MQ’s response to the 10-Year Health Plan

What does MQ want to see included in the 10-Year Health Plan and why?

Almost 23% of the total burden of disease in the UK is attributable to mental disorders, compared to 16.2% for cardiovascular disease and 15.9% for cancer. For this reason, it is vital that improving mental health is a priority for the 10-Year Health Plan.

We have identified four priorities we would like to see incorporated into the 10-Year Health Plan for England. These are evidence-based and will help to create a whole-person, mind-body-brain approach to healthcare.

 These are:

• Reduce the risk factors to improve prevention of mental illnesses;
• Reduce silos between services, including early intervention services;
• Make embedding research within the NHS a central component of the 10-Year Health Plan;
• Make routinely collected data accessible for research.

Reducing the risk factors

By improving people’s economic, social and environmental circumstances, we can reduce mental and physical illnesses in the future.

There are significant drivers of mental illness which must be addressed:

Poverty

Poverty is more than just an economic issue. It is a pressing public health problem with far-reaching societal impact. It can be both a cause, and a consequence, of mental illness.

In 2023, MQ published the Cost-Of-Living Report which reviewed the existing evidence about time impact of poverty and past economic crises on mental health.

The report found that rates of poverty in the UK is high, with around a fifth of people in the UK classed as living in poverty. This cohort is more than twice as likely to develop a mental health problem than those on an average income.

The prevalence of psychotic disorders among the lowest fifth of household income is 9 times higher than in the highest, and double the level of common mental health problems between the same groups.

As well as a cause of mental illnesses and distress, poverty can also be a consequence of mental health problems. Having a mental health condition, while not an excuse, can be a reason why it’s harder to manage money than for others. Many with mental illness report that spending patterns and financial decisions change notably during periods of poor mental health. In fact, a survey found 93% of those who took part spent more when mentally unwell and 92% found it harder to make decisions related to money.

Discrimination

Racism, sexism, ableism and other forms of discrimination can be overt or implicit. They can include reduced access to opportunities or even spaces, micro-aggressions and outright verbal or physical abuse.

Discrimination in all its forms can be detrimental to mental health. In a paper published by MQ Science Council member Professor Kam Bhui and GALENOS Director Andrea Cipriani, it was found that not only were people from Black and other minority ethnic groups experiencing significant mental health inequalities, but that these were exacerbated by the COVID-19 pandemic.

Poverty and discrimination are intrinsically entwined. Households which are classed as living in poverty are more likely to include someone living with a disability, to have 3 or more children, to be social renters and to include someone from a Bangladeshi, Pakistani or from the Black community.

Pollution

A 25-year study of young adults living in the United Kingdom has found higher rates of mental illness symptoms among those exposed to greater levels of traffic-related air pollutants, particularly nitrogen oxides, during childhood and adolescence.

Long term exposure to air-pollutants increases the risk of anxiety disorders and depression.

Air pollution isn’t the only environmental concern when it comes to mental health. Access to green spaces has been proven to be beneficial for mental wellbeing, for increasing physical activity and reducing stress.

According to the Lancet, the climate crisis is an unprecedented threat to human health and tackling this must be a long-term aim if we are to properly address the most significant risk factors for both physical and mental illness in the future.

Trauma and Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences, or ACEs, are highly stressful and potentially traumatic events or situations that occur in childhood. There is a strong correlation between ACEs and a range of significant negative outcomes that can impact people for their entire lives.

A national strategy to reduce ACEs and better treat Post-Traumatic Stress Disorders (PTSD) could better prevent the mental health problems too often faced by those who have experienced trauma.

Addressing these risk factors to improve mental health would require a whole-government approach, with different government departments and structures all working together to improve outcomes for people over the long term.

Reducing silos

Investing in more powerful public health infrastructure is also key to preventing illness and promoting better health. Having different government and institutional bodies working collectively, with the ability to cross-share important and relevant information, will ultimately save lives.

Building the workforce

Lack of investment in the NHS has led not just to inadequate services. Poor working conditions and stagnating wages have led to over 10% of nursing roles being left vacant and, even more shockingly, 18% of mental health nursing roles being left unfilled.

