Statistical modeling in pharmaceutical research and development.
Birmingham Health & Wellbeing Board Summit - July 2012
1. Birmingham's Way to Wellbeing
Birmingham’s Joint Health and Wellbeing and Social
Inclusion Process Summit
Thursday 12th July, 9am to 2pm
The Bordesley Centre, Birmingham
@bhwbb #bhwbb bhwbb.net
2. Welcome and introductions
Cllr. Steve Bedser
Cabinet Member for Health and Wellbeing,
Birmingham City Council
@bhwbb #bhwbb bhwbb.net
3. Definitions and concepts - what
does it all mean?
Dr Neil Deuchar
Medical Director (Mental Health)
NHS Midlands and East
@bhwbb #bhwbb bhwbb.net
4. West Midlands Strategic Health Authority
Wellbeing –
What does it all mean?
Neil Deuchar
Associate Medical Director
NHS Midlands and East
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
5. What’s in a name..... West Midlands Strategic Health Authority
mental
positive quality of
health
mental health life
mental
happiness capital
wellbeing
emotional resilience
wellbeing
flourishing
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
6. West Midlands Strategic Health Authority
Wellbeing is the subjective experience of
mental, social and spiritual health
It is not merely the absence of illness
It involves a sense of purpose, fulfillment,
agency, belonging and connectedness
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
7. West Midlands Strategic Health Authority
Wellbeing is similar to quality of life
Wellbeing derives from and confers
psychological resilience
Wellbeing in enough individuals produces
mental and social capital across
communities
Psychological resilience reduces both
mental and physical illness
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
8. West Midlands Strategic Health Authority
There are "Five Ways to Wellbeing" (Foresight/NEF) –
Connect
Give
Notice
Learn
Be Active
Prosocial behaviour enacts the "Five Ways"
This means active citizenship (personal rights and
responsibilities to each other)
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
9. West Midlands Strategic Health Authority
Public Mental Health is the promotion of
Mental Health / Wellbeing in communities
and the prevention of mental illnesses in
people at risk
Addressing public mental health reduces
physical illnesses, alcohol and drugs use
Adopting the "Five Ways" improves public
mental health
NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West Midlands
Chair: Sarah Boulton Chief Executive: Sir Neil McKay CB
10. Understanding the determinants
and what works
Dr Lynne Friedli
Mental Health Promotion Specialist
World Health Organisation
@bhwbb #bhwbb bhwbb.net
11. Mental health and wellbeing: understanding
the determinants and what works
Dr Lynne Friedli
Wellbeing Summit
Birmingham Health & Wellbeing
Birmingham
12th July 2012
12. Source: Ingram Pinn, Financial Times
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
13. Summary how we
feel about
&
• Mentally flourishing communities experience
our lives
• Recovery Oriented Communities
• Social Justice, Citizenship & Human Rights
• Commissioning for social value
• Health topics: RIP
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
14. What we all need....
To be:
• Heard
• Believed
• Understood
• Respected
Picture Source: http://sarahdrummond.wordpress.com/2010/12/13/an-
assets-alliance-scotland/
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
15. Mental health, and the factors that
influence mental health, have never been
more important
Mental
Social S Determinants
Health
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
16. Commission on the
Social Determinants of Health
Some living conditions deliver to people a life that is worthy of
the human dignity that they possess, and others do not. Dignity
can be like a cheque that has come back marked ‘insufficient
funds’ Martha Nussbaum
•material requisites
•psycho-social (control over lives)
•political voice (participation in decision
making)
Status Control Relatedness
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
17. Best start Quality work
Healthy places
Income Prevention
Education &
skills
18. Explaining the social gradient:
mental illness journeys...
Most of the experiences that cause mental distress are directly linked
to a lack of money....... powerlessness linked to poverty
Peter Campbell Beyond the Water Tower 2005
• Adverse childhood experiences/stressful life
events
• Racism and other forms of discrimination
• Contact with criminal justice system
• Socio economic status – parental income, tenure,
education, occupation
• Institutional care in childhood
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
19. Social Epigenesis: biological embedding *
Status Control Relatedness
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
20. Meta analysis: comparative odds of
decreased mortality
The relative value of
social support/ social
integration
Birmingham Wellbeing Summit Source: Holt-Lundstad et
lynne.friedli@btopenworld.com al
2010
21. Recovery oriented communities
They are saying that they are missing from the community,
they want to give and contribute and that
the community is missing out on their contribution.
