Time for a new paradigm in mental health?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“The numbers of children and young people living with a diagnosable mental illness far exceeds the numbers who get any help. One in ten children experience a diagnosable mental illness. Currently just one in four get treatment”  

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The number of people experiencing mental distress and life- long mental illness outstrips the ability of first world health systems to cope. The University of Birmingham's 8th policy commission has launched to explore new approaches.

The numbers of children and young people living with a diagnosable mental illness far exceeds the numbers who get any help.  One in ten children experience a diagnosable mental illness currently just one in four get treatment. By 2020 the gap may close, a little, if the plans in NHS England’s Five Year Forward View for Mental Health and Future in Mind are realised. 

Over half of life long mental illness and distress has its first signs in adolescence. The opportunity to do something to change people’s lives for the better and dramatically reduce the number of adults living with entrenched mental health problems is a great prize. 

In her first major speech of 2017 Prime Minister Theresa May stressed the importance of prevention. Green Papers on social justice and family and the role of schools in mental health and wellbeing are in the pipeline.

But can this treatment gap be closed by scaling up access to treatment and providing more digital mental health options alone? Where will the workforce come from to provide the extra services and sessions required?

What if we could reduce the number of people getting ill in the first place? What are the causes of rising levels of mental distress in childhood and what does the evidence show, could we put in place measures that increase resilience and reduce risk? Can we tackle the underlying causes, the social determinants?  What are the most promising approaches, how can we scale them?

These are some of the questions the University of Birmingham is setting out to explore in its 8th Policy Commission. I will be chairing the commission working with a range of experts by profession and experience. Together we are calling for evidence from NGOs, academics, public agencies, think tanks, people with lived experience across the UK and internationally.

I first outlined the ambitions of the University of Birmingham Mental Health Commission in my inaugural lecture last autumn. Our ambition is to describe a new paradigm for mental health that looks beyond treatment and containment towards prevention and early intervention. 

There is already some good evidence of what works in mental health promotion and illness prevention. As Minister for Mental Health I commissioned the LSE to review the evidence and the rates of return on investment. Amongst their findings was that school-based social and emotional learning programmes return £84 for every £1 invested. However, often the ‘saving’ does not land in the budget of those who must make the investment.  Siloed budgets and misaligned institutional objectives get in the way.

Last year I wrote in the Guardian about my visit to New York to learn about Mayor Blasio’s mental health programme: NYC Thrive. Thrive is a City-wide strategy and action plan devised from a population health perspective. It is trying to break-down some of the silos.  It does not begin with treatment it starts in schools and colleges, with housing providers, the police, business. Prevention and early intervention are at the heart of the approach.

The University of Birmingham has been closely involved in developing the West Midlands own Thrive strategy. While there is read across from that work and great interest in supporting its implementation the University’s Commission has a national ambition and a different focus.

Over the next twelve months the University of Birmingham Commission will be taking evidence, looking at the most promising approaches and setting out the actions that government and other agencies can take to make the shift to a prevention paradigm.

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