Real World Public Mental Health

Guests:Sally Armour is the Child Health Commissioner for NHS Highland, working with the Highland Health & Social Care partnership, children and young peoples integrated service partnerships and regional planning groups in Scotland. This involves having oversight of population and wellbeing and influencing the service design and delivery of health and other services to support children and young people to achieve the best outcomes across the life course and into adulthood.Dr Neha Shah is the Public Mental Health Research and Evidence Lead at Public Health England and holds an academic post at City University. She is a qualified doctor with specialists registration in public health medicine and is a practising psychodynamic therapist. She has an interest in better understanding and addressing the factors impacting on population mental health and enhancing the quality, relevance and impact of mental health research for those that use it.  Laura Fischer is an artist, activist, lecturer, consultant and researcher. Her work weaves creative approaches with scientific methods and focuses on trauma, often with an activist agenda. She believes that trauma survivors are not powerless, broken individuals and are rather the survivors that have power and the resources to lead their own healing and growth, and contribute to the healing and growth of our communities. A key aspect of Laura's work is to develop novel interventions to respond to violence, abuse and neglect. Her main focus is the neurobiology of childhood trauma and the use of body-based methods to express and process traumatic memories to support healing and growth. In this episode, the group discusses what psychological trauma is and how it relates to mental health.  Dr Neha Shah talks about how childhood trauma can have an increased likelihood of poor mental and physical health outcomes later in life as well as the difference between types of traumas, in particular the difference between PTSD and Complex Trauma. She also discusses what trauma-informed approaches look like in non-healthcare settings. Sally Armour, from a public mental health point of view, talks about 'toxic stress', the distinction between adversity and when adversity becomes trauma and fundamental survival strategies. She touches on the importance of validating the difficulty people have in finding their innate path to recovery and discusses why some adversity and tolerable levels of stress in life are important in shaping us, but need not define us. Laura talks about research she has been involved in since the first lockdown on the impact of social distancing, particularly for young people in abusive environments. A key finding is that we really need everyone to be able to firstly recognise and then respond to trauma. There is a need to make the experience of trauma and the language associated with it understandable to the public. She raises the simple, but impactful idea that being trauma-informed is just being human-informed, looking at a person, their experiences and their perceptions - looking at the human behind the outcome. As a key takeaway, the reality is that trauma is extremely prevalent so don't dismiss it and don't turn a blind eye. Learn to recognise and respond to trauma. Contacts:@Stu_King_Hh @sallycroachy & @acehighland @Neha_D_Shah@brains_brushes

Guests:Professor Peter Fonagy is the Head of the Division of Psychology and Language Sciences at UCL and the National Clinical Adviser on children and young people’s mental health at NHS England. He is the Chief Executive of the Anna Freud National Centre for Children and Families, London, which is particularly poignant as he himself found help as a child refugee at the Centre. Dr. Karen Bateson is the Head of Clinical Strategy and Development, Parent-Infant Foundation and is a Clinical Child Psychologist who has worked in the NHS for over 20 years in early intervention, Sure Start and NHS CAMHS (Child and Adolescent Mental Health Services). Dr Bateson’s work focuses on the importance of the first 1001 days of life from conception, perinatal mental health, and how best to support families, and forms part of the First 1001 Days Campaign.Jabeer Butt has worked in and with the voluntary sector to promote race equality and address health inequalities for many years. He was awarded an OBE in 2013 for his achievements in health and is currently the Chief Executive of the Race Equality Foundation. He has gained an international reputation for the use of evidence in developing interventions that help overcome discrimination and disadvantage.In this episode, the group discuss the importance of early experiences, such as good contact with a responsive adult who is sensitive to needs in order to build trust and secure the best foundations for mental health throughout life. Attachment, predictability and sensitivity are fundamental building blocks determining how we interact in the world. Parent influence early on shapes who we are as human beings, even down to nappy changing moments. Peter describes it as ‘the foundations of life’ with 3 principles:Self esteem – how to develop good self esteem Self discipline – controlling behaviour with parents and when they are out in the world Social competence – managing relationships in a supportive manner If these are not developed, it can impact relationships, empathy and problem solving throughout life. The group discuss process of ‘mentalising’, the impacts of micro-traumas and how people see themselves. Turning to what action can be taken, rather than trying to prevent abuse and maltreatment, the group discuss promoting positive childhood experiences through good attachments with positive adults. They talk about joined up thinking so that families can access a continuum of support, universal, targeted, specialist services as well as a workforce development strategy so that all professionals receive training in infant mental health. Taking a whole school approach is another example - changing a community by helping everyone in the school environment see each other as human beings and develop supportive relationshipsContacts:@Stu_King_Hh@PeterFonagy@ParentInfantfFDN & @KarenJBateson@ButtJabeer

