Public health has long been neglecting mental health. Professor Sally Davies of the UK chief medical officer has made the issue urgent by calling on mental health to receive the same priority as other urgent issues such as obesity.
In a recent article in The Lancet, Professor Davies used her most recent report to advocate for improved mental health training and integration of physical and mental health services. This is because it recognizes the important links between physical and mental health and the limitations in trying to treat one without the others.
Davies’ conclusions on certain aspects of the topic are also surprising. He uses arguments that don’t hold up under scrutiny and could be harmful to mental health. This is especially true when it comes to the inclusion of mental health in public health policies.
Mental health is not just about the absence of mental illnesses. It also includes the positive aspects of mental wellbeing. Mental wellbeing is often defined as “feeling well and performing well”, while mental illness is diagnosed based on feelings bad and poor performance.
Davies’ most recent report stated that there was not enough evidence to justify framing public mental health policy and commissioning based on wellbeing.
She said that mental well-being is poorly defined, its measurement is inaccurate and this “critically compromises the credibility” of the evidence.
This is in stark contrast to her conclusion in 2011, in which she stated: “Public Health must encompass not just physical health, but also mental and emotional wellbeing.” It is important to review all current interventions and consider ways in which wellbeing can be improved.
While there are differences in the definitions of mental well-being, they all share a common ground. It is not surprising that there are still many questions and discussions about the definition of wellbeing, as the topic has only just recently entered the public domain. It is healthy to do so, but that doesn’t mean you can’t develop useful programmes while we wait.
It is not until interest in mental health increases that we will gain a better understanding of its nature. Although we do not know the exact definition of what physical activity is best for your health, it’s clear that encouraging more exercise would be a great idea.
Many examples exist of instruments that are well-validated and measure mental wellbeing. It is not necessary to have the ability to measure public issues in great detail before launching preventive programs. In public health, good enough is usually enough.
We wouldn’t be tackling issues like alcohol, diet or physical activity if we didn’t know how to measure the problem precisely. The development of methods to define and measure these issues, and their ideal outcomes, should go hand-in-hand with the public health programs themselves.
The concept of mental well-being is spreading faster than others because it allows people to discuss an aspect of their health they intuitively know is important, but that health services do not address. Professor Davies’s recommendation is at best unexpected and at worst, likely to be harmful to the subject that she wants to promote.
The chief medical officer is a person of authority for policy makers and practitioners. It would be detrimental to the public’s mental health if, in response to her report, policy makers and practitioners decided to stop investing in services that promote mental wellbeing, or to end discussions about future service developments.