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Mental Capitaland Wellbeing:

Making the most

of ourselves in

the 21st century

EXECUTIVE SUMMARY

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Mental Capital and Wellbeing:Making the most of ourselvesin the 21st century

Executive summary

This report is intended or:

Policy makers and a wide range o proessionals and researchers whose interests relate to

mental capital and wellbeing. The report ocuses on the UK but is also relevant to the

interests o other countries.

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This report should be cited as:

Foresight Mental Capital and Wellbeing Project (2008).

Final Project report Executive summary.

The Government Oce or Science, London.

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The Government Oce or Science (GO-Science) would like to thank the

Projects Science Co-ordination Team who oversaw the technical aspects o the

Project, who were involved in much o the work, and who were particularly

involved in writing the nal report. They were led by Proessor Cary Cooper, CBE

and are Proessor John Field, Proessor Usha Goswami, Proessor Rachel Jenkinsand Proessor Barbara Sahakian.

GO-Science would also like to thank: Proessor Philip Dewe,

Proessor Eugene Paykel, Proessor Felicia Huppert and Mr Chris Riley who also

contributed to the nal report; Proessor Leon Feinstein, Proessor Tom

Kirkwood and Proessor Michiel Kompier who led parts o the rst phase o the

Project; and the company shitN who worked on the utures and systems aspects.

Particular thanks are due to the Projects High Level Stakeholder Group and

Expert Advisory Group as well as the many experts and stakeholders rom the

UK and around the world who contributed to the work o this Project, whoreviewed the many Project reports and papers, and who generously provided

advice and guidance. A ull list o those involved is provided in Appendix A o the

nal Project report which is available in hard copy or electronically through

www.oresight.gov.uk.

The Foresight Programme in the UK Government Ofce or Science is under the direction othe Chie Scientifc Adviser to HM Government. Foresight strengthens strategic policy-making

in Government by embedding a utures approach.

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The UK is a small country in a rapidly changing world. Major

challenges such as globalisation, the ageing population, the changingnature o work, and changing societal structures are already having

proound infuences on society and on our place internationally. So,

i we are to prosper and fourish in this evolving environment, then

it is vital that we make the most o all our resources and this is

as true or our mental resources as material resources. The

present Project was thereore conceived to provide a vision o

how that can be achieved.

The Projects scope is possibly unparalleled. It has taken an independent look at the

best available scientic and other evidence and has considered the actors that

infuence an individuals mental development and wellbeing rom conception untildeath. It has assessed how these are aected by: the policies o key Government

departments; by important stakeholders such as educators, healthcare proessionals

and employers; and by the diverse environments in which we live amilies,

communities and our physical surroundings. It has also analysed possible interventions

to address the uture challenges, drawing upon considerations such as scientic ecacy,

economics, governance and ethics.

I am most grateul to my predecessor Proessor Sir David King who commissioned this

Project, to the group o senior stakeholders who have advised on the work throughout,

and to those who have contributed to and who have peer-reviewed the work; over

400 leading experts and stakeholders rom countries across the world have beeninvolved. These have been drawn rom diverse disciplines including: neuroscience,

psychology and psychiatry, economics, genetics, social sciences, learning, development

and systems analysis.

The breadth o scope, coupled with the strong use o scientic and other evidence,

provides the key added value o the Project, and has enabled it to provide resh insights

and new thinking across a broad ront. Nevertheless, a report o this breadth cannot

aspire to consider every issue in ne detail, but instead it aims to provide signposts to

important uture challenges, and how they could be addressed within a coherent and

integrated ramework.

Through the publication o this nal repor t, I have pleasure in handing over the ndings

to Government. It is with equal pleasure that I am making all o this work reely

availably within the UK and worldwide.

Proessor John Beddington CMG, FRSChie Scientic Adviser to HM Government, and

Head o the Government Oce or Science

Foreword

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5

Preface

On behal o the Department or Innovation, Universities and

Skills, I am delighted to receive this nal report o the ForesightMental Capital and Wellbeing Project rom Proessor

Beddington. Mental capital and wellbeing are in many ways very

personal concepts, but Government has a role in creating an

environment in which everyone has the opportunity to fourish.

The uture o prosperity and social justice in the UK will be

strengthened by drawing on the mental capital and talents o its

citizens.

As this report demonstrates, the science that shapes our understanding o the

complex unctioning o human brains has progressed rapidly in recent decades, and

continues to develop. This gives policy makers new insights and creates reshopportunities to oer support to individuals, amilies, and organisations in building and

sustaining mental capital and good mental health.

The Project has shown that Government is already on the right track in many areas.

However, it also demonstrates that there is very considerable scope to go urther by

adopting a long-term and strategic perspective that spans an individuals liecourse.

Realising the ull benets could have implications or systems o governance o mental

capital and wellbeing and or how the decisions on trade-os or resource allocation

are made.

Nevertheless, the report identies a number o priority areas, where more immediatebenets could be realised, and the work o the Project is already being used to inorm

a number o important Government initiatives. I am particularly pleased that a wide

range o departments and organisations across Government and more widely are

committed to taking orward the Projects ndings and I will be overseeing the progress

o that over the coming year.

I would like to conclude by thanking Proessor Beddington or this excellent repor t, and

also the many individuals and stakeholders who have contributed, both inside and

outside Government, and rom other countries.

John Denham MPSecretary o State or Innovation, Universities and Skills

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1. The aims and ambitions o the Project 9

2. Mental capital and mental wellbeing explained: their critical importance 10

3. Why the Project was undertaken: major challenges ahead 11

4. How the Project adds value over previous work 13

5. Children 15

6. Adolescence 18

7. Adults and children: mental ill-health 21

8. Adults: learning 25

9. Adults: working lie 28

10. Older adults 33

11. Key choices or policy makers 39

12. Conclusion: next steps or Government 45

Appendix A Structure o the Project reports and supporting papers 49

Appendix B Synthetic view o the mental capital trajectory 52

Contents

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1 The aims and ambitions of the Project

A key message is that i we are to prosper and thrive in our changing society and in an

increasingly interconnected and competitive world, both our mental and material resourceswill be vital. Encouraging and enabling everyone to realise their potential throughout theirlives will be crucial or our uture prosperity and wellbeing.

