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The purpose of this chapter is to serve as a bridge between the chapters in the previous three sections and those in this fourth section. Thus far, we have sought to analyse the social bases of mental and physical wellbeing. Now, we turn to the question of how the fruits of these analyses can be applied in practice. That is, we have been reporting and interpreting the way the world impacts individual people for long enough; it is time to consider how we might change the world in order to improve our wellbeing.
This book’s roots are in an impactful seminar series hosted by the Royal College of Psychiatrists in which practitioners and scientists from a wide array of disciplines came together in 2014 to explore the social influences on our health and recovery from ill health. This volume echoes the evocative conversations in that College and is intended to rehearse research of potentially great impact. It presents practitioners, researchers, policymakers and students of a wide array of disciplines and roles with the material to support them in better harnessing what we now know about the impact of social factors on health. Thereby, the editors hope to influence how practitioners and the responsible authorities work together with members of the public and communities to design and deliver services. Our aspiration is to contribute to creating better-targeted approaches to promoting health and mental health and more effective and integrated interventions for people who have health problems or disorders.
This chapter pulls together key matters in this book. Its title is a quote from a line given to one of the characters in Hamlet by Shakespeare. That sentence perfectly outlines the intention of Section 5 of this book and the function of this final chapter in which I endeavour to align theory, research and the practical impacts of the topics covered by this book with the circumstances in which we find health services as we near the close of the second decade of the twenty-first century. But, first, I return to Chapter 1, to recapture some of those circumstances. Then, I look at the matters on which I think we should focus in order to sustain healthcare services and incorporate the social agenda identified in this book.
This book presents a compelling weight of evidence about how belonging to social groups confers advantages that help people to achieve and sustain good physical and mental health. A huge volume of work has been done to take the evidence-base to where it currently stands. But, arguably, the work required to embed these psychosocial understandings and, importantly, their implications for healthcare, is a larger and more challenging task. The contents of Chapters 23, 24 and 25 should be real assets in so doing.
One of the intentions of this book is to identify effective methods that can be applied to improving healthcare outcomes and delivery. However, linking people’s social relationships with their health, their social groupings, their communities and, within them, health and social care service functioning is undeniably complex involving far more than changing or adding a service.
We developed a fictional town, Smithtown, to support the exercises we undertook during the seminars that gave rise to this book. The town, and a small selection of its inhabitants, were presented to the seminars in 2014, in order to ground the ideas we discussed and focus our conversations about what approaches and actions might assist the population generally and, particularly, following a disastrous flood. We have included a summarised version of it in the book because we thought that readers might wish to think about the implications of the contents of this book for how responsible authorities might approach the challenge of planning for the population of Smithtown. Also, the nature of this fictional town and its recent narrative raises questions for theory, research and practice. Although the town and its inhabitants are entirely fictional, the problems faced by its inhabitants are not..
This chapter does two things. First, it shows how social identity principles can explain the basic psychological and behavioural effects of crowd membership. Second, it describes some recent research and applied work that shows how these basic effects operate to contribute to harmonious outcomes in potentially dangerous crowd events.
We begin by explaining some of the fundamental psychology of crowd membership in the next section.
Reading the first part of this book presents a striking contrast between current preoccupations in healthcare systems and the science presented here. In other words, between extant public concerns about entitlement to, funding of, and delivering healthcare in the second decade of the twenty-first century and the contents of Chapters 2, 3 and 4.
Healthcare systems and the people who fund, run and deliver them are, arguably, necessarily acutely sensitive to the socio-economic environment in which countries sit. The potential capabilities of healthcare continue to develop at increasingly rapid rates. By contrast, we live in a world in which the resources available are affected by austerity and in which the spread of affluence between the most advantaged people and the least affluent continues to grow. This is contributing to an increasing gap between potential capability and actual capacity, which appears to be expanding rapidly.
Public health is defined by the UK’s Faculty of Public Health as ‘The science and art of promoting and protecting health and well being, preventing ill health and prolonging life through the organised efforts of society’.
This definition locates the causes of ill health and the remedies in the realms of personal and societal agency, and not only in the remit of health practitioners. Although the latter have a role as members of society to make prevention a reality for themselves, families and communities, they play a special part in preventing further ill health for people who suffer mental illness and are seeking help for it.
Other chapters in this book attend to the relational and social fabric that enables people to flourish; it is made of good and trusting relationships, and material conditions that permit thought about purpose and meaning beyond survival.
Using current societal dilemmas, this book explores how social factors and social identity influence our health and recovery from illness. It includes recent research to present practitioners, researchers, policymakers and students of many disciplines with the material to support them in better harnessing current knowledge of the impact of social factors on health. The contents will influence collaborative working across policy, disciplinary and practice boundaries to design and deliver healthcare services. The book identifies the importance of social connectedness, social support, agency and self and group efficacy in people's health, longevity and resilience after adversity. Core perspectives include the social identity approach and a values framework for taking public health ethics into decision-making, both of which emphasise valuing people and co-productive relationships. Advocating better targeted mental health promotion and integrated interventions, this book strongly argues for a greater emphasis on social factors in evidence-based and cost-effective practice.
The UK's Choosing Wisely campaign aims to tackle the pressing issue of overuse in healthcare (i.e. overdiagnosis and overtreatment) through improving awareness and promoting shared decisionmaking. This campaign involves medical societies developing lists of interventions that are of questionable value and so require a genuine discussion between doctors and patients about their use. This article is about the problem of overuse and the launch of the Royal College of Psychiatrists' Choosing Wisely campaign. It provides a critical review of why this might occur and whether Choosing Wisely is likely to be successful.
• Understand the aims of the Choosing Wisely programme
• Define overdiagnosis and overtreatment
• Develop a critical perspective on potential areas of overuse in your clinical practice
This study explores the economic cost and carbon footprint associated with current patterns of prescribing long-term flupentixol decanoate long-acting injections. We conducted an analysis of prescription data from a mental health trust followed by economic and carbon cost projections using local and national data.
A reduction of £300 000 could be achieved across England by improving prescribing behaviour, which equates to £250 per patient per year and 170 000 kg CO2e. These savings are unlikely to be released as cash from the service, but will lead to higher-value service provision at the same or lower cost. Most of these carbon emissions are attributable to the carbon footprint of the appointment – 88000 kg CO2e (including energy use and materials used) and the overprescribing of medication – 66000kg CO2e.
Psychiatrists need to review their prescribing practice of long-acting injections to reduce their impact on the National Health Service financial budget and the environment.
To date there have been few peer-reviewed studies on the feasibility,
acceptability and effectiveness of digital technologies for mental health
promotion and disorder prevention. Any evaluation of these evolving
technologies is complicated by a lack of understanding about the specific
risks and possible benefits of the many forms of internet use on mental
health. To adequately meet the mental health needs of today's society,
psychiatry must engage in rigorous assessment of the impact of digital
There is robust evidence that electroconvulsive therapy is an effective treatment for some mental illnesses. Despite this, its use remains controversial and is declining in some countries, with a consequent loss of skills and knowledge. This, and the view of it as a ‘treatment of last resort’, may undermine its sustainability.
The availability and use of mental health treatments are influenced by many different factors. Prominent among these are scientific evidence, cost, ethics and politics. However, the social sustainability of treatments can also have a considerable influence on their use.