Responding to the pandemic
The full impact of the pandemic on mental health for all ages has yet to be fully realised. But councils are expecting a significant increase in demand for services. The pressure will come from referrals that would normally have been made when services were less restricted in terms of access. Referrals to services are expected to rise as a result of the strain the pandemic has put on families whether because of factors such as job losses, financial insecurity and bereavement. Long covid is also likely to put further pressure on mental health services.
Councils are also working closely with schools which are dealing with a range of challenges, including settling children back into routines, supporting them through pandemic-related anxieties, managing behaviour and re-establishing relationships to enable children to flourish.
Funding has been provided to councils to support schools under the Government’s Wellbeing for Education Return programme which was launched in September 2020 to respond to the additional pressures linked to the pandemic.
The government has also published a Mental Health Recovery Action Plan in 2021 in response to the mental health impact associated with the pandemic. This includes an expansion of Improving Access to psychological therapies (IAPT) and extra funding for the most deprived areas to pay for prevention work, including debt advice, youth projects and support to tackle loneliness and isolation
Integration
Mental health cannot be tackled by any organisation working in isolation. Councils, the NHS, education, and the voluntary and community sector (VCS) must come together with people who use services (children, young people and adults), carers and advocates to ensure that each area has a joined-up and coherent strategy and that services and approaches are delivered in an integrated way.
The 2021 Health and Care Bill is intended to enable local health and care leaders to pursue new and innovative ways of delivering for people and communities working as Integrated Care Systems (ICSs). It will establish Integrated Care Boards as new NHS statutory bodies, enabling the NHS and local government to work as equal partners to reduce health inequalities and improve population health. It will be important to ensure that mental health is given appropriate priority within these new arrangements, working with and in support of local health and wellbeing boards.
Prevention – tackling social determinants and inequalities together
Mental health problems are frequently associated with a range of other factors including poverty, poor housing, homelessness, disability and long-term illness and experience of violence or abuse. Groups who have higher levels of mental health problems include refugees and asylum seekers, veterans, the lesbian, gay, bisexual and transgender community (LGBT), looked after children, and some Asian, black and ethnic minority groups. Though people of all ages and backgrounds can have mental health difficulties at any point in their lives.
Councils, the NHS and the VCS should work closely with partners such as housing, education and employers to improve the social determinants of poor mental health, creating a place-based approach to mental wellbeing. Studies have shown that the following functions have a role in promoting good mental health:
- Workplaces that support mental wellbeing – many councils have initiatives, such as awards, that encourage this.
- Schools, colleges and universities ensuring they are mentally healthy spaces, running programmes and direct interventions and providing training to promote mental good health. Support to local businesses to help create jobs and training opportunities.
- Asset-based approaches to community development – reducing isolation and identifying mental health problems early.
- Parks and the natural environment – exercise and green and blue spaces are associated with mental wellbeing.
- Sports, culture and leisure services such as swimming pools and libraries – opportunities for exercise and social contacts.
- Good standards of housing and support for those at risk of housing insecurity.
- Planning the built environment with walkways, cycle-paths and a community focus.
- Supporting the financial resilience and wellbeing of communities through providing credit, food or white goods vouchers, council tax support, benefit advice etc.
- Bereavement support.
While there is a growing body of research on preventing mental illness, some areas are more advanced than others in evidencing impact. For example, evidence-based parenting programmes are estimated to generate savings in public expenditure of nearly £3 for every pound spent over seven years, with the value of savings increasing significantly longer term.
The health in all policies approach (HIAP) adopted by many councils should cover mental as well as physical health. Many councils have appointed councillors as mental health champions to champion better mental health and tackle stigma. Champions are supported by the Mental Health Challenge, a network where councillors can share ideas, seek advice and receive support with the aim of enhancing the mental health of their local communities.
Best use of funding
With limited funding, it is vital that investment decisions are based on evidence, support innovation and achieve the best outcomes, including tackling mental health inequalities. Through joint strategic needs assessments (JSNAs) and intelligence from public health and the NHS, councils and their partners can target investment in a way which meets local needs and supports the shift to prevention. For example, dependent on data, some areas may focus on reducing suicide, some on tackling bullying in young people and some on men’s mental health.
Questions to consider for all ages system-wide leadership
- What work is your Health and Wellbeing Board (HWB) taking forward to improve mental health? Is there a mental health strategy covering prevention, self-help, treatment and support for all ages, signed up to by all partners? How is delivery monitored?
- Is the HWB supported by planning structures and implementation plans that promote an integrated approach to mental health for children and young people, and for adults? Do these cover seamless transition from children’s to adult support?
- What mechanisms are in place to ensure that people with mental health problems (children, young people and adults), and carers are listened to, and that their views and priorities shape mental health services?
- Are the council and other key local partners actively involved in shaping mental health developments in the integrated care system (ICS) footprint?
- Does the JSNA help identify local priorities and support effective mental health commissioning and investment?
- Do local partners consider the impact of their wider investment decisions on mental health – for example CCG core funding, and council investment in areas such as parks and community assets?
- How is mental wellbeing tackled through council functions, such as leisure, planning and housing, and those that are joint with partners, such as education and criminal justice?
- What prevention approaches are in place to support groups at risk of mental health inequalities in your area, such as some ethnic minority groups or LGBTQI+?
- What measures do the council and key partners have in place to provide mentally healthy workplaces?
- How does the council support local employers to create mentally healthy workplaces?
- Does HIAP sufficiently cover mental health? What mental health training is given to front line staff in key agencies who work with the public? Is mental health first aid training provided? Is there mental health awareness training for councillors?
- Is there an active suicide prevention plan? What progress is being made on this?
- What are the council and key partners doing to reduce the stigma of mental health in the local area?
- Do the council and key partners have active mental health champions?
- Has mental health been included in the overview and scrutiny committee’s programme of reviews?
- What more could be done to make your area a mentally healthy place to live?