Mental Health for All Webinar: Public and Population Mental Health
Steve Appleton: European regional lead for IIMHL and co-convenor of the International Cities and urban Regional CoLlaborative (Chair)
Kathy Langlois: North American regional lead for IIMHL (Panellist)
Sean Russell: Head of Thrive West Midlands (Panellist)
Nina Acco Weston: Associate Director at Wellesley Institute, Toronto (Panellist)
- Kathy - the top priority is to engage the community and look to its assets
- Nina - improving mental health is a collaborative effort; partnerships are the firm foundations from which we can build sustainable, collective approaches. It requires continuous and targeted communication.
- Sean - it is about development of political and community leadership; turn talk into action and let our communities hold us accountable.
This session has been brought to you by the International Initiative of Mental Health Leadership (IIMHL), an organisation that was created in 2003 to assist in global learning in mental health and respond to the need for more rapid knowledge transfer about mental health program development and innovation. IIMHL is unique in the space as its primary focus is on leadership development, through building international collaborations amongst leaders and the rapid exchange of innovations to community services.
The aim of this session is to talk about the importance of population mental health, as too often this takes place on the fringes of mental health and population development, instead of as an integrated response.
Kathy, achieving focus on public mental health can be challenging. In your view, what are the benefits of such an approach?
This approach seeks to work at determinants of mental health level. E.g. – racism, poverty, food security, education, housing, community cohesion, inequities . It aims to ensure resilient mental health and reduce the need for mental health services. This means upstream working to prevent suffering. Cities are home to more than half the world's population: the environment and infrastructure can help people living in them be well and thrive. Action at the public mental health level makes for cities to adopt.
The attention is on the basic needs of the population, which then drive community safety, economic productivity, mental health wellbeing and resilience.
This focus on “upstream” prevention is particularly interesting, and something we will come back to throughout this session. How does Thrive West Midlands fit within a public and preventative mental health approach and have you sought to reach any particular communities?
In the West Midlands, to improve the mental health of regions, we need to understand the cost to the region. It is important to be very clear about where we can provide the best course of action. The mental health agenda is very big, and there is too much to tackle, we need to focus on key areas such as working age adults.
Among working age adults, we can put an emphasis on workplace wellbeing. In the UK most people are working until 67 years of age - a huge proportion of their lifetime. How do we ensure that we can help people effectively during that time?
There are 2.9 million people in the West Midland region, and an estimated 4.1 million working days lost at a cost of £6.1 million and, even more devastatingly we lose 530 people to suicide each year.
How do we keep people well in the workplace? We need to tackle cultural sensitivity to reduce stigma. It is really clear that some communities are inversely affected by the impact of poor mental health. Especially the young black community. We need to build trust and form an asset based approach, giving people tools to look after mental wellness, and reduce mental ill health.
We have an ambition to train 1/6th of the population in mental health awareness training.
What was the catalyst for action in Toronto?
Nina Acco Weston
Toronto has a complex mental health wellbeing story. Diversity is our strength and equity is our challenge. There are many players but it is not always clear who leads and what is the plan. There is a high social and economic cost of mental ill health and high disparity and prevalence of different mental health conditions across populations.
Toronto is the largest city in Canada. It is a vibrant diverse and growing city but poor mental health is exacting a devastating toll. CAD$17 billion in lost productivity over 10 years. People in need are unable to access coordinated, comprehensive and holistic support. 52% identify as racialised people, and income inequality has worsened significantly. Racialised and lower income groups have been disproportionately affected by COVID 19; 43% say their mental health has declined due to the pandemic. All of this catalysed Thrive Toronto to act.
We need to improve conditions in which people live, using a multisectoral approach, with space for local leaders to share knowledge, strategize and innovate to collectively improve well being across the city. The aim is to optimise existing public and private sector resources.
There are many similarities with other cities and some rural areas. There is a moral and economic imperative to take a population mental health approach. How is IIMHL connecting leaders around the world?
The idea of an International Ciy and urban Regional CoLlaborative (I-CIRCLE) came about in 2015 at the IIMHL International Leadership Exchange. Through I-CIRCLE, IIMHL has encouraged city leaders to talk to each other and learn from each other. There have been site visits to New York City, Sydney and Philadelphia, and Thrive is now in the UK; in the West Midlands, Bristol and London and there are other Thrives around the world e.g. Amsterdam (Netherlands). We have brought these leaders into the I-CIRCLE group to learn and exchange knowledge on public mental health.
