British Journal of Nursing - Wellbeing and mental health: applying All Our Health

In the article ‘The lady with the lamp or the lady with the pie chart?’ published in this journal in January (Waterall, 2020)

I proposed that health and care systems across the world remain preoccupied with treating, rather than preventing, avoidable ill health, death and health inequalities—and this needed to urgently change.

As we celebrate the World Health Organization's Year of the Nurse and Midwife and the bicentenary of the birth of the founder of modern nursing, Florence Nightingale, our profession has an opportunity to reflect both on our past achievements and, most importantly, on our future direction. As the largest health and care professional workforce across the globe, we are ideally positioned to lead a fundamental shift in the way that systems focus on preventing, protecting and promoting the public's health.

Throughout 2020, Public Health England (PHE) will be partnering with the British Journal of Nursing to focus on several priority public health topics. This will be achieved by exploring PHE's (2015)All Our Health evidence-based professional framework that outlines critical public health issues of our time and defines key population-, community- and individual-level interventions that health and care professionals can champion and deploy at scale.

Mental health and wellbeing

This month, I want to focus on mental health and wellbeing. Since 1993, the prevalence of common mental health disorders has increased. Nearly one in five adults aged 16-64 years now suffers from at least one mental health disorder such as depression, anxiety, phobias, obsessive compulsive disorders or panic disorders (PHE, 2019a).

This has significant financial implications. The Centre for Mental Health (2010) estimates that poor mental health carries an economic and social cost of £105 billion a year in England. Despite the commonplace nature of mental ill health, problems are often hidden, stigmatisation continues to be widespread, and many people are not receiving support in accessing evidence-based services and interventions.

Mental health problems start early in life; half of these are established by the age of 14 years, rising to 75% by age 24 years (PHE 2019b). Social risk factors such as poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender based), emergency and conflict situations, natural disasters, trauma and low social support all increase the risk for poor mental health and specific disorders. Across the UK, those in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems than those on an average income. Children who have been neglected are more likely to experience mental health problems, including depression, post-traumatic stress disorder and attention deficit and hyperactivity disorder (PHE, 2019b).

In 2017, there were 4451 deaths by suicide in England. Men are three times more likely to die by suicide than women, and it is the leading cause of death in men aged under 50 years and women aged under 35 years. Only 28% of all suicides are in people who have had contact with mental health services in the 12 months prior to death, and those who are bereaved are themselves at increased risk (PHE, 2019b).

‘People with severe mental illness, such as schizophrenia, have a life expectancy up to 20 years less than that of the general population, and the gap is widening’

People with severe mental illness (SMI), such as bipolar disorder or schizophrenia, have a life expectancy up to 20 years less than that of the general population, and the gap is widening. This is mostly due to preventable physical health problems, such as cardiovascular disease. It is estimated that for people with SMI, two in three deaths are due to physical illnesses and could therefore have been prevented (PHE, 2019b).

Adults (aged 15 to 74 years) with a serious mental illness are 1.8 times more likely to have three or more physical health conditions than is the case among the general population, and a young adult (aged 15 to 34 years) with SMI is 5.1 times more likely to have three or more physical health conditions than the general population. Loneliness and lack of social interaction are also risk factors for physical and mental health issues, increasing the risk of premature mortality by 30% (PHE, 2019b).

Action framework

The PHE's All Our Health framework identifies several actions that health and care professionals can employ, whether you are working directly with the public, as a manager, or working in a strategic or operational leadership role across the health and care system. The activities are listed in Table 1.

The PHE's All Our Health resources (https://tinyurl.com/aoh-resources) are a quick and simple way for nurses and midwives to recap or build on their knowledge about priority public health issues and find out about how they might embed prevention in their everyday practice.

Box 1.All Our Health mental health and wellbeing interventions for health and care professionals
Use the making every contact count resource, and take every opportunity to have brief conversations with people about making positive changes

Front-line health and care professionals	Team leaders or managers	Senior or strategic leaders
Use the making every contact count resource, and take every opportunity to have brief conversations with people about making positive changes Incorporate psychological aspects of care within all care pathways Identify risk factors and symptoms of mental health problems Signpost and refer appropriately Identify risk factors and indicators for potential self-harm and suicide, and support individuals who may present with suicidal thoughts, and refer appropriately Guide individuals with existing mental health problems through health promotion advice—and support them to access services to improve their physical health and wellbeing, such as screening and NHS health checks Use basic coaching techniques to support an individual who may be experiencing mental distress	Identify staff learning and development needs in relation to mental health and wellbeing—and provide access to appropriate training Build prevention and mental health promotion into day-to-day work Work collaboratively with colleagues and other teams to raise awareness of mental health issues and reduce the stigma associated with mental illness Provide and promote healthier lifestyle choices within mental health settings, including healthier food options, access to physical activities, and support to reduce and stop smoking Work with other local services to meet people's social needs, for example housing, employment and welfare Provide a psychologically safe environment for patients, visitors and staff and promote mental health in the workplace	Understand the mental health needs of your local population using Public Health England's better mental health: joint strategic needs assessments toolkit (PHE, 2019c) Sign up to the prevention concordat for better mental health. This is part of a wider drive to secure an increase in the implementation of public mental health approaches across the whole system (PHE, 2020) Develop integrated systems to identify and support people with long-term conditions who may experience mental health problems and to reduce the premature mortality of people with mental illness Work with community members, patient groups and other stakeholders to support collaborative action on improving mental health and wellbeing, and reducing the stigma associated with mental illness, including co-production and community approaches

I would encourage every nursing and midwifery colleague to start considering what additional actions they could be taking to address the significant burden that mental health disorders are increasingly placing on our society today. Further information on data sources, guidelines and additional training resources can be accessed by visiting our Wellbeing and Mental Health: Applying All Our Health online resource (PHE, 2019b).

Imagine the potential of every nurse and midwife committing to focus more on priority public health issues. By working together, we can be a positive force for change in improving the lives of all, but our focus must also be on addressing the unacceptable health inequalities that persist for many groups.