Editorial
| Published date | 01 December 2004 |
| DOI | https://doi.org/10.1108/17465729200400021 |
| Date | 01 December 2004 |
| Pages | 2-5 |
| Author | Lynne Friedli |
| Subject Matter | Health & social care |
journal of mental health promotion •volume 3•issue 4 •december 2004 © Pavilion Publishing (Brighton) Ltd
Editorial
It is perhaps no surprise that the English public health
white paper Choosing Health (Department of Health,
2004) has been largely welcomed by mental health
colleagues in both the statutory and voluntary sector.
We are used to feasting on crumbs.
No doubt public mental health will make the best
of the opportunities the white paper presents. Notable
among these is the reinforcement of standard one of
the national service framework for mental health. This
provides welcome continuity of support for local
mental health promotion strategies. Elsewhere, there
are explicit and implicit references to mental health and
well-being. Improving mental health is one of the six
overarching priorities, and includes a specific
recognition of the relationship between mental well-
being, physical health and health behaviours – or
choices, as these are now referred to. Other areas with a
strong focus on mental health include supportfor
parents, workin schools and with young people,
including looked-after children, and a range of
measures to improve employment practice, particularly
within the NHS. For people with existing mental
health problems, there is a restatement of the
importance of attention to physical health needs and
measures to strengthen social inclusion and compliance
with the Disability Discrimination Act.
Inevitably, there are concerns about resources – the
tiny percentage of the NHS budget currently allocated to
mental health promotion, and the limited capacity
within NHS organisations: for example, less than 30%
of London PCTs have either a consultant or senior
specialist dealing with public mental health. The detail of
the delivery plan, to be published in the spring of 2005,
will be crucial. It is unlikely that mental health
promotion will make much progress in the absence of
clear targets and a performance management framework
–including mental health in the annual performance
ratings of PCTs, for example.
So there are caveats amid the plaudits. But these are
largely the standardand routine responses of any health
specialism; we inevitably consider the relative importance
of our own field to be neglected and, in the case of
mental health, thereis a long historyof such neglect.
What is more worrying is the failure to engage with the
values and beliefs about health that this white paper
represents, and to ask whether these values and beliefs are
consistent with achieving mental health and well-being.
Choosing Health begins, like its predecessors The
Health of the Nation (Department of Health, 1992) and
Our Healthier Nation (Department of Health, 1999), by
celebrating England’s proud history of improving health
–notably,increases in life expectancy. What it doesn’t
address is a central contradiction: that improved socio-
economic conditions and better physical health have not
been matched by improvements in mental health. This is
about more than diagnosis: we don’t feel better and both
clinical and non-clinical populations appear to be
exhibiting a number of symptoms of emotional distress
and dysfunction. On a whole range of indicators – levels
of trust, fear of crime, anti-social behaviour, conduct
disorders, substance abuse, prevalence of depression and
anxiety,prescription of psychotropic medication, equity
and civic engagement – the evidence suggests a decline
in well-being, as Marks and Shah argue in this issue.
Ifimproved physical health is not matched by
improved mental health – on the contrary, has been
accompanied byadecline in mental well-being – we may
have lost sight of what health actually means. The chief
nursing officer’splan to launch a campaign (supported,
to their shame, by the Royal College of Nursing) to
tackle smoking among nurses certainly suggests that
we’ve lost sight of what health care means. When the
health behaviour of nurses is of greater note than their
attitude to patients, it’s time to admit defeat. What next
for public health role models? Overweight applicants will
not be considered and public consumption of chips or
alcohol becomes a disciplinary offence?
But even the physical health statistics arenot
unproblematic. Absolute mortality rates have fallen for
all social groups since the 1950s, but the gap between
people living in different areas has widened, and
healthy life expectancy has not improved (Bajekal et al,
2002). InScotland, the gap between years of healthy
life for the poorest and richest classes is 11 years for
women and 17 years for men (Clark et al,2004). The
figures for England aresimilar. Inareas with the lowest
2
Lynne Friedli
Editor
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