UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness

Citation

(2005), "UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness", International Journal of Health Care Quality Assurance, Vol. 18 No. 2. https://doi.org/10.1108/ijhcqa.2005.06218bab.002

UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness

Europe, Middle East and Africa

UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness

Keywords: Public health, Mental health services, Health education, United Kingdom

The Public Health White Paper is welcomed by the Royal College as an important and timely new commitment to prevention and public health interventions.

Research shows that such interventions can be effective. Self-determination, partnership and choice are all important facets of a coherent approach to improving health, and involving the population in this is clearly desirable.

The College has concerns, however, that the most appropriate models of public health intervention for physical illness are not necessarily appropriate for mental illness. The risk of mental illness may not be a matter of individual choice. As a result, they have doubts about how easily the recommendations in the Public Health White Paper can be applied effectively in the area of mental health. A complementary – but separate – public health strategy is recommended for mental health.

People can make lifestyle choices, such as whether to smoke and the kinds of foods they eat, and government does have an important role in helping to change behaviour. Whilst the College supports the need for a smoke-free ban in public and work places, banning smoking in psychiatric environments may be counter-therapeutic. For example, psychiatric patients often use smoking as a coping mechanism, and research has indicated that nicotine can help some brain illnesses.

It is known that improving physical illness will impact on mental illness; rates of chronic illness, with loss of function, are associated with higher rates of mental illness. If the results of the recommendations in the White Paper were to decrease morbidity and mortality in physical illness, this would reduce rates of mental illness.

The emphasis in the White Paper that individuals are responsible for their own health, rather than the NHS, Government and other institutions, does not apply to the area of mental health. The balance between individual and societal responsibility for people with mental health problems may be significantly different from the balance of equally preventable physical problems.

The key issues that need consideration include:

• •

  Increased stigma – The individualisation of risk and the impression that mental health is a matter of choice could lead to further stigmatisation of mental illness. The White Paper’s emphasis on choice and self-help can further increase the guilt, shame and stigma felt by patients, carers and their families. Changing behaviour is an important lever for improving health, but it is also important to recognise that the vast majority of mental illness cannot be improved by lifestyles choices only. Other contexts, such as societal and macro-economic decisions, which are outside individual and community control, also impact importantly on mental health.

• •

  Employers’ role in improving the heath of the workforce – Job insecurity, lack of autonomy in the workplace, poorly managed workplaces, racial and other forms of discrimination and bullying have all been associated with higher rate of common mental disorder, such as anxiety and depression. This has not been helped by increased scrutiny of public bodies by outside agencies. For example, school inspections by Ofsted, have been linked to anxiety and depression in teachers. The Department of Health is the largest employer in the UK, but its workforce has been characterised as having low morale and is under continual pressure due to its high level of responsibility, relatively low pay and constant change. The College would support effective strategies to improve the work environment and would welcome plans to attempt to make the public sector a less stressful place to work. A focus on improving the working lives of all its staff, and management strategies based on developing and enabling staff, may pay dividends.

• •

  Healthy lives – People with mental health problems may have fewer choices for healthier lifestyles. Smoking is a case in point. People with mental illness are more likely to smoke and it would be inappropriate to withdraw something that is used by patients as a 'coping mechanism' when they are very upset and distressed. It is not always practical to enforce a smoking ban in secure or 'semi secure' or closed environments, such as prisons, when people cannot go outside to smoke. Moreover, research has also shown that nicotine can help some symptoms of brain illness. Healthier lifestyle choices can also be limited by the prevailing social and economic climate and by education. There are a number of possible interventions that can improve an individual’s capacity to deal with psychological problems. In depression, for example, cognitive behavioural psychological techniques, coping skills strategies, personal growth classes, stress management classes, are techniques that can improve outcome.

• •

  The role of education and early intervention – It is possible to teach people in schools about mental illness, increasing emotional literacy, social skills, competence and coping skills. Such skills can help decrease depressive symptoms and improve psychological health in children. The National Curriculum has an important role in this area. Research has shown that getting help earlier, rather than later, is important in addressing psychological problems in young people. A campaign to improve the knowledge of an individual, and information about the support network of routes to care and resources available, is a viable option for helping people to get effective early treatment. Some individual measures may decrease the risk of mental illness or decrease morbidity by earlier treatment, but there may be greater impacts from environmental manipulation rather than initiatives geared towards the individual.

For further information, telephone Deborah Hart or Thomas Kennedy on 020 72354 2351.