Paul Burstow MP writes… Making the pursuit of happiness as important as GDP

cf reportOver the past 12 months I have been working with mental health experts and the think-tank CentreForum, grappling with the challenge of how we can improve mental health care.

Today sees the publication of our final report, The pursuit of happiness: a new ambition for our mental health. It reflects the expertise of many, makes a number of recommendations to transform not just health services, but the mental health of the nation, and it has one overarching call – that the pursuit of happiness should be a priority for government.

Costing the economy over £105 billion, 1-in-6 adults and 1-in-10 children suffer a mental illness at any one time in this country. The cost in human misery is incalculable, compounded by the burden of stigma and made worse by institutional bias even in the NHS. Institutional bias leads to evidence being overlooked and ignorance of the evidence means mental health does not get its fair share of resources.

Sadly, this is not new news. In 2011, as Minister for Mental Health, I published No Health Without Mental Health, setting our ambition for parity of esteem between mental and physical health. The strategy was widely welcomed, but the evidence reflects that not enough of the policy direction we set has followed through into action on the ground.

Norman Lamb, Lib Dem health minister, has also made mental health a priority, making a commitment to access standards and negotiating the crisis care concordat to make sure that people get the support they need in a mental health crisis. But we still have a long way to go before mental health is treated in the same way as physical health.

So the Mental Health Commission has taken stock of where we are today and what a new ambition for mental health should look like. Our goal has been to identify the key changes that over the next 5 to 10 years will reduce the number of people experiencing lifelong mental illness and help those who suffer mental illness to recover. The Commission has identified five big shifts in policy and practice.

First, make wellbeing or the ‘pursuit of happiness’ matter as much as GDP. The tools are available to evaluate policy and measure its impact with wellbeing in mind. This needs leadership right from the top of government and sustained action to tackle stigma.

Second, a national wellbeing programme led by Public Health England to foster mutual support, self-care and recovery. Locally tailored by Health and Wellbeing Boards to make the best of the skills and talents in communities up and down the country, building up community capacity where necessary.

Third, prioritise investment in the mental health of children and young people right from conception. By ending the buck-passing and fragmented commissioning, and by scaling up what works, we can transform the life chances of millions of children. Good mental health will reduce the costs to society of low educational attainment, bad behaviour, worklessness, crime and antisocial behaviour.

Four, make our places of work mental health friendly. The cost to business in terms of sickness absence and lost productivity runs to £23.5 billion. There is good practice, it should become the norm, and it would save money. Government should lead in its own employment practice and set the standard in its procurement.

Five, close the treatment gap that leaves 1-in-10 people needlessly suffering depression and severe anxiety. Equip primary care to identify and support the mental and behavioural health needs of its patients. Integrating mental health and social work expertise into the primary health care teams to ensure a holistic approach.

The Commission believe that NHS England should be set the clear goal of achieving parity of funding for mental health over the next decade. We are under no illusions about the difficulties of making these changes over the next five years against a backdrop of financial constraint. However, we believe that the case for spending to be rebalanced towards mental health is overwhelming. For example, poorly managed long term mental and physical health problems cost the NHS £13 billion a year.

The cost of doing nothing or simply settling for gradual change runs to billions of pounds, but the real cost is measured in human misery, misery for want of determination to act on the evidence.

* Paul Burstow MP, was Minister for Mental Health 2010-2012. The Centre Forum Commission on Mental Health comprises Lord Victor Adebowale CBE, Professor Dame Sue Bailey, Paul Farmer, Angela Greatley OBE, Paul Jenkins OBE, and Dr Alison Rose-Quirie.

* Paul Burstow is Liberal Democrat candidate for Sutton and Cheam and was the MP until the dissolution of Parliament on 30th March.

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  • Eddie Sammon 8th Jul '14 - 8:36pm

    I totally agree national happiness should be as important as GDP. However, just from reading your article I think too much emphasis is put on treatment and not enough on other policies that affect mental health such as poverty and extreme inequality.

    Everyone is different, but it looks daft talking a good game on mental health one day and introducing benefit sanctions the next. I haven’t read the report, but the article would have been better to recognise the importance of external factors a bit more.

  • Eddie Sammon 8th Jul '14 - 8:38pm

    By the way, thanks for writing to us!

