PHT June 2011_Jan 10 - UK Faculty of Public Health

SPECIAL FEATURE: EARLY INTERVENTION
Scotland aims
for the best
possible start
Parenting programmes
make long-term sense
EVERY pound spent on parenting
programmes to prevent conduct disorder in
young children saves the taxpayer £8 over
a child's lifetime. And this economic
impact of early intervention is over and
above the positive effects on the child’s
wellbeing.
Mental ill health is the largest single
cause of disability in the UK, accounting
for almost 23% of the overall burden of
disease compared to about 16% each for
cancer and cardiovascular disease. Most
mental health conditions first affect people
early in life, with 50% of cases occurring
by age 14. Most current public spending
on mental health is focused on crisis
intervention and expensive longer-term
care and support rather than on prevention
and early intervention. Yet there is
compelling evidence that good quality
public mental health interventions
dramatically cut costs and significantly
improve lives.
Behavioural or conduct problems which
emerge early in childhood are very likely to
persist into later life. The one in 20 young
children whose problems merit a clinical
diagnosis of conduct disorder face a
lifetime of disadvantage, including high
levels of ill health, offending and poverty.
Yet early onset conduct problems and
their risk factors are easily identifiable and,
in many cases, preventable. An increasingly
strong body of evidence demonstrates the
effectiveness of a range of family and
school-based programmes to prevent or
manage conduct problems.
Despite the undoubted benefits, the
availability of these programmes falls well
short of what is needed and the quality of
services is variable. A range of barriers
hinders the provision of evidence-based
interventions. Programmes are not always
compliant with what we know works, and
many fail to target those who need them
most. Take-up rates are low and drop-out
rates are high.
In a recent report*, we found that good
quality parenting programmes save the
taxpayer some £8 for every £1 invested.
Other evidence-based early interventions
also generate substantial savings. They
include health-visiting interventions to
reduce postnatal depression and schoolbased
social and emotional learning
programmes.
It is clear that early intervention in public
mental health is outstandingly good value
for taxpayers’ money. It represents a major
opportunity for directors of public health
and Public Health England to invest in
highly cost-effective interventions and
dramatically improve the life chances of
thousands of vulnerable children.
Michael Parsonage
Senior Policy Adviser
Centre for Mental Health
*Mental Health Promotion and Mental
Illness Prevention: the Economic Case
is published by the Department of
Health, the Personal Social Services
Research Unit (PSSRU) at the LSE,
the Centre for the Economics of
Mental Health and Centre for Mental
Health
www.centreformentalhealth.org.uk
IN SCOTLAND, the main government policy
statement has been the Early Years
Framework (2008), developed with local
authorities, leading to a sustained focus on
this key area of public health.
Across Scotland a number of initiatives
are being developed to test specific
elements of national guidance. These
include population-based parenting
programmes, pilots of the Family Nurse
Partnership model and evaluations of child
development contacts focusing on early
communication and behaviour.
The guidance, Improving Maternal and
Infant Nutrition: A Framework for Action
(2011), focuses on activities across the
preconceptual, antenatal, postnatal and
infant phases in order to improve
outcomes for mothers and children
through improved nutrition. It is coherent
with the Refreshed Framework for
Maternity Care in Scotland (2011) and the
accompanying guidance, Reducing
Antenatal Health Inequalities (2011), and
together these documents set out a broad
multi-agency approach to tackling
antenatal determinants through assetbased
work which will foster stronger
relationships with families.
The Pathway of Care for Vulnerable
Families (0-3) (2011) continues the
strengths-based theme, emphasises multiagency
working and creates a framework
to support the systematic search for needs.
The document supports multi-professional
working in the antenatal period.
A New Look at Hall 4 – the Early Years –
Good Health for Every Child (2011) sets
out a number of changes to child health
surveillance across Scotland, including the
introduction of a universal face-to-face
contact between 24 and 30 months. This
contact will assess social and behavioural
outcomes, provide health improvement
messages and create an opportunity for
parental issues to be addressed. In addition
to the new contact, there are planned
changes to the Health Plan Indicator (HPI).
The HPI is a measure of a child’s need.
Early years remains a priority in Scotland.
Time will tell how financial realities will
challenge the public sector to deliver this
agenda.
Dr John O’Dowd
Consultant in Public Health Medicine
(Child Health)
NHS Greater Glasgow & Clyde
10 PUBLIC HEALTH TODAY