is a vast array of National Institute for Health and Care Excellence (NICE) publications on mental health
and related conditions. It is not possible to
list them all here but the reader is advised to look these up at the NICE website.
there are some key points on what works to improve mental health and wellbeing of people with mental
- employment support for people with mental health problems
and support for people with mental health problems to improve access to work and social opportunities
(e.g. through day care or primary care services.
- promotion of positive mental health
- improved diagnosis and management of common mental disorders in primary
care, e.g. anxiety and depression
- equitable access to mental health services e.g.
black, Asian and minority ethnic (BAME) communities
- supporting community involvement
for people who are at risk of social
isolation or where they are disaffected.
Department of Health published a cross-government strategy on mental health, No
Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of
All Ages, in 2011 (the Strategy).
focuses on six shared objectives:
- More people will have good mental
- More people with mental health problems will recover.
people with mental health problems will have good physical health.
- More people will
have a positive experience of care and support.
- Fewer people will suffer avoidable
- Fewer people will experience stigma and discrimination.
objectives are based on three guiding principles:
strategy aims to bring about significant change in people’s lives. Bringing the changes, for everyone,
across the country and in the most effective way, will mean that:
health has ‘parity of esteem’ with physical health within the health and care system.
with mental health problems, their families and carers, are involved in all aspects of service design
- Public services improve equality and tackle inequality.
people have access to evidence-based treatments.
- The new public health system includes
mental health from day one.
- Public services intervene early.
services work together around people’s needs and aspirations.
- Health services tackle
smoking, obesity and co-morbidity for people with mental health problems.
with mental health problems have a better experience of employment.
- We tackle the
stigma and discrimination faced by people with mental health problems.
of Health Analysis of the Impact on Equality (AIE)
AIE explains and analyses the impact of equality on the six shared objectives identified in the Strategy.
The Equality Act 2010 covers nine protected characteristics, and there is a public sector duty to advance
equality and reduce inequality for people with these protected characteristics.
are three aspects to reduce mental health inequality:
- tackling the
inequalities that lead to poor mental health
- tackling the inequalities that result
from poor mental health – such as lower employment rates, and poorer housing, education and physical
- tackling the inequalities in service provision – in access, experience and
Department of Health
No Health Without Mental Health: Implementation framework
national policy integrates mental health and physical health and suggests that there should be a collaborative
programme of action to achieve the ambition that mental health is on a par with physical health:
planning and priority setting should reflect the mental health needs of the population. Mental health
and wellbeing are integral to the work of CCGs, health and wellbeing boards, and other local organisations.
translate the vision into reality, people with mental health, and their families and carers, should
be fully involved in planning, priority setting and delivery of services.
should actively promote equality and be accessible, acceptable, and culturally appropriate to all the
communities. Public bodies should meet their obligations under the Equality Act 2010. People including
children, young people, older people, and people from ethnic minorities should have access to IAPT.
- All people should receive evidence-based mental health promotion. Schools and colleges
should promote good mental health for all children and young people, alongside targeted support for
those at risk of mental health problems.
- The Public Health Outcomes Framework (PHOF)
includes mental health measures. Local public health services deliver clear plans for mental health.
organisations should recognise the value of promoting good mental health.
services should recognise and identify people at risk of mental health problems and take appropriate,
timely action, including using innovative service models. Early recognition and intervention will enable
stopping serious consequences from occurring.
- Public health campaigns should include
people’s mental health as well physical health. Services tackle and support people with dual diagnosis
and substance misuse to achieve better outcomes and reduce cost.
- Services working
together support people with mental health problems to maintain, or to return to employment.
workers, across the full range of services, are to be trained to understand better about mental health,
the principles of recovery and be able to tackle any stigma related to mental health.
health without public mental health: The case for action, Royal College
of Psychiatrists (RCP), 2010
This report describes
the key points and features that should be part of a public mental health strategy:
is no public health without public mental health. Investment is needed to promote public mental health.
This will enhance population wellbeing and resilience against illness, promote recovery, and reduce
stigma and the prevalence of mental illness.
- The Royal College of Psychiatrists strongly
supports the findings of the Marmot Strategic Review of Health Inequalities in England post 2010. It
recognises that inequality is a key determinant of illness, which then leads to even further inequality.
Government policy and actions should effectively address inequalities to promote population mental health,
prevent mental ill health and promote recovery.
- Physical health is inextricably linked
to mental health. Poor mental health is associated with other priority public health conditions, such
as obesity, alcohol misuse and smoking, and with diseases such as cancer, cardiovascular disease and
diabetes. Poor physical health also increases the risk of mental illness.
which apply across the life course need to be provided. Since the majority of mental illnesses have
childhood antecedents, childhood interventions which protect health and wellbeing and promote resilience
to adversity should be implemented. If mental health problems occur there should be early and appropriate
intervention. Strategies to promote parental mental health and effectively treat parental mental illness
are important since parental mental health has a direct influence on child mental health.
people also require targeted approaches to promote mental health and prevent mental disorder, including
dementia. Action is needed to promote awareness of the importance of mental health and wellbeing in
older age as well as ways to safeguard it. Ageist attitudes need to be challenged and values promoted
that recognise the contributions older people make to communities, valuing unpaid, voluntary work as
we do economic productivity.
