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This guide is part of ‘All Our Health’, a resource which helps health professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help front-line health and care professionals use their trusted relationships with patients, families and communities to improve their mental health and wellbeing.
We also recommend important actions that managers and staff holding strategic roles can take.
View the full range of ‘All Our Health’ topics.
Access the mental health and wellbeing e-learning session
An interactive e-learning version of this topic is now available to use. PHE and Health Education England’s ‘e-Learning for Healthcare’ have developed this content to increase the confidence and skills of health and care professionals, to embed prevention in their day-to-day practice.
Promoting mental health in your professional practice
Mental health problems are common, with 1 in 6 adults reporting a common mental health disorder, such as anxiety, in the last week - 1 and there are close to 551,000 people in England with more severe mental illness (SMI) such as schizophrenia or bipolar disorder2.
Problems are often hidden, stigma is still widespread, and many people are not receiving support to access services.
Together with substance misuse, mental illness accounts for 21.3% of the total burden of disease in England.3 Poor mental health is estimated to carry an economic and social cost of £105 billion a year in England.4
Mental health problems and suicide are preventable. Promoting good mental health will impact on physical health and many other aspects of people’s lives.
Mental health promotion
The World Health Organisation (WHO) defines mental health as ‘a state of wellbeing in which the individual realises his or her abilities, can cope with the normal stresses of life, work productively and fruitfully, and is able to make a contribution to his or her community’.5
Our mental health influences our physical health, as well as our capability to lead a healthy lifestyle and to manage and recover from physical health conditions.6
People with physical health problems, especially long-term conditions, are at increased risk of poor mental health - particularly depression and anxiety.7 Around 30% of people with any long-term physical health condition also have a mental health problem.8 Poor mental health, in turn, exacerbates some long-term conditions, such as chronic pain.9
Preventing mental health problems
Mental health problems start early in life. Half of all mental health problems have been established by the age of 14, rising to 75% by age 24.10
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, increase risk for poor mental health and specific disorders.11
Across the UK, those in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems as those on an average income.12
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.
In 2017 there were 4,451 deaths by suicide in England. Men are 3 times more likely to die by suicide than women, and suicide is the leading cause of death in men under 50 and women under 35.
Only 28% of all suicides are in people who had contact with mental health services in the 12 months prior to death,13 and those who are bereaved are at increased risk themselves. However, many people have had contact with other services.
Improving the physical health of people with mental health problems
People with severe mental illness (SMI) such as bipolar disorder or schizophrenia have a life expectancy up to 20 years less than the general population 14, and the gap is widening.15 This is mostly from preventable physical health problems, such as cardiovascular disease.10 It is estimated that for people with SMI, 2 in 3 deaths are due to physical illnesses and can be prevented.10
An adult (aged 15 to 74) with a serious mental illness is 1.8 times more likely to have 3 or more physical health conditions when compared to the general population, and a young adult (aged 15 to 34) with SMI is 5.1 times more likely to have 3 or more physical health conditions than the general population.16
Loneliness and lack of social interaction are also risk factors for physical and mental health – these factors increase risk of premature mortality by 30%.
Core principles for healthcare professionals
Healthcare professionals can provide advice and support to people of all ages (presenting with any issue) and work to:
- meet the patient’s mental health and wellbeing needs
- help identify those at risk of poor mental health
- prevent mental health problems from developing or worsening
- prevent suicide
When working with patients who have existing mental health problems, they can:
- ensure their physical health needs are met
- support their social needs
Front-line health professionals
Front-line health professionals can:
- use the Make 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 appropriately17
- identify risk factors and indicators for potential self-harm and suicide and support individuals who may present with suicidal thoughts and refer appropriately16
- guide individuals with existing mental health problems through health promotion advice - and support them to access services to improve their physical health and wellbeing (screening, health checks)
- use basic coaching techniques to support an individual who may be experiencing mental distress
Team leaders or managers
Team leaders or managers can:
- 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 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 workplace18
Senior or strategic leaders
Senior or strategic leaders can:
understand the mental health needs of your local population using PHE’s Better mental health: JSNA toolkit
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
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 stigma associated with mental illness, including coproduction and community approaches
Understanding local needs
PHE’s Better mental health: JSNA toolkit links mental health data, policy and knowledge to help planners understand needs within the local population and assess local services.
The Mental Health and Wellbeing JSNA knowledge guide provide an overview of the areas to consider when thinking about the mental health needs in a local area, with a focus on understanding place factors and population groups across the life course.
Preventing mental health problems and suicide and promoting mental health will impact on overall life expectancy and healthy life expectancy.
There are a number of indicators in the Public Health Outcomes Framework related to mental health and wellbeing. These include:
- school readiness
- adults in contact with secondary mental health services - who live in stable and appropriate accommodation, and are in employment
- sickness absence rate
- domestic abuse
- violent crime (including sexual violence)
- statutory homeless
- social isolation
- child development at 2 to 2.5 years
- emotional wellbeing of looked after children
- self-reported wellbeing
- excess mortality in adults with serious mental illness
- suicide rate
- health-related quality of life for older people
The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health and care professionals to record and measure their public health impact in a uniform and comparable way.
The ultimate measure of physical health outcomes for people with mental health problems is an increased life expectancy and healthy life expectancy.
The ‘Improving physical healthcare to reduce premature mortality in people with serious mental illness CQUIN 2017 to 2019’ by NHS England, focuses on improving physical healthcare to reduce premature mortality in people with serious mental illness (PSMI).
The CQUIN was introduced to support NHS England’s commitment to reduce the 20-year premature mortality rate in people with serious mental illness through improved assessment, treatment interventions, and communication between clinicians in primary and secondary care services.
