It has become an accepted fact among those of us who work in mental health that there is no health without mental health. But does the NHS think this way?
Mental ill health is not just a hugely significant and costly burden on those who live with it. It is also a major and under-recognised contributor to physical ill health. So we need to think about both together.
The current policy framework for tackling health inequalities in this country focuses very largely on inequalities in life expectancy through encouraging changes in lifestyle (smoking, drinking, eating and exercise). Mental health problems thus take a back seat, as they are not a major cause of premature death.
Basis of good health
If we are to grasp the opportunity that is currently being missed, the NHS needs to begin to think and act on the basis that there is no health without mental health. In HSJ last month, Andrew McCulloch said that “mental health and wellbeing need to underpin all public health campaigns, on any theme”. He is spot on in this analysis. Smoking, excessive alcohol consumption and overeating can all have serious psychological roots that traditional awareness campaigns simply cannot address. And many people who present to their GP with physical symptoms may actually have undiagnosed and untreated mental health problems.
Quantitative data produced by the World Health Organisation suggests that in countries such as Britain only about half the overall burden of disease is reflected in premature mortality, with the other half coming from morbidity and disability. The share of the latter is steadily rising over time, as ill health is increasingly manifested in chronic conditions rather than early death.
Mental health problems also increase the prevalence of a wide range of physical health conditions, including heart disease, stroke, cancer, diabetes and asthma.
People with depression are twice as likely to develop coronary heart disease, twice as likely to have a stroke and four times as likely to have a myocardial infarction as people without depression. Depression and stress explain about 30 per cent of the total risk of heart attacks.
Mental health problems substantially worsen the prognosis of many physical conditions. For example, stroke patients who are depressed are four times as likely to die within six months as those who are not depressed. As well as being desirable in its own right, reducing inequalities in mental ill health would contribute towards reducing inequalities in physical ill health.
The government’s New Horizons project, by developing a new framework for mental health policy, will offer an important focus for efforts to make mental wellbeing a bigger priority. But this will have to be supported by a radical shift in the thinking of public health professionals. This will mean accepting that, without good mental health, we will never have good physical health either.
There can also be a pay-off. The cost of mental illness, some£77bn annually in England alone, is enough to justify massive investment in proven preventive measures. In hard times, this becomes ever more important.