Well-being Promotion and Stigma Reduction in Calderdale

1. Well-being Promotion and Stigma Reduction in Calderdale Objective one: More people will have good mental health Objective six: Fewer people will experience stigma and discrimination No Health Without Mental Health (2011)

2. Development • This document has been developed jointly between SWYPFT and the local commissioners, at their request, and is undergoing review (by the Local Authority and Clinical Commissioning Group). Today we are inviting stakeholder and partner comments and contributions, as well as developing the accompanying action plan. The document is a direct response to the National Mental Health Strategy, ‘No Health Without Mental Health’ (2011) and focuses on two of the six objectives it outlines. Objective one: More people will have good mental health Objective six: Fewer people will experience stigma and discrimination • The document helps provide a common understanding of well-being and prevention definitions. Individual projects and organisations will be supported in contributing to the action plan, which will be structured using a life course approach and be based on the 5 building blocks. “It is proposed that achieving a small change in the average level of wellbeing across the population would produce a large decrease in the percentage with mental disorder, and also in the percentage who have sub-clinical disorder (those “languishing”)” (Foresight Mental Capital and Wellbeing Project, 2008).

3. Aims “The local population report and demonstrate a higher motivation to look after their own well-being needs and have accepting, helpful attitudes to mental health difficulties in others. These outcomes are aligned with objectives 1 and 6 of ‘No Health without Mental Health’ (2011)”. The desired outcome of implementing this approach over the next 5 years is: “Wellbeing is: A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment” (Director of Public Health Annual Health Report for Calderdale, 2011).

4. Accountability and Ownership • The document will be owned by the Mental Health Partnership Board • Support and development of the document and action plans will be taken forward by the Mental Health Promotion Alliance • www.southwestyorkshire.nhs.uk/mhpa

5. The Business Case for Well-being Promotion “Mental illness is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease. The wider economic cost of mental illness in England has been estimated at £105.2 billion each year. This includes direct costs of services, lost productivity at work, and reduced quality of life. The cost of poor mental health to businesses is just over £1,000 per employee per year, or almost £26 billion across the UK economy (NHS Choices website, 2013). “The direct financial cost to the state of the treating people with mental health problems is however the tip of an iceberg when it comes to the impact of mental health problems. Most of those experiencing problems are adults of working age, who have caring and family responsibilities. The economic and emotional impact on families when a main earner and carer experiences mental health problems can impact across generations.Successful interventions of any sort which have an impact on preventing mental health problems arising, or reducing their severity and duration by timely targeted support will have substantial social and cost benefits” (Calderdale JSNA website, 2013)

6. The local population • The population figures for children and young people will rise, with an additional 3,600 children aged 15 and below expected. The proportion of children of South Asian ethnicity will rise from 10% to 15%. • In the Calderdale area, the ageing population (65+) is set to experience the biggest increase in the next few years, with rapid growth in the numbers aged 65-74: a rise of 5,600 by 2018. • Calderdale has a higher unemployment rate and a higher percentage of young people classified as NEET (not in education, employment or training) than the average for England. • The estimated prevalence of depression among adults (18+) in Calderdale, as calculated from General Practice records, was 14.89% in 2011/12, which is significantly higher than the England rate of 11.68%. • In 2010, 21% of the population of Calderdale were living in the 20% most deprived areas of England.

7. In Calderdale we strive to see…. Increased mental and physical health literacy in all sections of all of the communities in Calderdale through a Five Ways to Wellbeing campaign, and improved cross-referrals between healthy weight/smoking cessation/physical activity services and mental health services. Parents and care-givers with the capacity and knowledge to meet the social and emotional needs of themselves and their families through interventions which promote parenting skills, family mental health and address childhood conduct disorder. A reduction in mental-health related absence and unemploymentthrough the expansion of delivery of workplace well-being, Five Ways to Well-being and Mental Health First Aid training, and implementation of best-practise across Calderdale employers. A reduction in mental ill-health amongst jobseekers and long-term unemployed, and an increase in motivation to adopt protective healthy behaviours through targeted interventions for jobseekers and promotion of the Five Ways to Well-being and physical health improvements such as increased exercise and smoking cessation.

8. In Calderdale we strive to see…. An increase in the number of people exhibiting early symptoms or higher-risk groups engaging in community-based activities which uphold good mental health and well-beingthrough raising awareness of the availability of these activities and organisations, and increasing signposting at the first signs of vulnerability to stress, anxiety, depression or social isolation. Older adults who feel secure in their communities and homes, who feel their mental capital is valued and who increase their uptake of opportunities for social and physical activities through targeted anti-stigma campaigning, ensuring community facilities and public transport are accessible to older people and used in safety and confidence, and an expansion of the resources aimed at this age group. Reduced inequalities in access to support through targeted promotion of these services to BME communities, and peer- and professional-support to make initial contact with a service or intervention to reduce anxiety or non-attendance. Increased networking and referrals between projects, programmes and services through utilising opportunities for cross referrals.

9. Preventative Interventions and Health Promotion Measures When we talk about ‘preventative measures and interventions’ we mean: • The maintenance of mental and overall well-being as protective factors against the development of symptoms of mental ill-health; building individual resilience and coping skills to rise to meet life’s challenges, and to reduce risk factors (primary prevention and mental health promotion). • Preventative interventions amongst identified higher-risk groups in the community to promote well-being, self-esteem and early-access to services should a problem begin to develop (primary and secondary prevention). • Comprehensive, holistic approaches to treatment for those developing early symptoms of mental ill-health and distress (secondary prevention).