The aim o the Foresight Project on Mental Capital and Wellbeing

This has been to use the best available scientic and other evidence to develop a

vision or :

The opportunities and challenges acing the UK over the next 20 years and beyond,

and the implications or everyones mental capital and mental wellbeing.

What we all need to do to meet the challenges ahead, so that everyone can realise

their potential and fourish in the uture.

The Project seeks to highlight where action is most important, and how we can better

allocate available resources.

An independent look

The analysis provides an independent look at the challenges ahead and how they might

best be addressed. As such, the ndings do not constitute Government policy. Rather,

they are intended to inorm the strategic and long-term choices acing Government

departments, business and society as a whole.

Executive summary

A word of caution

It is impossible or a broadly-scoped project such as this to consider the range o

issues and disciplines in the same detail as the more ocused work o individual

Government departments.

Rather, its insights should be seen as complementary: providing a resh look rom its

unique perspective; challenging existing thinking; and providing signposts to the most

important issues and to promising approaches. As such, it presents a ramework or

more detailed analysis and policy development by stakeholders.

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Final Project report Executive summary

2 Mental capital and mental wellbeing explained: their critical importance

An individuals mental capital and mental wellbeing crucially aect their path through lie.Moreover, they are vitally important or the healthy unctioning o amilies, communities andsociety. Together, they undamentally aect behaviour, social cohesion, social inclusion, andour prosperity.

A key conclusion o the Project is that mental capital and mental wellbeing are intimatelylinked: measures to address one will oten aect the other. This argues or them to beconsidered together when developing policies and designing interventions.

Mental capital1

This encompasses a persons cognitive and emotional resources. It includes their

cognitive ability, how fexible and ecient they are at learning, and their emotional

intelligence, such as their social skills and resilience in the ace o stress. It thereore

conditions how well an individual is able to contribute eectively to society, and also toexperience a high personal quality o lie.

The idea o capital naturally sparks association with ideas o nancial capital and it is

both challenging and natural to think o the mind in this way.

Mental wellbeing2

This is a dynamic state , in which the individual is able to develop their potential, work

productively and creatively, build strong and positive relationships with others, and

contribute to their community.

It is enhanced when an individual is able to ull their personal and social goals and

achieve a sense o purpose in society.

Whilst it is important or Government to address problems that aect the mentaldevelopment o specic groups, such as learning diculties and mental disorders, policiesand choices also need to nurture the mental capital and wellbeing in the wider population,so that everyone can fourish throughout their lives.

1 See Chapter 2, section 2.1 o the nal Project report and Appendix B o this Executive summary

2 See Chapter 2, section 2.2 o the nal Project report; Wellbeing in this report reers to mental wellbeing

unless indicated otherwise

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3 Why the Project was undertaken: major challenges ahead

Many important actors will aect the country over the next 20 years and beyond. Somewill make demands on our mental capital, requiring new skills and expertise. Some willcreate substantial threats to our mental health and wellbeing. And some will oer newopportunities or people to develop and fourish. Assessing how to manage these

opportunities and threats has been a key aim o this Project.

Important actors that will drive change include:

The demographic age-shift 3

Lie expectancy is projected to grow over the next ew decades: by 2071 the number

o adults over 65 could double to nearly 21.3 million, and those over 80 could more

than treble to 9.5 million. Over the same period, our concept o what constitutes old

age will change, and notions o career and retirement will shit in response to

longer working lives. The number o older people will also increase as a proportion othe working population, thereby creating possible tensions within society.

Two major challenges are:

How to ensure that the growing number o older people maintain the best

possible mental capital, and so preserve their independence and wellbeing.

Dementia will be a major problem and will have a substantial and increasing

impact on individuals, carers and amilies. Over the next 30 years in the UK, the

number o people aected could double to 1.4 million, and the annual cost to

the economy could treble to over 50 billion.

How to address the massive under-utilisation o the mental capital o older adults,

and how to reverse the continued negative stereotyping o older age. Achieving

these would benet everyone: older people themselves, business, and the rest

o society. However, ailure could result in a spiral o poor wellbeing, mental ill-

health and exclusion; and disenchantment in this large and growing sector o the

population.

Changes in the global economy and the world of work 4

Economic growth in countries such as China and India, new technologies and

globalisation will continue to present major challenges to business, and to our

increasingly knowledge- and service-based economy. Skill levels (both high and

low) in the UK workorce will be critical to competitiveness and prosperity.

Increasing numbers o workers will need to compete in a global market or

skills. It will be crucial or them to develop their mental capital by training and

retraining through their working years in order to compete eectively. Preparing

people to meet that challenge will need to start early in lie by ostering the best

possible disposition to learn.

3 See Chapter 6 o the nal Project report


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The relentless demands or increased competitiveness will combine with

changing amily commitments, such as the two-earner amily and the increasing

need to care or older adults. These demands will have major implications or

work-lie balance and the wellbeing o workers, and have knock-on eects or

their amilies and communities.

Overall, a major challenge will be to square the circle o meeting the demands o

increasingly intensive work, whilst preserving and nurturing wellbeing.

The changing nature of UK society

The evolving mix o cultures, changing amily structures, and changing patterns o

migration, will drive the need to connect better across cultural groups and across

generations. Several aspects o mental capital and wellbeing could contribute to this: or

example, learning through lie; new approaches to fexible working; and encouraging

the involvement o older people in inter-generational activities. Success could create a

virtuous cycle o oppor tunity, social inclusion and social cohesion. However, inequalityo opportunity could uel a cycle o tensions between dierent cultural and age groups,

ragmentation o society, and social exclusion.

Changing attitudes, new values and expectations of society 5

Increasingly, we expect more rom lie than living healthier and longer; wellbeing has

become one o todays buzzwords. A major issue will be to decide on the values and

expectations we are aiming to meet; and also to determine the balance o

responsibility or action between the State, employers, amilies and individuals.

