ITEM 5 APPENDIX

Contents

Introduction……………………………………………………………….2

Background……………………………………………………………….2

Policy Context…………………………………………………………….3

Factors affecting Mental Health and Wellbeing…………………….4

Reducing Stigma and Discrimination………………………………...5

Communities……………………………………………………………...5

Physical Activity…………………………………………………..6

Children and Young People……………………………………………7

People in Later Life………………………………………………………9

Diversity and Mental Health…………………………………………..10

Ethnicity…………………………………………………………...10

Gender……………………………………………………………..11

Sexual Orientation……………………………………………….11

The Working Population………………………………………………12

The Action on Stigma Principles……………………………..12

Primary Care/Chronic Disease and Long Term Conditions…….13

Housing…………………………………………………………………..14

Special Needs Groups And Other Vulnerable Groups…………..14

Prison Population………………………………………………………15

Prevention of Suicide/Self-harm……………………………………..15

Action Plan………………………………………………………………17

References……………………………………………………………….20

Appendix – Action Plan by Lead Organisation……………………22

HERTFORDSHIRE MENTAL HEALTH PROMOTION STRATEGY

2007 – 2009

“IMPROVING MENTAL WELLBEING”

1. Introduction

This strategy aims to establish that promoting good mental health and wellbeing is an important responsibility that must be shared across a wide range of organisations and partnerships across Hertfordshire and across all age ranges.

A working group which includes commissioners, statutory and non-statutory providers, users and carers’ representatives has been formed. The role of the group is to develop, disseminate and implement the strategy. Partners include the Hertfordshire Primary Care Trusts (PCTs), Hertfordshire Partnership Foundation Trust (HPfT), Practice Based Commissioning groups (PBCs) and GP practices, Hertfordshire County Council including Children Schools and Families (CSF) and Adult Care Services (ACS), the Joint Commissioning Team (JCT) and organisations from the voluntary sector.

2. Background

Mental health and mental wellbeing are fundamental to the quality of life and productivity of individuals, families, communities and nations, enabling people to experience life as meaningful and to be creative and active citizens (WHO European Declaration on Mental Health 2005).

Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO, 2002).

Mental health promotion includes any activity which actively fosters good mental health, through increasing factors which promote mental health such as meaningful employment and decreasing those factors which damage or reduce good mental health, such as fear of abuse or violence. Activities which promote mental health may also prevent mental illness.

Everyone has mental health needs, whether or not they have a diagnosed mental illness. Mental health influences how we think and feel and affects our physical health, our relationships and our working lives. By strengthening mental wellbeing, a range of social and health benefits can be achieved, for both the individual and the community.

Because we all have mental health needs we can all benefit from mental health promotion, which works to strengthen our capacity for positive mental wellbeing, whether or not we currently have a mental health problem.

Mental health is also linked to better:

  • Physical health
  • Relationships
  • Employment
  • Parenting
  • Education

Factors that protect the mental well being of everyone include:

  • Keeping physically active
  • Healthy eating
  • Drinking in moderation (within recommended limits)
  • Learning new skills
  • Caring for others
  • Avoiding substance misuse
  • Reducing exposure to stress
  • Maintaining healthy relationships
  • Stable parenting

3. Policy context

Standard One of the National Service Framework (NSF) (1999) for Mental Health requires that health and social care organizations should:

  • Promote mental health for all, working with individuals and communities
  • Combat discrimination against individuals and groups with mental health problems, and promote their social inclusion

Subsequent National Service Frameworks for Older People (2002) and Children, Young People and Maternity Services (2004) also include a commitment to promoting mental health and well-being. The need to promote mental health and well-being has also been a consistent theme in more recent mental health and health policy including the 2004 public health white paper, Choosing Health: Making Healthy Choices Easier which sets out three key principles: informed choice for all; personalized support to make healthier choices; and working in partnership to make health everyone’s business. It emphasizes the preventative dimension of mental health policy, committing the NHS and its partners to full implementation of Standard One of the NSF.

Other policies include the National Suicide Prevention Strategy (2002), Tackling Health Inequalities: A Programme for Action (2003), Celebrating our Cultures: Mental Health Promotion with Black and Minority Ethnic Communities (2004), Social Exclusion and Mental Health (2004) and From Here to Equality (2004).

Other government policies recognize the importance of mental health and wellbeing especially in children, for instance Department of Health guidance on Promoting the Health of Looked After Children (2002), the cross government document Every Child Matters: Change for Children (2004) and Valuing People (2001) which gives people with a Learning Disability the same rights of access to health services as everyone else.

