Mental Health and One Nation: Made in Many Communities

15th November, 2012 8:00 pm

By Steve Griffiths

Ed Miliband’s speech to the Royal College of Psychiatrists widened the reach of political debate about mental health in a way that suggests a coherent strategy that reaches, as Miliband says, ‘beyond the NHS itself’, ‘changing the way our wider society works’, starting in ‘our communities’. If we approach this right, we can create a sustainable flow of policy that integrates mental health, in the true sense of the term, with a project to reduce health inequalities through community empowerment. Miliband’s words, ‘Everybody has a part to play. Only a nation acting together can overcome the challenge we face. That is what One Nation is about’ are not just rhetoric. I start from the experience of a project (HELP – Health Empowerment Leverage Project) that builds resident-led neighbourhood partnerships involving local communities and staff of local public agencies, which can turn around some of the most deprived neighbourhoods. One key of that is the impact on mental well-being of an active, assertive community. The research base is immense: here are just a couple of relevant examples:

  • National surveys of psychiatric morbidity in adults aged 16-64 in the UK show that the most significant difference between this group and people without mental ill-health problems is social participation.   There is strong evidence that social relationships can also reduce the risk of depression.
  • Research also reports significant health benefits for individuals actively involved in community empowerment/engagement initiatives including improvements in physical and mental health, health related behaviour and quality of life.

Consistent with this is the idea that policy is not something that should be done to people.    Though this echoes some recent influential thinking about the nature of a ‘relational’ state, it is not new. Marmot and others have established the case for the association between poor mental health and deprivation, and extended it to make an evidence-based case for community empowerment.

An understanding has long been growing that a whole system that addresses the social determinants of health through an energised community can transform the functioning of both provider services, and the well-being of the communities they serve.   Its strong economic case  arises from a finding with profound implications: that lower levels of social trust are associated with higher rates of most major causes of death, including coronary heart disease, cancers, cerebrovascular disease, unintentional injury and suicide.

Cameron’s reality of a fragmented and marketised society has us running in precisely the opposite direction. Just as high unemployment increases suicides, the bipartisan model of profit-driven welfare reform  undermines the mental health of hundreds of thousands.

HELP have developed an outcomes and cost benefit model as a guide for resident-led community partnerships; and have recorded the narrative of such a partnership through the eloquent accounts of residents and service providers. The approach starts with people defining where they are – not having it defined for them – which can then lead to productive dialogue with agencies. The problem of inequality is a multi-dimensional one, but it is no more complex than the way individuals, families and communities people experience it day by day.

It follows that a case can be made for Clinical Commissioning Groups to invest, with local authorities through Health and Well-Being Boards, in whole-system preventive development which creates added value through extension of health pathways into an active community.  Inspired strands of such an approach are to be found – and there is an appetite for it, not least among many GPs suspicious of predatory capitalism in their field.

I believe that such partnerships have the potential to reduce some of the sharpest manifestations of inequality.   To take one example, small area analysis of the cost of emergency hospital admissions shows extremely high variations between neighbourhoods.      Reducing the peaks frees the resources to further enable a strategic shift to prevention and early intervention, to borrow a phrase archived by the Coalition.

I am convinced that if a future Labour Government puts a stop to the marketisation of health, Ed Miliband’s broader and more dynamic understanding of mental health might usefully harness this potential.  Why not apply this model to, say, the 1% of most deprived small areas and the neighbourhoods they are part of – 320 of them? The data are there.       Northern Ireland is moving in that direction by allocating a minimum percentage of health spend to community development, and Scotland is following a similar path.

Preventing ill health and improving confidence, resilience, and wellbeing through resident-led community partnerships brings together a lot of themes where it matters: it makes social, financial and moral sense.

Steve Griffiths is a writer, researcher and consultant in health and social policy, with a particular interest in reducing health inequalities by addressing the social determinants of health, and campaigning against the erosion of benefits for those who cannot work. 

  • Dave Postles

    8 December UKUncut

  • http://www.englishstandard.org/ Wyrdtimes

    Ed Miliband and UK Labour politicians can only vote on English mental health issues. Is the “one nation” the United Kingdom then? Or England?

    • Steve Griffiths

      Good point, Wyrdtimes. But I am writing about a wider conception of mental health, one that is not confined to health policy: the fact that our mental health is hugely affected by the social determinants of health and the quality of our communities. That individual and community living can be transformed by what i call resident-led community partnerships. That there’s a whole load of evidence for this, and it’s a cost-effective approach, and we might use data we’ve got to prioritise the most deprived neighbourhoods. That requires a cross-government vision, which reflects the way people live – they don’t experience life govt department by department. You can do that at a very local level. The smaller countries of the UK are ahead of England in this, as I point out in my article.

  • Pingback: ‘changing the way our wider society works’ - Manchester Users Network()

Latest

  • News 40 days to go: Alexander kicks off Labour’s campaign

    40 days to go: Alexander kicks off Labour’s campaign

    Today Douglas Alexander, Labour’s Chair of General Election Strategy, will visit marginal seat Ealing Central and Acton to mark the fact that there are 40 campaigning days left until the general election. Alexander will also visit this constituency, which Labour’s candidate Rupa Huq hopes to win from Conservative Angie Bray, to send a message that Labour have 40 policies that would make Britain better (a list of which can be found below). This ties in with Labour’s campaign slogan “A […]

    Read more →
  • Comment It’s time for the Tories to come clean on their secret £12billion plan to hit children, carers, families and disabled people

    It’s time for the Tories to come clean on their secret £12billion plan to hit children, carers, families and disabled people

    David Cameron and Iain Duncan Smith have repeatedly refused to explain how they would make the £12 billion cuts in social security spending that their fiscal plans for the next parliament depend on. If anyone wondered why, now  we know. Leaked documents drawn up by civil servants for Conservative ministers and reportedly discussed with Conservative officials, confirm that this extreme cuts plan would hit disabled people and their carers hard. The Tories have denied this is their plan. But the truth is […]

    Read more →
  • News Seats and Selections Geoffrey Robinson u-turns on retirement – he’s standing again on May 7th

    Geoffrey Robinson u-turns on retirement – he’s standing again on May 7th

    In recent days there were reports that Geoffrey Robinson was set to step down as MP for Coventry North West (at incredibly short notice), with Miliband aide Greg Beales reportedly a frontrunner for the seat. Then yesterday, reports emerged that Robinson might have had a change of heart, and could stay on as MP. An emergency meeting of Coventry North West CLP had been called for this evening, but LabourList understands this was cancelled early this afternoon, when local members […]

    Read more →
  • Video 36 years later – Michael Foot’s speech on the vote of no confidence

    36 years later – Michael Foot’s speech on the vote of no confidence

    As Scottish Labour’s latest video shows, it’s 36 years since Jim Callaghan’s government was brought down with a vote of no confidence. This was won by one vote, in which the SNP supported Margaret Thatcher and the Tories. Here’s Michael Foot’s speech from this day:

    Read more →
  • Comment The Tories won’t deliver a 7-day a week NHS, they’ll cut it

    The Tories won’t deliver a 7-day a week NHS, they’ll cut it

    With forty days to go, David Cameron is desperate to run away from his dismal record on the NHS. After five years in Downing Street, he stood in Manchester today and had the cheek to make all the same promises on a seven-day NHS. No-one will be taken in by it. People know that not only did this Government not deliver a seven-day NHS, they spent five years taking it backwards. It’s now harder to get a GP appointment from Monday to […]

    Read more →
Share with your friends










Submit