- Email: [email protected]
Responses to the Chief Medical Officer's report 2013
Correspondence
yet by recommending that “wellbeing interventions should not be commissioned in mental health as there is insufficient evidence to support this”,1 we think there is a risk she could be doing just that. I declare no competing interests.
Poppy Jaman [email protected] Mental Health First Aid England, London, UK; and Public Health England, London N1 6AH, UK 1
2
Published Online April 27, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)60306-3
3
4
For a full response to the Chief Medical Officer’s 2013 report from the Faulty of Public Health see http://www.fph.org. uk/reflections_on_the_annual_ report_of_the_chief_medical_ officer_2013
2576
Davies SC. Annual report of the Chief Medical Officer 2013, public mental health priorities: investing in the evidence. London: Department of Health, 2014. WHO. Mental health: a state of wellbeing. August 2014. http://www.who.int/features/ factfiles/mental_health/en/ (accessed Feb 24, 2015). Public Health England. Health and wellbeing: introduction to the directorate. May 16, 2013. https://www.gov.uk/government/ publications/health-and-wellbeingintroduction-to-the-directorate/health-andwellbeing-introduction-to-thedirectorate#our-programmes (accessed Feb 24, 2015). Erlangsen A, Lind BD, Stuart EA. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Lancet Psychiatry 2015; 2: 49–58.
At the Faculty of Public Health, we welcomed the 2013 report of the UK Chief Medical Officer, which was the first ever to cover mental illness. However, we were surprised to see the recommendation about wellbeing, repeated in The Lancet (April 11, p 1472),1 that “There is insufficient evidence to justify the framing of public mental health policy and commissioning in terms of wellbeing”. This statement contrasts with one of the conclusions of the Chief Medical Officer’s 2011 report2 in which she recommended that “Public Health needs to encompass not only physical health but also mental health and wellbeing. All current interventions should be reviewed to consider how improving wellbeing can be incorporated”. In 2013, the Chief Medical Officer argued that that the concept of mental wellbeing was not sufficiently well defined and that measurement
was therefore often based on proxy measures “crucially compromising the credibility of the evidence base”.1 Many public health problems, such as physical activity, are difficult to define and measure precisely, but this is not deemed a good reason for inaction. The second argument made by the Chief Medical Officer is that there is no evidence to support the Rose Hypothesis—ie, that continuously distributed public health issues are best addressed with universal approaches that shift the population mean and, in doing so, reduce the prevalence of the public health problem.3 The evidence needed to support this argument exists: the prevalence of mental disorders can be predicted by the mean level of mental health in the population4,5 and it is possible to change the mean level of mental health or established risk factors in universal populations.6,7 SS-B developed the Warwick-Edinburgh Mental Well-being Scale (a way to measure mental wellbeing).
*Sarah Stewart-Brown, John Middleton, John Ashton [email protected] UK Faculty of Public Health, London NW1 4LB, UK 1
2
3
4
5
6
7
Mehta N, Croudace T, Davies SC. Public mental health: evidenced-based priorities. Lancet 2015; 385: 1472–75. Davies SC. Annual Report of the Chief Medical Officer, volume one, 2011, on the state of the public’s health. London: Department of Health, 2012: 12. Rose G, Khaw K, Marmot M. Rose’s strategy of preventive medicine. Oxford: Oxford University Press, 2008. Goodman A, Goodman R. Population mean scores predict child mental disorder rates: validation SDQ prevalence estimators in Britain. J Child Psychol Psychiatry 2011; 52: 100–08. Veerman JL, Dowrick C, Ayuso-Mateos JL, Dunn G, Barendregt JJ. Population prevalence of depression and mean Beck Depression Inventory score. Br J Psychiatry 2009; 195: 516–19. Weare K, Nind M. Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int 2011; 26 (suppl 1): i29–69. de Vibe M, Bjørndal A, Tipton E, Hammerstrøm K, Kowalski K. Mindfulness based stress reduction (mbsr) for improving health, quality of life, and social functioning in adults. Campbell Systematic Reviews 2012; published online Feb 1. DOI:10.4073/ csr.2012.3.
Department of Error Yacoub M. Cardiac donation after circulatory death: a time to reflect. Lancet 2015; 385: 2554-56—In this Comment, the twelfth bar in the figure should have read Austria. This correction has been made to the online version as of April 27, 2015, and the printed Comment is correct. Clotet B, Feinberg J, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study. Lancet 2014; 383: 2222–31—In this Article (April 1), in the Results section, the third sentence of the sixth paragraph should have read, “The dolutegravir group had significantly fewer LDL values of grade 2 or higher than did the darunavir plus ritonavir group (5% vs 16%; p=0·0001), against a pre-specified p value threshold of 0·045 (two-sided; appendix).” This correction has been made to the online version of the Article as of June 26, 2015. Ong ACM, Devuyst O, Knebelmann B, Walz G, on behalf of the ERA-EDTA Working Group for Inherited Kidney Diseases. Autosomal dominant polycystic kidney disease: the changing face of clinical management. Lancet 2015; 385: 1993–2002—In figure 3, panel C, of this Review (May 16), the baseline mean estimated glomerular filtration rate of the placebo group in the sirolimus study should be 92 mL/min/1·73 m² and the mean age 32 years. This correction has been made to the online version as of June 26, 2015. Dzau VJ, Ginsburg GS, Van Nuys K, Agus D, Goldman D. Aligning incentives to fulfil the promise of personalised medicine. Lancet 2015; 385: 2118–19—In this Viewpoint (May 23), the Declarations of interest section should have stated that David Agus co-founded Navigenics in 2006, but has had no financial interest in the company since February, 2010. This correction has been made to the online Viewpoint as of June 26, 2015.
www.thelancet.com Vol 385 June 27, 2015
yet by recommending that “wellbeing interventions should not be commissioned in mental health as there is insufficient evidence to support this”,1 we think there is a risk she could be doing just that. I declare no competing interests.
