Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health.

The report presents evidence on a range of factors affecting disparity between mental and physical health, and includes case studies and examples of good practice to illustrate some of the key issues and solutions. It should be seen as the first stage of an on-going process over the next 5"10 years that will deliver parity for mental health and make whole-person care a reality. It builds on the Implementation Framework for the Mental Health Strategy in providing further analysis of why parity does not currently exist, and the actions required to bring it about. A parity approach should enable NHS and local authority health and social care services to provide a holistic, whole person response to each individual, whatever their needs, and should ensure that all publicly funded services, including those provided by private organisations, give people's mental health equal status to their physical health needs. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa. The report makes a series of key recommendations for the UK government, policy-makers and health professionals. Recommendations include: The government and the NHS Commissioning Board should work together to give people equivalent levels of access to treatment for mental health problems as for physical health problems, agreed standards for waiting times, and agreed standards for emergency/crisis mental healthcare. Action to promote good mental health and to address mental health problems needs to start at the earliest stage of a person's life and continue throughout the life course. Preventing premature mortality " there must be a major focus on improving the physical health of people with mental health problems. Public health programmes must include a focus on the mental health dimension of issues commonly considered as physical health concerns, such as smoking, obesity and substance misuse. Commissioners need to regard liaison doctors (who work across physical and mental healthcare) as an absolute necessity rather than an optional luxury. NHS and social care commissioners should commission liaison psychiatry and liaison physician services to drive a whole-person, integrated approach to healthcare in acute, secure, primary care and community settings, for all ages. Mental health services and mental health research must receive funding that reflects the prevalence of mental health problems and their cost to society. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), larger than that of cardiovascular disease (16.2%) or cancer (15.9%). However, only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010/11. Culture, attitudes and stigma " zero-tolerance policies in relation to discriminatory attitudes or behaviours should be introduced in all health settings to help combat the stigma that is still attached to mental illness within medicine. Political and managerial leadership is required at all levels. There should be a mechanism at national level for driving a parity approach to relevant policy areas across government; all local councils should have a lead councillor for mental health; all providers of specialist mental health services should have a board-level lead for physical health and all providers of physical healthcare services should have a board-level lead for mental health. The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) should consider how medical and nursing study and training could give greater emphasis to mental health. Mental and physical health should be integrated within undergraduate medical education.This resource was contributed by The National Documentation Centre on Drug Use.

Facing the challenge: The impact of the recession and unemployment on men's health in Ireland

The economic recession with its accompanying rise in unemployment rates is linked to extremely adverse effects for men’s mental health. This research report Facing the Challenge – The Impact of the Recession and Unemployment on Men’s Health in Ireland identifies a strong expectation of increased mental health problems for men given the very strong correlation between unemployment and male mental ill health. The report is the result of a research and consultation process carried out, in Northern Ireland and the Republic of Ireland, by Nexus Research Co-operative on behalf of IPH. 93% of frontline organisations, North and South, in contact with unemployed men linked health challenges to unemployment and recession and all organisations surveyed noted adverse health challenges for men they work with. In addition to health challenges being higher for unemployed men, they were also very high for men who saw themselves as being threatened with unemployment. The organisations surveyed and the men who were interviewed identified the challenges to health as:•    High levels of stress or anxiety•    Dependency on or over-use of alcohol/other drugs•    Deterioration in physical health•    Development of conflict in family or close personal relationships•    Isolation (including sharing or communicating problems)•    A reluctance to approach services or seek help

Putting a health inequalities focus on the Northern Ireland cardiovascular service framework

The PHA, supported by the Institute of Public Health in Ireland (IPH) and other agencies and individuals, has completed a health impact assessment (HIA) on the Cardiovascular Service Framework (CVSFW) for Northern Ireland.The CVSFW is the first in a series of service frameworks developed in Northern Ireland to guide HSC provision from prevention and health improvement over early intervention in communities and general practice into hospital and other institutional settings towards rehabilitation, palliative care and end of life.The CVSFW is relevant to everyone who has a part in HSC services for health improvement, hypertension, hyperlipidaemia, diabetes, heart disease, cerebrovascular disease (stroke), peripheral vascular disease and renal disease. This includes patients, carers, families, communities, voluntary and statutory service providers, policy makers and researchers. There are many determinants which impact on cardiovascular disease. Individual lifestyles are major contributors and smoking remains one of the biggest risk factors for the disease alongside sedentary lifestyles and alcohol consumption. Circumstances experienced during the early years influence health and wellbeing into adulthood. Breastfeeding can help protect against obesity, while physical activity and eating habits developed from a young age often form lifelong patterns of behaviour. Living and working conditions also impact on health. Type of job, level of control and employment conditions are major factors. Educational achievement and income are also powerful influences on health. The environment where we live can provide access to open and green space, which plays an important part in physical activity patterns alongside available transport infrastructure. As well as physical health impacts, all of these factors also influence mental health and emotional wellbeing.