Local policies which should be read in conjunction with this document include the Health promotion Strategy for Older People in Hertfordshire (in draft), the Joint Commissioning Strategy for Mental Health Services for Older People in Hertfordshire (in draft) and the Children and Adolescent Mental Health Services (CAMHS) Mental Health Strategy (in draft).

4. Factors affecting Mental Health and wellbeing

The Making it Happen document (2001) outlines the process that enables different groups and agencies to meet their responsibilities in relation to Standard One of the Mental Health NSF. The document was produced by Mentality, a charity dedicated to promoting mental health. Mental health promotion can work at three levels. People from all sectors of the population link into these levels.

  • Strengthening individuals : by strengthening an individual’s emotional resilience, it is possible to improve their coping strategies with difficult life events such as bereavement or financial problems, which could otherwise increase their susceptibility to mental health problems.
  • Strengthening communities : Using mental health promotion at a community level improves the social inclusion of people with mental health problems. Evidence shows that people with a good social network, which offers support and integration, can reduce the likelihood of developing mental health problems.
  • Reducing structural barriers to mental health : by dealing with mental health promotion at a policy level, it is possible to make widespread differences to the mental health of the population.

5. Reducing Stigma and Discrimination

The discrimination faced by people with mental health problems is debilitating and can have a profoundly negative impact on their quality of life. There is known to be a gap between people’s professed attitudes to mental illness and the experience of mental health users and staff.

Stigma and discrimination discourage people from seeking help for mental distress, leading to untreated mental health problems and impaired quality of life. Stigma is also felt by the carers of people with mental health problems, which can make it difficult to be open about the nature of their caring role and cut them off from accessing support.

Enduring stigma or discrimination, whether felt or actual, for any characteristic can have a detrimental effect on mental health, as it undermines emotional resilience, reduces social inclusion and can fragment supportive social networks.

Actions

5.1 Work with communications departments of partner organisations to develop a positive communication strategy for mental health

5.2 Draw up a voluntary code with local media about how mental health illness is presented and the development of mental health friendly awards

5.3 Partner organisations to agree a process to achieve high coverage of staff in mental health awareness training

5.4 Partners to contribute to a annual programme of mental health awareness events including activities on World Mental Health Day to increase the profile of mental health in Herts

5.5 Organisations to be given information about the NHS Health Promotion resource centre services

6. Communities

Community cohesion along with individual resilience are factors that contribute to positive mental health.

Crime and the fear of crime, and the urban environment in general have a strong relationship with people’s mental wellbeing (Thorne, Guite and Chu, 2003). In the Hertfordshire Local Area Agreement (LAA): Safer and Stronger Communities strand – Reducing the fear of crime and improving public reassurance and confidence, the target is to increase the number of people who feel more safe in their local areas, and one action to achieve this is by increasing the number of Police Community Support Officers and Special Constables.

Support also needs to be in place for victims of crime and co-ordinated between statutory and non-statutory providers .

In urban areas creating more green space has been shown to have a beneficial effect on mental wellbeing, an effect known as ‘biophilia’. In the LAA : Safer and Stronger Communities – Making neighbourhoods cleaner and greener and helping communities take an active role in managing their own environment strand the aim is to increase the number of Green Flag (a national accreditation scheme for public open spaces) accredited sites in Hertfordshire.

Public transport availability in rural areas of Hertfordshire can be an issue that can affect social networks and support.

To improve information sharing between organisations and with members of the public, partners will have links to relevant websites concerned with mental health issues from their own websites.

Physical Activity

Much research shows that physical activity has helped people with problems such as anxiety and depression and may even reduce the chances of someone developing such problems in the first place (Mutrie 2000). A recent review of diet and physical activity which supports the ‘biophilia hypothesis’ i.e. closeness to nature increases well-being, advocates the adoption of physical activities within nature.

The authors have described this synergy as ‘green exercise’ (Pretty et al 2003). Although it needs more research, physical activity seems to be used effectively alongside other treatments for mental health problems. People should be encouraged to take part in physical activity that can be integrated into their daily lives, such as walking, gardening and cycling and partners are encouraged to seek information on existing local clubs and societies that can facilitate these activities (please also see links with 8. People in Later Life section).

