Summary
Kooth has more than 20 years’ experience in providing digital mental health services to 15m children, young people, and adults. In this time, we’ve learnt some important lessons about the challenges that face the mental health system, and as a result, firmly believe that holistic, person-centred, joined up mental health services can and will complement existing services and deliver positive outcomes.
This article is the first of five exploring the model of a whole population approach and how - together - we can deliver this ideal for the benefit of everyone. We briefly discuss the increasing demand for mental health services in the UK and the strain on existing resources, and go on to propose a whole population approach to mental health, focusing on four levels:
- Individual
- Community
- Health system
- Whole population
What is a 'whole population' approach?
A whole population approach aims to provide inclusive, accessible, and effective mental health services by integrating prevention, early intervention, and treatment, and addressing systemic factors like living standards. The goal is to create supportive environments, improve awareness, and collaborate on interventions, ultimately reducing service pressures and improving outcomes.
The approach also emphasises how success is measured not only in symptom reduction, but also in other facets, including wellbeing and broader societal impacts, like reduced crime and substance misuse, improved educational attainment, and system cost savings.
The article highlights the need for innovative practices and technological changes to improve service delivery and patient experiences and encourages a more integrated, holistic view of mental health care.
If you’d like to hear about the successes and learnings of real-world whole population approaches first-hand from commissioners who have implemented them, register to receive the full report by clicking here.
Population health and public mental health is rising up the policy agenda, but in mental health, there isn’t yet a clear view yet on what success looks like.
In this article - the first in a series of five - we dig into the current system challenges for mental health and explore how a whole system approach can complement existing services and deliver positive outcomes.
We will consider four different levels - the individual, community, the health system, and whole population - and explore how a focus on each leads to better population health in mental health and beyond.
What we’re facing
In 2022, a record number of referrals for mental health support were received in England. In Wales, referrals to community mental health teams increased by 39% in 2021/22 compared with the previous period, while in Scotland calls made to NHS 24 for a mental health concern rose 580% in the three years to 2022.
With one in four people experiencing a mental health problem each year, coupled with over 1.2M people now estimated to be on NHS mental health waiting lists, it’s well known that services are under enormous pressure.
While patients are affected by the psychological impact of Covid and the cost of living crisis, services are also suffering. A “vicious cycle of staff shortages” has contributed to mental health waiting lists of almost half a million children and waiting times for talking therapy for adults in excess of a year in some areas.
At the same time, there are indicators that more people are seeking help earlier - before challenges become clinical issues. Although this does increase immediate pressure on the system, earlier support before people are in clinical need of ‘treatment’ is well-evidenced to prevent the development of mental health conditions like major depressive disorder, anxiety disorder, and substance (including alcohol) abuse, as well as being important for physical health, life satisfaction, resilience, ability to handle stress, and future mental wellbeing. And of course, the long-term impact of addressing emerging mental health issues is likely to be fewer conditions needing to be treated, and happier, healthier people in our society.
However, with more people seeking support than ever before, providing accessible services with alternative routes embedded within communities is more essential than ever to keeping us all healthier into the future..
The case for joined up support
As outlined above, mental health support at the right time is key for good mental health, physical health and life satisfaction but right now, public sector budgets are tight and existing services are stretched thin. These difficulties call for innovative practice and technological change to drive service improvement, better outcomes and experiences for people. This can be through new ways of working and new care models created by joined up approaches to service delivery.
Services for adults and children are usually commissioned separately which does allow for the creation of treatment pathways specific to the presenting issues of each group. However, only a quarter of young people successfully move to adult mental health services from children’s services, indicating the transition process isn’t ideal. Some never go on to get assessed at all, and for those that do, a proportion wait a year or more for treatment.
For years, we’ve seen the benefits of a more joined up approach across the mental health system:
- Mental Health Liaison Teams can significantly decrease the percentage of A&E attendances for mental health issues
- Co-location of mental health services reduces stigma and judgement around accessing support
- Collaborative working and service alignment between CAMHS & AMHS improves the experience for young people during transition between mental health services.
As a mental health system, when we find ways to break down silos and adopt an integrated whole population approach to service design, we begin to unlock opportunities to develop new whole-person pathways. These have been shown to provide benefits such as more holistic assessments of people’s needs, providing care to people with ‘sub-threshold’ symptoms, and improved mental health outcomes and general functioning and quality of life.
