Christopher Evans discusses the nation's mental and physical health.
The Covid-19 pandemic is re-shaping priorities in Downing Street. Boris Johnson, a prime minister with libertarian instincts, is spearheading a national campaign to wean us off pizza and burgers and relieve the NHS of the heavy burden of obesity. Johnson’s Damascene conversion is very welcome. A Public Health England study, published in June this year, estimated that 1,428,000 adults were morbidly obese in England in 2018, representing 3.2% of the population. As we are all too aware, a health crisis can very easily precipitate an economic crisis. Public Health England’s most recent estimate of the economic cost of obesity stands at £27 billion a year, a figure that represents nearly a quarter of the total NHS England budget in 2018/19.
A joined-up and comprehensive approach to improving the nation’s physical health is long overdue. So too, however, is an ambitious plan for mental wellbeing. Since the introduction of the Health and Social Care Act 2012, the NHS has been committed to ‘parity of esteem’ between physical and mental health - a vital commitment for both patients and the economy. A Centre for Mental Health report, published in 2010, estimated that mental illness cost the English economy £105.2 billion a year, nearly four times as much as the obesity epidemic. One might think that a Prime Minister desperate to ‘turbo-charge’ the economy would ditch the motto ‘Build, Build, Build’, in favour of ‘Talk, Talk, Talk’.
An ambitious plan for improving the nation’s mental health must embed the ‘parity of esteem’ principle into all areas of policymaking. As a teacher at a rural secondary school in Berkshire, I see little evidence of parity of esteem in the education system. Physical education remains a statutory requirement, while little time is given in the curriculum for discussions about mental health. Meanwhile, the waiting list for mental health services remains long and attempts to access these services are arduous. The Local Government Association claims that the average waiting time for young people to access mental health provision ranges from 14 to 200 days, illustrating that a young person’s chances of receiving adequate support remain something of a postcode lottery.
There is also little evidence of parity of esteem in the social care system, with the number of over-50s experiencing loneliness set to reach two million by 2025/26, according to a 2018 Age UK report. This number is hardly surprising, given the number of elderly people who live on their own, or for whom daily care visits represent the only form of face-to-face contact. In 2015, an article in the Daily Telegraph revealed that more than 500,000 home care visits lasted less than five minutes, leading NICE to review their guidance. Today, the guidance states visits should last at least 30 minutes. Whilst this provision may be able to meet the physical needs of most elderly people, it is unlikely that this model of social care will ever be able to meet their needs for social support, or help tackle the loneliness epidemic.
Our national conversation about mental health is often rather pessimistic in tone. We talk more readily about mental health ‘problems’, ‘disorders’ and ‘crises’, all of which, of course, require some form of treatment. This ignores the age-old wisdom, however, that prevention is better than cure. The government understands this, as shown by the positive approach they have adopted to physical health, encouraging people to ditch the doughnuts and building new cycle lanes to increase the number of two-wheelers on our streets. Mental health policy needs to take the same, positive approach, encouraging healthy lifestyle choices that will reduce the need for treatment and counselling in the long term. Just as infrastructure can promote physical activity, creating something as simple as a few extra park benches, for example, can encourage older people to leave the house and feel more involved in their local community. Pairing the new obesity strategy with a positive mental health strategy, which embeds parity of esteem across all areas of policy, would not only make us happier, but would also lead to greater economic prosperity. Who knows, we may eat fewer doughnuts too.
Christopher Evans is a secondary school teacher in West Berkshire, and a local Labour party activist. Alongside teaching, he has keen interests in education policy and young peoples' mental health.
He tweets at @ChrisEvans34.