Promoting

Positive Mental Health and Resilience

Children and Young People’s Mental Health: Promoting integration and early

intervention

Manchester, 8th December 2016

Lily Makurah

Deputy National Lead – Public Mental Health and Wellbeing

Content

1. The challenge: public mental health in England

2. The response: national action on prevention and partnerships

3. What support PHE is giving to the system

2

1. The public’s mental health in England

Mental health problems in the general population

Mental illnesses account for the largest burden (23%) of diseases in England

23%

• One in four adults experiences at least one diagnosable mental health

problem in any given year

• One in five older people living in the community and 40 per cent of

older people living in care homes are affected by depression

• Up to three quarters of people with mental health problems receive no

support

• People in marginalised groups are at greater risk, including black,

Asian and minority ethnic people, lesbian, gay, bisexual and

transgender people, disabled people, and people who have had contact

with the criminal justice system

Children and young people

Opportunities for prevention and improving outcomes

• One in five mothers has depression, anxiety or in some cases

psychosis during pregnancy or in the first year after childbirth

• One in ten children aged 5-16 has a diagnosable mental health problem

• Children living in poor housing have increased chances of experiencing

stress, anxiety and depression

• Key high risk groups include:

Looked after children

People of all ages who have experienced traumatic events, poor

housing or homelessness

People have multiple needs such as a learning disability or autism

are also at higher risk

10%

One in ten children between the ages of one and 15 has a mental health

disorder.

Inequalities, experiences and impact

While life expectancy has increased overall, there has been little, if any,

improvement in inequalities:

• People living in the most deprived areas are only just approaching the

levels of life expectancy that less deprived groups enjoyed in 1990.

• Inequalities in life expectancy and burden of disease are actually greater

within regions than between them - so largely related to deprivation not

geography.

• People with mental health problems are often overrepresented in high

turnover, low pay and often part time work.

• Common mental health problems are more than twice as high among

people who are homeless compared to the general population, and

psychosis is up to twice as high.

• Poor mental health carries an economic and social cost of £105 billion a

year in England. The economic cost of each death by suicide is estimated

to be £1.67 million.

Understanding the non-communicable

disease (NCD) ChallengeSocial and structural determinants matter to children and young

people’s outcomes

• Economic prosperity and a good start to life

• Whilst individuals’ behaviours do matter (e.g. half of health inequalities

between rich and poor are the result of smoking), the reality is that our

health is impacted by a range of wider determinants including:

– good employment

– higher educational attainment

– safe, supported, connected communities

– poor housing and homelessness

– living on a low income

– social isolation, exclusion and loneliness

– stigma and discrimination

Why act early? Impact on childhood life

8

Why act early? Impact on adolescent life

9Graph sources: Estimates calculated from ONS mid year population (MYE) and prevalence from British Child and

Adolescent Survey

• Mental illness for those aged 14-16 years

carries the highest risk of unhealthy

lifestyle behaviours

• About 50% of children and young people

with conduct disorder smoke, which is

nearly 86,000 children

• About 30% with emotional disorder and

hyperkinetic disorder are regular smokers,

which means provides an estimate of

50,000 children

• About 50,000 children with mental illness

may drink regularly

• About 38, 000 children with mental illness

may be using drugs

2. National action and partnerships

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An integrated methodology informed by the

WHO approach to public mental health

Everyone, irrespective of where they live, has the

opportunity to achieve good mental health and

wellbeing…especially communities facing the greatest

barriers and those people who have to overcome the most

disadvantages. This includes those living with and

recovering from mental illness.

Mental health promotion

Improving lives,

supporting recovery and

inclusion

Mental illness prevention and suicide prevention

Key themes:

• Reducing health inequalities

• Community centred approaches

• Embedding and integrating mental health

• Improving workforce capacity and competency

Independent Mental Health Taskforce Report

(February 2016)

Recommendations include……… implement Future in Mind and

building on the 2015/16 Local Transformation Plans and going further to

drive system-wide transformation

Cross system action and tools

Opportunities for Better Mental Health for Everyone

• Increased attention and ambition for mental health reflected in the Five

Year Forward View for Mental Health recommendations. Including:

• Increased access to timely, high quality intelligence and data enabling

local needs and assets analysis by life course and/or pathway

• Increased emphasis on early intervention and providing people with

timely access to evidence-based care through the life-course

• Implementation of Future in Mind in full

• Prevention focussed action to create a ‘Prevention Concordat for

Better Mental Health programme

• A new reinvigorated Suicide Prevention Strategy for England

• Increased emphasis on the multi-sectoral partnerships required, with

actions for all across the Voluntary and Community Sector, CCGs, LAs

and private sector businesses

Flourishing People

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3. What support PHE is giving to the system

