6 April 2017
According to the King’s Fund the direct costs of mental ill-health for the NHS and social services in England are now around £22.5 billion a year; and that does not include the indirect costs such as the impact on the criminal justice system and lost employment. Mental ill-health costs the NHS more than 12% of its total budget. So it is essential that we do all we can to promote mental wellbeing, both for the good of our residents, and because it makes economic sense.
We know that there are four social determinants of mental ill-health that include: social, economic, ecological and health inequalities. When the causes of each are looked into – it is clear that district councils are critical partners in the battle against mental ill-health.
Social inequalities include factors such as adverse childhood experiences, stigma and discrimination, violence etc and district councils in their community safety roles work on combating these issues every day. Some districts also work to prevent bullying both online and offline – and all this work helps to promote mental wellbeing. Isolation, not exclusively for older people, is also a major cause of depression and other mental issues and districts help to prevent loneliness with housing policies and their community work.
Economic inequalities obviously include poverty, and as the housing authority, ensuring people are living in good quality housing is a good start. Other factors such as debt and unemployment also impacts on our mental health. Districts are often working on the front line to help eradicate debt and unemployment through supporting local organisations such as the CAB, or by providing their own support to help people back into work. Housing Associations, sometimes in partnership with their district councils, often provide services in these areas as well – as it ensures people pay their rent and prevents homelessness.
Ecological inequalities can be tackled by the districts planning and environmental health roles. Transport issues and adverse environments can be directly tackled by planning; and environmental health clearing up filthy and verminous houses, alleyways and streets. Not only that, planning can actually proactively create healthy natural environments ensuring plenty of green spaces and encouraging active travel.
It is harder for districts to influence health inequalities, but even in this area they have a role to play. Their Community safety units help tackle addictions; and as addictions often lead to debt their debt advice services also help to combat addictions. People suffering from long term physical conditions can offer suffer with mental ill-heath as a consequence of their pain and discomfort. With community activities, and the provision of leisure and local theatres districts can help bring enjoyment to peoples’ lives – which can help. A district’s housing and community role is critical. Providing various types of supported housing and building dementia-friendly towns and villages all helps to reduce a range of health inequalities.
For too long we have all sat back and allowed the NHS to simply fix medical problems as they arise. Mental ill-health is becoming so widespread that the NHS alone is going to struggle. We all have to see how we can contribute to promoting wellbeing, and district councils, with their range of preventative tools are in a strong position to create and build healthy environments for people to live. And it is up to the government, the NHS and county councils to fully recognise the contribution that districts can make and include them as full and equal partners in their health discussions.