PFG Doncaster
People with mental
Full health problems
Quality of have access to
citizenship everyday activities,
life
resources,
Human relationships and
opportunities
rights
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
22. Why bother? What works?
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
24. Because it’s worth it....
While there are multiple barriers to economic growth, the growth of human
potential is unlimited Coote and Franklin 2010
•Contribution mental wellbeing and mental illness
make to wide range of outcomes
•The ‘unexplained excess’ – classical risk factors do not
account for level of variation in outcomes
•Improving wellbeing saves (a lot of) money
•Improving wellbeing delivers social (as well as
economic) returns
•Improving wellbeing reduces inequalities
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
25. Reduce pressure here
NO HEALTH PUBLIC
ADULT
WITHOUT HEALTH NHS
SOCIAL CARE
MENTAL OUTCOMES OUTCOMES
OUTCOMES
HEALTH FRAMEWORK FRAMEWORK
FRAMEWORK
MENTAL HEALTH AND
Get it
WELLBEING right here
Using data and evidence from: Delivering better mental health outcomes;
Economic Case
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicatio
nsPolicyAndGuidance/DH_123766; See also Champs
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
www.champspublichealth.com
26. Scope of Action
Material resources Relationships and
Increasing equitable access Respect
to assets that support Social support, collectivity,
mental wellbeing respect for people experiencing
Interventions misfortune
to promote
mental
wellbeing
Inner resources
Meaningful Opportunities to
activity develop senses,
Opportunities imagination,
to contribute reason, thought
(Martha Nussbaum Capabilities)
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
28. Net return on investment
Source: Knapp, McDaid & Parsonage 2011
29. Tentative analysis of economic case:
workplace
400
Extension of Flexible
£s millions per annum avoided
300 Working Arrangements
Integration of
200 Occupational and
Primary Health
Implementing Stress
100
and Wellbeing Audits
0
Source: Mental Capital & Wellbeing: Foresight 2008 – Overhead David
McDaid
30. Mental health risk and debt
(OR) risk of poor mental health
Unadjuste
d
Income adjusted
Adjusted for
income and socio-
demographic
variables
Number of debts
Source: Jenkins R et al 2008 Debt, income and mental disorder in the general
Population Psychological Medicine 38:1485–1493.
31. Routes to partnership/joined up delivery
Wild
NHS Commissioning Health & swimming
(for social value) Wellbeing Boards club
Health & Wellbeing Food
Primary Strategies Train
Care Time
Link Integrated
bank
workers Wellness
•Referral Service Community
criteria Garden
•Feedback Community
Referral Hub
loops
Local Area Debt advice/
•Extended
Coordination credit union
consultation Language
Social and
Midnight literacy
Care football
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
32. Priorities for moving forward
Innovation is hard. And social innovation is doubly hard. The system will
often absorb new ideas, and then spit them out in forms that their
originators would not recognise... Simon Duffy
ommission for social value – each £ spent also produces
wider community wellbeing
nd health topics: whole life/total place /wellbeing services
oin up delivery: wellbeing, recovery, resources for citizenship
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
evelop an inequalities imagination (Angie Hart)
33. Return to the social....
•Wellbeing is produced socially
•Quality of social relationships has a material context
• I am, because we are...