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A Public Health approach

Strategic

• Life course, place and settings-based approaches

• Evidence and data

• Health inequalities - ensuring those at highest risk receive the greatest levels of support

• Addressing the wider social determinants

Tactical

• Prevention and early intervention – evidence based

• Asset based and holistic approach – families and building resilience

• Integrated responses – whole-systems, multi agency

1616

Children and young people’s health

PHE, alcohol and drug prevention17

Six key principles

• Putting relationships at the centre

• Focusing on what helps young

people feel well and able to cope

• Reducing health inequalities

• Championing integrated services

• Understanding changing health

needs as young people develop

• Delivering accessible, youth

friendly services

(You’re welcome quality criteria)

Snapshot of key activity 2016/2017 in addition to Five Year Forward View for Mental Health delivery support

1. Working across the lifecourse - with specific strands on children, young people and families

– Public Mental Health JNSA toolkit;

– Return on investment toolkit

– Prevention Concordat

2. Children and young people’s lifecourse

– Perinatal and infant mental health competency framework capacity building

– Increasing profile of prevention in NHSE funded activity

– Anna Freud supported mental health in schools toolkit

– Adolescence Resilience Framework

– ‘You’re Welcome’ refresh

– Health Behaviour of School Aged Children

3. Specific products

– New ‘Sleep in Adolescence’ Minded resource

– Rise Above online resource for young people (key content on stress embedded throughout )

– Time to Change for young people (DH led)

– Shelf Help ‘books on prescription’ library initiative for young people (Arts Council led)

4. Bespoke activity

– Suicide Prevention and self harm

– Reviewing work contributing Trauma informed practice and violence

– Universities

– Vulnerable persons and Syrian refugees health assessment guidance

Snapshot: children and young people

Prevention: It’s never to soon

• Mental health problems in the perinatal period are very common, affecting up to 20% of

women. Examples of these illnesses include antenatal and postnatal depression,

obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and postpartum

psychosis.

• Almost a quarter of women who died between six weeks and one year after pregnancy

died from mental-health related causes. 1 in 7 women died by suicide.

• Perinatal mental illnesses cost the NHS and social services around £1.2 billion for each

annual cohort of births. A significant proportion of this cost relates to adverse impacts on

the child.

* LSE and Centre for Mental Health, The Costs of Perinatal Health Problems (2014)

*MBRRACE-UK, Confidential Enquiries, 2015

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Improving access to good quality, timely

mental health intelligence and data

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Health intelligence products and tools to enable every local area to improve

their emphasis on prevention and early intervention – primary, secondary and

tertiary

• Joint Strategic Needs Assessment tool for public mental health

• Suite of health economics return on investment tools

• New fingertips tools for perinatal and infant mental health

• Updated fingertips tools for suicide prevention

• Refreshed and extended tools for children and young people

Perinatal and Infant Mental Health Key data

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Key risk factors - perinatal mental health

Previous or current history of mental health problems

Traumatic childbirth, stillbirth, infant death - Data indicator: Stillbirth rate, infant mortality

Domestic violence and abuse - Incidents of domestic abuse reported to police

Poor social support - Proportion of sole registration births

Key risk factors - Infant and early years mental health

1. Maternal mental health

Drug and alcohol misuse - Parents receiving drug treatment who live with their children, Parents

receiving alcohol treatment who live with their children

Teenage parents – Births where the mother is aged under 18 years

Looked after children - Looked after children aged under five years

Child maltreatment - Children subject to a child protection plan

Homelessness - Family homelessness: households containing children or a pregnant women

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http://www.chimat.org.uk/PIMH_Needs_Assessment

A key knowledge hub

‘How to’ guide

23

A short guide to how to make the most of the report can be downloaded

from our website. We recommend you read this before using the report.

24

July August September October November December January FebruaryMarch/

April

2016 2017

Rapid review

of evidence of

what works

Local Prevention

Planning Guidance

Training for local authority elected

members MH Champions to support

them as prevention focused leaders

Prevention Concordat for Better Mental Health

Mental Health

Joint Strategic

Needs

Assessment

toolkit

Mental Health Promotion

and Prevention Return

on Investment Tool

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Resources snapshot: Suicide prevention

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– Updated guidance for developing a local suicide

prevention action plan

e.g. young people in contact with justice are recognised

as a priority group of younger people

– Responding to potential suicide clusters

– Preventing suicide among key groups of young people

e.g. lesbian, gay and bisexual young people; trans

young people

– Help is at Hand’ bereavement support after suicide

e.g. improved responses to children and young people’s

experience of bereavement

– ‘Support after a suicide: a guide to providing local

services (publication imminent)

– Suicide prevention masterclasses

Thank you

lily.makurah@phe.gov.uk

Acknowledgements: Public Mental Health Team