Recruiting and training more mental health staff will help to cut waiting lists and increase access to talking therapies and other interventions to stop people from reaching crisis point.

However, it is important that these staff are not left with sole responsibility for patients’ mental health.

Neurodiversity training, how to deliver trauma-informed care and training in signposting to mental health services should be delivered as standard to all frontline healthcare staff.

Better early years support

75% of mental illnesses develop before adulthood, with 50% developing before the age of 14. It is vital that better early years support is provided to ensure future generations can thrive.

The Government has already committed to extra funding for early support hubs in local communities. But this is only for 24 hubs in total across the nation.

Additionally, early intervention services are not restricted to mental health services. Schools, local authorities and community healthcare services all play a role helping children to thrive, and so should be able to work collaboratively to do so.

1 in 5 children will experience bullying at school. MQ research has proven the link between bullying and an increased risk of mental illness in later life. It is important that schools not only have robust anti-bullying programmes, but also that appropriate support is provided to the victims of bullying to help them recover quicker, and lessen the impact on their long-term mental health.

Embedding research in the NHS

Following Lord Darzi’s recent report into the challenges faced by the NHS, it has been made clear that our National Health Service is in a critical condition. This is for multiple and complex reasons, including the aftermath of the pandemic, Long COVID, an ageing population, significant inequalities in health and care, and years of underinvestment.

The government have recognised this and committed to investing an additional £22.6 billion of resource spending. However, without efforts to embed a research culture in the NHS, this investment will not help accelerate better treatments, preventions and care for physical and mental illnesses.

The UK already has a thriving life-sciences industry. In fact, 4 of the top 10 globally-ranked universities for life sciences and medicine are based in the UK.  The value of the life sciences industry to the UK economy has already been recognised by the UK government and was even highlighted by Chancellor Rachel Reeves in the Autumn budget.

Despite this, funding for mental health research remains woefully lagging. According to research from MQ, just £9 per person impacted is spent on mental health research. By comparison, £228 is spent per person impacted on cancer research.

Allocating funding for research studies, clinical trials and technology-driven solutions can facilitate the development of evidence-based practices, improved treatment modalities and innovative interventions. Collaboration between academia, health care providers and industry can accelerate progress in understanding mental health conditions and developing more effective interventions.

According to the NHS themselves, embedding a research culture into the day-to-day activity of the NHS is a net positive:

Making data accessible for research

Everyday health data is collected by a range of institutions. Doctors surgeries, hospitals, schools, local authorities, the criminal justice system and more.

This data, if collated, anonymised and made available for research, could provide valuable insight into population-level health trends, and help experts to identify areas where resources can be targeted to improve peoples’ lives.

This has already been proven to be effective but projects such as the MQ-funded Adolescent Data Platform, which used anonymised data collected in Wales to identify trends in self-harm among school children. This resulted in new guidance being issued to schools throughout Wales, which has helped to reduce the prevalence of self-harming.

There are challenges that prevent the collecting and use of this data. People are rightly protective of their personal data and GPs are often the gatekeepers for accessing anonymised health records.

One reason for this is that many people feel their health data can not only make them vulnerable to discrimination, but that it is inherently valuable, and they do not want to see private investors profit from it.  More education is needed to reassure people that anonymised data cannot be used to discriminate against individuals, and that it can be truly valuable in research. This should be done in conjunction with safeguards to ensure data collection and storage is done safely.

Another challenge is that data is collected in many different formats for many different uses, making the collation of this data from different sources in a manageable way that is useful for researchers, difficult. This is a challenge that was discussed at a recent roundtable event hosted by MQ and Rethink Mental Illness.

Rather than considering health data to be a valuable asset which necessitates its protection by GPs and other gatekeepers, it should be considered a public resource that, when properly anonymised, can be used to improve population wellbeing.

It is vital that mental health is not a secondary consideration when it comes to developing a 10-year health plan for the nation. It is not enough to protect the meagre amount of funding that is already ringfenced for mental health services. We must invest in improving the care, treatments and preventions of mental illnesses. This can only be done though investment in research, in prevention and early intervention, and by working together.