Publication Date05 December 2019
Date05 December 2019
AuthorWoody Caan
SubjectHealth & social care,Mental health,Public mental health
Woody Caan
This month I seem to have had the same conversation again and again, with different people:
how can public health evidence influence policy-makers? Each time, different colleagues gave
differing answers, and few were hopeful that, for example, the US President or the UK Prime
Minister responds to any such evidence. As I compose this editorial, the UK Conservative Party
is choosing its new leader, who then becomes the next Prime Minister. The outcome of postal
voting from that limited electorate has been the selection of Mr Boris Johnson. I am just waiting to
see what a Johnson Government might do for Mental Health policy (Simple Politics, 2019).
Johnson has a long history of both print and broadcast journalism. A week before his election, he
wrote explicitly about population mental health ( Johnson, 2019), mainly a common mental
illness: depression. Johnsons proposal to improve mental health is based on neither
epidemiology nor experiment, but on a single, deceased, case from History, Winston Churchill.
It was with work that he pitchforked off his depression; and what was true for Churchill is
basically true for all of us. The policy of our new Prime Minister is to offer tax cuts to employers
who offer counsellingto depressed employees. He asserts that we can chase away those
Black Dogs, boost the economy and save money, all at once( Johnson, 2019).
There are many flaw s in that policy, for ex ample, just 43% of p eople with mental h ealth
problems are in emp loymentand half of all mental healt h problems have been establish ed by
the age of 14(Mental Health Taskforce to the NHS in England, 2016). Tax breaks might
interest large, Private sector employers but many people with mental health problems are
self-employed or work in the Public or Community sectors. Depression (in Johnsons
language, that Black Dog) is a global problem that needs a high priority for policy-makers
(Caan, 2015). Adults with depression who are in employment often benefit from psychological
treatments (Caan et al., 2006) but if they are pushed back into full-timework too quickly,
their depression tends to re-emerge. However, the most serious flaw in our Prime Ministers
thinking that the cure is work(Johnson, 2019) is that it promotes victim-blaming by
employers, services and governments: someone who continues to affected by depression
must be lazy, irres ponsible or subve rsively obstina te.
At the population level, depression is a major risk factor for suicide. In the USA, suicides among
young people aged 15 to 19 years have risen alarmingly (Mahase, 2019). The same age group in
the UK has shown a similar rise (7.9 per cent annual increase in suicides, during 2010 to 2017,
Bould et al., 2019). As noted above, depression often begins during teenage, and this weeks
Channel 4 television schedule is showing a programme on Young, British and Depressedthat
promises to explore this crisis. There are many determinants of depressive symptoms in
adolescence, but new work from Canada (Boers et al., 2019) suggests that the increasing
engagement with social media seen in many countries has a dose-related effect, increasing the
number of such symptoms. Here in Cambridgeshire, emergency services such as the police and
ambulance are stretched to their limits by people with urgent, unmet mental health needs
(especially young people). Our mental health trust has created a First Response Service (NHS
England, 2019) to provide community-based support in a crisis, and this is already reducing use
of: the emergency department, acute hospital beds, ambulance call-outs and out-of-hours
general practice doctors. However, increasing professional mental health support, by itself, can
never prevent the rising incidence of depression. The advice of the United Nations to
Governments about population mental health is clear:
they need to reduce inequality, poverty and social isolation (Arie, 2019).
Reducing violence and all forms of abusive relationship is the aim of a new Commission hosted
by Lancet Psychiatry (Oram et al., 2019). In London, fatal stabbings give rise to more and more
headlines, and it is refreshing to see prevention with a public health model in the Save London
DOI 10.1108/JPMH-12-2019-087 VOL. 18 NO. 4 2019, pp. 209-210, © Emerald Publishing Limited, ISSN 1746-5729
PAG E 209

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