Clearly individual behaviour choices, such as smoking or substance misuse, amongst people with mental health conditions, offer some explanation for the levels of illness and premature death amongst these groups. But the fact of having a diagnosis of mental illness often impeded service users from getting the necessary care and treatment for their physical health. Participants also noted major challenges around mental health in black and minority ethnic (BME) communities, which are disproportionately represented in mental health services.

There was some agreement that a variety of government initiatives in recent years had gone some way to addressing these problems. Particularly noteworthy were e.g. providing routine physical examinations to patients admitted to secondary mental health care; establishing of Severe Mental Illness (SMI) registers in GP practices leading to proactive and opportunistic health checks; and offering holistic wellbeing services by Third Sector agencies.

One participant described successful efforts to overcome barriers to mental health provision in BME communities. Producing materials in native languages is clearly an insufficient response to the problem, failing to take account of cultural sensitivities around the concept of mental ill health. Rather, paid community development workers able to better understand broader community networks and seek out individuals in the community who can refer patients directly to mental health services, was seen as an example of best practice in ensuring better access for marginalised groups.

Improvements were also noted in specialist services in the area of child and adolescent mental health services (CAMHS), and in early intervention strategies for working age adults. A major area of concern, however, remains inpatient services, requiring greater personalisation of services and a focus on staffing levels and skills to improve the quality of relationships with patients. Future work related to older people, such as the national strategy on dementia, were highlighted, as well as the greater focus that maternity services, children's and youth services should give to mental well being.

The overriding question, it was felt, for such a wide-ranging agenda was the extent to which a single, clear vision of a strategy to tackle mental health inequalities could be articulated. Such a strategy would need to link up action across government departments and services at an individual, local and national level.

One participant noted an apparent disparity between the individual cognitive behavioural approach (making use of personal care budgets for example) that has had some success, but fails to mesh with a wider collective approach to mental health promotion. It was felt that better public mental health strategies would be vital in this respect, and disappointment expressed from a number of participants at the somewhat marginal place afforded mental health in the 2004 Public Health White Paper.

It was suggested that rather than a "Cinderella part of the health service", mental wellbeing should be placed at the very heart of not only the health mainstream, but of a Labour government's conception of a socially just society. Mental health it was noted impacts profoundly on just about every public policy issue, from social exclusion and the family to social mobility and economic growth. There was much debate about the form of argument and language that this shift in emphasis requires.

A distinction was drawn between the narrative needed to convince the Treasury in particular of the central importance of mental wellbeing to the government's overriding political agenda, and that needed to shift wider public opinion and the pervasive social stigmas surrounding mental health issues.

It was suggested that the 'business case for mental health' provides a compelling case of the economic costs of inaction over mental health issues to both businesses and society as a whole. A major cause of sickness leading to days off work and worklessness, both business and government can be presented with opportunities for major productivity savings by taking mental health problems amongst people both in and out of work seriously. It was vital for government to address the real and widespread discrimination which resulted from stigma.

While public sector employers have a good record on these issues, the private sector has yet to fully internalise their significance. The DoH/DWP guide to tackling the stigma associated with mental health in the workplace was recommended as a good start. One participant noted the better practice of companies in the USA from which employers in this country could learn, more aware of the issue perhaps as a result of US employers' responsibility for the health costs of their employees.

Some participants worried, however, that an overly econometric case for the significance of mental health might detract from the wider public and political resonance of the issue. The importance of the language and 'branding' of a narrative around mental health was stressed. This would require sensitivity around catch-all terms such as 'mentally ill', though greater differentiation between types of mental health problems might lead to yet further stigmatisation. One participant noted that their mental health trust would be dropping the term 'mental health' altogether from its title.

The role of evidence used to support these arguments was also discussed. Mental health inequality is a complex system problem unresponsive to single, simple solutions, and unsuited to traditional quantitative research. This should not, one participant noted, prevent policy-makers from drawing on micro examples of best practice. The challenge, they noted, would be in industrially scaling-up such experiences to have a more profound impact on social wellbeing. This, it was felt, may require a review of the commissioning framework for mental health promotion to take account of the range of interventions this might involve.

Ultimately it was felt that mental health and the importance of narrowing inequalities in mental health, could be put at the heart of a strategy to both create a fairer society and one able to respond economically to the pressures of globalisation. Both strands of this narrative would be necessary to win the case for the significance of mental health in the Cabinet Room, corporate boardrooms, the media and wider society.

Back to Health Inequalities forum