Editorial

Citation

Caan, W. (2013), "Editorial", Journal of Public Mental Health, Vol. 12 No. 2. https://doi.org/10.1108/jpmh.2013.55612baa.001

Editorial

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 12, Issue 2.

A growing workforce challenge in building up Public Health capacity is how “to prepare participants to be public health leaders and innovators” (Czabanowska et al., 2013). For academics in Public Health, the WHO has identified a need for new research capacities that can support development of innovative health systems and related, inter-dependent health policies (Ghaffar et al., 2013). As a small speciality, Public Mental Health has an urgent need to nurture capacity both for leadership and research. This April I will be representing JPMH at a meeting of the Centre for Science and Policy on “Future Directions for scientific advice in Whitehall” (see www.csap.cam.ac.uk/events/csap-annual-conference-2013/) trying to pick up tips on how to connect up policy makers with practitioners and researchers. The current UK government often takes a very laissez-faire approach to national Public Health, waiting for local initiatives or a relying on behaviour change by individuals. This is summed up by their behavioural insights team (the “nudge unit”) as “Really big things don’t need legislation” (Halpern, 2013).

Local or individual efforts are not sufficient to lead action for population mental health, faced with threats like the massacre of 20 elementary school children and six adults, shot in Newtown last December. Exposure to violence, traumatic bereavement and fear of future violence all undermine mental wellbeing, whatever country experiences such violence. Far from the USA, research with the Greater Manchester Police had already begun to illuminate the complex but specific systems involved in gun-related homicide (Brookman, 2011). An inter-disciplinary summit on Reducing Gun Violence in America was held by Johns Hopkins Bloomberg School of Public Health in January 2013 and the consensus on “informing policy with evidence and analysis” has just been published. Although the summit's aim was improved legislation in America (and a related bill on gun control is passing through the senate now) the evidence presented was international. For example, UK experience was summarised by a father, bereaved by the Dunblane school massacre (North, 2013).

In terms of health behaviours in at a population level, the summit paper by Wintemute (2013) confirmed a familiar pattern: a hazardous behaviour tends to cluster with other risks. For example, compared to people without firearms, gun owners are more likely to be binge drinkers, to risk drinking and driving (odds ratio 1.8) and those who drink and drive also keep a loaded, unlocked firearm at home (odds ratio 3.5). Here in England, only about 57 deaths per year (10 per cent of all murders) involve perpetrators who were mentally ill at the time of the homicide (Centre for Mental Health and Risk, 2012) and the most common cause of death is by stabbing. The USA had 31,672 gun deaths in 2010, with a wide variety of people pulling the trigger, in diverse situations. According to the FBI's 2010 crime statistics, states with the highest annual rates of homicide also see the highest proportion of gun murders (e.g. Louisiana, 9.6 deaths per 100,000, 80.3 per cent involved guns) whereas safer states see a much lower proportion of gun murders (e.g. Vermont, 1.1 deaths per 100,000, 28.6 per cent involving guns=just two deaths in that state). The summit paper by Swanson et al. (2013) presented eight years’ research from Connecticut, looking at violent crime in relation to laws disqualifying certain groups from buying guns (the most common disqualification is because of previous convictions for violence: 96 per cent of crimes were committed by people with no recorded history of serious mental illness). However, preventing gun sales to the small minority detected with mental illness offered a small, positive benefit in reducing violence. Swanson's team found that most gun-related deaths were suicides, often combined with a history of mental illness: what was needed was that “development of innovative health systems and related, inter-dependent health policies” identified above, to improve earlier access to treatment services as well as subsequent the access to weapons. Seeing health risks within the whole system is also important: recent research by Crump et al. (2013) shows that having any mental disorder increases your risk being a victim of homicide by 4.91 times!

Some preventive action on deaths from firearms is clearly needed, and this is likely to be strengthened by legislation and evidence-based law enforcement. CNN recently broadcast this vignette of an Oklahoma resident who acquired a variety of guns over time, to shoot his mother and her cat: “He bought them like any normal person would " he got them at Walmart”, said Oklahoma City Police Capt. Dexter Nelson (Christensen, 2013).

To influence policy change, politicians may need relevant education in Public Mental Health. In the UK, the All Party Parliamentary Group on Mental Health (2012) has produced a guide to mental health, for use across Parliament. At a time when both the National Health Service and Local Government in England are undergoing re-organisation, careful use of Mental Wellbeing Impact Assessment may help guide policies (Boardman and Friedli, 2012). When communicating evidence in Parliament, including areas of uncertainty in the research, balanced and coherent use of statistics has proved a most valuable skill within public health leadership (Moore and Caan, 2012).

A lesson from the elementary school in Newtown

Will the Land of the Free andThe Home of the BraveRestrict the GunOr enlarge the Grave?

Brainpower and FirepowerHave met their High Noon […].Protect the Meek?Blast off at the Moon?

News and Views

Symposium: 10 May 2013, University of Warwick, UK

The IDEA collaboration on Ethnicity and Health. “From Research to Action.” see web site: www.gp.warwick.ac.uk/ideacollab

Conference: 6 June 2013 in London, UK

“Healthy Young Minds, Healthy Communities”

The programme will help delegates to understand the extraordinarily close links between early experiences, both in the womb and as a young infant, and the health of the community and public.

Find out more and to register see web site: www.rsph.org.uk/en/courses-conferences-and-events/events/index.cfm/healthy-young-minds-healthy-communities

International Conference: 24-26 June 2013 in Bristol, UK.

“Culture, Health & Wellbeing”

To find out more and to register see web site: www.culturehealthwellbeing.org.uk

Corrigendum:It has been brought to our attention that William Jones, John Morgan, (2010) “Eating disorders in men: a review of the literature”, Journal of Public Mental Health, Vol. 9 No. 2, pp. 23-31, did not fully attribute a source drawn upon. This was Amanda Caroline Freeman, (2005) “Eating disorders in males: a review”, South African Psychiatry Review, Vol. 8, pp. 58-64. The authors sincerely apologise for this oversight and wish to recognise the major contribution of Freeman to this field.

Woody Caan