Where next for prevention in mental health? An analysis of the 2019 General Election manifestos

Every week in England, one in six adults experiences a common mental health problem, such as anxiety or depression, and, at some point in their lives, one in five adults has considered taking their own life.[1] This level of distress places an unsustainable strain on the NHS and can cause misery in the lives of those affected.

As mental health awareness has grown in recent years, so too has our understanding of the factors that can cause problems to develop, and the steps we must take as a society to prevent this from happening.

The risk of developing mental health problems is increased by a range of factors, including experiences of poverty, inequality, homelessness, violence, unemployment, and traumatic life events. But mental health can also be protected, for example by good employment practices, financial and housing security, nurturing home environments, positive parenting and friendships, good education which includes social and emotional learning, and strong social and community connections.

Many of these are factors that the next government can seek to influence – by addressing those that increase the risk of poor mental health and building on those that protect good mental health, ultimately preventing mental health problems from developing and improving the mental health of the population.[2]

What are the parties saying about preventing mental health problems?

The Public Health Grant

Preventing mental health problems – an area of policy known as “public mental health” – has historically received little attention, both in terms of policy proposals and funding. Local authorities are responsible for delivering public mental health in their local area, and this is largely funded through the public health grant.

The public health grant has been cut by around 4% year-on-year since 2015/16[3], limiting local authorities’ ability to fund public mental health, especially as spending on mental health already represents a low proportion of overall spending of the grant.

The Conservative government recently announced a 1% real terms uplift to the public health grant for 2019/20, signalling a shift away from the recent years of cuts, and public health spending  features in several parties’ manifestos, with Labour pledging to invest £1 billion in public health and the Liberal Democrats advocating restoring the public health grant to 2015/16 levels. The Greens also plan to restore local government budgets more generally.

We hope to see further detail from all parties on how they will encourage local authorities to prioritise spending on public mental health, which needs to go beyond the Public Health Grant, and include a focus in all local authority policies and responsibilities on how they protect or harm mental health.

Cross-government approaches to mental health

While it is tempting to think of mental health purely as an issue for the Department of Health and Social Care and NHS England, the causes of mental health problems are influenced by policies across government. To name just a few examples: education, housing, employment and benefits, and criminal justice all play a part in both protecting wellbeing and creating risks to people’s mental health.

In this election, each party is taking a different approach to promoting good health and wellbeing across government.

The Conservative manifesto includes an ambition to "tackle the underlying causes of increase in NHS demand, for example via a long-term strategy for empowering people with lifestyle-related conditions such as obesity to live healthier lives". Although this does not explicitly mention mental health, this ambition likely refers to the Conservative government’s prevention strategy – published for consultation in July this year – which did include some proposals for preventing mental health problems. Our response to that consultation can be read here and we hope that whichever party forms the next government will include an ambitious prevention strategy in its programme of work.

Labour’s cross-government approach to mental health and wellbeing takes the form of a “Future Generations Wellbeing Act”. This approach is modelled on a similar law passed in Wales which aims to make public organisations consider the long-term impacts of any policy on people’s prosperity and wellbeing. Labour’s manifesto states that their Act will “target a reduction in health inequalities” by “enshrining health aims in all policies”. The Act would also create a new duty for NHS Agencies to “collaborate with directors of public health”.

The Liberal Democrat manifesto presents two cross-government ideas for improving the nation’s wellbeing. The first is a “National Wellbeing Strategy” which would put “better health and wellbeing for all at the heart of government” with “ministers from all departments responsible for implementing the strategy”. The second is a wellbeing budget, which is modelled on New Zealand’s new economic approach and, according to the Liberal Democrat manifesto, would mean “basing decisions on what will improve wellbeing as well as on economic and fiscal indicators”. As part of their cross-government approach to wellbeing, the Liberal Democrats would appoint a “Minster for Wellbeing”.

There are also cross-government health and wellbeing policies in other parties’ manifestos. The DUP manifesto commits the party to a “prevention first” approach to mental health with a focus on “building resilience and coping skills”. It also has policies aiming to tackle the impact of trauma and adverse childhood experiences, two well-known causes of mental health problems. Plaid Cymru’s manifesto pledges to “continue to support whole population approaches towards improving mental health and preventing illness through better education in schools, access to green spaces, and tackling stigma and discrimination.” The SNP’s manifesto aspires to ensure that economic growth leads to increased wellbeing. The Green Party want to move away from GDP as a key measure of economic success and towards indicators that measure human and ecological wellbeing, such as work/life balance and quality of life, which could incentivise government departments to shift their focus towards wellbeing.

Conclusion

Committed and sustained government action to address the causes of mental health problems and build individual and community resilience to adverse life circumstances is long overdue. This election sees all the major parties proposing policies to tackle the health inequalities which lie at the heart of the current unacceptably high levels of mental ill-health.

After the election, it is imperative that the parties remain committed to delivering these policies and reducing these high levels of avoidable mental distress which would be considered unacceptable in any other area of health. Above all, the next government must urgently address the economic and social circumstances that can lead to mental health problems.

We will continue to advocate for the policies contained in our own manifesto in which we outline evidence-based ways to help deliver better mental health for all.