Mental Health A Public Health Perspective Dr Andrea Atherton Director of Public Health 20 th June...
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Transcript of Mental Health A Public Health Perspective Dr Andrea Atherton Director of Public Health 20 th June...
Mental Health A Public Health Perspective
Dr Andrea AthertonDirector of Public Health
20th June 2013
A Definition of Public Health
Public Health is the science and art of preventing disease, prolonging life and
promoting health through the organised efforts of society.
Sir Donald Acheson
A Definition of Health
Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.
World Health Organization 1948
A Definition of Mental Health
Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to her or his community.
World Health Organization
NHS Reforms and Opportunities for Public Health
Health and Social Care Act 2012• From 1st April – PCTs and SHAs abolished• Clinical Commissioning Groups - local commissioning
bodies (Southend CCG)• NHS England:28 area teams (Essex Area Team)New public health system• Public health in upper tier/ unitary authorities• Public Health England
NHS Reforms (2)
• Focus on outcomes – 3 outcomes frameworks• Public Health Outcomes Framework• Requirement for CCGs and Local Authorities to
prepare a Joint Strategic Needs Assessment and Health & Wellbeing Strategy
• Local authorities are required to have a Health & Wellbeing Board – membership to include local authorities, NHS, Healthwatch
Southend Health& Wellbeing Strategy
• A positive start in life• Promoting healthy lifestyles• Improving mental wellbeing• A safer population• Living independently• Active and healthy ageing• Protecting health• Housing• Maximising opportunity
Why prevention of mental health problems is a public health priority
• At least one in four people will experience a mental health problem
• One in ten children 5-16 yrs has a mental health problem
• Self harming in young people: 10-13% of 15-16 year olds has self harmed
• Almost half of all adults will experience at least one episode of depression
• One in ten new mothers experiences post natal depression
Why prevention of mental health problems is a public health priority (2)
Economic impact• Cost to the economy in England : £105 billionEffectiveness of treatment modalities• Current limitations in effectiveness of
treatment modalities The evidence• Preventative interventions: risk factors and
protective factors
Risk factors for mental disorder in children and young people
• Use of alcohol, tobacco or drugs during pregnancy
• Maternal stress during pregnancy• Low birth weight• Poor maternal mental health• Unemployed parent / no qualifications• Poor parenting skills• Deprivation
Neurological Development
• Brain development depends on both genes and experiences
• Rapid brain development takes place in the first year of life
• Early interactions directly affect the way the brain is wired
• Early relationships set the thermostat for later control of stress response
Family Nurse Partnership Programme
• A structured intensive home visiting programme delivered by family nurses & family nurse supervisors
• A preventative programme• First time parents under 20• Nurses visits parents from
pregnancy until child age two• Each visit uses materials
and activities to build self-efficacy, change behaviour and promote attachment
FNP in Southend• Higher deprivation
compared to England• Higher levels of long term
unemployment• Relatively high levels of the
adult working population with no qualifications
• High levels of mental ill health
• High levels of drug misuse• High numbers of hospital
stays for alcohol related harm
• I in 4 children live in poverty• Number of children on the
child protection register and Looked After Children
• Southend has a high teenage pregnancy rate
Outcomes of FNP
• Rigorously tested – 3 scientific trials in USA and in UK since 2007
• Improvements in women’s antenatal health and behaviours
• Better parenting• Better outcomes for children:• Higher IQs, better language development,
better school readiness in maths, fewer behaviour/ mental problems reported
Impacts of Alcohol
• UK is among the heaviest alcohol consuming countries in Europe
• Over 1.1 million alcohol related hospital admissions per year
• 3% of deaths in UK attributed to alcohol • Alcohol-related harm costs society around £21
billion per year
Health Effects of Alcohol
Acute• Acute toxic effects of
alcohol poisoning• Impaired judgement leading
to unintentional injuries and accidents
• Risky sexual behaviour• Self harm and suicide:
alcohol is implicated in up to 65% of suicides in the UK
Chronic• Neurological problems• Cardiovascular problems• Psychiatric problems:
depression, anxiety, and suicide
• Cancer: mouth, throat, oesophagus, liver, colon, and breast
• Liver diseases: alcoholic hepatitis and cirrhosis
Wider Impacts of Alcohol
“Passive Drinking”• Antisocial behaviour• Crime - violence - vandalism• Domestic abuse• Family breakdown• Child protection• Road traffic accidents
Defining Drinking Patterns
• 1 unit of alcohol = 10ml or 8gms of pure alcohol
• Guidelines: men 3-4 units /day women 2- 3 units/day
Defining Drinking Patterns
• Binge drinking:> 2x daily guidelines in one day• Moderate – heavy (hazardous) 22-50 units /week for men 15 -35 units /week for women
• Very heavy: (harmful) - 6% of men, 4% of women 51+ units /week for men 36+ units /week for women• Alcohol dependency - 6% of men, 2% of women
Interventions to Reduce Harm from Alcohol
• Media• Regulation, including age restriction• Taxation – minimum pricingHarmful drinkers buy 15 x more alcohol than
moderate drinkers, yet pay 40% less per unit. MUP of 50p per unit would reduce total alcohol consumption by 6.7% in the first year
• Multi -buy discounts – restricting to 10% is equal to MUP of 40p per unit
Interventions to Reduce Harm from Alcohol
• Business sector sign up to Public Health Responsibility Deal Pledge to ‘foster a culture of responsible drinking, which will help people to drink within guidelines’
• Product labelling on unit content• Unit messaging in the on-trade and off-trade • Combatting under age sales: Challenge 21 &25• Actions on advertising – including not putting
adverts near schools
Identification and Brief Interventions
• Use of AUDIT tool to identify hazardous and harmful drinking
• Brief interventions constitute a variety of activities characterised by their low intensity and short duration
• Highly cost effective – numbers needed to treat is 8-10
• Now included as part of NHS Health Check
Look After Your Mental Health…• Talk about your feelings• Eat Well • Drink sensibly• Keep in touch • Take a break• Accept who you are• Keep active• Ask for help• Do something your good at• Care for others