Published: 07/10/2004, Volume II4, No. 5926 Page 26

Your HSJ 100 panel on patients' responsibilities for their health (pages 22-23, 23 September) missed the key public health issue facing us. It is mental illness, most notably depression, which is fast becoming the most costly disease in the developed world.

In England, an estimated£77bn a year is lost to the economy through its effects. It is not just the 900,000 people with mental illness who live on incapacity benefit, many of whom would love to work if only employers would give them a chance, or they could afford to take a job, or the mounting cost of sick pay to employers for those in work.

It is also the appalling impact of suicide, now the single highest cause of death in the under-35s.

And improving the nation's mental health would have the added long-term benefit of reducing demand for acute and primary care services.

Whatever the causes, the main issue for the forthcoming white paper on public health must be tackling mental illness and distress. The things that improve physical health are also good for mental health.

However, to take the physical health advice, you have to be feeling OK about yourself.

Of course, we would like to see more helpful mental health legislation. Fair shares for specialist mental health services would also be nice. But let's get the key message right first: mental health is everyone's business.

Lisa Rodrigues Chief executive West Sussex Health and Social Care trust