11. Building Blocks for Calderdale’s Well-being These building blocks are a visual graphic to accompany the statements of results below. R P F W C L Resilient Individuals, Families and Communities Positive Attitudes and Behaviour towards Mental Health Funded and Supported Activities Well-being Literacy Comprehensive Strategies, Action Plans and Evaluation A Life-Course approach to Well-being: Provision for all Calderdale residents at every age and time of life. Starting well: pregnancy, families and young children under five Developing well: children and young people under 18 Living well: adults in their community and home settings Working well: workplaces and employment related issues/services including the unemployed and jobseekers. Ageing well: older people 50+

12. These building blocks are statements of the outcomes we wish to see in Calderdale; the results of activities by third sector and statutory organisations. Resilient Individuals, Families and Communities R Resilience-building encompasses the skills and attributes which enable individuals to effectively cope with life stressors and events. It also takes account of the risk factors which increase the likelihood of mental ill health or less than optimum well-being and the measures which reduce these risks. Activities which contribute to this result include: Neighbourhood Schemes Community Health Champions The Family Nurse Partnership Workplace Health Programmes Relaxation Skills Training Behavioural Interventions for young people Workplace Stress Training Parenting Skills Training

13. Positive Attitudes and Behaviour towards Mental Health • Timeto Change campaign (National and Local level) • In Calderdale, achievement of this result would involve: • Workplaces which are sympathetic and supportive towards staff experiencing stress and well-being issues • Individuals with increased motivation to take care of their mental health and engage in healthy behaviours • Positive experiences of community involvement, workplace environments and statutory services for those with mental health problems, free from stigma or discrimination P

14. Funded and Supported Activities F This result will be achieved through community groups’ use of funding to run and expand their programmes of activities, and having training and resources available to improve the service they provide. Advice for creating a funding bid or fundraising activities as provided by organisations such as north bank forum and Community Voluntary Action Calderdale. Groups and Projects have access to training for staff and volunteers and are informed of networking and referral opportunities. Increased networking and referrals between projects, programmes and services

15. W Well-being Literacy Mental Health First Aid and Mental Health First Aid for Young People Training A public campaign centred on the Five Ways to Wellbeing, including suggestions for helpful actions and pursuits which contribute to well-being and physical health. Educational material around maintaining the conditions for positive mental health In Calderdale, people will be empowered to make positive choices about their own health and well-being, and to take full advantage of the variety of activities on offer.

16. C Comprehensive Strategies, Action Plans and Evaluation • Once approved, the Well-being Promotion and Stigma Reduction Strategy for Calderdale will be in place for 5 years. • Each contributing organisation can create a yearly action around these five building blocks. • Improvements in the public mental health of Calderdale residents will be seen: • When strategies are written in mutually-understood terms and clear language, accompanied by specific, measurable actions. • Interventions and activities are appraising their impact • Smaller projects are equipped with tested measures to quantify their effects on participants

17. Developed by the new economics foundation as part of the Foresight Mental Capital and Wellbeing project, the Five ways to Wellbeing are: Example graphics from Five Ways to Wellbeing campaigns in other areas

18. Connect… With the people around you. With family, friends, colleagues and neighbours. At home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day. Be active… Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness. Take notice… Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you. Keep learning… Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set a challenge you will enjoy achieving. Learning new things will make you more confident as well as being fun. Give… Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out, as well as in. Seeing yourself, and your happiness, linked to the wider community can be incredibly rewarding and creates connections with the people around you.

19. Creating an Action Plan • We designed the building blocks using an Outcomes Based Accountability approach (an overview of which follows this slide) • Today’s workshop activity will focus on the actions from all partner organisations which will contribute to the achievement of our aims for Calderdale.

20. Outcome Based Accountability: 2 Ends and 2 Means • Results/Outcomes – A population level condition of well-being for Calderdale residents - • Indicators – Measures that help quantify the achievement of a result • Strategy – A collection of actions and reasoning about what will work • Performance measures- How well a programme, agency or service is working

21. Baselines and Turning the curve Adults Accessing NHS Specialist Mental Health Services This dataset is produced from the Mental Health Minimum Dataset (MHMDS) and provides data on the number of people aged 18 and above who were in contact with NHS specialist mental health services in a year. These services include not only in-patient services, but also services provided in the community or through outpatient clinics. Mental Health Service Users Total (Persons) Source: The NHS Information Centre for Health and Social Care

22. Baselines and Turning the Curve

23. Seven questions to guide action planning • Who are our clients and service users? • How can we measure if our clients and service users are better off? • How do we measure if we are delivering services well? • How are we doing on the most important of these measures? (Baseline of historical performance and a forecast of where we will be in the future if services stay exactly the same) • What partnerships have a role in improving performance? • What works? Including low cost and no cost ideas. • What do we propose to do?

24. Evaluation and Performance Measures

25. Measuring Self-reported Improvements Well-being: The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) The Recovery star The Office for National Statistics ‘Subjective Well-being Questions’ (which have formed part of the Integrated Household Survey since April 2011) The Social Trust Question

26. Attitudes and Behaviour: Mental Health Knowledge Schedule (MAKS) Community Attitudes towards Mental Illness (CAMI) Reported and Intended Behaviour Scale (RIBS)

27. Conclusion