Putting People First (HM Government, 2007) is clear that it expects public services to make ‘a strategic shift towards early intervention and prevention' Prevention can be difficult to define because it embraces a wide continuum from intermediate care to supporting social inclusion (Hudson and Henwood, 2008) and Putting People First therefore offers a broad framework to help in planning the shift to prevention (Department of Health, 2008).
It suggests three categories:
- Primary prevention/promoting wellbeing aimed at people who have little or no particular social care needs or symptoms
- Secondary prevention/early intervention that aims to identify people at risk and to halt or slow down any deterioration and actively seek to improve their situation
- Tertiary prevention aimed at minimizing disability or deterioration from established health conditions or complex social care needs.
Activity and interventions would need to be planned across all three of these categories to achieve wellbeing outcomes that would meet the needs of all.
Getting help early on can be crucial (Marshall et all, 2005) as the first few years of severe mental ill health carry the highest risk of serious physical, social and legal harm.
As a citizen I have access to services that promote well being.
Examples of things that help with this:
- Partnerships (for example between leisure services, community development, supporting people programme, public health, community safety partnerships, housing, employers and employment services, fire service and community safety programmes, health and social care) that work with individuals and communities to provide:
- Activities to address social isolation
- Practical help, if I need it, to run my home and keep it safe
- Health living advice and support and access to local activities and opportunities that promote health
- Community safety initiatives that tackle some of the things locally that may be causing anxiety and stress (e.g fire safety, crime prevention)
- Housing choices and improvements
- Transport options
- Investment in employee health I get help when I ask for it, even if I do not meet eligibility criteria. I get help before a crisis occurs.
Examples of things that help with this:
- Pro-active work to identify people who could benefit from access to information and support e.g. older people at risk of developing mental health needs
- Information and support for people to access universal or voluntary sector services, such as ‘navigator' services for signposting and self-help websites
- Community involvement projects that include funding for well being projects
- Support teams and programmes for those at risk of admission to hospital or to facilitate discharge from hospital
SIGNPOSTS
older people and mental health
1. Bradford and Airedale Older People's Health in Mind project. A programme to help older people with mental health needs and carers to improve their quality of life and stay independent and healthy. www.bradfordhealthinmind.nhs.uk
2. Health in Mind Evaluation, university of Bradford, 2008. www.bradfordhealthinmind.nhs.uk/NR/rdonlyres/716d7346-c3cE-44cd-8999-E06191d03ddf/65015/bradford_HealthinMindEvaluation_finalReport_300608.pdf
3. Camden Networkers. The Camden Networkers promote information on healthy living, mental health and social care issues to their peers. The project is also creating a database of specialist Mental Health Networkers who will undertake additional healthy living programmes, be informed of wider health prevention services available, act as sign-posters, and establish links/choices with older mental health users, mental health professionals, health agencies, community centres and associations through information sharing. www.dhcarenetworks.org.uk/Prevention/MakingItHappen/PracticeExamples/Access/?parent=3939&child=4004
4. Practicalities and possibilities. Information and stories.
www.helensandersonassociates.co.uk/Reading_Room/Who/Older_People. html
information and programmes
4. Improving mental health care pathways: National Mental Health Development unit. This programme has an emphasis on prevention, early intervention and the support of personalised and socially inclusive care at all stages of a persons experience of mental distress. The programme works to demonstrate that it is age inclusive, gender and culturally sensitive. The focus in 2009/10 is to embed a recovery oriented approach. www.nmhdu.org.uk/our-work/improving-mental-health-care-pathways/?keywords=Early+intervention
5. A window of opportunity: A practical guide for developing early intervention in psychosis services: Briefing 23 The Sainsbury Centre for Mental Health, 2003. www.scmh.org.uk/pdfs/briefing+23.pdf
6. Rethink website: information about early intervention. www.rethink.org/about_mental_illness/early_intervention/index.html
7. All stages diversion: a model for the future, Sainsbury Centre for Mental Health, 2008. Describes a diversion model for people with mental health needs who enter, or are at risk of entering, the criminal justice system. www.scmh.org.uk/pdfs/all_stages_diversion_model.pdf
resources for early intervention
8. Social Care Reform Grant - providing additional resources for public services to make the shift to prevention. Details in LC(DH)(2008) Transforming adult social care. www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/ LocalAuthoritycirculars/dH_081934
9. Care Services Efficiency Delivery CSED helps councils to identify and develop more efficient ways of delivering adult social care. The programme is currently focusing on mental health, physical and learning disability needs. www.csed.csip.org.uk
Housing
10. Camden Extra Care Housing for people with mental health needs.www.dhcarenetworks.org.uk/Prevention/MakingItHappen/PracticeExamples/Avoidi ngInstitutionalism/?parent=3940&child=4019
11. Housing for older people.www.dhcarenetworks.org.uk/ IndependentLivingchoices/Housing/Topics/browse/HousingOlderPeople/
Home support and mental health
12. East Sussex Mental Health Care Home Support Service. www.dhcarenetworks.org.uk/Prevention/MakingItHappen/PracticeExamples/Reablement/?parent= 3945&child=4059
13. For other examples of prevention partnerships and projects see Prevention section on the DH Carenetworks website: www.dhcarenetworks.org.uk/Prevention/MakingItHappen/PracticeExamples/Access/
Health at work
14. Health, Work and Well-being is a Government-led initiative to protect and improve the health and well-being of working age people. www.workingforhealth.gov.uk
15. Improving health and work: Changing lives: The Government's response to Dame Carol Black's review of the health of Britain's working age population, The Stationery Office, 2008. www.workingforhealth.gov.uk/documents/improving-health-and-work-changing-lives.pdf
