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Is mental illness the “Great Stink” of our times?

By Rosie Hayes

Last week, we argued that investment in social infrastructure is equally important as investing in physical infrastructure for our economy. Today, on World Mental Health Day, it seems appropriate to explore how early action can be applied to mental health – and how this can create better outcomes and deliver significant savings too.

The ‘Great Stink’ of London. Image by David Holt.

Since the 19th century, the government has recognised the benefit of investing in public health. The “Great Stink” of 1858 led Victorian reformers to make the case for investing in public sewage systems – physical infrastructure that enabled healthier lifestyles and reduced the significant costs of disease. These reformers recognised that poor public health not only had a terrible human cost, it was also bad for the economy as people were less able to work.

Today, we are facing a comparable situation in mental health. Mental health problems represent the largest single cause of disability in the UK, affecting one in four adults and costing the economy around £105 billion a year – roughly the cost of the entire NHS. Yet mental health budgets in the NHS and Public Health remain low, and despite mental health gaining increasing prominence in the public realm there still seems to be little recognition from other sectors that mental health is also their concern.

We’re making the argument for society to act earlier – by acting before mental illness occurs and stepping in quickly when problems arise – ensuring people are ready to both deal with setbacks and seize opportunities for flourishing lives. We’ve realised that many of the broad tenets of early action can be applied specifically to mental health, some of which are outlined below.

Make mental health everyone’s responsibility

A key ingredient for effective early action is breaking down siloes and promoting ‘joined-up’ services. To ensure that support is provided at the right time it is crucial that mental health is seen as everyone’s responsibility – embedded at every scale and in every activity. Whether it’s by placing talking therapies within the community like Haringey Thinking Space, taking mental health into schools like Mancroft Advice Project, or addressing mental health in the workplace like happier@work, it is clear that extending mental health beyond the health sector enables earlier action to support people’s positive mental wellbeing. We are not arguing here that all service professionals, for example, should be experts in mental illness and therefore able to deal with acute mental distress: that is the remit of referral routes and specialist services. However, we are saying that everyone should have some understanding of good mental health, ensuring that those who don’t qualify for specialist support aren’t neglected until they reach the point of crisis.

Focus on transitions throughout the life course

In our previous early action work, we’ve talked about the need to focus on transitions throughout the life course. Some of these transitions are universal, such as starting school or work, or facing retirement, whilst others are experienced by particular groups, such as leaving care, having a child, or leaving prison. People can be particularly vulnerable at these transition points if they are not prepared for them, and this can negatively affect their mental health. Ensuring people are prepared to face these transitions not only means they are resilient to such shocks, but also that they are ready to seize opportunities when they arise. Not only can this deliver savings as people are less likely to suffer mental health problems, it can also stimulate growth in the economy – as Cliff Prior argued in our blog series, a Question of Growth, with regards to supporting people back into work.

Make ‘deep value’ relationships central to delivering services

Whilst researching for our case study gallery, we have constantly been hearing about the importance of long-term, trusting, and compassionate relationships between service providers and recipients – what we call ‘deep value’ relationships. This can take a variety of forms, such as the peer-mentoring undertaken by SOS Project or the long-term relationships that Includem builds with young people. It appears that these type of relationships make interventions more effective because they have the underlying benefit of improving people’s mental wellbeing, often relating to their confidence and self-esteem. Tellingly, the standards for ‘enabling environments’ created by the Royal College of Psychiatrists to promote positive mental wellbeing in any setting, including schools, hospitals and prisons, state that the ‘nature and quality of relationships are of primary importance’.

The case for early action on mental health

It appears that we are facing our own version of the “Great Stink” today, as the public increasingly recognises the crucial importance of positive mental health and the current crisis in mental health care. We believe that an early action perspective on mental health presents the moral and economic case for investment, and the themes above indicate the beginnings of what our social infrastructure could look like.

We’ll be building on this work in our upcoming themed paper on mental health, following on from ‘Secure and Ready’ and ‘Looking Forward to Later Life’. The series aims to provoke new ways of thinking and acting earlier, beyond just the realm of experts already working in and around the topic. To support this aim, we are exploring mental health through the settings of education, work, money, housing, communities, and criminal justice. If you would like to discuss the report further with us, or you have any interesting case studies you think we should feature, please do get in touch.

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