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
35. Select bibliography
Warwick-Edinburgh Mental Well-being Scale
www.healthscotland.com/documents/1467.aspx
Cooke, A., Friedli, L., Coggins, T., Edmonds, N., O’Hara, K., Snowden, L.,
Stansfield, J., Steuer, N. and Scott-Samuel, A. (2010) The mental well-being
impact assessment toolkit. 2nd ed., London: National Mental Health
Development Unit
http://www.apho.org.uk/resource/item.aspx?RID=95836
Friedli L (2009) Mental health, resilience and inequalities WHO Europe London/
Copenhagen http://www.euro.who.int/document/e92227.pdf
Friedli L and Parsonage M (2009) Promoting mental health and preventing mental
illness: the economic case for investment in Wales Cardiff: All Wales Mental
Health Promotion Network
http://www.publicmentalhealth.org/Documents/749/Promoting%20Mental%20H
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
36. Select bibliography
Knapp M, McDaid D and Parsonage M (2011) Mental health promotion and mental
illness prevention: the economic case Department of Health
Campbell F (2010) Social determinants and the role of local government
http://www.idea.gov.uk/idk/aio/17778155
Newbigging K and Heginbotham C (2010) Commissioning mental wellbeing for all :
a toolkit for commissioners UCLAN
http://www.nmhdu.org.uk/news/commissioning-wellbeing-for-all-a-toolkit-for-comm
DH (2011) No Health Without Mental Health: A Cross-Government Mental Health
Strategy for people of all ages (Feb 2011) gateway reference 14679Solar O and Irwin
A (2011) A conceptual framework for action on the social determinants of health
Geneva: WHO
Dept of Health (2011) The economic case for improving quality and efficiency in mental
health
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digit
OECD 2011 Divided we stand: why inequality keeps rising
http://www.oecd.org/document/51/0,3746,en_2649_33933_49147827_1_1_1_1,0
Birmingham Wellbeing Summit lynne.friedli@btopenworld.com
37. What makes us healthy?
Jane Foot
Independent Public Policy Adviser
@bhwbb #bhwbb bhwbb.net
38. What makes us healthy?
Birmingham Wellbeing Summit
12 July 2012
Jane Foot
www.janefoot.co.uk
www.janefoot.co.uk 38
39. Reframing our thinking
When we work with people and
communities we focus too much on their
failings, deficiencies, problems and needs.
And we prescribe services to fix those
problems.
We don’t actively look for what creates
health and sustains wellbeing, the things
that are working, the potential for people to
connect their own and others’ assets to
improve their lives.
www.janefoot.co.uk 39
40. What are health assets ?
An asset can be defined as any factor or resource
which enhances the ability of individuals,
communities and populations to maintain and
sustain health and well-being. These assets operate
at the level of the individual, family or community as
protective and promoting factors to buffer against
life’s stresses.
Skills, capacity or knowledge of individuals
Passion of families and neighbours that give them energy for
change
Networks and connections in a community – place, identity,
interest
Effectiveness of community associations
Resources of institutions – public, private or third sector
Physical, environmental and economic resources
www.janefoot.co.uk 40
41. What is the evidence?
Resilience – what are the social factors
that support resilience
Social networks make you healthier and
happier. Stress and isolation are bad for
you.
Mental wellbeing and psychosocial factors
– both a cause and a consequence of
inequality
Good wellbeing makes it possible to ‘get
ill better’.
Evaluative task is to understand assets
and the dynamics that link assets to
change www.janefoot.co.uk 41
42. An assets approach
People are a resource rather than a problem
Identifies and connects the assets that can
enhance wellbeing
Values what works well in an area and what has
the potential to improve health
Sees citizens and communities as co-producers
of their health rather than recipients of services
Promotes community networks, relationships
and friendships that can provide caring, mutual
help and empowerment
Supports individuals health and wellbeing
through self esteem, coping strategies,
resilience skills, networks, knowledge,
Empowers communities to control their futures –
capacity releasing
Creates tangible resources such as services,
funds, buildings www.janefoot.co.uk 42
43. 1. Health & Wellbeing Boards
Shared understanding of health as a
positive state and its determinants as those
things that protect and promote good
health
Prioritise the ‘causes of the causes’
Whole system – everyone who contributes
to health assets
Whole life course
Shift from targeting to whole community
Commissioning framework – redesign,
support, procurement
www.janefoot.co.uk 43
44. 2. Asset mapping & mobilising
Makes us learn to ask what communities
have to offer and care about
Improves our understanding of HOW
people understand wellbeing and what
helps them cope
It makes explicit the knowledge, skills,
resources and capacities that already exist
Helps to make best use of individual skills ,
physical and organisational resources
within the community
It helps to build trust between
professionals and the local community
Assets are a resource to meet needs –
influences commissioning
www.janefoot.co.uk 44
45. 3. Community development – build
social capital
Core health and wellbeing asset
Intentional community building
Work with existing community
networks and activities
Release the capacity and strengths
Do not undermine networks and
social support
www.janefoot.co.uk 45
46. 4. Co-production
Professionals, service users, families,
neighbours are involved in an equal and
reciprocal relationship
Planning, design and delivery of agreed
outcomes
Services do not produce positive health
outcomes – people do
An awareness of assets in the area
means that residents are valued for
their contribution
Pooling of different knowledge and skills
www.janefoot.co.uk 46
48. 5. JSNA + Assets
A better balance of information
between needs and assets.
