King's College London

This week (27 September 2023) the Centre for Mental Health published their ‘A Mentally Healthier Nation’ report in partnership with 30 charities and not-for-profit organisations working in the mental health space.

The themes covered in the report and its policy proposals align with the work of the ESRC Centre for Society and Mental Health which has put forward a response to the report, outlining some of the research that is bringing evidence to support the recommendations and their implementation.

Overall, the report calls for a firm policy response to enable people to live their lives with better mental health. It calls for a ‘mental health in all policies’ approach, to embed a new way of making decisions that will benefit all. We support this approach and our Co-director Hanna Kienzler has written a commentary on the concept and its use in context of conflict.   

By placing this responsibility on governments it acknowledges that the mental health of individuals – particularly those from vulnerable and marginalised groups – is strongly influenced by socio-economic contexts and the social systems and structures that people must navigate to try to meet their needs.

Equality - health gaps between different groups will be closed

'A Mentally Healthier Nation’ calls for the health gaps between different groups to be closed and sustained action to boost race equality throughout mental health services. The TIDES study, led by ESRC Centre for Society and Mental Health co-investigator Professor Stephani Hatch, investigates how discrimination experienced by both patients and healthcare practitioners may generate and perpetuate inequalities in health and health service use. This has included research on racial and ethnic differences in accessing NHS talking therapies, and on how harassment and discrimination affects NHS staff.

The ESRC Centre for Society and Mental Health's work in this area is also aligned with Patient and Carers Race Equalities Framework (PCREF) and will provide insight to inform its implementation. Our ongoing CONNECT study, working in partnership with community organisations, seeks to investigate how to reduce inequities experienced by Black and other minoritised groups.

The report states that the injustices in how people with severe mental illness are treated must be addressed. Our SEP-MD project is analysing and linking data on mental health with census data to better understand relationships between mental health, employment, ethnicity, and overlapping forms of disadvantage. This project has shown that the pandemic exacerbated excess mortality in people with mental disorders and learning disabilities. Through the 'At the Edge of Care' review we have also produced research in partnership with parents with mental illness to identify the challenges they face in the social care system.

As part of its recommendations on equality 'A Mentally Healthy Nation' also calls for the end of ‘hostile environment’ policies. A study by Zara Asif and our Centre Co-director Professor Hanna Kienzler highlighted the role of discriminatory policies, racism, and exclusion in perpetuating health inequalities among refugees, asylum seekers and undocumented migrants. Ultimately, significant reform is needed to ensure that migrants in need of care are provided with accessible, meaningful and culturally sensitive healthcare and social support.

Prevention - More people will enjoy good mental health

The report calls for a reduction in child poverty and the introduction of a Minimum Income Guarantee. Working in partnership with young people and based on longitudinal research on the mental distress of young people by Dr Gemma Knowles and our Centre Co-director Professor Craig Morgan the REACH (Resilience, Ethnicity & AdolesCent Mental Health) study  produced a 6 Point Plan to help young people thrive post-pandemic. This recommended improving support and security for families on low incomes and conducting a national debate on the implementation of a guaranteed income scheme. More broadly, it echoed the report in calling for a ‘change of narrative’ and recognition that mental health problems disproportionately affect the most vulnerable and marginalised people.

The ESRC Centre for Society and Mental Health's report on the Cost of Living Crisis and mental health made similar points, recommending an increase to welfare benefits alongside the provision of services to support and advise people facing sanctions or changes in benefit entitlements to mitigate distress and to prevent them falling into debt.

'A Mentally Healthier Nation' calls for improvements to the physical environment and the reduction of air pollution and cites a study by one of our researchers Dr Rachel Latham, which indicates a potential role for childhood ambient air pollution exposure in the development of adolescent Major Depressive Disorder. The ESRC Centre for Society and Mental Health recognises the role of environmental determinants in mental health and ill-health and would welcome action to improve air quality.

Support - Everyone will have timely, local access to the services they need

The 'A Mentally Healthier Nation' report recommended that the social security system should be reformed to ensure it treats people with mental health difficulties fairly, and that the Work Capability Assessment (WCA) and its equivalent for Personal Independence Payment should be replaced with a fairer system of assessment for disability benefits.

Recent research from one of our researchers Dr Annie Irvine found that the WCA fails to acknowledge the ways in which mental distress arises from and is inextricably linked with this wider range of circumstances in a person’s life, and recommended that any future capability assessment should ideally look at wider set of socioeconomic and structural barriers and challenges.

The report also calls for the modernisation of the Mental Health Act, backed by investment in the mental health estate. Our Lived Experience Advisory board (LEAB) provided a written submission to the Joint Parliamentary Committee on the Draft Mental Health Bill last year, which similarly argued for modernised mental healthcare rooted in the principles of respect, equality, and accessibility. Any changes should acknowledge the intrinsic social nature of many factors leading to and maintaining poor mental health, and the inequalities experienced by different social groups. The LEAB also felt that any legislative changes should be followed up with investment at all levels of the system.

Working in partnership

The report highlights the importance of working in partnership with people with lived experience and affected communities in developing the policy recommendations and to create an equal partnership as the norm in the design, development and delivery of services.

Partnership working is woven throughout all of the work at the ESRC Centre for Society and Mental Health. This includes overarching input from the Lived Experience Advisory Board and the development of resources to enable peer research. In this way we hope to help ensure that the evidence on which policies are produced and evaluated is done in partnership with those who are impacted by these policies and services.

At the ESRC Centre for Society and Mental Health we support the campaign for these policies to be adopted as part of a 10-year, cross-government mental health strategy leading up to the general election. The recommendations contained within the report align with the research carried out by our Centre and our academic and community partners. Urgent action must be taken to deal with the wider determinants of mental health.