In these uncertain times, the UK faces a mental health crisis alongside the wider NHS crisis. Mental illness, rapidly rising energy costs, inflation, soaring personal debt and affordable housing due to the effects of the Covid-19 pandemic are at risk of overwhelming health services. It’s time to fundamentally change the way non-NHS frontline public services are designed so that they can be used to respond to crises. This saves money and keeps people from getting sick.
In the UK alone, the broader economic cost of mental illness is estimated at £105.2 billion annually. Mental illness is the second leading cause of disability in the UK. His 10% of the UK workforce (2.5 million people) are registered as long-term ill, according to data from the Office for National Statistics. And 40% of those who lost their jobs cited mental health as the main reason. Even before Covid-19, 23% of those receiving Job Seekers Allowance (JSA) suffered from general mental health problems.
Meanwhile, the UK economy is fueling precarious jobs, lowering living standards and increasing household debt. Far from climbing the social mobility ladder, millions of workers are realizing that one job is not enough to make a living. Compounding the problem is that the sick and mentally ill do not have the time, personal resources, or energy to seek employment. Budget cuts and austerity measures could increase unemployment, unemployment and poverty. We know these can have a devastating effect on mental health.
The constant restructuring and dissolution of public institutions such as Public Health England, NHS Digital and NHSX also It has had a destabilizing impact on the government’s ability to respond to social and economic crises. In a state of flux and instability, civil servants and frontline staff are overwhelmed and demoralized. In the field, services are chronically underfunded and over capacity. After years of neglect, the investments needed to restore the operational capacity and capacity of mental health services depend on stable governments and capable ministers committed to change. It depends a lot on how much they understand that existing briefs should extend beyond hospitals and clinics.
The NHS has become a ‘sick service’ that goes for repairs, much like taking a car to a garage when it needs repair. It is no longer the public health system or institutions that keep people from getting sick. But evidence shows that our health and well-being are affected by social, economic and political conditions. Nonetheless, policy makers have not yet fully grasped the preventive approaches that can address the causes of mental illness.
With the creation of the Health and Care Act of 2022 and the Integrated Health System (ICS), we will begin to address the broader social and economic determinants of health, and will have greater capacity to address health disadvantages and inequalities. A number of combined policies have been created. Former Health Secretary Sajid Javid’s Mental Health and Wellbeing Plan sought to create a more comprehensive approach to preventing mental illness and suicide among the most vulnerable. It takes time and very little is said about how to actually do it.
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Unfortunately, health is seen as in the hands of clinical services at all levels of government, from national and regional to local. Given the pressing social and economic challenges facing the country, we urgently need to move beyond this and focus on preventing people from becoming patients in the first place. , means that the NHS will increasingly need to work in partnership with services such as employment centers and employment providers to housing associations. Non-NHS departments such as the Ministry of Finance, the Department of Work and Pensions (DWP) and the Department for Business, Energy and Industrial Strategy need to provide leadership and guidance. These sectors create social and economic conditions in which people can find stability and mental health can thrive.
The employment center has changed little since the new Labor Party reformed the welfare system after its 1997 election victory. For the most part it’s an outdated and depressing place, as many people who have to use employment centers say. But this is counterproductive and negatively impacts people’s mental health, employment and economic outcomes. Thousands of people use these services every day, but little is known about their mental health and how this data is collected to get them the right support.
Job centers are ideal environments for providing critical public health and preventive support services. They need to be places of support, stability and rehabilitation where people can get professional help with both job search and mental health issues. There is a new initiative linking employment services to improving access to psychotherapy (IAPT) and piloting a ‘Health Model Office’ (HMO). The problem is, the reality is that clinically she would have to be nearing a devastating mental health episode to be referred to the IAPT, and HMOs have yet to be fully tested. Many people report mental health issues as the reason they are unable to work. Yet frontline services such as job centers lack the operational capacity to triage vulnerable people with mental health issues quickly and at scale. Early identification of mental health risks and their integration into non-health services is essential for prevention.
As part of this new approach, the role of job center ‘work coaches’ should be reconfigured as ’employability and social support advisors’. Fortunately, there are existing models, including career guidance services for young people and quality return-to-work programs that provide counseling-style support from qualified professionals. This holistic approach aims to facilitate access to learning and skills beyond work, while supporting people with mental health issues, personal needs and domestic constraints. All of these promote social support, stability and employability.
Governments face the enormous challenge of stabilizing the economy while offsetting the impact of dramatic economic change on the most vulnerable. Responding to this requires a cultural shift that includes a more agile, systematic and people-centred approach to policy design and implementation. Together, the Treasury, Health and Human Services, NHS, DWP and Employment Centres, could prevent thousands of people from falling ill as unemployment and poverty could soar in the years to come. These policy choices will affect not only the economy, but also the health, well-being and productivity of the country in the next decade and beyond.
We thank our colleagues at the NHS, JCP and the Office for Health Improvement and Disparities (OHID).
Dr. Coutts is supported by the National Institutes of Health (NIHR) Applied Research Cooperation, East of England (NIHR ARC EoE). The views expressed are those of the authors and not those of the NIHR or ARC EoE.
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