  • This is ridiculous. It is no business of the government’s whether I am happy or not.

    The government’s job is to pass the right laws, and make sure the economy and public services run. That is all (and indeed often it seems to be beyond the capabilities of the government, so why they think they have the ability never mind the right to go poking into people’s heads is beyond me).

    After that it is up to each individual person whether they want to be happy or not.

    Happiness, or otherwise, is private and the government should stay the hell out of it!

  • Richard Dean 9th Jul '14 - 5:23am

    I agree in the sense that my happiness is primarily my own business. However, if I believe I need help for a mental health issue, I’d like that help to be available on the NHS. I’d also like to be able to call on professional help if it looked like my child or other relative was developing a mental health issue. Money and GDP are not the only things that should motivate government actions; helping individuals achieve “wellbeing” seems a worthwhile goal too.

    I get the impression that CentreForum wants to go much further, however, including having a system of judging whether people have mental health issues even when the people being judged don’t recognize it. See the recommendations about Families and Schools on page 10 and 11 of the detailed report. Some of this work must already be done by social services, so I hope that CentreForum took account of existing experience.

  • Mental health problems, fine, yes, need to be treated just like physical health problems.

    But unhappiness is not a mental illness!

    People who are unhappy do not need to be ‘treated’ to make them happy!

    I get the impression that CentreForum wants to go much further, however

    Bring out the Soma, and let’s all have a good time.

  • Chris Leaman 9th Jul '14 - 2:03pm

    This is an excellent report. What I like about it particularly is it doesn’t just focus on mental health services but instead looks at mental health across the population. We all have mental health just as we all have physical health. Making the country as a whole more mentally healthy should be a priority for Government just as promoting better physical health is now.

    What CentreForum is talking about is basically a prevention programme. Does anyone doubt that improving the physical health of the nation and cutting obesity wouldn’t have a significant impact on the rates of diabetes and heart disease? Why can’t this be achieved with mental health?

    There is overwhelming evidence that early intervention particularly among children and young people makes a huge impact on the outcomes of children and young people. Boosting the resilience and wellbeing of children and young people not only helps children who at risk of developing mental illness avoid it, it also has a significant impact on the overall child population helping them cope with things like exams and school life – which then in turn then leads to better academic results.

    The other thing this report does well is talk about money. Mental health services have been chronically underfunded for generations and continue to be. The Government has done some very good policy work – the Mental Health Strategy, the Crisis Care Concordat, Parity of Esteem among others but what hasn’t happened is investment in services. Children’s mental health services are in crisis with funding cuts meaning that only the children with the most severe illnesses getting treated. What sought of situation is it where we tell children and young people, as we do now, who are struggling with mental illness to come back when they are sicker?

    Money lies at the heart of the problem for improving mental health in the UK. To borrow a line from the film ‘Jaws’ – “we are going to need a bigger boat” – if we are to see real improvement in the provison of mental health services in this country. There is a lot of political goodwill from all parties at the moment around mental health but is there the will to solve this fundemental problem? On that, I’m not so sure.

  • Shirley Campbell 9th Jul '14 - 6:07pm

    Eddie Sammon 8th Jul ’14 – 8:36pm

    Yes, Eddie, successive government policies have a lot to answer for when it comes to measuring the underlying anxieties of the population. Mental illness should never be equated with everyday anxieties. I am not surprised that people are anxious and not hopping and dancing with glee when they are trying to meet high rents whilst seeking to survive on low wages.

    Thanks to our “intellectual betters”, public housing was sold off at a discount, or given away to so-called housing associations, who pay their managers huge salaries and bonuses – council officers hitherto did the job at a fraction of the cost. Private sector rents are beyond the wages of many, and “the many” are compelled to apply for housing benefit, which swells the so-called “benefits bill”. Oh, I believe that tax credits were introduced to mask the fact that employers were paying below subsistence wages. Oh, and “payday lenders” emerged from the woodwork. England in the twenty-first century! We are a “democracy” governed by whom?

    I am a LIBERAL, by instinct; twentieth century LIBERALS, with far greater intellects than mine, saw the folly of permitting the vast majority of the population to live in a state of destitution and degradation. Where do twenty-first LIBERALS reside? The population is seemingly being driven mad and who exactly is responsible for this dilemma?

