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'As nurses, we are well-placed to lead in mental health promotion and prevention'

Seamus Watson
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The growing emphasis on the promotion of mental health, the prevention of ill-health and improving the lives of people living with mental health difficulties is long-awaited and welcomed.

As nurses, we are used to talking about services for people who are already experiencing mental health problems, but rarely speak up about the promotion of mental health and the prevention of ill-health.

The opportunity to take on this new challenge has arrived. As nurses, we are well-placed to lead this change.

On 7 January, the NHS Long Term Plan was published, setting out the aspirations for the NHS over the next 10 years. The plan reminded us that England lags behind other countries on many key health outcomes – improvements in life expectancy are no longer progressing and health inequalities are widening.

”There are now far more conversations taking place about the fact that many of our lives will, at some point, be touched by mental health problems”

To address this, the plan aspires to move away from a way of working that is just focused on diagnosing and treating physical and mental illness, and towards one that is based on promoting health and preventing ill-health.

There are now far more conversations taking place about the fact that many of our lives will, at some point, be touched by mental health problems.

Compared with the other major health challenges which affect communities – for example cancer and diabetes – we have not yet successfully made the case that mental health deserves an equivalent emphasis on promotion and prevention.

It may be that we are so busy responding to the needs of people who are already experiencing mental health problems or that we don’t have a history of advocating for promotion and prevention in our field of expertise. However, we do have a position of respect within communities and a long history of trying to improve things which places us well to take on this exciting new advocacy.

The evidence and knowledge already exists that would form the foundations for our argument. We know about the importance of social and economic circumstances in nurturing the mental health of individuals, families and communities.

We know about the wider determinants that impact greatly on mental health including housing, education, finance and social integration.

The evidence reminds us of the importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into childhood and adolescence, during adulthood and through to older age.

Action throughout these life stages improves the opportunities for both promoting and preventing mental ill-health.

We know that there are additional recommended principles and approaches to addressing the promotion of mental health, the prevention of ill-health and improving the lives of people living with mental health problems:

  • Universal health coverage: Regardless of age, sex, socioeconomic status, race, ethnicity or sexual orientation, and following the principle of equity, people with mental health difficulty should be able to access – without the risk of impoverishing themselves – essential health and social services that enable them to achieve recovery and the highest attainable standard of health;
  • Human rights: Mental health strategies, actions and interventions have to be compliant with human rights and disability standards;
  • Evidence-based practice: Mental health strategies and interventions for treatment, prevention and promotion have to be based on knowledge and evidence;
  • Partnership approaches: Reminding us that a comprehensive and coordinated response for mental health needs partnership across many organisations such as health, education, voluntary sector, employment, justice and housing;
  • Empowerment of people with mental health problems: Although we have been making some progress in this area, we have to continue our efforts to empower and involve with people with mental health difficulty in health advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation.

I believe we do not want to be a profession that waits for people to become unwell before we take interest.

We have our knowledge of mental health, our history of delivering major change and are living at a time when promotion and prevention are seen as important parts of our 10-year plan.

We now need to co-ordinate our efforts to take on this challenge and to talk equally about prevention and promotion when we are having conversations about mental health.

Seamus Watson is improvement director, NHS Improvement

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