Guests:Professor Kate Pickett Professor of Epidemiology at Department of Health Sciences York, and the University's Research Champion for Justice and Equality.  She is co-author of The Spirit Level and The Inner Level and Co-Founder and Trustee of The Equality Trust. Kate is Co-Principal Investigator for the Born in Bradford study.Rose Ssali Programme Lead and Founder of Support and Action for Women Network (SAWN), which promotes the welfare of Black/African women in Oldham and Great Manchester. Rose has worked on immigration, FGM, domestic violence, parenting and money matters for 15 years. She is Chair of Mama Health and Poverty Partnership (MHaPP) a partnership of 14 Black women-led organisations.Andy Bell Deputy Chief Executive at the Centre for Mental Health.  He is a member of the Mental Health Policy Group and was chair of the Mental Health Alliance from 2006 to 2008. Andy has researched the implementation of national mental health policies and local mental health needs assessments.Episode Description:The group define social inequalities and explain how they impact on mental health.Andy shares the findings of the Centre for Mental Health’s Commission for Equality in Mental Health reports. Rose gives examples of how this affects Black /African women. For example, how the lack of trust by official bodies, language barriers, parenting issues, economic issues and immigration status combine to impact on these women's mental health. Then due to mental health stigma, there is little recognition of these problems.  The group explores how early life has profound effects on mental health, income and other outcomes. Kate shares an example of bullying statistics from the Born in Bradford study, and discusses why the UK is ranked lower than other Western countries for child wellbeing and how this impacts on inequalities. Rose demonstrates how this plays out in the real world, with rigid systems preventing access to services. Covid has also had an impact - highlighting pre-existing inequalities and amplifying the effect on mental health.The discussion turns to solutions. At the national level, the need for substantial policy changes and a move away from seeing mental health as an individual responsibility. At a local level, involving communities in meaningful co-production of interventions. This requires mutual respect and trust, as well as a commitment to accepting other communities and cultures. Finally, each guest shares one thing they would like for people listening to take away:For local authorities to focus on root causes and systemic inequalities that underpin public mental health, as this will fix mental health as well as other health issues.  To own your patch, whatever it might be - ask what else you can do to help.Go out to schools, youth organisations, community groups and spend time listening. Don’t accept that things are immovable.Contact:Host Stu King @Stu_King_HhProfessor Kate Pickett @profkepickettAndy Bell  @CentreforMH, Report on the Commission for Equality in Mental HealthRose Ssali @rose_ssali, @SupportSawn

Host Stu King, CEO of BeeZee Bodies, and guests discuss Public Mental Health in the workplace and supporting employers.Professor Dame Carol Black was Principal of Newnham College, Cambridge until 2019. She has advised the British Government on the relationship between work and health.Professor Neil Greenberg is Professor of Defence Mental Health at King’s College London. He has served in the Armed Forces and advises the Academic Department of Military Mental Health. He also runs March on Stress.Dr Jane Suter is Lecturer in HR Management at University of York Management School and Principal Investigator on the insight report Managing Mental Health in Small and Micro Businesses.Our guests outline the importance of public mental health in the workplace and influencing factors such as the role of managers and culture. The group explores the impact of Covid-19 and Jane talks about pressures on small and medium enterprises, accounting for the majority of UK employers. Neil shares his experience in long-term traumatic environments, what helps people cope and moral injury. The group talk about presenteeism, identifying the driving factors of mental ill-health and measuring impacts of interventions. The group recommend training in psychologically safe conversations, shown to be cost effective in a study with Australian firefighters. Neil recommends a condensed, on-line version REACT Mental Health®, validated peer support programmes such as StRaW or TRiM, and occupational health advice. When selecting interventions, Carol suggests looking at organisations in Britain’s Healthiest Workplace awards. The Midlands Engine mental health productivity pilot provides examples for small and medium enterprises, such as Prime Accountants.Contacts:@drjanesuter@DameCarolBlack@ProfNGreenberg@Stu_King_HhOther Resources:Thriving at Work: the Stevenson/Farmer review on mental health and employers, 2017Mental health at work resources for employers (including during Covid) Local government guidanceBITC/PHE health and wellbeing at work tool-kits