  • Where expectation exceeds reality , there is un-happiness- Buddist saying. I would suggest the problem is materialism.
    1. Someone may be happy drinking a beer , another person unhappy with their champagne.
    2. Someone may be happy reading a great work of literature bought for 50p , someone else may want the latest computer game.
    3. Someone may spend £100s on tickets to see bands , someone else may prefer playing music with an instrument costing a £100.
    4. Someone may keep fit by running carrying 50lb on their backs and undertaking pull ups, press ups and sit ups and achieve high enough fitness to enter the Special Forces , someone may spend £100s on trainers and gym memebership and achieve on low level of fitness.
    5. Those who endured the horrors of WW1 or WW2 may be happy that they survived unscathed and consider every day a great gift , others have temper tantrum when ever their demands are not met.

  • Nigel Cheeseman 10th Jul '14 - 1:39pm

    I think that, perhaps, use of the word ‘happiness’ has given the subject matter a frivolity that it does not deserve. As Charlie points out, it is largely a matter of attitude. Being an avaricious miserable sod does not mean you have a mental health problem. Mental illness underpins much of what is wrong in our society. Homelessness, for example, I have come to realise has little or nothing to do with housing in the sense that house building does. Drug addiction, alcohol abuse, domestic violence, child abuse etc. etc. do not exist in a vacuum. If only these things could be fixed as easily as a broken leg. Otherwise, this report sounds like a good start.

  • Dav, if a state exists for any good reason then that reason should be to assist with attending to the wellbeing of its citizenry. Your gripe, as pointed out by Nigel Cheeseman, seems more to do with the use of the word ‘happiness’. Obviously the state can’t make people happy. What it can do is ensure that mental health is treated on a par with physical health and give people the opportunity to seek help when they are suffering.

  • Shirley Campbell 11th Jul '14 - 2:59am

    Charlie, I have noted thus:

    Those who endured the horrors of WW1 or WW2 may be happy that they survived unscathed and consider every day a great gift , others have temper tantrum when ever their demands are not met.

    Charlie, my father (1920 – 1999) and my grandfather (1880 – 1965) knew nothing but war and conflict and they would be devastated if they could see the way their former fellow men are being treated by the current so-called “ruling class”. Do not disparage the likes of me who knew these men and their like . My mantra is and always will be: “I once knew men.”

  • SIMON BANKS 11th Jul '14 - 4:34pm

    The proposals are all good sense. They would have some interesting implications: for example, on mental-health-friendly workplaces, managers have persistently ignored good reasons to think that “flexible working” with no option for an employee to have his/her work station and before that the abolition of small offices in favour of big open plan have negative effects on some employees’ mental health.

    Pursuing happiness as a government objective, something New Labour espoused, has the big advantage that it widens our concerns from GDP and brings in things most people want encouraged but which don’t show up in traditional targets. My reservations are that happiness is a nebulous concept which tends to be measured by asking people how happy they are (which will mean different things to different people and may not get honest answers) and that mental health and happiness are not the same thing. For example – who is more mentally healthy, the person who loses a loving partner, child or parent and is desperately unhappy for a while, or the person whose happiness is unaffected by the loss?

  • Flexible planning is not much use in construction sites, oil, mining , armed forces , manufacturing, fishing. One cannot have a crane operator starting at 10a m , when everyone else starts at 8 am. In many jobs teamwork is required, therefore everyone needs to be working at the same time , so flexible working is not possible. Many construction projects critical phases when everyone has to work over a week end or even a long weekend. Off shore work depends upon the weather and tides.

    When something goes wrong, often everyone may need to man the pumps. When there is a problem senior people may have to travel around the World and stay until it is sorted, especially if there is loss of life. If one is involved in a mine rescue or putting out an oil field fire , one cannot decide to leave the site and attend a parents evening if one is working thousands of miles away.

    An example of mental attitude was the beginning of WW2 . Many merchant ships were being sunk and even though sailors were in lifeboats they discovered many were dying even in warmer climes. When they assessed who were dying they realised it was the older ones, those in their 40s, 50s or even 60s who were living , the younger were dying. The authorities realised the older one had gone to sea when conditions were tougher so were mentally and spiritually more resilient. As a result, Outbound Courses were developed to toughen up sailors physically, mentally and spiritually so they had better chances of survival if they were sunk and had to endure time in the sea.

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