Preventive psychiatry within public health

Thank you, BJPsych, for your timely editorial on population mental health. ¹ It is a pity that the authors did not mention the strategy for England entitled No Health without Mental Health, launched in February (before their final submission) as this strategy did involve precisely the teamwork of psychiatrists, public health specialists and economists that they see as ‘the challenge’. Their ‘must list’ for psychiatry begins with help ‘to remedy the consequences of adversity and vulnerabilities’.

A key weakness of UK attempts to address health inequalities has been a failure of leadership ² – and the common mental disorders show a steeper social gradient than common physical illnesses such as heart disease. Can the Royal College of Psychiatrists take a lead in addressing the antecedents of adversity and vulnerability, not just the ‘consequences’? Desolate, impoverished neighbourhoods spawn childhood mental illness ³ and rising unemployment breeds desperate drinking and suicidal despair. ⁴ In the original National Health Service Act 1946, maternity services were the exemplar of planning equitable care on the basis of population health needs… but in England today many maternity services are at breaking point, with antenatal care services widely sacrificed to maintain staffing for deliveries. The College could speak with unique authority on the need for better antenatal care, to prevent a generation blighted by neurodevelopmental problems. ⁵

I suspect that consultant psychiatrists are, on average, better educated, more articulate and able to reflect than, say, Members of Parliament. Urban degeneration, unemployment and the breakdown of comprehensive health services need to be linked explicitly to escalating economic and social costs of mental illness. Only the College could ‘join up the dots’ convincingly for MPs to respond to urgent population mental health needs.

There is a timely opportunity to test such specialist influence on national policy. Thanks to heroic lobbying by thousands of women before the last election, the training and deployment of 4200 extra health visitors became one of the goverment’s top 10 priorities. ⁶ The editorial on preventive psychiatry describes ‘opportunities to break the intergenerational transmission of risk’. Can psychiatric expertise now permeate into the skill set and effective practice of these 4200 public health practitioners?