Explore ways of collecting analysing
and understanding assets – not just
the what but also the how.
Align with data on needs and
resources
Commission to sustain the health
assets
www.janefoot.co.uk 48
49. 5. Commissioning for outcomes
The potential of co-production and asset
approaches is not best served by our
current procurement models
Co-production + asset-rich communities –
requires a new commissioning framework
Require providers to identify and build on
assets in the families and
neighbourhoods.
Intentionally support community
development and social capital
Do our services undermine health assets?
www.janefoot.co.uk 49
50. Health inequalities are driven by underlying
social factors and action is required to
address these ‘causes of the causes’.
“the health and wellbeing of people is
heavily influenced by their local
community and social networks. Those
networks and greater social capital
provide a source of resilience. The extent
to which people can participate and have
control over their lives makes a critical
contribution to psychosocial wellbeing
and to health”
Professor Sir Michael Marmot,
Foreword to What makes us healthy?
www.janefoot.co.uk 50
51. WHAT MAKES US HEALTHY ?
The asset approach in practice:
evidence, action and evaluation
Free download at
www.janefoot.co.uk
www.assetbasedconsulting.net
Foot (2012) ISBN 978-1-907352-05-08
www.janefoot.co.uk 51
52. Integrating Primary Care Mental
Health and Well Being Services
Dr Ian Walton
Clinical lead for Primary Care Mental Health Services SWB
CCG
@bhwbb #bhwbb bhwbb.net
53. ‘Integrating Primary Care Mental
Health and Well Being Services’
Dr Ian Walton
GP, PEC chair and mental health lead for Sandwell
and West Birmingham Clinical Commissioning Group
Ian.walton@nhs.net
54. Complex Patients or complex services
Low Aspirations
◦ Patients
◦ Clinicians
◦ Statutory sector
Dealing with Individuals and their families not Populations
High level needs analysis
Silo Approach to commissioning and provision
NICE had led to a disease focussed model
Wrong care, wrong service, wrong person, wrong time
55. Needs Analysis
Breadth and depth of need at whole population
level
◦ GP population and individual
Large amount of sick people and their carers
◦ Correlated with poor and inadequate housing
◦ Worklessness
◦ Physical and Mental Ill Health and Addictions
56. The Challenge – To improve the
outcome of the whole population
including……
Frequent attendees
Complex needs
Medically Unexplained Symptoms
Prevention and early detection
Those not meeting ‘psychiatry ‘ criteria – sub threshold
Emotional distressed
Socially Excluded
Homeless
Diverse needs
Not mentally ill but emotionally distressed eg Sadness , grief,
loneliness– crisis v crysis
Services did not fit the patient
57. Targeted groups
Young people at risk of mental ill
health/asbo
Deaf population
South Asian women
Carers
Men
People with existing mental health
problems
58. How did we do it?
Listened
Asset mapped locally
National and international best practice that
works
Identified a series of pre and post outcome
measures
Quantitative and Qualitative approaches
Sourced funding
Established benchmarks
More pilots than British Airways.......
59. Human Needs
Security-a safe territory-a space to grow
Attention (to give and receive)
Having a sense of Autonomy and Control
Emotionally connected to others-intimacy
Being part of a wider community
The need for privacy to reflect and consolidate
experience
Self esteem – via confidence and achievement
The need to be stretched which comes from a
sense of meaning and purpose.
Compassion
60.
61. Books on prescription
A Social Prescribing project
After a successful pilot in Cardiff in 2003, similar schemes have been taken up
across many areas in the UK.
Sandwell first piloted Books on Prescription in 2006, and the service became
mainstreamed across all Sandwell libraries and GP surgeries in 2007.