This month Stu is joined by:Dr Jen Dykxhoorn, Senior Research Fellow in Public Mental Health at UCLEd Davie , Councillor at London Borough of LambethCaron Walker, Assistant Director for Adult Public Health Improvement at Calderdale CouncilSome technical problems meant that only part of Caron and Stu’s conversation could be recorded, but check out Calderdale Council’s ‘Staying Well in Calderdale’ Project for more on Caron’s work.The group begin by defining exactly what loneliness and isolation mean and look like. They explore the importance of ‘weak ties’ to feeling connected and belonging in a community, and how COVID-19 measures such as social distancing have impacted these interactions, particularly over a long period of time.Ed and Jen explain how the impact of COVID falls most heavily on those already facing inequalities, for example, availability of technology, internet access,  ability to travel and many others. They also discuss the difficulties people can face over the festive period, and whether the change in guidance over Christmas can provide relief during a time of chronic loneliness. Caron joins the discussion by explaining how the Staying well Calderdale project looks at cross-community factors and programmes such as befriending over phone and socially distanced door step visits to help people stay well.Moving towards financial impacts, Jennifer and Ed share how programmes to support financial instability (worsened during COVD-19) can be made most effective and sustainable.Finally, the group looks to the future to discuss how we might be able to use 2020 as a reset - the need to consider the environment, social determinants and individual actions altogether, and invest in research to better understand mental health, and why certain programmes succeed.Contacts & InformationDr Jen DykxhoornLinkedIn ProfileEdward DavieLinkedIn ProfileLGA's Councillor's Workbook on mentally healthier placesZero Suicide Alliance Social Risk Factor MapCaron WalkerCalderdale CouncilStu King LinkedInTwitterStu's BlogsWith thanks to:BSPHN for funding this podcast and to all of the partners, PHE, ADPH, LGA, Centre for Mental Health, Mental Health Foundation & NIHR School for Public Health Research

Welcome to episode one! This podcast is released in conjunction with PHE's webinar on 3rd November 2020: Prevention & Promotion for Better Mental Health in Local Systems (COVID-19). Click for details and to register for this free event.Stu King chats with Dr Jonathan Campion, Director for Public Mental Health & Consultant Psychiatrist at South London & Maudsley NHS Foundation Trust. Jonathan is visiting Professor of Population Mental Health at UCL & Fellow of Royal College of Psychiatrists. He is involved in development and implementation of local, national and international public mental health (PMH) strategy.Stu and Jonathan look at Jonathan’s journey into PMH, including gathering evidence for determinants of mental disorder and wellbeing, and evidence for interventions. He has also worked in local implementation, writing guidance for needs assessments.Turning to current PMH, they look at impacts and costs of mental disorder and wellbeing (8:37). Plus, causes and risk factors which can increase them (11:34 ), such as COVID-19, through reduced social interactions and the infection itself (13:37).Jonathan shares examples of cost effectiveness and societal benefits of interventions, such as parental, school and workplace (21:39). However, there is an implementation gap (33:33). With a minority of those with mental disorder in UK receiving treatment, Jonathan shares causes of this gap (35.42) and actions that can narrow it (41:01).Links to articles & resources: Economic case for improved coverage of PMH interventions. The Lancet Psychiatry (2018)PMH: key challenges and opportunities. BJPsych International (2018)Launch of ‘PMH: Evidence, practice and commissioning. RSPH (2019)(Navigation available here)PMH and associated opportunities. Indian Journal of Psychiatry (2020)Addressing the PMH challenge of COVID-19. The Lancet Psychiatry (2020)WPA Working Group launches PMH Briefing on COVID-19. WPA(2020)The Need for a PMH Approach to COVID-19. WSP (2020)Public Mental Health e-learning session. HEE (2020)Thanks to BSPHN, PHE, ADPH, LGA, Centre for Mental Health, Mental Health Foundation & NIHR School for Public Health Research