Post on 22-Nov-2014
description
Public Mental Health and People’s Rights
Sarah Stewart-Brown Professor of Public Health, Warwick Medical School
Co-Chair Faculty of Public Health’s, Mental Health Committee
SHOES 12
OR How to stay (more or less) sane over 30 years in public health
OR How to stay (more or less) sane over 30 years in public health
OR How to stay (more or less) sane over 30 years in public health
•Social Inequalities •Human Rights
Where are we?
Where do we want to get to?
How do we get there ?
How do we get there ?
What underpins our present situation ?
How do we get there ?
What underpins our present situation?
What are we not getting?
Mental, emotional and psychological
health and wellbeing
Descartes
Descartes’ writings were misleading The mind and body work as one system
Descartes made a mistake
Key things about mental health
• Mental health (feeling good and functioning well) is a fundamental determinant of physiological functioning
Key things about mental health
• Mental health (feeling good and functioning well) is a fundamental determinant of physiological functioning
• Mental health is more than the absence of disease (hence mental wellbeing)
Distribution of Mental Health
Poor mental health/ mental illness
Good mental health/ mental well being
No of People
Distribution of Mental Health
Poor mental health/ mental illness
Good mental health/ mental well being
No of People
Distribution of Mental Health
Poor mental health/ mental illness
Good mental health/ mental wellbeing
No of People
Social determinants of mental wellbeing adjusted for age sex, employment status, marital status, ethnicity religion
Odds of Mental Illness relative to highest category of
income or education
2nd highest
3rd high
est
4th high
est
5th high
est
6th high
est 0
0.20.40.60.8
11.21.41.61.8
2
**
Odds of Mental Wellbeing relative to highest category of
income or education
2nd highest
3rd high
est
4th high
est
5th high
est
6th high
est 0
0.5
1
1.5
2
2.5
Income Education
*
Life Satisfaction and GDP in the UK 1973-2011
By Kind Permission of Ewen Mckinnon Cabinet Office Nov 2012
Gudmundsdottir D.G. The impact of economic downturn on happiness Social Indicators Research 2013;110:1083-1101
Iceland Banking Crisis:
Happiness scores declined marginally, but almost as many people had an increase in happiness as a decrease
Decline in happinessNot predicted by education, unemployment, income or
financial difficulties
Increase in happiness Predicted by education and social relationships
Mental illness
Educational successWealthEmployment
Mental wellbeing
Educational failure Poverty Unemployment
Key things about mental health
• Mental health (feeling good and functioning well) is a fundamental determinant of physiological functioning and thus physical health
• Mental health is more than the absence of disease (hence mental wellbeing)
• Mental health has its origins in childhood
Life Course Influences
By 14 years By 20 years Rest of Life
50% of all mental illness has emerged by 14 years of age
Parenting shapes the emotional and social brain
• Neuroscience • Animal studies
• Human studies
• Stress response
• Gene expression
• Epidemiological/ sociological studies
• ‘Attachment’ based studies•
Findings from Animal Models•Stress due to neglectful care-giving disturbs the higher and mid brain circuits that regulate response to psychosocial threat
•Neglectful care-giving produces offspring who as adults are more fearful and exhibit persistent physiological abnormalities
•As a consequence they have difficulties learning and problems trusting others and making health-enhancing relationships throughout life
•They lack resilience to mental illness
Mechanisms Mirror Neurons
Epigenetic phenomena• DNA Methylation• Modification of
transcriptome
Dr Stephen Suomi and team University of Maryland