Poppy Jaman [email protected] Mental Health First Aid England, London, UK; and Public Health England, London N1 6AH, UK 1
2
Published Online April 27, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)60306-3
3
4
For a full response to the Chief Medical Officer’s 2013 report from the Faulty of Public Health see http://www.fph.org. uk/reflections_on_the_annual_ report_of_the_chief_medical_ officer_2013
2576
Davies SC. Annual report of the Chief Medical Officer 2013, public mental health priorities: investing in the evidence. London: Department of Health, 2014. WHO. Mental health: a state of wellbeing. August 2014. http://www.who.int/features/ factfiles/mental_health/en/ (accessed Feb 24, 2015). Public Health England. Health and wellbeing: introduction to the directorate. May 16, 2013. https://www.gov.uk/government/ publications/health-and-wellbeingintroduction-to-the-directorate/health-andwellbeing-introduction-to-thedirectorate#our-programmes (accessed Feb 24, 2015). Erlangsen A, Lind BD, Stuart EA. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Lancet Psychiatry 2015; 2: 49–58.
At the Faculty of Public Health, we welcomed the 2013 report of the UK Chief Medical Officer, which was the first ever to cover mental illness. However, we were surprised to see the recommendation about wellbeing, repeated in The Lancet (April 11, p 1472),1 that “There is insufficient evidence to justify the framing of public mental health policy and commissioning in terms of wellbeing”. This statement contrasts with one of the conclusions of the Chief Medical Officer’s 2011 report2 in which she recommended that “Public Health needs to encompass not only physical health but also mental health and wellbeing. All current interventions should be reviewed to consider how improving wellbeing can be incorporated”. In 2013, the Chief Medical Officer argued that that the concept of mental wellbeing was not sufficiently well defined and that measurement
was therefore often based on proxy measures “crucially compromising the credibility of the evidence base”.1 Many public health problems, such as physical activity, are difficult to define and measure precisely, but this is not deemed a good reason for inaction. The second argument made by the Chief Medical Officer is that there is no evidence to support the Rose Hypothesis—ie, that continuously distributed public health issues are best addressed with universal approaches that shift the population mean and, in doing so, reduce the prevalence of the public health problem.3 The evidence needed to support this argument exists: the prevalence of mental disorders can be predicted by the mean level of mental health in the population4,5 and it is possible to change the mean level of mental health or established risk factors in universal populations.6,7 SS-B developed the Warwick-Edinburgh Mental Well-being Scale (a way to measure mental wellbeing).
*Sarah Stewart-Brown, John Middleton, John Ashton [email protected] UK Faculty of Public Health, London NW1 4LB, UK 1
2
3
4
5
6
7
Mehta N, Croudace T, Davies SC. Public mental health: evidenced-based priorities. Lancet 2015; 385: 1472–75. Davies SC. Annual Report of the Chief Medical Officer, volume one, 2011, on the state of the public’s health. London: Department of Health, 2012: 12. Rose G, Khaw K, Marmot M. Rose’s strategy of preventive medicine. Oxford: Oxford University Press, 2008. Goodman A, Goodman R. Population mean scores predict child mental disorder rates: validation SDQ prevalence estimators in Britain. J Child Psychol Psychiatry 2011; 52: 100–08. Veerman JL, Dowrick C, Ayuso-Mateos JL, Dunn G, Barendregt JJ. Population prevalence of depression and mean Beck Depression Inventory score. Br J Psychiatry 2009; 195: 516–19. Weare K, Nind M. Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int 2011; 26 (suppl 1): i29–69. de Vibe M, Bjørndal A, Tipton E, Hammerstrøm K, Kowalski K. Mindfulness based stress reduction (mbsr) for improving health, quality of life, and social functioning in adults. Campbell Systematic Reviews 2012; published online Feb 1. DOI:10.4073/ csr.2012.3.
Department of Error Yacoub M. Cardiac donation after circulatory death: a time to reflect. Lancet 2015; 385: 2554-56—In this Comment, the twelfth bar in the figure should have read Austria. This correction has been made to the online version as of April 27, 2015, and the printed Comment is correct. Clotet B, Feinberg J, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study. Lancet 2014; 383: 2222–31—In this Article (April 1), in the Results section, the third sentence of the sixth paragraph should have read, “The dolutegravir group had significantly fewer LDL values of grade 2 or higher than did the darunavir plus ritonavir group (5% vs 16%; p=0·0001), against a pre-specified p value threshold of 0·045 (two-sided; appendix).” This correction has been made to the online version of the Article as of June 26, 2015. Ong ACM, Devuyst O, Knebelmann B, Walz G, on behalf of the ERA-EDTA Working Group for Inherited Kidney Diseases. Autosomal dominant polycystic kidney disease: the changing face of clinical management. Lancet 2015; 385: 1993–2002—In figure 3, panel C, of this Review (May 16), the baseline mean estimated glomerular filtration rate of the placebo group in the sirolimus study should be 92 mL/min/1·73 m² and the mean age 32 years. This correction has been made to the online version as of June 26, 2015. Dzau VJ, Ginsburg GS, Van Nuys K, Agus D, Goldman D. Aligning incentives to fulfil the promise of personalised medicine. Lancet 2015; 385: 2118–19—In this Viewpoint (May 23), the Declarations of interest section should have stated that David Agus co-founded Navigenics in 2006, but has had no financial interest in the company since February, 2010. This correction has been made to the online Viewpoint as of June 26, 2015.
www.thelancet.com Vol 385 June 27, 2015