Due to COVID-19 a lot of the dialogue between I-CIRCLE leaders has moved online and therefore become more inclusive and more frequent. The pandemic has also emphasized that addressing social determinants of mental health is a vital approach, for example in Aukland they have managed to swiftly find ways to house the homeless. Furthermore we have seen that essential workers need to be recognised and protected.
Prior to the pandemic, the I-CIRCLE group worked on a Declaration of Principles and then created a Playbook with all of the examples across all of the cities involved organized according to the Principles – this was created as an asset bank so that city leaders could easily exchange information with one another
Currently, we are creating a How To Get Started (H2GS) Guide - for those cities who want to know how to do this work and the best way to get going. Future plans include expanding the circle to cities in the Global South and to leaders who work with people living with a disability – all based on connecting leaders into the network.
What has been the value of international collaboration and knowledge exchange both for your area and for others in the collaborative?
It can be a very lonely place as an official working in local government trying to understand how best to communicate with colleagues, especially with public health (prior to pandemic). Since COVID-19 public health has been put at the heart of everything we do.
I have been advocating for years on social determinants of health, and how a better system can improve individual outcomes. Our systems make the individual case seem complex but in actual fact the system is just not efficient for a person-centred approach.
Peer support has been hugely helpful, with assessing the effectiveness of interventions that other IIMHL leaders have tried. Most value has come from learning from interventions that didn't work, and finding clear evidence of other approaches that have worked in other cities.
I am not a mental health specialist by core function, but due to my background as a police officer, I feel like I am embedded in community relationships and stakeholder management. I have learnt so much and am able to bring a different lens to the public mental health conversation.
I recommend everyone join IIMHL - the challenge and opportunity to learn is amazing.
What advice do you have for cities and regions who might be looking to initiate similar work?
Nina Acco Weston:
Our New Zealand partners described starting a city mental well-being initiative as “organic, adaptive, painful, wonderful and local.” Peri Renison September 2019 I-CIRCLE Match, Toronto.
You need to communicate, foster partnerships and continuously measure and monitor. Meaningful relationships and inclusive, community-oriented collective action can bring about impactful change in how cities address mental health. This can also help mitigate typical challenges that Sean spoke about that you are most likely to encounter.
Strong communications programmes can help to establish understanding, buy in and overcome possible resistance. Comms should be simple, clear and targeted so that it resonates with stakeholders and allows them to take action.
Inclusive participation is the driving force of a city mental health wellbeing initiative. This programme needs to be a platform for people with lived experience to share their stories to drive innovative and impactful intervention that drives well being and inclusivity.
This approach needs to be integrated across the government, to spread ownership of the initiative. The key things are a shared, and agreed upon strategy and to invest in implementation and management as well as measuring.
Questions from the audience
What advice would you give to the population and local communities, to get people to invest in and be aware of their own mental health? Having resources is great, but that needs to be utilised prior to crisis.
There is no health without mental health; and health and wealth are two sides of the same coin. Health and economic future need to be designed hand in hand.
It all starts with the individual looking after themself to then be able to help others. We emphasise the five steps to wellbeing and encourage people to maintain that.
We have seen a far greater use of green and blue spaces during COVID-19 and we want to encourage this along with other ways to drive the wellbeing of society. We need to make sure there is a parity of mental and physical health.
Are there any standout, city based mental health initiatives that have been shown to reduce mortality rates among people living with severe mental health conditions?
The social determinants of health are extremely important. We need to continue to measure and monitor.
In New Zealand, New York and areas such as Glasgow we have seen housing, income and broader mental health literacy having a significant impact on: how people are living their lives, and are able to stay well and cope and the use of more acute and lower level mental illness services. Better enviroments can impact better mental health and well being but also reduce deaths by suicide, alcohol and instances of domestic violence.
All of these upstream initiatives are showing to have impact downstream.
Most of these initiatives we have spoken about today are taking place in large cities, but there are plenty of opportunities to adapt them for rural areas too. It is also important to learn from each other including from colleagues in the Global South e.g. the Friendship Bench project from Zimbabwe which has been taken to NYC and London.
Thank you and thank you to UnitedGMH. To find more information visit www.IIMHL.com and join for free to access the i-CIRCLE playbook and other resources.
The next Mental Health For All session will be focused on mental health research funding you can sign up via the UnitedGMH website.