The changing nature of public services

The trend in recent years has been towards a model o public services based on

greater levels o personal choice, active citizenship, personal responsibility, and co-

production. This is set to continue. To work most eectively, these models o service/

client relationship require the greatest number o the public to be equipped with the

mental capital and disposition to participate. This calls or a policy mindset that aims to

oster mental capital and wellbeing across the whole population.

New science and technology

These will create substantial opportunities or improving how we develop our mental

capital and promote mental wellbeing. For example: new understanding is already

leading to new ways o addressing learning diculties and mental disorders; advances in

new technology or learning has the potential to play an important role in

personalisation o education; and new technology could help everyone to fourish by

changing how we socialise, work, learn and communicate.

However, arguably the biggest challenge will not be the development and

implementation o these new technologies, but rather, in ensuring equality o access to

5 Appendix B o the nal Project report outlines three uture scenarios that have been used to explore dierent

possible utures or the UK.

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the benets. This will be critical i they are to reduce social inequalities in the uture,

rather than uelling urther divisions.

4 How the Project adds value over previous work

The Project combines a uniquely broad vision to take an independent look ar into theuture. In so doing, it sets out to challenge existing thinking.

The Projects analysis has:

Drawn upon the advice o over 400 6 leading experts and stakeholders rom across

the world, and rom diverse disciplines such as: economics; modelling and systems

analysis; social sciences and ethics; neuroscience, genetics and mental development;

psychology and psychiatry; and sciences relating to education, work and wellbeing.

Looked across the liecourse: it has considered how experiences and interventions

at one stage o lie can aect an individuals mental capital and wellbeing or years

and even decades.

Spanned the interests o key depar tments across Whitehall, and o diverse

stakeholders outside o Government.

The state-o-the-art in 80 areas o science have been reviewed7 to develop an

understanding o how mental capital and wellbeing evolve through the liecourse, and

to identiy which aspects are most critical or meeting uture challenges. The ollowing

sections summarise what is important at successive stages o lie.

6 See Appendix A o the nal Project report or details o those involved in the Project.

7 Appendix E o the nal Project report provides a list o the main Project reports and the 80 reviews o the state-

o-the-art o science. These reports, along with a number o other Project discussion papers, workshop reports and

analysis papers will be made available through www.oresight.gov.uk.

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5 Children8

Todays children will shape the uture o the country, and their childhood is critical in settinga course or their trajectories through lie. Early interventions to address learning dicultiesand to help children fourish are particularly promising: or improving outcomes or children,and or oering good value or money.

New science has transormed our understanding o child development, learning andlearning diculties. We need to capitalise on these developments or all children: by placingmore emphasis on starting early, even rom birth; improving parenting, and home andnursery care environments; and combining interventions in dierent settings the amily,nursery care, and school. The benets would be improved pro-social behaviour, improvedattitudes to independent learning through lie, and better resilience in terms o coping withthe challenges o their uture lives.

Learning diculties are a particular problem, aecting up to 10% o children9. Yet too oten

they remain unidentied, or are treated only when advanced. The result can be under-achievement in school and disengagement by the child, sometimes leading to a long-termcycle o anti-social behaviour, exclusion and even criminality. Improvements in earlydetection combined with ocused interventions could prevent problems developing and

create broad and lasting benets or the child and society.

5.1 Interventions to promote the best possible mental development need to start asearly as possible mental development starts in the womb10:

Addressing maternal stress, diet, and smoking should be high priorities , as thesethree actors are particularly crucial. Also, similar concerns exist in regard to

mothers abusing illegal substances, such as stimulant drugs e.g. methamphetamine,

cocaine.

Avoidance o alcohol exposure during pre-natal development is also potentiallyimportant, since oetal alcohol syndrome (FAS) is the most commonenvironmental cause o learning diculties, aecting rom one to seven per 1,000

live-born inants. However, a continuing controversy involves the degree to which

the decits observed in FAS conditions derive rom brain damage in the womb

or rom the neglectul and/or non-stimulating environments provided by alcoholic

mothers who continue to drink.

5.2 Enabling the best possible amily, social and physical environments in whichchildren are nurtured should be a priority11:

Parents should be oered coaching in skills, particularly those who have notexperienced eective parenting skills in their own upbringing. Early amily andnursery environments are crucial, as they provide the learning environments

that can nurture the social and sel-regulation skills that will enable children to


9 Note: learning diculties such as dyslexia are not the same as Special Educational Needs, which include physicaldiculties and generalised intellectual disabilities. Learning diculties are considered in the Project report: Goswami.

Learning difculties: Future challenges; and in the Project science reviews Appendix A reers

10 See Chapter 2, section 2.1 o the nal Project report


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fourish: warm and contingent caretaking, rich language, and avoiding directiveness12

and punitiveness are all important and should be promoted. Conversely,

adverse experiences in the post-natal period can lead to cognitive impairments:

environmental risk actors include low socio-economic status, and also trauma such

as childhood sexual abuse.

Ensuring good housing quality is likely to be important poor housing is akey actor associated with childrens mental development, although it is notknown whether the association is causal. Housing quality could be a good proxymeasure or the quality o the home learning environment e.g. lack o resources,

disruptive amily circumstances, lower-quality social support networks. Children

living in poorer-quality housing have also been shown to have higher levels o stress

hormones and behavioural problems.

5.3 Early identication and prompt treatment o learning diculties in childrenare vital13:

Increasing eort here could substantially help to address long-term social and

economic consequences or the child and or society. Two particularly important types

o learning diculty have been considered by the Project:

Developmental dyslexia. This aects the literacy skills o between 4-8% o children:it can reduce lietime earnings by 81,000, and reduce the probability o achieving

ve or more GCSEs (A*-C) by 3-12 percentage points. A range o possible

interventions has been identied by the Project or both home and school.

Developmental dyscalculia because o its low prole but high impacts, its

priority should be raised. Dyscalculia relates to numeracy and aects between4-7% o children. It has a much lower prole than dyslexia but can also have

substantial impacts: it can reduce lietime earnings by 114,000 and reduce the

probability o achieving ve or more GCSEs (A*-C) by 720 percentage points.

Home and school interventions have again been identied by the Project. Also,

technological interventions are extremely promising, oering individualised

instruction and help, although these need more development.

