Our Conservative Party conference events began with another discussion on how local government can improve mental health in communities.
Mental Health Network director of policy Becky Cotton chaired, and was joined by Dr Julie Hankin, executive medical director of Nottinghamshire Healthcare NHS Foundation Trust, Cllr James Jamieson, leader of the LGA Conservative Group and vice-chair of the LGA, and Andy Bell, deputy chief executive of the Centre for Mental Health.
James Jamieson opened the session by welcoming the significance that has been given to mental health in recent years. So many of the issues faced by local council have a mental health element to them, but money is being taken away from early intervention. He brought up environment, stating how important it is for mental health; pollution, housing, infrastructure all fall within the remit of local government, and a system solution is important for continuity and consistency. Referring to older people, he picked out loneliness and isolation as crucial factors in mental health.
There is so much that can be done in the local community to combat this, he suggested, but the focus should be to cultivate a sense of community among older people; often there will be several lonely people living next to each other on the same street, and he urged the sector to find a way of meaningfully connecting people like this. When prevention services are being cut across the board, it is unsurprising that patients end up in hospital, and then the hospitals need more money. He said that we have to break this paradigm and shift away from relying on acute services and towards prevention.
Andy Bell acknowledged that discussions about mental health often focus too closely on the NHS and not what local government can contribute. Prevention is crucial, but so too are social care, housing (which is particularly important for children’s mental health), drug and alcohol services and children and early year services. He suggested that local elected members can provide leadership for raising mental health awareness in communities and in scrutinising services.
On older people, he commented that there’s a tendency to assume that mental ill health is just a part of getting older. We know the links between mental and physical health are very important, and people with multiple chronic conditions are much more likely to suffer from mental health problems. For young people’s mental health, he encouraged a focus on interventions with parents and to introduce mental health into the school curriculum and make it a normal part of PSHE.
He added that rather than assume we know what young people need to improve their mental health, we should ask them and work with them to design programmes and treatments that will have a positive impact.
On work, he said that being in work is generally good for mental health (when compared with unemployment), but certain things at work can contribute to poor mental health: insecurity, lack of control over things like hours, overworking etc. There are small things that managers can do to help employees with mental ill health, such as offer flexibility, offer time off, or encourage them to seek help. As our awareness of mental health goes up, he said it must be followed by mental health literacy.
Among young people, particularly women, there is a greater awareness of mental health problems but a lack of knowledge about how to approach it and where/when to ask for help. We focus a lot on the things that kill people, but not enough on the things that can make people’s lives miserable, particularly the mental effects of living with long-term physical conditions.
He advocated collaborative care and moving away from dealing with one health issue at a time (particularly when speaking to GPs), in order that we can better treat the complexity of living with long-term or multiple conditions.
Dr Julie Hankin reminded the audience that mental health cannot be neatly packaged; it crosses many different policy areas, and we have the balance of funding wrong if we want to deal with mental ill health effectively. She rejected the current approach of sitting in our separate silos fighting over an ever-shrinking pot of money, but said we are starting to get to a point where we’re looking at a whole population, and also considering what communities can do for themselves.
She highlighted the difficulties facing mental health services; if there were easy ways forward, we would have already done it. We have to find different ways to have these conversations and to make sure we have them together. Speaking about mental ill health in older people, she suggested that we get caught up in conversations about dementia and that we neglect more general mental health problems among the elderly.
Becky Cotton commented that Theresa May commissioned a review of mental ill health in the workplace that hasn’t received much attention. Local government itself is a huge employee, and so there’s a big question about how it manages its employees’ mental health.