Public health

Fighting for improved public health services for people with experience of mental distress

What do we mean by public health?

Public health services aim to prevent ill health. Public health services may help people to exercise more, to manage stress, to stop smoking, to eat more healthily and any other activities to improve health and wellbeing.

How are public health services in England changing?

In November 2010 the Government proposed a reform of public health services in the England, in the White Paper Healthy Lives, Healthy People. The Government emphasises preventing mental health problems in the strategy.

Organisations and individuals were invited to provide feedback to the Government on the proposed changes by 31 March 2011. Mind asked you to give us your feedback on the strategy, so that we could represent the opinions of people with experience of mental health problems and make sure mental health services get fair consideration in the public health reforms. We'll post our response to the public health consultation here in mid-April 2011.

How does the consultation process work?

The proposed new strategy has been split into three areas for consultation. Mind is feeding back to the Government on each of these issues separately.

The three consultations look at: how to ensure people receive services based on what works and what is effective; how services can be funded and controlled by local areas; and how to measure whether the services are working as they should be.

An overview of the proposed changes

The Government will pass responsibility for public health from the NHS to local authorities. They are creating a new body within the Department of Health, Public Health England, with a £4 billion budget. Most of this will go to local councils who will decide what public health services to commission in their area. The money will be ring-fenced so councils cannot spend it on anything else. The remainder of the money will be used for commissioning public health services that the Government have decided on nationally, such as their plan to recruit an extra 4,200 health visitors by 2015.

Local authorities are expected to contract to a wider range of providers and new partners. Businesses are expected to work with government to influence healthy behaviours (for example, positioning fruit near the check-out at supermarkets in more disadvantaged areas was found to increase the number of purchases).

The Government has also listed a number of outcomes. These will be used to assess whether councils are delivering high quality and effective public health services. Councils who improve quickly on the outcomes are likely to get more money, especially if they have affected the outcomes of more vulnerable groups who tend to have poorer health and live shorter lives.

How will the Government measure the effectiveness of public health services?

There are five main areas of outcome:

Protect the population’s health from major emergencies and ensuring they remain resilient to harm (such as through cleaner air and population-wide vaccination)
Tackling factors which affect health and well-being (such as housing)
Helping people to live healthy lifestyles and make healthy choices (such as reducing smoking and increasing physical activity)
Reducing the number of people living with preventable ill health (such as identifying HIV earlier on)
Preventing people from dying prematurely (such as reducing suicide and cancer rates)

Domain 1: protect the population’s health from major emergencies and ensuring they remain resilient to harm
There are no mental health-specific indicators in this domain. Do you think there should be a mental health-specific indicator and what would it be? Indicators include:

Life years lost from air pollution
How much of the population is covered by vaccinations
How many people complete the treatment plan for Tuberculosis
How many public sector organisations have an approved sustainable development plan

Domain 2: Tackling factors which affect health and wellbeing.
Indicators include:

Proportion of people with mental illness and or disability in settled accommodation
Proportion of people with mental illness and or disability in employment
The number of people using green spaces for personal health and exercise – there is strong evidence to suggest that green spaces have a beneficial impact on mental wellbeing
Social connectedness – Evidence suggest that where individuals have an opportunity to discuss health issues in social groups they are less likely to make poor decisions about their own health
Proportion of people in long-term unemployment (work is considered to have a positive impact on mental health and wellbeing)
Employment of people with long-term conditions
The number of ‘statutory homeless households’ – these households contain some of the most vulnerable members of society. Data collected by the Department for Communities and Local Government
Housing overcrowding rates

Domain 3: Helping people to live healthy lifestyles and make healthy choices.
Indicators include:

Self reported wellbeing
Rate of hospital admissions per 100,000 for alcohol related harm.
Percentage of adults meeting the recommended guidelines on physical activity (5x30 minutes per week)
Number leaving drug treatment free of drug dependence
Under 18 conception rate

Domain 4: Lowering the number of people living with preventable ill health.
Indicators include:

Rate of hospital admissions as a result of self harm
Work sickness rate – measured by number of working days lost due to ill health
Smoking rate of people with serious mental distress – people who experience mental distress are much more likely to smoke and die younger. Almost half of total tobacco consumption and smoking-related deaths occur in people who experience mental distress
Emergency readmissions to hospitals within 28 days of discharge

Domain 5: Preventing people from dying prematurely.
Indicators include:

Suicide rate
Mortality rate of people with mental illness
Mortality rate from Chronic Liver Disease in persons less than 75 years of age – liver disease associated with alcohol consumption

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