5.4 Teachers and ront-line childcare proessionals should be given scienticallyaccredited training in elds relating to how children learn and develop, and also

learning diculties14:

The training would capitalise on the new scientic understanding in these elds.

It would empower the proessionals to better address the needs o individual children,

and to improve learning and development trajectories. For example, there is a need to

oster wider recognition that most learning diculties in children such as dyslexia and

dyscalculia are genetically transmitted, with genes subsequently interacting with

environments to aect developmental trajectories.

12 Directiveness is ignoring the childs ocus o attention and instead directing them to ocus elsewhere see glossary

o terms in Appendix D o the nal Project report

13 See Chapter 3, sections 3.1 3.3 o the nal Project report


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Looked-after children15

Much more could be done to enable looked-ater children to realise their uturepotential. Only 2% o looked-ater children are so placed because o theirunacceptable behaviour. The majority are in care because they have been the victims

o abuse, neglect and amily dysunction. Yet they are stigmatised as though they

themselves are at ault, and they also experience diculties in accessing services.

It is estimated that 45% o looked-ater children have a mental health disorder, that

they are 10 times more likely to have a statement o special educational need, and

that their educational attainment is considerably worse than that o other children

(or example, 41% attain ve GCSEs [A* to G] compared to 91% o children

overall). Also, these disadvantages ollow them through their lives: or example,

unemployment on leaving school is our times more likely; and around one-third o

prisoners were in care as children. Moreover, children who are in residential care

show even more severely disadvantaged trajectories.

This argues strongly or the need to:

Increase the priority and nature o their support with a view to improving: thepromotion o good mental health; better prevention o mental disorders; and

more eective help or those aected. Strengthened and systematic educational

support is also needed to reduce the major inequality o educational attainment

or all looked-ater children.

Provide training to enable carers to improve developmental trajectories orlooked-ater children, while also supporting amilies. O particular importance

are: investment in the education and skills o oster carers, adopters andresidential sta; and attaching a higher value to the caring proessions.

Foster the better use o the science and evidence base to identiy the causeso these disadvantages.


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6 Adolescence16

The adolescent brain has been compared to a car with a strong engine but poor steering.Science helps us to understand what is happening during this crucial period odevelopment.

A Year 8 dip (age 12-13) in academic perormance has been reported and mightcorrespond, at least in part, to the reorganisation o the brain around puberty so that it canlearn more eciently. However, a number o important environmental actors, or example,alcohol and substance abuse, can combine to disrupt this neural reorganisation, making thebrain particularly vulnerable during this critical time.

A key message is the need to address substance and alcohol abuse in adolescents. However,the science shows us that the changing adolescent brain specically makes teenagersvulnerable to poor decision-making. Thereore, we need to use science to inorminterventions to help adolescents to navigate their way through this dicult time.

6.1 Several important actors can contribute to alcohol and substance abuse:

There is evidence that adolescents may process reward dierently to adults:

immediate positive outcomes, such as peer approval, may outweigh potential,

long-term, negative consequences. This dierence in the anticipation o outcomes

may help explain why some young people gravitate toward risky behaviours such

as substance abuse.

Other conditions such as mood disorders may predispose adolescents to substance

abuse.

Youngsters subjected to amilial risk, those with aective disturbance, conduct

problems, and neurotic or disinhibited personalities all appear to be at risk o

escalating substance abuse.

Neuroimaging and neuropsychological studies indicate that adolescent substance use is

associated with neural disadvantages, particularly in neural networks involved in

learning, attention, and executive unction17. Also, heavy use o cannabis during

adolescence may adversely aect brain development and lead to decrements in

attention, learning and memory.

Within a strategy to address the problem o alcohol and substance abuse, action to

reduce availability should orm an impor tant element. This is because rates o

consumption o alcohol and other substances, and hence hazardous consumption and

dependence, are directly related to availability (price relative to earnings, and

distribution).


17 See Appendix D o the nal Project report or a glossary o terms

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The growing use of drugs for cognitive enhancement18

These drugs can prove useul or healthy people, or example, in times o stress such

as sleep deprivation; or or the elderly (see below). They can help combat atigue

and jet-lag, and improve attention and other orms o cognition. They are thereore

becoming more widely used by people in a variety o settings including: shit workers;

international travellers in business or academia; and students or studying and exams.

However, careul and critical evaluation is needed concerning possible long-term

risks, which are presently unknown. In par ticular, their potential eect on the

developing brains o children is a cause or concern. A cautious approach to their

availability and use is thereore warranted.


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7 Adults and children: mental ill-health19

Mental ill-health can have diverse and long-term eects on individuals, amilies and society.Estimates place the costs at about 77 billion per year or England when wider impacts onwellbeing are included, and 49 billion or economic costs alone. The pervasive importanceand long-term costs o mental ill-health in society suggest the need to reappraise the

resources devoted to it: currently only about 13% o the NHS budget.

Many people experience mental ill-health: or example, about 16% o adults and 10% ochildren are aected by common mental disorders such as depression and anxiety at anyone time. However, whilst all disorders are best detected and treated early, many goundiagnosed or are only treated when advanced, and when the impacts are severe or theindividual and amilies.

Mental disorders are infuenced by diverse biological and social risk actors, including:genetic actors; biographic characteristics (age, sex); amily and socio-economic

characteristics (marital status, number o children, employment); individual circumstances(lie events, social supports, immigrant status, debt); household characteristics(accommodation type, housing tenure); geography (urban/rural, region); and societal actors(crime, deprivation index).

These diverse social actors may change over the coming years in a variety o ways, and soit is not possible to make general predictions o the prevalence o disorders. (Dementia is anotable exception see below). Thereore, a challenge will be to develop policies that arerobust to uture uncertainties. A strategy that is fexible and adaptable should emphasisethe ollowing:

7.1 Addressing the risk actors associated with mental disorders:

Examples include:

Debt 20. There is a strong case or Government to work with nancial organisations

and utility companies to break the cycle between debt and mental il lness. Recent

research has indicated that debt is a much stronger risk actor or mental disorder

than low income. A range o possible interventions are suggested: beginning with

better training or teenagers in managing nance; greater awareness o the link

between mental health and debt by banks and nancial institutions; and measures

by utility companies to handle arrears better.