The national Preventing Ill Health by Risky Behaviours – Alcohol and Tobacco CQUIN has the potential to reduce the risk of physical health conditions such as heart disease, as well as reduce future hospital admissions.
Data from the CQUIN’s first year of operation shows some improvements in the proportion of patients with mental health problems, who are being routinely screened and offered support for these health risks but there is wide variation across Mental Health Trusts.
Quality and Outcomes Framework for 2017 to 2018 (QOF) includes several indicators relating to the physical health of people on the primary care register, for people with serious mental illness (patients with schizophrenia, bipolar affective disorder and other psychoses).
These indicators help to identify, for example:
- people with SMI who have a comprehensive care plan documented in their record in the preceding 12 months
- people with SMI who have a record of blood pressure in the preceding 12 months
- percentage of patients with SMI who have a record of alcohol consumption in the preceding 12 months
- females aged 25 to 64 years with SMI, whose notes record that a cervical screening test has been performed in the preceding 5 years
Physical health screening and monitoring is no longer the sole responsibility of physical healthcare professionals, such as GPs and practice nurses in primary care services. Every health and care professional has a role to look after the whole person. This integrated approach is supported by bringing together physical and mental health.
Further reading, resources and good practice
There are several programmes and campaigns that offer advice for patients and the public.
Rise Above is a social marketing programme which aims to equip 11 to 16-year-olds with the skills they need to withstand social pressures and build their resilience.
One You is a nationwide programme that supports adults in making simple changes that can have a huge influence on their health, such as through eating well, moving more, drinking less and quitting smoking.
Every Mind Matters is a national campaign and digital platform which launched in October 2019 with the aim of equipping people to take simple, early steps to look after their mental health, improve their mental wellbeing and support others.
NHS.UK is the UK’s biggest health information service which provides advice, tips and tools to help you make the best choices about your health and wellbeing.
Equally Well UK is an initiative which seeks to promote - and support - collaborative action to improve physical health among people with a mental illness.
MindEd is a free educational resource on children and young people’s mental health, that is aimed at parents, carers and anyone who volunteers or works with young people.
Professional resources and tools
The Public mental health collection provides a range of PHE resources to support national and local organisations to improve the public’s mental health.
The Health matters: reducing inequalities in mental illness outlines actions that local areas can take to reduce health inequalities experienced by people living with mental illness.
Suicide prevention resources and guidance provides help for local authorities, public health and care professionals, police forces, and others to prevent suicides in their areas.
Prevention concordat for better mental health provides resources to help local areas with prevention planning arrangements.
The Public mental health leadership and workforce framework can inform and influence the development of public health leadership and the workforce in relation to mental health.
Online tools intelligence and data provide up to date data and information about local mental health outcomes, risk factors and needs, as well as assets.
What Works Centre for Wellbeing collaborates with PHE and provides evidence, guidance and discussion papers on numerous topics.
Mental Health for Employers is a series of joint PHE and Business in the Community toolkits, that provide free, online to help every organisation support the mental health and wellbeing of its employees
The ‘Improving the mental health of children and young people’ reports support local commissioners that describe the importance of children and young people’s mental health and wellbeing, the case for investing and evidence of what works to improve local services.
Suicide Prevention case studies and information sheets National Suicide Prevention Alliance website.
NHS England’s House of Care includes emotional and psychological support, in particular, the mental health and wellbeing of people with ‘physical’ health problems.
The Mental Health Core Skills Education and Training Framework is for staff who need general mental health awareness or have contact with people experiencing a mental health problem.
Training and information for practice and community nurses in mental health and wellbeing is provided by the Charlie Waller Memorial Trust.
Psychological support of people living with cancer was commissioned by London strategic clinical networks.
Five Ways to Wellbeing is a solution-focussed framework for working with individuals to take steps to improve their mental wellbeing.
Mental health awareness eLearning short programme aims to raise the awareness of mental health amongst health care staff.
Physical healthcare for people with mental health problems is evidence-based information to help mental health nurses improve the physical health and wellbeing of people living with mental health problems.
Breaking Down the Barriers aims to support the NHS workforce by providing awareness training materials to enhance existing skills, knowledge for early recognition, assessment, management and signposting of mental and physical health needs of patients.
NHS England has produced a practical toolkit for mental health trusts and commissioners, designed to help them improve the physical health of patients with serious mental illness. The toolkit looks at different approaches to implementing the Lester screening tool.
Good practice examples
Smoke-free implementation in the Sheffield NHS trust: Sheffield Health and Social Care NHS Foundation Trust is reducing harm from tobacco to service users and staff, addressing complex implementation challenges.
Implementing ‘Preventing ill health by risky behaviours’. This commissioning for quality and innovation (CQUIN) allows South London and Maudsley NHS Foundation Trust to refocus on alcohol screening and interventions.
Improving Physical Health for people experiencing Serious Mental Illness (SMI) – Bradford. The physical health template was developed by Primary and Secondary Care with academic and data quality support. It provides a systematic way to record all necessary cardiometabolic metrics as well as a host of other information relating to screening. It could be seen as the practical way to deliver the Lester tool, which has been incorporated into the template with the help of NHSIQ.
World Health Organization. Strengthening mental health promotion. Geneva: WHO; 2001. ↩
Naylor C, Parsonage M, McDaid D and others. (2012) Long term conditions and mental health – the cost of co-morbidities. Accessed 20 July 2018. ↩
Chesney E and others. ‘Risks of all-cause and suicide mortality in mental disorders: a meta-review’ World Psychiatry 2014: volume 13, issue 2, pages 153 to 160 ↩
HEE/ Skills for Health. Mental health core skills and knowledge framework. 2016. ↩