Dublin Simon Community health audit. The complexities of homelessness.

The Dublin Simon Community Health Audit took place during a one week period from Tuesday October 27th to Monday November 2nd 2009. During this one week period the survey was conducted with representative sample of people using Dublin Simon services to provide a snapshot picture of the presenting needs and issues Dublin Simon Community work with on a daily basis. The information gathered builds up a picture of the complex nature of both homelessness and the physical/mental health needs of those experiencing homelessness. Specifically it looks at the physical health issues, diagnosed and undiagnosed; mental health issues, diagnosed and undiagnosed; and drug and alcohol use of those using Dublin Simon services over this one week period.This resource was contributed by The National Documentation Centre on Drug Use.

Active East - A Physical Activity Framework for the East of England 2006

This document sets out the role of physical activity, not just in terms of its known health benefits (prevention of obesity), but also its wider social contribution. Physical activity is a cross cutting agenda and needs to involve a variety of organisations working in partnership with the health sector.

AMH New Horizons Belfast

This project focuses on individuals learning more about their health and wellbeing and developing action plans that they will take responsibility for. This will allow participants to examine and challenge issues which impact on their mental and physical health, including medicines. This project will involve users, staff, pharmacist and other providers. Like all projects this is a 2 way learning process, the staff will be use the pharmacy as a resource and the pharmacist will gain more awareness of health issues and the impact of living with mental health issues.

Young at Heart Men's Club

This project will work with men aged 50 and upwards on a range of health issues including physical health, healthy lifestyle, mental health etc. Other organisations will be brought into talk to the men during the sessions. The project aims to improve the health of the men and encourage them to make healthier choices.

Cognitive behavioural therapy leaflet.

This leaflet is for anyone who wants to know more about Cognitive Behavioural Therapy (CBT).It discusses how it works, why it is used, its effects, its side-effects, and alternative treatments. If you can't find what you want here, there are sources of further information at the end of this leaflet. What is CBT? It is a way of talking about: ï,§ how you think about yourself, the world and other people ï,§ how what you do affects your thoughts and feelings. CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now. When does CBT help? CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue. How does it work? CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are: ï,§ A Situation - a problem, event or difficult situation. From this can follow: ï,§ Thoughts ï,§ Emotions ï,§ Physical feelings ï,§ Actions Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. All these areas of life can connect like this: {5 Areas - click related link below} What happens in one of these areas can affect all the others. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. The way you think can be helpful - or unhelpful. An example: If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself. If you avoid the other person, you won't be able to correct any misunderstandings about what they think of you - and you will probably feel worse. This 'vicious circle' can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways. CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can 'do it yourself', and work out your own ways of tackling these problems. [For full factsheet â?" click on link above]This resource was contributed by the National Documentation Centre on Drug Use.

Making the Link Between Obesity and wellbeing

Making the links between Obesity & Well-being. A briefing paper developed for Care Services Improvement Partnership (CSIP) North West. The paper covers the epidemiology and evidence of links between health and obesity. Mental well-being is a key factor of obesity and weight management. Good mental health is a protective factor for good physical health and against physical illness and is essential for making healthy lifestyle choices and behaviour changes. Poor mental health can lead to unhealthy lifestyle choices and unhealthy weight management. Obesity and physical illness can also lead to poor mental health. People with mental health problems, especially severe, are also at increased risk of obesity and related poor health. In order to ensure that strategies and programmes effectively address the relevant mental well-being factors, a mental well-being impact assessment (MWIA) could be undertaken. This process is based on health impact assessment methodology and a set of evidence based mental well-being determinants and factors, grouped under the four themes of enhancing control, increasing resilience and community assets, facilitating participation and promoting inclusion. The process also involves identifying indicators to measure progress. Evaluation shows it is effective in engaging stakeholders in service development and evaluation and it increases understanding of mental well-being and its determinants.