Harnessing wider policies in Government. Common mental disorders aect 16%

o the population and are aected by a wide range o issues such as employment,

housing, urbanisation, exposure to crime, and debt. When policies are developed in

areas such as these, there is a clear case or taking more account o the implications

or mental health, as is generally the case or physical health and saety.

19 See Chapter 3, section 3.8; Chapter 4 o the nal Project report


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7.2 Diagnosing early and treating promptly21:

Realising the considerable scope or the primary care setting to play a pivotal rolein providing more integrated access to appropriate sources o help, such as social,psychological and occupational care22. An estimated 30% o GP consultations havean underlying mental-health cause, many o which have a socio-economic basis,

e.g. debt, amily breakdown, trauma, bullying at work, etc. However, many GPs donot currently eel it is their job to help patients seek support to address those

social risk actors. Promoting reerral rom primary care to social, psychological and

occupational proessionals could thereore be win-win: individuals would benet

rom earlier and more eective treatments; GPs would have ewer repeat visits; and

there could be net savings to the care budget.

Improving access to treatments. This has the potential to oer particularly goodvalue or money. As an example, the Project has considered the specic case o

depression. From data in the recent Kings Fund report and the 2000 Psychiatric

Morbidity Survey, it is estimated that there are 828,000 people with moderate

to severe depression in England, yet in 2007, or example, only 10% o guidanceproduced by NICE related to mental health. Extending NICE-recommendedtreatment to all suerers would deliver economic benets well in excess o 1billion each year, and the extra treatment costs would be vastly outweighed byhigher Government revenues and reduced benet payments. Benets to individualwellbeing would add very substantially to this gure.

7.3 Addressing important mediating actors:

For example:

Addressing stigma associated with mental ill-health 23. Stigma and discriminationrelating to mental ill-health is widespread. It aects peoples willingness to undergo

diagnosis and treatment, and it can itsel exacerbate some disorders. Analysis

commissioned by this Project has shown that a sustained and integrated approach

involving a range o dierent stakeholders (such as the amily, employers, schools, the

media) is needed.

Well-designed work placement, support and intervention programmes to helpthose with mental health problems. Better access to work or those with mentalhealth problems is known to oer both clinical and economic benets; such

schemes oer good value or money.

7.4 Targeting high-risk groups:

These include looked-ater children, drug users, and prisoners. Crucially, mentalillnesses oten go unrecognised and/or untreated in these groups, and the

behaviours associated with the disorders go unrecognised and misconstrued. The

individuals can then easily all into a cycle o exclusion, inappropriate responses by

the authorities, and subsequent deprivation. Breaking this cycle is a major challenge,

but ailure to do so will lead to substantial and long-term costs in the uture.

21 See Chapter 4, sections 4.2 4.5 o the nal Project report



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Promoting positive mental health and wellbeing24

The importance o promoting positive mental health or the general population has

been a consistent message throughout the work o this Project. It is proposed thatachieving a small change in the average level o wellbeing across the populationwould produce a large decrease in the percentage with mental disorder, and alsoin the percentage who have sub-clinical disorder (those languishing).

Throughout this report, interventions are proposed to promote positive mental

health and wellbeing or many groups, or example:

Promoting fourishing in children.

Fostering mental wellbeing or workers.

Unlocking the mental capital in older people and promoting their wellbeing so

that they can fourish.

Promoting wellbeing in key ront-line proessions, such as teachers and doctors.

Five ways to mental wellbeing

In addition, the Project has commissioned work to identiy the wellbeing equivalent

o ve ruit and vegetables a day. The suggestions or individual action, based on an

extensive review o the evidence are:

Connect1. With the people around you. With amily, riends, colleaguesand neighbours. At home, work, school or in your local community. Think o

these as the cornerstones o your lie and invest time in developing them.Building these connections will support and enrich you every day.

Be active2. Go or a walk or run. Step outside. Cycle. Play a game. Garden.Dance. Exercising makes you eel good. Most importantly, discover a

physical activity you enjoy and that suits your level o mobility and tness.

Take notice3. Be curious. Catch sight o the beautiul. Remark on theunusual. Notice the changing seasons. Savour the moment, whether you are

walking to work, eating lunch or talking to r iends. Be aware o the world

around you and what you are eeling. Refecting on your experiences will

help you appreciate what matters to you.

Keep learning4. Try something new. Rediscover an old interest. Sign up orthat course. Take on a dierent responsibility at work. Fix a bike. Learn to

play an instrument or how to cook your avourite ood. Set a challenge you

enjoy achieving. Learning new things will make you more condent as well

as being un.

Give 5. Do something nice or a riend, or a stranger. Thank someone. Smile.Volunteer your time. Join a community group. Look out, as well as in. Seeing

yoursel, and your happiness, as linked to the wider community can be

incredibly rewarding and creates connections with the people around you.


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8 Adults: learning25

Learning in adult lie should not be seen in isolation, but as part o a continuum whichbegins in childhood and extends into old age.

Workers at all levels will increasingly need to be sel-motivated and empowered to take

personal responsibility to train and develop through their working lie. This will be vital ithey are to compete at all levels in the global marketplace or skills.

Government is already implementing important initiatives in this area; however, these couldbe amplied by urther eorts to:

Stimulate demand or learning and skills development in individuals and employers.

Empower individuals to learn, through strengthening inormation, advice and guidance.

Improve levels o basic skills.

Realise the considerable potential o new technologies or learning.

Workers will increasingly need to compete at all levels in the global marketplace or

skills. However, the growth in that marketplace, together with a trend towards shor ter-

term jobs, will reduce the incentive or rms to continuously develop their existing

workorce, thereby creating a market ailure. Starting early will be crucial: it will be

important to create experiences or young learners that promote their motivation

and capacity to engage in learning throughout their lives i.e. promoting their

disposition to learn.

8.1 Stimulating the demand or skills:

A range o possible approaches are suggested or consideration by stakeholders:

Targeted awareness-raising. This could be achieved through a series o high-qualitycampaigns or lielong learning. These would be targeted at specic groups within

the adult population that have particular needs, or that do not engage strongly in

learning e.g. people with specic English language requirements, or those towards

the end o their working lives.

