People increasingly understand the importance of good mental health. But the incentives for improving the mental wellbeing of the nation are not just related to health. There is a monumental economic imperative there, too. Some £105bn is lost each year to mental ill health, much of which comes from a depletion of productivity.
Duncan Selbie, chief executive of Public Health England, believes local government has a unique role to play in improving mental wellbeing – and thus unlocking billions – through co-ordinating targeted, preventative investments across the public sector.
In an interview with The MJ, Mr Selbie explains that while the focus on mental health is often associated with the likes of schizophrenia and bipolar disorder, there are many conditions that local authorities and their partners can prevent.
‘What is affecting people’s regular health at home and in the workplace?’ he says. ‘I am talking about relationships at home, childcare issues, stress or just having a boss who is not easy to be with. That can lead to a great deal of ill health and absence from work.
‘The singular most important thing to do to improve wellbeing for people is to get them in work. When in work, pay attention to health and, within that, mental health.’
Public Health England has released a tool that helps local public health teams identify the most cost-effective mental health programmes, as well as a raft of evidence-based resources. The tool outlines the estimated savings society can make from targeted investments. For instance, for every pound invested in children’s social and emotional learning, a saving of £5.08 can be made to society over the course of three years.
But some familiar problems remain. The first is that councils have been squeezed to their limits. Many authorities increasingly have to forgo long-term preventative investments in order to fund immediate high-needs pressures.
‘Nothing comes close to the fiscal ruthlessness of local government and in public services it stands alone. It should be very proud', says Mr Selbie. 'That is a standout achievement. But there are still opportunities to spend what is being spent now more wisely. There are many occasions where the spend is there but it is not acting in a preventative way. I am not saying there is enough money to get on with it. I am saying this is all the money you have got, get on with it.’
Despite the fact that it is not always straightforward to see where the investment, or indeed the savings, of a preventative intervention might be, Mr Selbie maintains it is the smartest approach. The failure to focus on prevention until now is ‘why we have the pressures we have got today’, he says. ‘The best way to win the argument for more investment is to show what you have done with what you have got. I am arguing for as much as possible in local government because I know it will spend it well.’
The second problem is the organisations that invest are not necessarily the ones drawing a direct financial return. This is where Mr Selbie believes local government has a significant role to play as leaders of place. ‘Local government never had a lever on everything, but has ascended in the last five years to a place where it did not have to try [to have a lever on everything].’
Mr Selbie says local government’s role is to create a great place in which to live, work, raise a family and be educated. The sector does this through attracting inward investment, creating homes people want to live in, influencing schools and creating an environment for businesses to flourish.
In order to prevent mental ill health and boost productivity, Mr Selbie believes local authorities are key. ‘It all depends on collective integrated action – not just learning, but acting together. The sector is uniquely placed to co-ordinate and lead as a place leader. Local authorities can get the chief constable, the NHS and businesses in the room and say “here are a few areas where we would do better working together”. There is no substitute for local government in that. To convene and influence is the unique selling proposition of local government.’
Mr Selbie explains there is a huge amount of latent economic activity in each local authority area that can be harnessed to tackle problems like mental ill health.
In Sheffield, for instance, he points out that the council’s public health budget is around £30m, but the council’s budget is around £1bn and the economy of the area is well in excess of £4bn. ‘There is a lot of economic activity,’ says Mr Selbie. ‘But, are we using it in the best possible way?
‘Nobody nationally is preventing [the public sector] from making certain investments where there is collective agreement that this is the best thing to do.
‘Pool resources and spend it as smartly as possible,’ he advises.