Death by Suicide: A Report Based on the Northern Ireland Coroner’s Database

Funded by HSC R&D Division, Public Health Agency Why did we start? Potentially new information, especially relating to the characteristics of those who had died by suicide was made available through the Coroner’s Office.  The information made available to us covered deaths that occurred in the years 2005 to the end of 2011. What did we do? First we addressed the descriptive characteristics associated with this group of individuals. These descriptive characteristics included information relating to (1) means by which the death occurred (2) gender, age and employment status of the person (3) prior attempts (4)  alcohol and prescription use around time of death (5) adverse events (6) use of health services and (7) mental and physical health problems. Second we examined area level residential location in terms of Local Government Districts, and Wards within Northern Ireland. To address this area level of analysis, standardised mortality ratios (SMRs) were used.      

A Health Economics Model. The cost benefits of the Physical Activity Strategy for Northern Ireland - a summary of key findings

This summary report follows on from the publication of the Northern Ireland physical activity strategy in 1996 and the subsequent publication of the strategy action plan in 1998. Within this strategy action plan a recommendation was made for the health sector, that research should be carried out to evaluate and compare the cost of investing in physical activity programmes against the cost of treating preventable illness. To help in the development of this key area, the Department of Health, Social Services and Public Safety's Economics Branch agreed to develop a model that would seek to establish the extent of avoidable deaths from physical inactivity and, as a consequence, the avoidable economic and healthcare costs for Northern Ireland.

30 minutes of physical activity a day is good for your health

This poster promotes the message that 30 minutes of moderate physical activity a day has substantial health benefits, and highlights the fact that you don’t have to do 30 minutes all in one go.

Health Impact of Physical Inactivity (HIPI) Tool

Regular physical activity has substantial health benefits, yet only a minority (approximately 21%) of the population in England achieve the minimum levels as recommended by the four home countries’ Chief Medical Officers, in their Start Active, Stay Active report HIPI has been developed to estimate how many cases of certain diseases could be prevented in each local authority in England, if the population aged 40-79 were to engage in recommended amounts of physical activity. This first release (March 2013) includes the following health impacts: preventable cases of diabetes (only shown for Counties and Unitary Authorities) preventable emergency admissions to hospital with a coronary heart disease preventable new cases of breast and colon cancer total number of preventable deaths (all causes). Users can select geographical areas from a map or list. The data is also provided in a downloadable excel spreadsheet. HIPI uses estimates of local levels of physical activity from the Sport England Active People survey. It models the potential benefit from increased levels of physical activity for each local authority. This is pre-calculated to show the health impacts if 100%, 75%, 50% or 25% of the local population undertake the UK Chief Medical Officers’ recommended levels of physical activity. Other assumptions and sources of data are described in the technical document.

Obesity in an ageing society implications for health, physical function and health service utilisation.

Key Findings • Based on body mass index (BMI) measurements, 36% of Irish over 50s are obese and a further 43% are overweight. • Based on waist circumference measurements, 52% of Irish over 50s are ‘centrally obese’, i.e., with a ‘substantially increased’ waist circumference, while a further 25% have an ‘increased’ waist circumference. • Using BMI as an indicator of obesity, a higher proportion of men (38%) are obese than women (33%); however, using waist circumference as an indicator of obesity, a higher proportion of women (56%) have a ‘substantially increased’ waist circumference than men (48%). • The prevalence of obesity in Irish men over 50 is comparable with US men over 50 (while English rates are much lower).     .This resource was contributed by The National Documentation Centre on Drug Use.

Physical activity and mental health in ageing

This research brief examines the links between maintaining recommended levels of physical activity and positive effects on mental health and brain functioning as well as the public policy strategies in place to promote physical activity in the older population. It is based on three CARDI-funded projects:- Physical activity and core depressive symptoms in the older Irish adult population, led by Karen Morgan at the Royal College of Surgeons in Ireland.- Using aerobic exercise to promote brain plasticity, conducted by Richard Carson at Queen’s University, Belfast.- Leading dance for older people, led by Sylvia O’Sullivan at the University of Limerick.