Locally-led and ocused schemes using loans or nancial incentives to motivateand empower individual demand. Evidence shows that these could oer substantialpotential.

Incentive systems or employers, building on Train to Gain. The evidence showsthat such incentives work best when embedded in a wider structure and culture o

collaboration on skills.

The role o trade unions in raising employer demand or skills, as well as

promoting learning to their members, could be developed; particularly or types oemployee that are oten under-represented in education and training.


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8.2 Empowering individuals to learn:

The strategic economic role o career guidance needs to be reconsidered andemphasised. This is because the nature o careers is changing or a large proportiono the population, and because the provision o learning or adults is becoming more

demand-led and more complex.

As careers, career expectations and opportunities change in the uture, it will beimportant to develop new markers o career success and dierent criteria thatrefect the diversity o the workorce and the changing aspirations o individuals.

The announcement o the planned creation o the Adult Advancement and Careers

Service rom 2010/2011 is a welcome development. Importantly, the Department or

Innovation, Universities and Skills (DIUS) has announced that it will be available to all

adults; including those experiencing mental ill-health, who are likely to require special

targeting.

8.3 Addressing the gap in basic skills:

Basic skills will be vital to meet the challenges o the 21st century global economy:

Rapid changes in the job market mean that within the next 15-20 years, the

prospects or employment or those with ew qualications and limited literacy and

numeracy will become substantially reduced.

Longitudinal cohort studies have repeatedly shown that poor basic skills signicantly

increase the probabilities that people will experience unemployment, imprisonment,

and poor health and reduce the probabilities o civic engagement.

These actors underline the need to address the gap in basic skills. However, whilst

there has been some progress in recent years, around ve million adults in the UK

remain unctionally illiterate, and almost seven million unctionally innumerate.

It will be important to build upon existing progress and strategies, rather than launching

entirely new initiatives. In particular, it is impor tant or providers to engage consistently

with stakeholders who represent the groups the initiatives are targeting e.g. union

learning representatives.

8.4 Realising the considerable potential o new technologies or learning should bea priority:

These could play a major role in the personalisation o learning, promoting social

inclusion or learners, and increasing productivity or both learner and teacher.

Two messages are particularly important:

New technologies should be driven by the needs o learners rather than tryingto adjust learners to technologies developed or other purposes (such as the leisure

or business markets). Only then are the ull benets likely to be realised.

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Ensuring equality o access will be vital. For example, it will be important toaddress the digital divide. This is still marked; people rom lower socio-economic

strata are less likely to have internet access than people rom proessional and

managerial backgrounds. Also, rates o access to technology remain strongly

contingent on age.

The Project has identied a number o technologies that are already making an impacton education and training, and others with potential to do so in the uture. The latter

category includes: ubiquitous and mobile technologies; articial intelligence; assessment

technologies; and tools to support teachers in designing and exchanging learning

activities.

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9 Adults: working life26

People can benet rom work not only nancially, but also in their general ullment andwellbeing. It should thereore be a priority to ensure that these benets are available toeveryone, including those with mental health problems. There is strong evidence thatprogrammes to encourage and support people with mental health problems into work

oer very high economic and social returns: these programmes should be expanded andintensied.

The world o work is changing, with ar-reaching consequences: globalisation and thegrowing intensication o work will combine to increase workers levels o stress and anxiety,and aect their health and eciency. Changes in the nature o work will also interact withchanges at home, such as growing numbers o two-earner households and increased needor care or older relatives, thereby creating pressures on amilies. Maintaining andimproving wellbeing in the ace o these trends will be a major challenge. The Project

thereore proposes a range o interventions to encourage employers to promote wellbeingin their workorces.

A Government lead in promoting wellbeing in its own workorce would be win-win: besidesbeneting the considerable number o public sector employees and the perormance o itsown business, it would set an important example to the private sector.

9.1 There is a strong case or expanding activities to improve access to work orthose with mental health problems:

There is a great deal o evidence that interesting and ullling work can be generally

benecial or mental health, and that measures to help people with mental health

problems into work oer high returns. Supported employment schemes such as

Individual Placement and Support have been shown to deliver both long-lasting

economic benets and clinical improvements.

9.2 Ensuring mental health in the workplace:

Poor conditions in the workplace can cause stress and exacerbate mental health

problems, and so limit the benets o working. Also, in the uture, changes in the

economy and increasing global competition may increase these dangers, with

substantial risks to the wellbeing o individuals and their amilies, competitiveness, levels

o employment, and benet payments.

Employers should be encouraged to oster work environments that are conducive to

good mental wellbeing and the enhancement o mental capital. Following consultation

with key stakeholders, promising suggestions are set out below. Economic benets are

dicult to quantiy, but analysis o the rst three suggest they may be very cost-

eective due to reductions in the costs o presenteeism27, labour turnover, recruitment

and absenteeism.


27 Presenteeism is dened as the potential lost productivity that occurs as a result o an individual being less than

totally productive while being at work.

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The collection o wellbeing data against Key Perormance Indicators and theundertaking and implementation o annual wellbeing audits. There is clear evidencethat once people all out o work due to mental disorders, they can lapse into long-

term absences, or may never return to work. However, this initiative would help

prevent this, and enable people to remain in work. Employers in both the public and

private sectors should thereore be encouraged to carry out an annual stress and

wellbeing audit, and to act on its ndings. Standardised auditing instruments o theHealth and Saety Executive (HSE) or others should be used to identiy i there is a

problem, and i so, the source o the problem.

Integration o occupational health proessionals with primary care. This is a subseto the primary-care intervention mentioned above (see Section 7 on mental ill-

health). Here it would have two components:

The co-ordination o employment advisors/occupational health proessionals

and clinical psychologists with GP practices to acilitate the early identication o

workplace stress and mental ill-health in patients (such co-ordination need not

include physical co-location).

The employment advisors/occupational health proessional would, with the

agreement o the patient, approach the relevant employers and work with them

to address those aspects o the workplace environment that are aecting mental

health.

