Dr Heema Shukla Presentation

What is a sensible approach to the use
of evidence in mental health policy
Dr Heema Shukla PhD, FFPH
Independent Consultant in Public Health
SETTING THE CONTEXT FOR DISCUSSION
-CMO REPORT CHAPTER 2
• "Unlike many other areas of health and medicine, public mental health is a complex field
to define because it would ideally embrace notions of both good and poor mental health
within its scope.
• In current usage, it has contested boundaries and terminology, and presents challenges in
achieving a common understanding that can be applied in everyday practice by the NHS,
government departments and executive agencies, service users, patients and funders, as
well as by users of research."
A SENSIBLE APPROACH?
• Should application of evidence for mental health policy be any different from
health policies in other areas- cardiovascular health, sexual health, nutritional
health?
• What approaches have worked in other areas of health policy and can they be
applied to mental health policy?
• What evidence already exists and is it used effectively in mental health policy?
• What are the gaps in evidence and what can be done to address these?
IN PURSUIT OF THE OPTIMAL HEALTH
THE HEALTH GRID
Very Favourable
Environment
Death
Health
Axis
POOR HEALTH
(in unfavourable
environment)
Environmental
PROTECTED POOR
HEALTH
(in unfavourable
environment i.e
through social and
cultural institutions
institutions
HIGH LEVEL WELLNESS
(In favourable
environment
Axis
Peak
Wellness
EMERGENT
HIGH LEVEL WELLNESS
(In unfavourable
environment
Very Unfavourable
Environment
Source US Department Of Health, Education And Welfare, Public Health
Service, National Office Of Vital Statistics cited in Dunn HL (1959) High
Level wellness for man and society AJPH vol 49 no 6
Source : http://wmhp.cmhaontario.ca/
WHO DEFINITIONS OF WELLNESS AND MENTAL
HEALTH
• Wellness is the optimal state of health of
individuals and groups. There are two focal
concerns: the realization of the fullest potential
of an individual physically, psychologically,
socially, spiritually and economically, and the
fulfilment of one’s role expectations in the
family, community, place of worship, workplace
and other settings.
Mental health is a state of well-being in which
an individual realizes his or her own abilities,
can cope with the normal stresses of life, can
work productively and is able to make a
contribution to his or her community.
•
Ref: WHO (2014) Mental Health Strengthening our response Fact Sheet
220
Ref: Smith B et al (2006) Health Promotion Glossary : New Terms
Health Promotion International Advance Access published
September 7
HEALTH IS A POSITIVE CONCEPT WITHIN THE
CONTEXT OF HEALTH PROMOTION
• Health has been considered less as an
abstract state and more as a means to an
end which can be expressed in functional
terms as a resource which permits
people to lead an individually, socially and
economically productive life.
• Health is a resource for everyday life, not
the object of living. It is a positive
concept emphasizing social and personal
resources as well as physical capabilities.
• The Jakarta declaration for Health
Promotion refers mental health
promotion to positive mental health,
considering mental health as a resource,
as a value on its own and as a basic
human right essential to social and
economic development.
Ref: Hosmon C, Jane llopise and Shekhar S Prevention of
mental disorders Effective interventions and policy options
WHO 2004
APPLYING PUBLIC HEALTH APPROACH TO MENTAL
HEALTH IS NOT DIFFERENT TO PHYSICAL HEALTH
Mental health promotion involves
actions to create living conditions
and environments that support
mental health and allow people to
adopt and maintain healthy lifestyles.
These include a range of actions to
increase the chances of more people
experiencing better mental health.
Ref: WHO Mental Health site
PUBLIC HEALTH ALLOWS A COMMON LANGUAGE
• Health promotion
• Prevention –primary, secondary and tertiary
• Health equity
• Needs assessment and healthcare planning
• Global burden of disease – using ICD10 codes
EVIDENCE BASED PUBLIC HEALTH
• Evidence Based Public Health follows the
same principles as evidence based
medicine , but includes a larger variety
of evaluation methods that can capture
the features of the social context and
the nature of public health
interventions. Because of the complex
nature of social interventions, evidence
in public health may be best achieved
by using both experimental and nonexperimental methods.
Evidence
in Public
Mental Health
Commissioning,
interpreting and making
use of evidence on mental
health promotion and
mental disorder
prevention:
an everyday primer
Auhors: Eva JanéLlopis, Heinz Katschnig,
David McDaid, Kristian
Wahlbeck
• Is a public health endeavour in which
there is an informed, explicit and
judicious use of evidence that has been
derived from any of a variety of
science and social science research and
evaluation methods
•
Rychetnik L : A glossary of
evidence based public health practice 2004
National Institute of Clinical Excellence –Evidence based Guidance on Mental Health
Antisocial behavioural and conduct
disorders in children and young people
NICE CG 158
Social and emotional wellbeing of
children and young people
NICE PH Guidance 12, 20 40
NICE LG Briefing 12
Perinatal mental health
NICE CG192
Personality disorders in adults
NICE CG77
NICE CG78
Preventing harmful drinking
NICE PH guidance 7 and 24
NICE LG Briefing LGB6
Common mental health problems
NICE CG 123
Workplace mental health promotion:
Reducing work related stress in adults
NICE PH guidance 22
Psychosis and Schizophrenia
NICE CG155
NICE CG178
Improving mental health of older people
Occupational therapy and physical activity in older
people
NICE PH Guidance PH16
Self-harm
NICE CG16
Harmful drinking and alcohol dependency
NICE CG 113
Disturbed and violent behaviour in inpatient settings
NICE CG 25
Alcohol use disorders
NICE CG100
Self-harm
NICE CG133
Anxiety
NICE CG31
NICE CG 113
NICE CG159
NICE CG26
Autism
NICE CG 128
NICE CG 170
NICE CG 142
Mood (affective) disorders
NICE CG185
NICE CG28
NICE CG90
NICE CG91
Social and emotional wellbeing for children and yyoung
oung people o
ovverview
NICE Pathways
NICE PATHWAYS AND QUALITY STANDARDS
EVIDENCE BASED GUIDANCE FROM OTHER SOURCES
EARLY INTERVENTION
FOUNDATION GUIDEBOOK
YLD by age for mental health and behavioral disorders
(Male, Europe 2011, % of all YLD)
60.0
50.0
40.0
30.0
20.0
10.0
0.0
5-14 years
15-29 years
30-49 years
50-69 years
Unipolar depressive disorders
Bipolar disorder
Schizophrenia
Alcohol use disorders
Drug use disorders
Anxiety disorders
Eating disorders
Pervasive developmental disorders
Childhood behavioural disorders
Idiopathic intellectual disability
Other mental and behavioural disorders
70+ years
IMPACT OF CHILDHOOD BEHAVIOURAL PROBLEMS ON
LIFE CHANCES
• 2 times more likely to leave school without any qualifications
• 8 times more likely to be on the child protection register
• 4 times more likely to be dependent on drugs
• 3 times more likely to become a teenage parent
• 20 times more likely to end up in prison
• 6 times more likely to die before age 30
Ref Young Minds Presentation at Capita Conference on Public Mental Health 2014
WHERE IS THE GAP?
• An action plan to support implementation of
NICE guidance is required
• It should include public health audits of
commissioning strategy for mental health at local
level
A PUBLIC HEALTH APPROACH TO MENTAL HEALTH
IS A SENSIBLE APPROACH
THANK YOU
[email protected]