Public Health Dialogue: mental health and wellbeing

The role of health and wellbeing boards • The third sector needs to understand the relationship between health and wellbeing boards and commissioning groups • No one is sure what the boards are, and no one understands the nature of them • The third sector is being told that health and wellbeing boards are where charities can make a difference, but many charities are not really sure what they are, how you get on one and who decides who can sit on them • There's the fear that third-sector services could miss the boat when it comes to health and wellbeing boards • Accountability is a key issue. Who will be accountable for health and wellbeing boards? • Charities need to ensure that they are clustered appropriately and positioned properly in the right cluster so that they're not in trouble 12 months down the line Geographical boundaries • Managing boundaries and the geographical challenges that come with them in local authorities will be a big problem for local authorities • Dividing up between providers looks messy The demand for mental health services is growing • More people are accessing mental health services than ever before: "There are black holes and people are drowning." • There is no recognition of the complexities of people's mental health problems • Services provided by the third sector are effectively working in a social care role but with fewer resources • There is a huge, increasing demand for mental health services. Services are grappling with localism versus providing a business case - "a horrendous no-man's land" • There needs to be more recognition of mental health problems in specific groups (for example, lesbians, gays, bisexual and transgender) A need for softer outcome frameworks • Local authorities are going to want to commission to reach targets, rather than trying to help in the appropriate ways • "It's easier to measure tangible things like teenage pregnancies than the systematic reasons why people are having unprotected sex at an early age" • On targets, local authorities are going to be "ticking the box but missing the point" • Attempts were made before to set more sophisticated targets, but nothing's happened since • In outcomes targets in public health ,we need to recognise the huge importance of education • Services shouldn't be commissioned on evidence and outcomes • "We need to accept that the Department of Health is just not going to commission certain things" • "There's no point reaching targets on ambulance response times when a patient doesn't need to go to A & E but receive appropriate mental health support" There is a gap in funding • "Ringfencing" money means nothing in local authorities • It won't be hard for local authorities to move to charging for services (ie, stopping smoking) • Ultimately, "the sector points to money" • Why are we getting banks interested in our services to support their staff, but not the NHS? • Local authorities know what they want to fund, but are just going to stick to what they know • There seems to be no budget for mental health issues • Councils need more holistic measures • "We can sell to banks but not to primary care trusts" Mental health wellbeing • Who is leading the debate about what public health should look like? • More and more public services are being funded by the voluntary sector • Commissioners don't even know how to commission our services properly • In mental health there's more than one answer. But they are really simple