62. National Findings
Patients get more information and a greater understanding of their
condition
Helps them recover from the problems they are experiencing
Helps them make informed choices and take a proactive part in
improving their health
Anecdotal evidence indicates that there has been a low rate of
people returning to their GP once taking up the book prescription
Patients prescribed books whilst on the waiting list for
psychological therapy resulted in 50% reduction in the number of
sessions they then required
63. But no-one reads in Sandwell!
Approximately 1100 book issues per year
Patients are more likely to access if a GP refers
them to the scheme
Majority of our current referrals are self-
referrals
83% of B.O.P. users have applied the techniques
they learnt by reading the books
83% report improvements in their general
wellbeing and mood as a result of accessing the
scheme
64. Health Improvement Programmes
Since the services started we have had
over 4,000 people complete prevention, 64 Long Term Conditions
wellbeing and health improvement 58 Relationships
programmes this equates to £800,000 57 Self Defence and Empowerment
prevention costs. 56 Workplace Wellbeing
50 cCBT
47 Wellbeing Awareness Training
1007 Stress Awareness 35 Relaxation
33 EFT - Emotional Freedom Technique
769 Health Improvement programme 25 Make Friends with a Book
351 Food and Mood workshops 22 Yoga (FLW)
333 Laughter Yoga 17 Stress and Relaxation (FLW)
305 Happiness and Wellbeing 16 Flourish
15 Redundancy
218 Chin-up 12 Laughter Yoga (FLW)
102 Music and Wellbeing 11 Food and Mood Workshops (FLW)
89 Yoga 7 Capnography
70 Positive Mental Training
2 Maternal Mental Health HIP
67 Tai Chi Plus over 3,000 people access talking
therapies which using the same formulae
64 Happiness and Wellbeing (FLW) would be £600,000
65. Chin up programme
Aimed at youngsters “at risk of offending”
Originally given 8 teenage girls
They told 20 of their mates..
You can’t have the lads they really are too
much trouble
Top of our league tables for improving
wellbeing
66. Conditions Management Programmes
Long term conditions
Capnography
Positive Mental Training
Wellbeing programmes
Emotional Freedom Technique
www.confidenceandwellbeing.co.uk
67. Local outcomes
3,468 sessions run 2011 -12 for 1,640 patients all programmes show a
measurable difference clinically and also in their wellbeing and social
needs
Welfare Rights - 240 cases gains of £157,544,
Reduction in referral to crisis services
Frequent attenders managed in partnership with probation and A
and E at SWBH
Access pathways to health for refugees and asylum seekers,
homeless people
59.5% average recovery rates for IAPT one of top IAPT services
nationally
Other services are showing comparable results and impact on
wellbeing
73. The magic formula
Assets V needs
Starfish
Collaborative care - warm hands.
Integrated budgets
Co- location
Integrated care across all conditions
Education and training for all
74. Conclusion
Invest in prevention and not in sick
people
Money talks and there is a business case
for this
KNAPP Martin; MCDAID David; PARSONAGE Michael; (eds.);
Mental health promotion and prevention: the economic
caseLondon: Personal Social Services Research Unit, 2011.
43p
http://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise
75. Thanks
With particular thanks to Lisa Hill,
Primary Mental Health Improvement Lead
Sandwell PCT.
lisa.hill@sandwell-pct.nhs.uk
www.confidenceandwellbeing.co.uk
www.primhe.org.uk
ian.walton@nhs.net
77. Key Line of Enquiry: Preliminary
Findings
Karen Jerwood
Head of Sport and Physical Activity
Birmingham City Council
@bhwbb #bhwbb bhwbb.net
78. Introduction to table-top
workshop
Dr. Jerry Tew
Senior Lecturer, Institute of Applied Social Studies University
of Birmingham
@bhwbb #bhwbb bhwbb.net
79. Health and Wellbeing Update- 12th
July 2012 Summit
Alan Lotinga
Director of Health and Wellbeing
@bhwbb #bhwbb bhwbb.net
80. Ongoing Top Joint Priorities
• Making the transition to new health and care
systems and structures
– Keeping eye on whole system consequences of change : so
many things starting from April 2013
• Joining up transformation programmes
– e.g. frail elderly, children's services, personal budgets
• Massive efficiency and productivity challenges -
recurring savings
– e.g. joint commissioning
@bhwbb #bhwbb bhwbb.net
81. Ongoing Top Joint Priorities
• Maintaining and improving where possible service
quality, safety and performance, with particular
emphasis on personal experience
• Health inequalities
@bhwbb #bhwbb bhwbb.net
82. Some important opportunities to build on
• Year 3 of biggest pooled budget, mental health/learning disabilities.
