Avoiding breaking point? The role of public mental health within the NHS By Lisa McNally I’m fed up hearing about how much we love our NHS. We clearly don’t. In fact, at the moment, we seem to be doing our level best to break it. While the NHS buckles under our expectation that it sorts out all of society’s problems, we ease our conscience by blaming “immigration”, the “ageing population” or some other distraction from our own failure to address health problems at source. There’s no better example of this than the expectations we place on NHS mental health care. Mental ill-health is a product of so many different societal factors, yet its alleviation is often left solely at the door of the NHS. Waiting lists and caseloads grow, forming a vicious circle of deteriorating wellbeing and an even greater demand for treatment. To avoid reaching a surely imminent breaking point we need to see poor mental health for what it is; a system-wide problem requiring system-wide solutions. While the NHS buckles under our expectation that it sorts out all of society’s problems, we ease our conscience by blaming “immigration”, the “ageing population” or some other distraction from our own failure to address health problems at source. Adequately funded NHS mental health care needs to be supported by adequately funded public mental health programmes – including those focused on parents, schools, colleges, workplaces and throughout our local communities. These will allow us to really tackle the factors that drive poor mental health, like bullying, debt, social isolation and stigma. If we can drag ourselves out of our ‘medicalised’ comfort zone and address mental health in this systemic way, then the evidence suggests we have an awful lot to gain (PHE & LSE, 2017). It won’t be easy to get right. Rather than a random scattering of isolated programmes, our approach to public mental health requires a strategic vision that draws together local authorities, schools, businesses, voluntary agencies and, most importantly, representatives of local communities. A pivotal moment came with the recent report from the University of Birmingham’s Mental Health Policy Commission, including recommendations that aim to improve our mental wellbeing as a society and promote individual and community resilience. The Commission, led by Professor Paul Burstow, is a significant step in the right direction, moving us closer to a robust strategic vision for achieving better population mental health. If we can drag ourselves out of our ‘medicalised’ comfort zone and address mental health in this systemic way, then the evidence suggests we have an awful lot to gain Importantly, the implementation of this vision needs to be defined and driven locally. Public mental health in any given area will be determined by a different balance of factors, values and cultural contexts that mean national initiatives will only get us so far. Rather, a localised approach is required that, while adhering to evidence based principles, is shaped by the experience, expertise and energy of local people. This ‘asset based’ way of working will not only ensure that public mental health work is tailored to local needs and preferences, but will also give it the scale and sustainability that it needs if it is really going to alleviate pressure on NHS mental health services. Many areas, including my own Bracknell Forest, have already started on this journey with large scale community driven programmes. The potential is clearly there. But we’ll only get so far relying on local good will and existing, dwindling resources. Public mental health in any given area will be determined by a different balance of factors, values and cultural contexts that mean national initiatives will only get us so far. So just imagine this. Local areas being given a ‘Community Mental Health Grant’ to implement their own strategy for improving mental wellbeing. Mental health will increasingly become an asset to promote, not a problem for someone else to treat. It will become a matter of local pride and ambition, not scandal or shame. Most importantly, we’ll start giving NHS mental health care the breathing space it needs, and if we’re lucky, a fighting chance of surviving for another 70 years. View Lisa’s ten top tips for improving public mental health This blog is part of our NHS 70 series. Take a look at other posts in the series.