Written evidence submitted by Dr Miranda Budd (PHS0003)

I am a Consultant Clinical Psychologist working in Lancashire and South Cumbria NHS Foundation Trust. Across the region, we have significant deprivation and high mental health need. I am the Clinical Lead for a new workforce (known as Associate Psychological Practitioners- a Health Education England workforce innovation) of psychological practitioners working in General Practice (GP) settings. By March 2023, across the 41 Primary Care Networks (PCNs) in Lancashire and South Cumbria, we will be working in 32 of those PCNs with a focus upon mental health prevention and promotion. I am also the Principal Investigator on a National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) Feasibility RCT, exploring mental health prevention and promotion in GP settings.

Why the Health & Social Care Committee should consider this issue as part of its Prevention Inquiry:

The Mental Health Foundation issued a stark warning that when we fail to prevent, years are lost, and lives are damaged: sentiments echoed by the Royal College of General Practitioners. GP is an excellent place to focus upon mental health prevention and promotion, partly because of the frequent contact everyone has with their local surgery and practices ability to engage with, and serve their local community. It is estimated that a third of GP appointments have a mental health component and those with lower levels of mental wellbeing have greater healthcare use. GP currently engage in ‘watchful waiting’ until someone deteriorates enough to warrant a referral, or prescribing antidepressants as a ‘stopgap’- with prescribing rates increasing at an alarming rate. I have written a review article in this area with additional information- ‘Mental health promotion and prevention in primary care: What should we be doing vs. what are we actually doing?’ published in The Journal of Mental Health & Prevention (Budd et al., 2021).

Teaching people how to care for their emotional wellbeing, either via brief psychological interventions in GP, or by engaging with local community groups to help teach others such skills should be part of the Prevention Inquiry.

Why the Committee should look at it now: in particular, whether there is an opportunity for it to add value to existing research and evidence:

The North West Coast has a higher than national average prevalence of common mental health disorders, despite this, there is a much lower proportion of people being recruited into research. There is a real need for additional research and evidence about mental health prevention and promotion work to strengthen the service delivered in GP settings. There is a real opportunity to improve people’s health and reduce the demand of mental health on NHS services.

GP is changing, in response to the NHS Long-Term Plan, the ‘Additional Roles Reimbursement Scheme’ was introduced, which has meant Mental Health Practitioners have started working in PCNs. There is a real opportunity to support these developments and to ensure at least part of their role focuses upon mental health prevention and promotion to improve wellbeing.

Why this area would benefit from scrutiny:

We have published our first year evaluation results of the service ‘Can a new role, the (Trainee) Associate Psychological Practitioner (T/APP), add value in General Practice? Results from the pilot year evaluation’ in the journal of Primary Health Care Research & Development (Budd et al., 2022) and have developed this into a NIHR RfPB funded feasibility RCT. However, more research needs to be done to support mental health prevention and promotion, increase its profile and help increase understanding about how important a proactive approach is.

With the new developments in PCNs comes a lot of opportunity to improve communities’ resilience and wellbeing. More scrutiny and learning is absolutely vital at this stage of development to ensure effective care for the public.

Why the Government needs to take action in this area:

In summary to what I have written above:

•                                                                                                                                                                                                                                                                                                                Mental health prevention and promotion is vital, to reduce distress, help save lives and reduce the cost to society and the NHS. There is a clear economic case for investing in prevention of mental health conditions in the UK (Mental Health Foundation, 2022).
•                                                                                                                                                                                                                                                                                                                GP is an excellent place to engage in a proactive approach.
•                                                                                                                                                                                                                                                                                                                Additional focus and research needs to go into mental health prevention and promotion work to ensure services are delivering effective and evidence based approaches.
•                                                                                                                                                                                                                                                                                                                There is additional government investment going into PCNs at present and focusing some of this investment on a preventative approach is a real opportunity for positive impact for the general public, on multiple levels.

February 2023