Genes involved in the HPA axis that are significantly differentially methylated between mother and nursery reared rhesus monkey
Genes T cells PFCNR3C1 NR3C2 AVPI1 AVPR1A AVPR2 AVPR1B CRH CRF1_MACMU CRHR2 IL1A_MACMU IL1B_MACMU IL1R1 IL1RL1 IL2_MACMU IL6_MACMU TNFA_MACMU TNFC_MACMU INFG_MACMU INFA14 INFA16 INFA8 INFAR1 INFAR2 NKKB1
Hypermethylated in mother-reared
Hypermethylated in nursery-reared
MR.31MR.44MR.43MR.41MR.55PR.47PR.40PR.37PR.35
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70
54
80
DD
X2
0L
OC
70
34
58
SA
TB
1L
OC
70
88
08
---L
OC
69
70
95
CA
MK
4L
OC
70
43
01
LO
C7
05
61
1Z
MY
ND
11
------Z
NF
14
6L
OC
70
53
46
---------L
OC
69
56
06
---L
OC
71
54
71
------L
OC
71
47
64
LO
C7
08
87
1 /// L
OC
70
93
04
SM
C3
------L
OC
70
76
64
XC
L1
---L
IMA
1L
OC
71
10
71
------A
TP
1B
1---L
OC
70
44
51
EX
OS
C3
LO
C6
95
39
9---L
OC
70
16
69
LO
C7
11
97
5L
OC
69
60
06
---L
OC
70
08
69
LO
C7
11
28
0---L
OC
71
09
66
---L
OC
71
10
66
LO
C6
98
75
9---L
OC
69
56
06
H1
F0
LO
C7
22
00
4---------L
OC
70
57
88
---------D
YR
K2
LO
C7
09
48
3---L
OC
71
09
42
------L
OC
71
28
25
ITP
R1
---L
OC
70
33
73
LO
C6
94
19
0---L
OC
69
49
61
LO
C7
04
62
4---------L
OC
72
25
28
LO
C6
96
60
6L
OC
71
21
25
---L
OC
70
02
22
LO
C7
04
51
3L
OC
71
06
90
------L
OC
69
77
40
LO
C7
15
92
7---L
OC
71
70
92
AD
D3
LO
C7
08
81
2L
OC
70
95
85
---Z
NF
22
6L
OC
69
64
16
LO
C7
02
13
5---S
LC
26
A2
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OC
70
15
22
---M
GS
T1
ZX
DB
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IAA
05
62
LO
C7
14
76
1---L
OC
70
01
18
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OC
70
15
55
---L
OC
70
42
92
---R
CH
Y1
---------L
OC
69
60
86
---L
OC
72
17
89
---L
OC
71
72
80
LO
C7
15
92
7L
OC
71
75
89
ZN
F1
41
LO
C7
08
69
1------L
OC
70
62
29
CA
MK
4IG
KV
1-5
/// LO
C7
20
22
5L
OC
71
04
57
---L
OC
72
13
94
LO
C7
05
49
1---L
OC
71
25
68
LO
C6
97
71
8---L
OC
71
78
24
LO
C6
98
63
2S
UC
LA
2---L
OC
71
34
36
LO
C7
04
36
2L
OC
71
55
26
LO
C7
10
29
0---L
OC
70
42
21
PT
TG
1------L
OC
69
41
59
LO
C7
10
95
1---L
OC
70
34
58
LO
C7
06
45
6L
OC
69
47
23
/// LO
C7
18
16
0---L
OC
70
44
12
---L
OC
69
72
06
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SP
G5
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OC
70
34
56
LO
C6
94
81
7---C
D5
LL
OC
70
23
85
LO
C6
93
27
0L
OC
70
19
19
---Z
XD
BL
OC
69
95
11
LO
C6
95
42
9------L
OC
71
64
08
---E
XP
H5
LO
C7
04
24
8---L
OC
71
38
31
LO
C6
97
81
3---L
OC
70
52
28
LO
C7
17
28
8------------------L
OC
70
40
37
---L
OC
69
83
37
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OC
70
50
93
KL
F4
LO
C7
12
82
5L
OC
71
20
79
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OC
70
21
58
LO
C6
97
57
7L
OC
70
71
95
---L
OC
70
18
37
---R
AB
11
FIP
2L
OC
71
10
63
LO
C7
04
41
2---------C
D8
B---L
OC
70
73
88
LO
C7
18
09
1L
OC
69
87
85
LO
C7
10
27
6L
OC
70
25
16
LO
C7
04
91
6C
TG
FL
OC
70
33
26
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OC
70
59
46
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E2
SL
C2
7A
2L
OC
70
31
52
LO
C7
14
22
3L
OC
70
08
43
CY
TH
1L
OC
71
50
15
AX
IN2
LO
C7
05
55
1L
OC
71
21
25
LO
C7
08
22
6P
RM
T6
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OC
70
10
38
LO
C7
03
01
8------IT
GA
6IL
8M
YC
LO
C7
04
91
6L
OC
71
56
83
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OC
70
27
05
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OC
69
34
28
---L
OC
70
07
47
LO
C7
17
28
8L
OC
71
64
75
------L
OC
71
53
57
---L
OC
71
07
44
LO
C7
08
09
4------L
OC
71
69
49
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OC
70
75
60
LO
C6
93
80
3L
OC
69
64
07
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OC
71
72
28
------M
GS
T1
LO
C7
07
74
3L
OC
71
03
61
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OC
69
83
29
LO
C6
96
75
6---L
OC
71
17
87
---L
OC
71
03
19
LO
C6
98
90
4L
OC
70
46
67
---Z
NF
39
7---------L
