness about MH problems through public health, local authorities, communities, and work places should be prioritised to reduce the impact of MH (Mind, 2018).
Mental Health Foundation 2016) noted the need for a change in strategies which help promote health seeking behaviours, the availability of consistent messages supporting long-term behaviour change and they should be recovery focused.
Innovative strategies are required to make the policy known to the public and to be effective. Educational information should be made available to all who are in need and accessibility to GPs, MH services more readily available to reduce the impact of MH. The health belief model noted that preventive behaviour will only occur once the “perceived benefits outweigh the cost” (Green & Tones, 2010). Preventive measures should be accessible, attractive, and tangible such as having access to exercise facilities, decent job, money, and respect. Well designed plans are the depended upon for success services of the preventive strategy before disaster strikes (Schneider, 2014).
The Ottawa charter for health promotion (1986) has been tested and proved to be an effective which can be used to improve the strategies about new MH strategy as they cover different well-being aspects as equality in health promotion (WHO, 2018). The charter also identified education, peace, shelter, food, income, and others as prerequisites for health which the new strategy has targeted to tackle (WHO, 2018).
It has been identified that MH problems have a great effect in the UK economy and significantly still a burden to the ill health system (DOH, 2011). However, the NHWMH policy has tried to reduce the impact of MH problems, there is still more that needs to be addressed in order to end the MH problem within the UK and the world (DOH, 2011).
The issues of stigma and discrimination and accessibility of the services by all has be highlighted and the commendation by CQC of the reduction in the impact of stigma seen by the number of people seeking help for MH problems. This has, however, caused some strain to the system causing some hinderance to the quality of the delivery of services (CQC, 2016/17).
No Health Without Mental Health Policy Analysis