Highly successful – savings, better services. 10% of total City health
and care spend
• Health and care partnership Compact agreed
• “Frail Elderly” transformation programme to build on (and others
commencing)
• Strong support for place-based budgeting approach – e.g. Troubled
families
• Big push towards integration with primary care
• City Council’s Leader’s Policy Statement – “Promoting health and
wellbeing so that older citizens, children and young people are active
and healthy, and live with dignity and independence. We will use the
transfer of public health responsibility…to eliminate health inequality
between the rich and poor and working through the Health and
Wellbeing Board to achieve this.”
• Wellbeing Key Lines of Enquiry - the work and next steps from today.
@bhwbb #bhwbb bhwbb.net
83. Next Steps with our Health and Wellbeing
Board
• Next meeting 24 July
• March 2012 review by existing members – what works, what to
improve. Purpose, membership, network of relationships (many
new).
• Labour Council, “no” vote for Mayor, localisation agenda and
determination to address inequality.
• Strategic guide to our health and care system.
• A number of areas where better links sub-structures need
creating, co-opted, to support the work programme eg 3rd
Sector generally, MH/LD joint commissioning, Children's
Services, NHS Provider Forum, Quality and Safeguarding,
Enterprise and Jobs, Crime and Safety.
• Importance of informal meetings and discussion.
@bhwbb #bhwbb bhwbb.net
84. Purpose of the Board
• Hold the “centre ground” to prioritising and applying resources
across all agencies, not a magnet for all issues and not a
scrutiny function
• Little direct infrastructure available, therefore need strong
members and networks
• Deliver Marmot objectives, e.g. service integration and joint
commissioning are key means to deliver these ends
• Strategy based on the “big issues” of the city (as defined by
the JSNA), and deliver
• Keep close eye on big changes (Public Health transfer, CCG set
up, Healthwatch) and whole system issues (de-commissioning,
prevention and enablement activity, QIPP activity)
@bhwbb #bhwbb bhwbb.net
85. Health and Wellbeing Board – Network of relationships
• National
- Department of Health
- NHS Commissioning Board
- Public Health England
- Care Quality Commission
- HealthWatch England
- Monitor
- NICE
@bhwbb #bhwbb bhwbb.net
86. Health and Wellbeing Board – Network of relationships
• Sub National
- Regional “arms” of above
- Clinical Networks and Senates
- Possible HWB federations
- Joint Scrutiny
• Local (providers, partnerships, communities)
- NHS Provider Trusts
- Private Sector
- voluntary and community providers
- other partnerships – children, enterprise, crime and safety,
safeguarding, environment
- Council departments
- Patients, service users, carers, the public
@bhwbb #bhwbb bhwbb.net
87. Birmingham Draft
Joint Health and Wellbeing Strategy
• This strategy is an opportunity for us to be clear
about our vision for the health and wellbeing of our
City, and identify what the key partners – the City
Council, NHS and others – will do together to
achieve it. We want our citizens to be able to live
healthier and happier lives, and for the services we
commission to be better at supporting this.
@bhwbb #bhwbb bhwbb.net
88. Birmingham Draft Joint Health and Wellbeing
Strategy
• The Strategy is not a statement of everything we need to do
in health, public health and social care in Birmingham but a
statement of what the most important priorities in health and
care should be.
Many of the most challenging health issues in Birmingham are
significantly affected by educational attainment, standard of
living (good employment) and other factors like the places
we live in. This strategy seeks to reflect that.
Making better use of community assets, co-production, more
involvement of local communities, as well as agencies
working better together, will be crucial to delivery (key
themes from today).