OC
71
00
80
LO
C6
95
43
7---------L
OC
70
89
30
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PR
18
3L
OC
71
84
08
---L
OC
70
23
07
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OC
70
06
15
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DE
6A
DY
RK
2C
16
orf7
0L
OC
70
68
73
FZ
D1
0S
FR
S5
FO
SL
OC
69
60
63
---------L
OC
71
60
13
ZC
3H
13
LO
C6
95
78
0N
DF
IP2
---L
OC
71
34
60
---IT
GA
6P
DE
7A
---L
OC
69
60
21
------C
EP
29
0---------------L
OC
69
92
55
LO
C7
11
38
6L
OC
70
12
18
LO
C7
03
56
7L
OC
69
94
18
LO
C7
08
22
6L
OC
71
27
54
PO
LR
1C
LO
C7
06
53
1------H
IPK
2L
OC
70
21
53
---L
OC
70
68
36
LO
C7
19
28
4L
OC
71
15
01
---L
OC
70
50
93
---L
OC
71
11
41
---L
OC
71
59
74
---L
OC
71
13
02
HM
GC
S2
LO
C6
93
85
0L
OC
71
47
86
------L
OC
69
82
75
---L
OC
71
24
03
---L
OC
70
95
40
---L
OC
70
99
01
---L
OC
70
18
89
------L
OC
71
55
11
LO
C7
04
41
2L
OC
69
51
93
LO
C7
03
78
1---L
OC
70
27
75
---L
OC
70
07
50
---------L
OC
71
53
57
---L
OC
69
54
37
/// LO
C7
05
26
6L
OC
70
28
46
LO
C7
22
56
7P
OL
R1
CL
OC
69
91
96
LO
C7
11
50
1---C
PA
3---------------W
IF1
LO
C7
11
14
1---------------P
F4
AR
L4
CF
CE
R1
AL
OC
69
54
37
/// LO
C7
05
26
6L
OC
70
89
02
LO
C7
02
87
8------------E
GR
2---L
OC
71
23
38
---------
Regulation of Genetic Activity in Mother Reared (MR) and Peer Reared (PR)Macaques
Up-regulated
Down - regulated
Abusive
Mother reared
Peer reared
717521
InflammationCell growth/differentiation
Transcription control
Immunoglobulin productionType I interferon antiviral response
Early life social conditionsS. Suomi
Up-regulated
Down - regulated
The risk factors for poor parenting are:
– Parental mental illness– Parental drug and alcohol misuse– Parents who were in care or abused as children
– ?? Teenage parenting – ?? Poverty – ?? Educational underachievement
Hostility, depression, anxiety, anger
fear Distress, crying,
withdrawal
Sets thermostat on HPA stress response
Adult who is prone to
fight, flight or freeze
responses
Parent
Infant
A systems approach
communityParent
Infant
Mental health of societies
Social and fiscal policy
Parent
Infant Adult
Systems Thinking: Complexity
Unpredictable OutcomesEmergent Phenomena Everything is connected
Determinants of Mental Health
Parenting and Genes
Social Environment
Self
A Right to Mental Health ?
Settings and approaches in which mental health promotion is ‘evidence- based’
Very well • Parenting • Schools Quite well • Workplaces • Communities
– Asset based approaches – Physical activity promotion – Debt management – Time banks
• Elderly – Physical activity, social engagement, new learning
• Adults – Meditation/mindfulness, bodywork practices, relaxation, fruit and veg– Creative endeavour, music, – 5 ways to wellbeing: volunteer, take interest, physical activity – Laughter sleep, natural environment
You can’t make people healthy You can’t give someone health
You can’t make people healthy You can’t give someone health
You can help them find it
How do we get there ?
What underpins our present situation ?• Unconscious processes and beliefs
What is the next step ?• Understanding ourselves
Understanding of others and thus understanding mental health come from understanding self
How do we get there ?
What underpins our present situation ?• Unconscious processes
What is the next step ?• Understanding ourselves
What is needed to take that step ?
We are part of the problem and part of the solution
Exploring and improving our own mental wellbeing is the best way to enable mental health in others
Head banging doesn’t work
Resources FPH : Better Mental Health for All Website http://www.fph.org.uk/better_mental_health_for_all
FPH: Special Interest Group http://www.fph-groups.org.uk/members/members_registration.php
DH Wellbeing : why it matters to health policy https://www.gov.uk/government/publications/wellbeing-and-health-policy