Importantly, this intervention would seek to address the underlying problems in the

work environment, thereby potentially also beneting co-workers.

Extension o fexible working arrangements. Two possible variants have beenconsidered:

The extension o the right o all employees with children at or below the age

o 18 to request fexible working arrangements, and the duty o employers

to consider these requests. This would build on the recent legislation that has

extended the right to request fexible working arrangements or all working

parents o children at or below the age o 16.

A second variant would grant all working people this right.

Economic analysis o these options suggests that better rates o return could be

obtained and the economy strengthened, particularly i the right to request was

extended to all.

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9.3 Other suggested interventions (or which economic analysis has not beenperormed):

Better training or managers so they understand the impact they can have onmental capital and wellbeing. A possible way to promote the training or managersin social and interpersonal skills would be to extend the Train to Gain programme

so that employers, particularly small and medium-sized enterprises (SMEs), canobtain partial unding or this.

Raising the prole o the importance o mental health and wellbeing at work.This addresses the concern, which is supported by evidence, that levels o mental

ill-health and mental wellbeing in the workplace are insuciently recognised by

employers. One possibility would be to encourage companies to include wellbeing

indicators in their annual reports thereby benchmarking their perormance or

shareholders, and showcasing any improvements.

The establishment o a Workplace Commission. This would: raise awareness o the

importance o mental capital and wellbeing at work; promote stress audits; and helpSMEs to act on the ndings o those audits.

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10 Older adults28

By 2071, the number o people over 65 could double to nearly 21.3 million, while thenumber o people aged 80 and over could more than treble to 9.5 million. However, thisexpanding group will be beset by two major challenges:

The increasing prevalence o cognitive decline, particularly due to dementia will becritical. However, other mental disorders, notably depression and anxiety will also beimportant: addressing the relatively poor access o older adults to treatment (comparedwith younger adults) should be an immediate priority.

The need to reverse the continued negative stereotyping and massive under-utilisationo their mental capital: this is crucial so that the considerable mental resources o olderpeople are recognised and unlocked or the benet o themselves and society.

A new mindset is needed: involving a rethink o older age, and addressing the stigma

associated with it.

At a strategic level, there is a strong case or a step-change in the governance o olderpeople in order to promote their wellbeing and unlock their mental capital. In particular, a

high-level lead within Government will be important to ensure sustainable long-term actionthat is integrated across Government and which adopts a liecourse perspective.

10.1 Addressing cognitive decline should be high priority29:

This is set to rise substantially with the ageing population, and dementia will be a

particular problem, as age is a key risk actor. Over the next 30 years, the number opeople with dementia in the UK could double to 1.4 million, with major impacts on

those aected, their amilies and carers. It also constitutes an expenditure time bomb;

over the same period, costs to the UK economy could treble rom 17 billion a year

today, to over 50 billion a year. For these reasons, the current development o a

national strategy or dementia is par ticularly welcome. However, in view o the

magnitude o the challenge, a high-level commitment to resource its ndings will be

crucial.

A review o evidence in this Project suggests that such a strategy should include:

Starting early in lie. It would be a mistake only to address the risk actors ocognitive decline when they occur in old age. Examples would include encouraging

exercise in middle age in order to promote a healthy cardiovascular system, and

encouraging education and learning through the liecourse to promote cognitive

reserve.

The development and use o new methods or early diagnosis (biomarkers) ocognitive decline and dementia. Biomarkers will acilitate the development, testingand use o new treatments; however, they are costly and risky to develop. A more

ocused approach to research, involving a par tnership between the research



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community and industry, would help to ocus eor t and realise eciency savings,

both in terms o research eort and development costs.

The eective and timely use o new treatments to arrest the progression odementia. A priority should be to develop and use treatments to slow or arrestdecline in the early stages, beore quality o lie suers substantially, and beore

suerers become dependent on amilies and state. Also, there is a case or reviewinghow we make decisions on the provision o new treatments.

Consideration should be given to the development and use o pharmacologicaland other types o cognitive enhancers or older people experiencing decline.The benets could be considerable or this age group in the uture. Moreover, in

the case o pharmacological enhancers, the balance o risks and benets when

used by older adults could be quite dierent compared with their use by children

(see above).

10.2 Addressing other orms o mental ill-health in older adults will also beimportant30:

As mentioned above, mental disorders such as depression and anxiety will continue to

be particular problems or older people, particularly since they can be associated with

actors associated with older age, such as physical and mental decline.

Targeted action is needed now to improve access to treatments or these and other

mental disorders, so that long-term impacts are avoided. Such action will be a critical

component in a wider strategy to improve mental wellbeing in older adults (see

below). Pharmacological and psychological treatments that are matched to the needs

o older people are likely to be important.

10.3 There is a strong case to develop a strengthened strategy or promoting themental capital and wellbeing o older people31:

Here, unlocking the mental capital in older people and promoting their wellbeing are

considered together since they are intimately linked: many interventions that target

one, will also improve the other. This Project has identied a large number o possible

initiatives that should be considered. Older people themselves have helped to rene

these ideas through a consultation exercise. The initiatives are too numerous to list in

this Executive Summary, but are grouped into the ollowing categories:

Promoting social networking. Scientic and other evidence shows the importanceo social networking in promoting mental capital and wellbeing in older adults, and

indicates three specic types o intervention that are successul:

Group interventions involving educational and social activity, targeting social

isolation and loneliness.

Volunteering.



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Interventions that promote trusting relationships, requent contacts with riends,

and which seek to improve the quality o social relationships.

Encouraging and empowering older people to engage better in learning. Evidenceshows that learning can help to promote wellbeing, as well as protecting against

normal age-related cognitive decline. Furthermore, when learning takes place

in social settings, it can promote wellbeing indirectly through social networking.

As elsewhere, initiatives that take account o the particular needs o older people

will be important.

Promoting valued and valuable engagement, enabling people to work i they wish.There is a case or Government to review the right o older adults to continueworking. This could yield a quick win: both the wellbeing and the mental capital oolder workers would be promoted, with consequential benets to wider society.