Advocating for a whole population approach to mental health
Digging deeper: the whole population approach in detail
A whole population approach to mental health services is the joined up provision of inclusive, accessible and effective mental health services for an entire population. This approach calls for putting the person at the centre of service design and addressing presenting issues as they appear in the community, while also creating robust care pathways for clinical support and acute intervention when needed.
Supporting good mental health in this way draws from prevention, early intervention and treatment approaches, and enables a broader view of intervention design as we begin to look at resources outside the traditional view of clinical commissioning. It encourages us to view the needs of the entire population rather than focusing on individuals with clinical mental health conditions, and leverages potential partners as additional resources to help deliver positive outcomes.
Success is measured not only through the lens of symptom reduction, but also takes into account patient experience, patient goals and improvement in social functioning. Of course the wider determinants of health play a key role in moderating the effectiveness of any population health approach and must be taken into account here also.
A whole population approach might require policy changes, reallocation or ring fencing of resources for pilot projects, or specific strategies for certain target groups as well as more collaborative working with target groups to ensure they are engaged by broader public health campaigns.
Four Levels of focus
Since 2019, we have been working directly with the NHS, Local Authorities and community organisations to provide access to mental health support for hundreds of thousands of children, young people and adults. These learnings have shown us four key areas of consideration for delivering a whole population approach.
- Recognising Individual Needs
At this level, every individual has access to mental health support and is equipped to maintain good mental health and address any challenges as they occur. A whole population approach will provide help in multiple formats, each tailored to individuals’ specific needs. Empowering people to understand and manage their own mental health is important here, so ensuring these options are accessible, inclusive and coupled with information campaigns and community outreach projects is key.
A whole population approach also acknowledges that systemic factors - like standard of living and quality of life - can create or compound mental health issues. Therefore, issues that might be indirectly related to mental health, but no less important, should also be addressed.
- Support Whole Communities
At this level, supportive environments are fostered in local communities to support the mental health of all members. Not only are initiatives that allow for increased connections and peer-to-peer support leveraged, but these are naturally relevant and appropriate to the particular community given shared membership and stake in one another’s wellbeing.
In the community pillar, localised campaigns to improve awareness about available resources and support might be employed. Creating positive mental health ecosystems is the goal, and concurrently supporting multiple cohorts is an essential part of creating healthier communities. This means collaborating and co-producing interventions and projects to strengthen the mental health of everyone in that community setting. For example, rather than treating the mental health of students in a school, a whole population approach would aim to create a mentally healthier school environment through joined-up support for students, teachers, other staff, and parents or carers, based on joint needs assessments and joint outcomes.
- Support and complement existing system provision
At this level, the focus turns to how existing mental health systems and infrastructure are set up, how patients interact with existing support pathways, and where current pressure points and gaps exist. A whole population approach coordinates resources, strategies and outcomes across children, young people, and adult cohorts to create a seamless provision of care across the life course. In this way, it works to directly reduce existing service pressures, increase capacity in current pathways, and divert needs to be supported within the community or digitally where appropriate.
This is of course challenging. But progress is already being made and we are excited at the prospect of supporting more commissioners to meet increasing levels of demand and improve patient experience and outcomes. A whole population approach aims to reduce the number of mental health presentations in inappropriate pathways, and reduces the overall cost of providing mental health services to children, young people and adults. - Consider Whole Population Impact
The culmination of impact across individuals, communities and systems leading to a mentally healthier population. A whole population approach recognises that mental health does not solely exist within clinical settings, therefore outcomes should not be measured as such. Instead, the impact of a whole population approach to mental health is seen as a combination of individual symptom reduction, increases in mental well being, as well as reduction in crime, smoking and substance misuse, improvement in educational attainment and ultimately cost savings across multiple government departments. Although this is outside the scope of mental health commissioning, and is an ever moving target, evidence supports the case for addressing emerging mental health needs, building positive mental ecosystems, and building healthier mental health systems.
We’re excited to share our learnings on the potential impact of a whole system approach and hope you join us as we explore the four pillars and share examples of success from across the UK.
We’ll be publishing more about each pillar in the coming weeks, with our next article focusing on pillar 1: How a whole population approach leads to healthier individuals.
In the meantime, if you'd like to learn how other commissioners are pioneering a more joined up approach to mental healthcare provision, we're publishing a full report showcasing their experiences, challenges, and share practical advice in the coming months. Pre-register to secure your free report:
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