Simon Kitchen, Chief Executive of Bipolar UK, discusses taking a public health approach to improve serious mental health conditions.

The last few years have seen a welcome focus on mental health both as a priority within the health service and society as a whole. NHS England have made it a focus of their Long Term Plan and big corporations are seeing a proliferation of mental health networks. This focus provides a welcome opportunity to view severe mental illness through a public health lens. 

For example, around 1.8% of the workforce and 2% of the population are living with bipolar; a mood disorder characterised by extreme manic highs and suicidal lows. The World Health Organisation (WHO) identified bipolar as the 6th leading cause of disability in the world.

Having bipolar increases the risk of suicide by 20 times, with an estimated 800 people with the condition completing suicide every year in the UK alone. Despite general reductions in suicide rates across the UK, this figure remains stubbornly high. The challenges of living with the condition mean that people with bipolar are also more likely to live alone, be out of work, smoke and experience obesity (due in part to some medication) - these increase the risk of co-morbidities and can create a vicious cycle of despair.

Serious mental illness doesn't obviously lend itself to a public health approach. Genetics play a far bigger role in causing serious mental illness than for other long-term conditions. The component causes of bipolar are roughly 74% genetic and 26% environmental. Medication also has a big role to play in helping people stay well. However, that 26% does play a vital role in helping people with bipolar manage their condition and prevent/reduce manic and depressive episodes.

The first step to self-management is adapting your lifestyle to reduce triggers that might take you over into mania or depression, in the same way a person with a predisposition to lung cancer might avoid smoking. This could include mood monitoring regular, reviews of medication, sleep hygiene, a candid and supportive relationship with friends and family, reducing alcohol and caffeine and avoiding multiple major life events such as getting married, starting a new job and having a baby occurring all at the same time.  

Employers also have role to play. One way to support a member of staff with bipolar disorder is  through the use of an Advance Statement, which is co-produced by the manager and employee. An Advanced Statement describes the person's experience of the condition, sets out reasonable adjustments and specifies actions that can be taken when an employee enters different moods, to bring them back to a more level place. This could include allowing someone to come into work a bit later if they aren't sleeping, having a quiet space to reduce stimulation and stopping the employee taking on too much work. The statement gives piece of mind to both parties and can allow people to stay in work and progress within their chosen careers.

Effective self-management should be underpinned by peer support. At Bipolar UK, every year we connect thousands of people with the condition to help each other to self-manage. Peer support increases a sense of belonging, reduces social isolation, allowing people to exchange tips and supporting and encouraging each other to stay well. It’s cheap to deliver, costing approximately £54 to support someone to stay well for a month. A recent economic assessment by the LSE of the Side by Side Peer Support Project found that this approach could save health services over £1,000 a year per person, through reducing hospitals stays and other community health costs.

After the notable progress on tackling health in general, it is now time for the public health community to grasp the nettle of severe mental illness. The solutions will be more bespoke but the opportunities to transform individual lives is great. Through promoting self-management and peer support for people with bipolar, the public health community would see improvements across a range of health indicators. With the NHS Long Term Plan, there is no better time to invest to save.