@bhwbb #bhwbb bhwbb.net
89. Respond by :7th September 2012
Online at
• http://bhwbb.net/joint-strategic-needs-assessment/health
Email by requesting from
• Birmingham.Phi@nhs.net
Or Phone Birmingham Public Health
• Kulwant Ghaleigh, 0121 465 8029
@bhwbb #bhwbb bhwbb.net
90. Feedback, conclusions and
proposals
Karen Jerwood
Head of Sport and Physical Activity
Birmingham City Council
@bhwbb #bhwbb bhwbb.net
91. All presentations for today can be
found at:
http://bhwbb.net/download/BHWBB%20Sum
@bhwbb #bhwbb bhwbb.net
Editor's Notes
We probably have to live with a debate about language and the use of different terms Language also reflects debates in field of mental health – terms like positive mental health and mwb are used to distinguish mental health from mental illness – can’t be separated from wider politics – still important in user survivor and recovery movements, history of struggle There are also cultural debates – and concerns about dominance of western (esp. north american) philosophical traditions which privilege individual over the collective – I over We Debate about language reflects different disciplines, different sectors, professional boundaries and different research traditions – we probably have to live with some fluidity – as we’ll see in webinar three, this is also reflected in a range of different wellbeing measures – capturing different dimensions
At just a few hours old, the human baby is already making valiant efforts to mimic the expression on her mother’s face (just as new born babies cry in their mother tongue) - to establish the social connections, the social cues, on which her survival will depend. Recognise me, I’m like you. That baby’s efforts are a reminder – that we depend on each other – and that human beings are profoundly, quintessentially, social. Hence the importance of the social determinants – both societal – how power, privilege and resources (income and wealth) are distributed – and social – the impact of this distribution – on human relationships. mh and wellbeing debates, movement – played important role in reminding us of the Social nature of human beings – importance of designing population health around that
An underlying question is how does thinking about wellbeing shape the story ? Does it shift our perspective if we look at the pressing challenges of our times - economy, education, employment, crime, social justice - through a wellbeing lens? what can a ‘wellbeing lens’ contribute to addressing persistent inequalities and complex issues of welfare and public sector reform
Before moving on – reflect on what we all need for our own wellbeing Insights from neuroscience and also work of Sen and others on capabilities – attempt to identify what people need from others in order to function well We all need – heard, believed, understood, respected – but profound inequalities in whose story is heard, believed The greatest (and most painful) inequality may be inequalities in the distribution of respect – and how these are linked to material inequalities – and the impact of both - inequalities in respect and material inequalities - on wellbeing
Overwhelming theme emerging internationally is growing importance of mental health – the domain of think/feel/relate/make meaning - across many different disciplines and in relation to wide range of health and social problems the profound importance of mental health to life chances and life outcomes And that mental health influences so many outcomes Because of the Social nature of human beings – Impact of mind on body Contribution of mental health to inequalities
Mh - the social, emotional and spiritual - has deepened understanding of the social determinants of health International comparative studies suggest that status – the respect we receive from others – control - influence over the things that affect our lives/ - and r elatedness - affiliation, sense of belonging - are universal determinants of wellbeing and we need to pay more attention to the impact of injuries to these needs We need to pay much greater attention to the factors that injure these needs and to the impact of injuries to these needs – lack of status, lack of control, lack of affiliation – primary causes of stress - undermining what Sen has called ‘freedom to live a valued life’. But in these accounts – the distribution of economic assets is still of fundamental importance. There’s a link between living conditions and dignity. The idea of justice is paramount. What’s fair?
This also involves understanding the wider structural factors that influence individual mental illness journeys – individual and collective experiences of pain, anger, demoralisation, despair an enduring perception that mental illness is a random misfortune it is the poorest and most deprived families who bear the main burden of mental distress. Lone parents, those with physical illnesses and the unemployed make up 20% of the population, but 51% of those with disabling mental disorders How we explain inequalities is a mental health issue.... Fix the individual? Or fix society?
