Flourishing individuals, connected com m unities: I m plications for local strategic planning Catherine Reynolds Strategic Lead: Public Mental Health Liverpool PCT
Flourishing Individuals, Connected Communities • New Horizons – Population Mental Health & Wellbeing • Perceiving • Articulating • Professional • Acting • Organisational • Strategic Partnerships
A way of looking
Janus • the gift to see both future and past • the god of the home entrance ( ianua ) • frequently used to symbolize change and transitions such as the progression of past to future, of one condition to another, of one vision to another
The Clinical Gaze Bio-medical • In the 1960s the French philosopher and historian Michel Foucault questioned the wider implications of the methods developed by French physicians to understand disease. His work focused specifically on the social and political changes brought by the Revolution. He argued that doctors’ new powers of diagnosis relied on their ‘gaze’ - a new type of medical perception and experience. Physicians who observed bodies carefully could potentially penetrate the illusions of outdated theories and see the hidden ‘truth’ of disease. In the process, practitioners gained much power and status, because no-one could challenge their stories of illness. The patient’s own experience or perception became less important than the doctor’s judgment. This trend within biomedicine continued until the second half of the 1900s, when efforts began to be made to look at the patient’s perspective on medical care. • M Foucault, The Birth of the Clinic: An Bio-psycho-social Archaeology of Medical Perception (New York: Pantheon Books, 1973)
A way of articulating
“To live is the rarest thing in the world. Most people exist, that is all.” Oscar Wilde (in Flourishing: positive psychology and the life well lived. Keyes and Haidt (eds) 2002.
Giving meaning. . . ? flourishing Happiness Well- Well-being being Quality of Mental life well-being Positive mental Emotional health well-being Mental So, which of Capital Mental these resonate health with you? nef
Definitions of well-being New Horizons Foresight A positive state of mind and Mental well-being is a dynamic body, feeling safe and able to state, in which the individual is cope, with a sense of able to develop their potential, connection with people, work productively and communities and the wider creatively, build strong and environment. positive relations with other and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society.
A way of being
RECESSION LABOUR MARKET MARGINALISATION UNEMPLOYMENT Low pay, job insecurity, Chequered work history, Work ethic stigma HEALTH BEHAVIOUR STRESS POVERTY CHANGES Social isolation, tobacco, alcohol, drug abuse, less exercise, etc. MENTAL HEALTH PHYSICAL HEALTH EFFECTS EFFECTS SUBNUTRITION Anxiety Bronchitis, Lung cancer, Heart disease Depression FUEL POVERTY Accidents, Low birth weight babies Parasuicide POOR HOUSING Infant growth retardation: Suicide General susceptibility Source: Smith, R (1987) Unemployment and Health: A disaster and a challenge, New York, OUP.
Uncertainty. . .friend or foe? Without a measureless and Health Literacy Related Skills perpetual uncertainty, the drama • Cognitive of human life would be destroyed. • Behavioural Winston Churchill • Advocacy The desperation to maintain as • Existential sense of certainty can lead to – Include the ability to make mental health problems. sense of life, live with Dorothy Rowe uncertainty and avoid We are born into a world we know descending into depression, nothing about, and in which larger self-pity, hopelessness or forces incessantly buffet us like a helplessness. cork in an ocean. Tim Lott
Hope Hope is sitting on a globe representing the world, her eyes are bandaged signifying that what is to be seen is not encouraging. She is playing on a lyre of which all but one of the strings is broken; she leans over it to catch the very small sound that may emerge. It is the hope implied by the expression “hoping against hope”. It is the hope of those who refuse to submit to despair when it beckons. George Frederick Watts (1886) Walker Art Gallery, Liverpool
A way of responding
New Horizons: A new vision, a new language, a new focus? “ This is about more than preventing mental illness...it is also about helping individuals and communities to bring the best out of themselves ”. Good mental health is more than just the absence or management of mental health problems; it is about our ability to cope with life’s problems and make the most of life’s opportunities. It’s about feeling connected with people and surroundings and being able to function well.
Aspiration & Realisation A cross-government action programme, produced by the Department of Health and including commitments to action by 11 government departments. – For the first time it sets out a new approach with the twin aims of • improving people’s quality of life and well-being, and • improving the quality and accessibility of services for people with poor mental health.
New Horizons: A shared vision? The new strategy covers a number of areas to better address people’s mental health and well-being. These include: • making everyone’s mental well-being better • helping everyone to understand mental health problems and not to treat people with mental health problems unfairly • making it easier for people to find and get the help they need • spotting mental health problems early • providing services and treatments in ways that meet people’s individual needs • making sure people have a say in the treatment they get. • making it easier for young people to keep getting help after they are 18 • carry on making services better and using resources effectively • working with councils, the NHS and others to make sure people get services that look after all their needs
Mental Disorder: 18% Languishing: 11% Moderate mh: 54% Flourishing: 17%
The gains from improving mental well-being • Increased quality of life and overall well-being • Improved educational attainment and outcomes • Safer communities with less crime • Reduced health inequalities • Reduced mortality • Improved productivity and employment retention • Reduced sickness absence • Reduced levels of poor mental health and mental illness
A way of acting
Critical Questions: (nef) 1. What are the key levers and opportunities for developing a local response to this well-being survey? 2. How can a case for promoting population mental health and well-being be made, especially in the light of the current recession? 3. How can our knowledge, experience, skills and good practice be built upon? 4. What does this well-being survey mean for local partnership working?
Strategic implications: The local level • The role of Local Government – The power of wellbeing – Supporting the development of safe, sustainable, connected communities – Co-production of neighbourhood services • The role of Strategic Partnerships – Local Area Agreements – Strategic alignment and integration: wellbeing & inequalities – Total Place (Birmingham – Mental Health) – Commissioning for Wellbeing • The role of Public Health & Stakeholder Engagement – Articulating a strategic population approach – JSNA – Communicating the centrality of well-being ( nef’s Five Ways ) – Testing out, innovation, extending the evidence base • Asset-based approaches: Social Prescribing, Timebanking, Volunteering, • The role of Mental Health Commissioning – Earlier intervention for child, young people and adults • IAPT • Suicide Prevention • Physical health of adults with severe mental illness – Recovery based approaches in secondary care and in community services
The Joint Strategic Framework for Public Mental Health aims to promote positive mental health and ameliorate mental distress by actions that: • enhance wellbeing (i.e. increasing flourishing) • prevent mental illness from occurring • treat mental illness when it is present
Social Prescribing & Community Referral • Connect community service providers in • Establishment of Social primary, secondary care Prescribing Pathway and the third sector to across statutory and third better meet people’s needs sector providers in the Alt – Debt management Valley Area as a model for – Benefit Maximisation neighbourhood working – Personalisation – Advocacy – Reading groups – Creativity & Arts – Leisure facilities – Opportunities for Learning, Volunteering etc
“Tend to the social and the individual will flourish” Jonathan Rutherford Cited in ‘The Joint Strategic Framework for Public Mental Health 2009-12’
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