Mental Health First Aid: addressing mental health as a public health priority.

Abstract

Would you know how to help a friend in the midst of a panic attack? Do you believe your manager has the skills to recognise when positive stress tips over into detrimental anxiety and offer appropriate support? Crucially, would you know how to help yourself or where to go for support if your mental health started taking a turn for the worse?Mental health is fast becoming a hotbutton issue in our ever-busier, fastpaced lives, particularly in major cities such as London, where there is often a propensity for a long-hours culture. However, evidence suggests that mental health is still the poor cousin to physical health, both in terms of society's awareness around what constitutes good and bad mental health and the level of public spending allocated to the issue. When Deputy Prime Minister Nick Clegg called for waiting time standards to be applied to mental health services,1 he further cemented the argument for parity of esteem. And yet, with a Freedom of Information request by the BBC revealing real term funding cuts in mental health care of 2.36% from 2012 to 20142 and a recent report by mental health charity Mind highlighting that local authorities in England spend only 1.36% of their public health budget on mental health,3 the inequalities are stark.UNDERSTANDING THE CURRENT ISSUESThe disparity between public health spending on preventing physical health problems (over £1 billion combined) and that dedicated to mental health (£40 million) is huge, despite the overwhelming evidence that the two are inextricably linked.4 But if we truly want to empower individuals to make healthy choices in their lives, addressing their mental health needs is paramount - precisely because the links between poor mental health and poor physical health have been repeatedly proven.People with poor mental health are two to four times more likely to die prematurely, and complex, long-term health issues such as substance and/or alcohol misuse or smoking are more frequently found in people with mental ill health.5 The Royal College of Psychiatrists found that depression, for example, doubles the risk of developing coronary heart disease, and that 'people with a mental disorder smoke almost half of all tobacco consumed and account for almost half of all smoking-related deaths'.6 Many people with mental ill health who are undiagnosed and unaware of their mental health problems may self-medicate with drugs and/or alcohol, which in turn exacerbates their mental health problems.7The impact of these mental health problems on London - and England on the whole - is undeniable. An average of 579 people take their lives in the capital each year; yet, this figure is the tip of the iceberg, with a further 4.2% of Londoners (almost 300,000) having contemplated suicide in the past year.5 These figures are alarming, especially in light of the latest suicide statistics showing an increase in deaths in line with the economic downturn.8 At the less extreme end of the spectrum, the impact is felt, too: nearly half of Londoners are anxious, and almost one-third report low levels of happiness, with life satisfaction lagging behind the national average.5 The Greater London Authority estimates the total cost of mental health to London at £26 billion each year, and £70 billion across the United Kingdom which equates to 4.5% of the country's gross domestic product.9 These figures do not even begin to take into account the links between complex public health issues such as sexual health, smoking or obesity with mental health, although these are well established.6,10,11 If a high proportion of people affected by these physical health concerns have underlying and unaddressed mental health issues, it is questionable how much traction government funded educational campaigns targeting these concerns would achieve.With a clear gap between the need for better mental health services and current funding, there is a strong argument for increasing the focus on prevention and early intervention work. …