What’s come from epigenetics is a body of evidence on how : Social Processes can influence gene function What Clyde Hertzman has described as experience that gets under the skin and alters human bio-development In other words: systematic differences in social experience lead to different bio-developmental states the differences are stable and long-term; they influence health, well-being, learning, and/ or behaviour over the life course What’s emerging is the importance of paying much greater attention to the factors that injure these needs and to the impact of injuries to these needs – what epigenetics demonstrates is that social determinants stretch back in time
We see from this very powerful meta analysis based on around 145 studies the importance of social support/social integration on mortality risk The size of this effect (someone to turn to, sense of belonging) is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity) Received support is less predictive of mortality than social integration facilitating patient use of naturally occurring social relations and community-based interventions may be more successful than providing social support through hired personnel
That means identifying barriers to recovery Public mental health can support recovery goals by asking what kind of communities support recovery and by investing in community based support that: builds community capacity reduces need and demand for specialist secondary mental health services alleviates the risk of crises LAC makes social care services and supports more personal, local, flexible and accountable, and thereby to build and strengthen informal support and community self sufficiency
Where do we turn for the ideas, resources, creativity that are needed There’s received wisdom -
Pull out a few key themes Wellbeing is an important factor in understanding differences in outcome/in risk Wellbeing can help to account for the unexplained excess – so whether we look at crime, education, health, issues like alcohol, drugs – classical risk factors – behaviour or material factors – don’t account for level of variation – wellbeing has been an unexplored determinant – as we’ll see There’s a broad understanding of link between mental illness and poorer outcomes = but absence of wellbeing – what Tom Hennel and others have called ‘ill-being’ – also influences outcomes
We have the evidence – what we don’t have is a clear framework setting out the pathway between mental health and wellbeing and other outcomes separates health from other important aspects of life such as work, family and community. It prioritises professional expertise over the experience of individuals, despite the fact that effective management of chronic diseases depends more on individuals than professionals
Scope of action might look like this Meaningful activity – issues of livelihood are crucial and urgent, especially for young people, but we also need more ways to recognise and reward those who contribute outside the money economy Include social outcomes – the quality of relationships matters – commissioning for social value – commissioning that supports family life, household production, creates local jobs, empowers communities, strengthens control, uses local resources or skills, builds connections, strengthens networks Some of the most promising initiatives bring together: Involving children and young people Making the most of natural heritage Social enterprise Arts and culture
It’s not an exact science, but best buys for wellbeing would include a combination of interventions where there is very robust evidence family support – parenting, but also partnerships between pre-school/primary school and families that support the home learning environment – reading initiatives – books for babies, reading recovery school, workplace and education/training – with the latter targetted at increasing positive destinations for young people leaving school And where evidence is emerging but promising: Environmental improvements Always in the context of a localised analysis of need
Number of debts and source of debt impacts on mental health
Many different models that support knowing about, drawing on, building, identifying new opportunities – in communities From walking groups to literacy and numeracy classes, from learning English to managing debt, finding out about sources of low cost credit, tenancy maintenance, cookery classes and gardening projects, green space, blue space and places to ‘stop and chat’, all neighbourhoods will have assets that support recovery and many are rich in community and voluntary organisations. Commissioning that supports and protects these sources of support, as well as identifying gaps and barriers to access, makes good economic sense (DH 2010b; Knapp et al 2010) but may be vulnerable to short term thinking in the current financial climate
Commissioning for social value – sometimes called SROI – organised around trusted local sources of support/valued resources - means asking how each intervention £ also protects or enhances the social – supports family life, creates local jobs, empowers communities, strengthens control, uses local resources or skills, builds connections addressing outcome clusters involves whole community or total place approaches – Mental health is an important factor in explaining the clustering of disadvantage and the urgent need for public health to move away from single issue, single outcome interventions. Not least because of substitution – if we fail to address the underlying issues, even if everyone stops smoking, stops drinking – tobacco, alcohol, will be replaced by something else and health inequalities will remain. “
We’ve seen a recognition of the social nature of wellbeing : Social – core economy Solidarity – identifying common interests and mutual responsibility Collective – coming together (to change things, improve things, protect things) Which raises questions about what protects the social – the role of Equity and Social Justice but also the nature of the relationship between professionals and disadvantaged communities 1.Social justice 2. Opportunities for advancement 3. Financial resources 4. Access to and quality of work (Christian Kroll – four priorities for social democratic priorities)