- An effective public health strategy requires both universal
interventions, applied to the entire population, and interventions targeted at those people who are
less likely to benefit from universal approaches and are at higher risk, including the most socially
excluded groups. Such groups include children in care or subject to bullying and abuse, people of low
socioeconomic status, those who are unemployed or homeless, those with addictions or intellectual disability,
and other groups subject to discrimination, stigma or social exclusion. Health promotion interventions
are particularly important for those recovering from mental illness or addiction problems. Those with
poor mental health as well as poor physical health require effective targeted health promotion interventions.
prevention of alcohol-related problems and other addictions is an important component of promoting population
health and wellbeing. The RCP supports the development of a minimum alcohol pricing policy and a cross-government,
evidence-based addictions policy.
- Smoking is the largest single cause of preventable
death and health inequality. It occurs at much higher rates in those with mental illness, with almost
half of total tobacco consumption and smoking-related deaths occurring in those with mental disorder.
Therefore, mental health needs to be mainstreamed within smoking prevention and cessation programmes.
suicide prevention strategy should remain a government priority and should include strategies to address
and reduce the incidence of self-harm.
- Collaborative working is required across all
government departments in view of the cross-government benefits of public mental health interventions
across a range of portfolios, such as education, housing, employment, crime, social cohesion, culture,
sports, environment and local government. Actions to combat stigma related to mental illness should
be included in these strategies.
- Doctors can be important leaders in facilitating
local and national implementation of public mental health strategies. Many psychiatrists already adopt
a public mental health approach in their work and influence national and local strategy. Psychiatrists
should be supported in assessing the needs of their local population for health promotion.
should be engaged in the commissioning process and inform commissioners of the expected prevalence of
specific disorders to anticipate levels of service provision and unmet need, and to help prioritise
resource allocation. Support and training are required to facilitate this.
should take into account the effects of mental health and mental illness across the life course as well
as the economic benefits of protecting and promoting mental health and wellbeing.
should consider the existing arrangements and adequacy of services for comorbid disorders and unexplained
medical symptoms where cost-effective interventions could be provided.
works to improve mental wellbeing in older people (NICE 2008)
therapy involvement in the design and development of locally relevant training schemes for those working
with older people.
- Advice and support to older people and carers.
sessions based on occupational therapy principles to aid daily routine activities.
and information on health, personal care, safety and other issues.
tailored exercise programmes.
- Developing, organising and promoting walking schemes.
further information see Mental wellbeing and older people overview (NICE website)
Clinical Guideline CG123: Common mental health disorders: Identification and pathways
to care, 2011
mental health disorders are depression, generalised anxiety disorder, panic disorder, obsessive-compulsive
disorder (OCD), post-traumatic stress disorder (PTSD) and social anxiety disorder. Depression and anxiety
disorders can have a lifelong course of relapse and remission. There is considerable variation in the
severity of common mental health disorders, but all can be associated with significant long-term disability.
This guideline offers best practice advice on the care of adults with a common mental health disorder.
guideline offers advice on the identification and the care of adults who have common mental health disorders
with a particular focus on primary care.
priorities for implementation are:
- Improving access to
services: Services need to be integrated for delivery, with clear explicit criteria for entry to the
services, focused on entry and not on exclusion criteria. There should be multiple ways to entry to
the services including self-referral, and multiple points of access with links to wider healthcare system.
People with a common mental health problem should be provided with information about services and available
treatments according to their knowledge and understanding of mental health disorders appropriate to
the communities. Local care pathways should promote access to the services by wider communities including
socially excluded groups such as black and minority ethnic groups, older people, those in prison or
in contact with the criminal justice system and ex-service personnel.
care: Use of the stepped-care model to organise the provision of services and to help people with common
mental health disorders, their families, carers and healthcare professionals, is the most effective
way of interventions.
- Identification and assessment: It is important to identify
early possible depression particularly in people with a past history, and assessment should be done
by competent staff and provide appropriate treatment and referral accordingly.
and referral for treatment
- Developing local care pathways: A collaborative
local care pathway needs to be developed for people with common mental health problems. The local care
pathway should promote implementation of the key principles of good care. It should be negotiable, workable,
accessible and acceptable by wider communities who are in need of the services. It should be outcome
standard QS8: Depression in adults, 2011
quality standard covers the assessment and clinical management of persistent subthreshold depressive
symptoms, or mild, moderate or severe depression in adults (including people with a chronic physical
Quality standard QS14: Service user Experience in adult mental health, 2011
quality standard outlines the level of service that people using the NHS mental health services should
expect to receive. It covers improving the experience of people using adult NHS mental health services.
It does not cover mental health service users using NHS services for physical health problems, or the
experiences of families or carers of people using NHS services specifically.