The well-known US psychologist, Ed Diener, once complained his professors wouldn't let him study happiness – depression yes, but happiness? Never. To me, that sums up the traditional focus we've had on mental illness. Of course that's important, but it risks missing the opportunity we also have to promote and nurture mental wellbeing for everyone, including those living with or recovering from mental health difficulties. It feels to me that’s beginning to change in quite profound ways. Later this week, we’ll be marking World Mental Health Day, so it seems like a good moment to reflect on mental health – both good and poor – and its importance to public health; what we can do at Public Health England and how we can support local leaders to improve the mental health of their populations.
Good mental health matters because it’s fundamental to our sense of wellbeing. Without it, it’s harder to stay healthy, and to live as long and as well as we can.
The statistics are staggering: mental illness is responsible for the largest burden of disease in England – a bigger burden than cancer, for instance, or heart disease. People with serious mental illness die on average 20 years earlier than the rest of the population, and many of these deaths are avoidable. This is everyone’s problem: mental illness affects more than 1 in 4 of us at any one time. The human and economic cost (estimated at £105bn a year) is enormous. So we need to intervene when and where we can to prevent mental illness from taking hold in the first place. This will yield huge benefits, as will more support for people living with and recovering from mental illness to lead healthier, happier lives. Promoting wellbeing can help on both these counts. It can be a resource for those living with mental health difficulties and is rightly at the heart of our public health agenda.
What does wellbeing mean? A definition I've found useful is “a positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment.” The work on wellbeing is still fairly new, but some key insights are emerging. First, it evolves and fluctuates throughout a person’s life, with dips in adolescence and middle-age. Second, it’s influenced by the same factors that crop up again and again in our conversations about health – good jobs, homes and friends. Third, it is linked to better physical health, though it’s hard to know exactly what causes what – people with higher levels of wellbeing are less likely to smoke and they tend to eat a healthier diet. We also think that healthy behaviours, in turn, promote wellbeing.
If we can improve wellbeing, we stand to gain on a wide range of health, social and economic fronts. What does that translate into in policy terms? What can people do to improve their wellbeing at the different points in their lives and the places they’re in – at school, at work, at home? These questions are at the heart of our research effort. For some, there may be a lot to learn from the steps and tools others use to manage stress and low mood and to keep positive. For example, the five ways to wellbeing are a set of actions (connect, be active, take notice, keep learning and give) that can promote wellbeing. PHE is involved in a pilot on this with social marketing in Cheshire and Merseyside.
But the job of improving wellbeing is not just one for individuals. Communities, employers, schools, local and national government – all can do their bit. This week, PHE is signing up to the Time to Change campaign and the Government’s Public Health Responsibility Deal on mental health, wellbeing and resilience in the workplace. These are important landmarks in promoting wellbeing and improving the lives of people living with mental illness. They are public demonstrations of our commitment to remove the stigma from mental illness and to create a work environment that supports the mental wellbeing of our employees.
Stigma and discrimination are like a double whammy: hitting people when they are down, with potentially devastating impact on their health and their chances of recovery. We’re getting better, as a society, at protesting against overt signs of stigma: witness the twitter storm the other week at the sale of Halloween costumes. But we also need to highlight the more insidious ways in which stigma of mental illness can harm – especially the more disadvantaged communities. A recent report described how the system was letting down people with serious mental illness by not focusing enough on their physical health: compared with the general population, they are far more likely to smoke, have higher risks of diabetes and hypertension and may not get the physical checks and support they need.
At PHE, we can help by raising our voice against stigma and discrimination and championing the wellbeing agenda. We can also help by being the best employers we can be. The Responsibility Deal supports that with tools to improve mental health in the workplace. And finally, we’re helping to develop the evidence base of what we know works in promoting wellbeing. There is existing evidence, and there are many projects and pilots – ranging from school-based programmes on anti-bullying to community-based exercise for older people. We want to make sure the evidence and examples of best practice get out to all those stakeholders who can use them.