Actions:

6.1 Issues affecting communities will be addressed by partners

working towards LAA objectives

6.2 Partners to include links to suitable websites on mental health from their own websites

6.3 Partners to promote and support the Health Walks programme through the Countryside Management Service

6.4 Partners to support projects funded through the Big Lottery Fund : Well

Being Fund which predominately focus on healthy eating, physical activity

and mental health

7. Children and Young People

A stable home environment is an important factor in mental health. Risk factors for poor mental health include poverty and family conflict and childhood mental health problems can be as a consequence of the separation or divorce of their parents. Mental health problems can also arise from children or young people experiencing difficulties in coping with life due to developmental difficulties such as speech and language disorders, specific physical or sensory difficulties, physical ill health, education difficulties such as reading disorders, bullying, or social difficulties such as parental violence, neglect, abuse etc. Many of these difficulties will be better addressed by primary care, education or Children Schools and Families (CSF) Family and Community services in Herts, where professionals have unique skills and understanding about working with children, young people and their families. However, for some the impact on their personal and psychological well being may require additional support from the dedicated Child and Adolescent Mental Health Service (CAMHS) services.

Rates of mental health problems differ according to the type of environment in which children live. Children who are Looked After are among the most vulnerable in society. Many will have faced severe problems in their family of origin, which may include psychological, emotional, physical and / or sexual abuse. The prevalence of mental disorders in children aged 5 to 10 who are looked after by local authorities is five times more likely than children in private households. Among 11 to 15 year-olds, those children who are looked after by local authorities are four or five times more likely to have a mental health problem.

The Hertfordshire Children and Young People’s Plan (CYPP) 2006/09 sets out priorities for the five Every Child Matters outcomes. Priorities include Being Healthy – Promote emotional wellbeing and – Support children and young people to avoid drugs and alcohol misuse.

The PCTs and Herts County Council through the Children and Adolescent Mental Health Services (CAMHS), Connexions and the Healthy Schools programme have developed a “Feelin’ Good Day” website for young people and professionals to celebrate good mental health and emotional well being of children and young people in Hertfordshire. Resources, lesson plans and leaflets have been developed for under 5’s, the primary school age group and the secondary age group and above. Information is given on resources for other aspects which may affect mental health such as bereavement, bullying, drugs and alcohol, abuse and for young carers.

The Healthy Schools Programme has four compulsory themes one of which is emotional well-being including bullying. Schools who are part of the programme have to be able to identify vulnerable groups and design strategies to support them and their families. Schools also have to have in place a behaviour and reward policy, explore feelings in the curriculum, have a confidential pastoral support system and confidentiality policy and need to display values that combat stigma and discrimination. They also have to have an anti-bullying policy, have training in place and have developed criteria about participation and self-confidence in pupils.

These initiatives link to the LAA – Children and Young People strand – which has a target to reduce the number of children who state they have been bullied.

It is also thought that there are many young carers in Hertfordshire although accurate figures on children who are carers are hard to obtain. The stress of caring may have a long-term impact on the mental health of the child or young person.

As regards to the misuse of illegal drugs there are links between cannabis use and later menal health problems. The use of cannabis and ecstasy has been linked with the development of depression and psychosis in some susceptible individuals.

Eating disorders, such as Annorexia Nervosa, Bullimia Nervosa and Binge Eating Disorder, often are long-term illnesses that may require long-term treatment. In addition, eating disorders frequently occur with other mental health disorders such as depression, substance abuse and anxiety disorders. More than 90% percent of those who have eating disorders are women between the ages of 12 and 25. it is important to raise awareness of the signs and symptoms of eating disorders to ensure that preventative measure can be put in place.

Actions:

7.1 Support implementation of a range of initiatives in the Children and Young People’s Plan (CYPP)

7.2 University of Hertfordshire has a Mental Wellbeing Student Self-help Group supported by Herts Mind Network and Viewpoint. Monitor to assess whether this model would be appropriate in other settings i.e. Further Education colleges

7.3 Identify internet sources of information for young people and develop

7.4 Partners to promote Feelin’ Good Day and Feelin’ Good Website

8. People in later life

In this document ‘older people’ refers to those aged 65 and over, although many of the issues covered may be relevant to people under 65. The numbers of people over 65 are rising. In 2007 15.4% of the Hertfordshire population were over 65 years old. People aged over 85 years made up 1.9% of the population. However the percentage of the population who will be over 65 years old and 85 years old by 2020 is estimated to increase to 17.8% and 2.9% respectively. This could mean there might be an extra 5,800 people aged over 85 years old in Hertfordshire by 2020.

Older people have many challenges often unique to them. It is for many a time of major change, a transition point in peoples’ lives. Challenges older people face will include retirement, moving home, going into a type of supported care scheme or residential home, going into hospital, isolation and major life events involving change and loss such as bereavement and illness. Older people are also more likely to be carers themselves. These will all place pressure on older people and challenge their resilience and coping mechanisms.