A key message is that unlocking the mental capital o older people need not incur net costs:

interventions could benet amilies, business, wider society, and Government, as well asolder people themselves. Older people should be a key resource used or planning andimplementing new interventions.

10.4 Promoting environments to enable older people to fourish32:

I older people are to fourish sustainably, then the various environments in which they

live, learn, socialise and work need to suppor t this aim. The policies o many par ts o

Government will be critical in achieving this:

Achieving a physical environment that meets the needs o older people. Becauseit can take decades rather than years to substantially change the built environment,

the needs o the growing number o older people need to be at the heart o long-

term plans being developed now. A range o dierent scales need to be considered

houses, open spaces and town planning. Examples o initiatives could include:

Improving the design o homes and towns to meet the needs o older people;

older people themselves are a key resource to advise on this.

Improving access and reach-ability to public spaces.

Better provision o training or decision-makers who infuence the physical

environment.

Promoting good work environments. Employers could benet considerably romthe skills o older people, and realise savings due to reduced churn in employees.

The ollowing will be important in promoting the right work environments:

Education o employers will be critical so that they understand the benets o

older workers, and understand how to match work and working environments

to the needs and capabilities o older adults.


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The extension and development o middle years and pre-retirement training.

Helping employers to recognise the importance o investing in the training

o older workers and to understand better their training needs. This could

contribute substantially to making lielong learning a reality.

Encourage employment centres (physical and online) to advise older people onwork opportunities, training and retraining.

Harnessing the considerable potential o inormation and communicationstechnology (ICT). The development o new products and services should beencouraged to: enable the elderly to remain socially and economically active or

longer; create new opportunities or learning; and to promote their wellbeing.

However, promoting equality o access and opportunity will be vital to counter

a possible digital divide and to enable all older people to benet. Older people

could themselves provide a valuable resource in helping to design and trial

applications specically or older users, and in promoting their uptake.

Addressing the stigma associated with older age, both within older peoplethemselves, and also within wider society.Substantial and sustained eorts overmany years will be needed to reverse the negative stereotyping o older people in

society. However, this will be vital within a wider strategy to improve their wellbeing.

Methods developed by the Project (or addressing stigma associated with mental

disorders) could be adapted and used to develop an integrated approach involving

teachers, amilies, the media, Government, and older people themselves.

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11 Key choices for policy makers33

The Project has identied a number o undamental issues and choices that cut acrossGovernment and its decision-making process: these are outlined below. However, whilst theresolution o some o these is outside o the scope o the present Project, they willnevertheless condition how best to proceed, and will need to be addressed i the ull

benets are to be realised rom this report. They are thereore provided here as a stimulusto urther debate.

Who needs to act?

The picture is mixed: there is a clear rationale or action by Government in some areas, andor companies and individuals elsewhere. But in many cases, it will be important ordierent parties to work together in concert. Overall, it will be crucial to be clear about thebalance o action, and to ensure adequate inormation and incentives to make actionhappen.

Government

The analysis suggests that action to improve mental capital and wellbeing could have

very high economic and social returns. The high costs, or example o mental illness and

learning diculties, are not sucient in themselves to establish the case or ur ther

intervention. However, the nal Project repor t demonstrates a clear economic case or

Government intervention and, importantly, that there are cost-eective measures it can

take where the economic and social benets are likely to signicantly exceed the costs

involved.

The economic rationale or Government intervention to improve mental capital and

wellbeing is based on a combination o equity and eciency arguments. Equity

considerations suggest that those who are particularly prone to suer rom stigma,

reduced wellbeing, and economic loss because o mental health problems or learning

diculties should not be required to bear those losses without support or themselves

or or their inormal (oten amily) carers. Such people are oten among the poorer in

society. The main eciency arguments relate to the wider social and economic benets

o action, which go well beyond those accruing to the people directly aected, and the

need or better inormation about impacts and potential remedies.

Personal and corporate responsibility

Despite the rationale or action by Government, the analysis has made it clear that

companies and individuals may also need to act and have clear incentives to do so.

Three examples are provided:

In the eld o learning, individuals can substantially increase their employability and

earnings potential by improving their skills and mental capital, and companies can

benet rom helping their employees to train and retrain through their working

lives. However, there is a wider social and economic case or Government to help

individuals to recognise and take advantage o these benets, supporting themin childhood and empowering them to take control o their own learning and


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retraining in later years; and to provide companies with stronger incentives which

take ull account o the wider benets involved.

People have clear incentives to adopt liestyles in mid-adulthood that will prepare

them or older age, and protect them against mental decline. An example here is

exercise, which helps to stimulate the cardiovascular system and coner protection

against normal cognitive decline. However, people apparently tend to discount theselong-term benets rather heavily, and there is a good case on wider economic and

social grounds or Government encouragement and incentives so that they are

accorded a higher priority.

Companies have a strong incentive to adopt working practices that look ater the

mental health and wellbeing o their employees. It makes them more productive

and increases the companys competitiveness. However, provision o Government

support and advice may be needed to ensure that companies also actor in the

wider benets or individuals and society.

Diverse players acting in concert

In general, the greatest benets will be obtained when concerted actions are taken by

a range o dierent stakeholders in par ticular contexts. The Project has identied a

number o instances where an integrated approach will be vital. Two examples are:

Early child development: as indicated above, there is a case or inter ventions that

adopt basic principles (such as responsivity and warmth), to be integrated in

dierent settings in the amily, school, and inter-generationally.

In addressing the stigma o mental health, an integrated approach is needed involving

a range o stakeholders: parts o Government, the media (such as television and

radio), mental health proessionals, and educators.

What criteria should underpin policy development in a situation where resources areinevitably constrained?34

Choices concerning interventions, and the amount o resources assigned to them, will needto be made against a background o evolving public expectations, and the values to which

society will aspire over the next 20 years. There is a strong case or Government to consider

these urther as part o its consideration o this report.

For example:

How should we balance resources between: helping those with the most chronic

or acute problems; preventing problems developing; and shiting the overall level

o wellbeing or the entire population? This latter option, or example, could

substantially transorm the outlook or a large proportion o the population, but

care would be needed to ensure that it was not at the expense o providing the

right level o treatment and support or those with disorders.


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How should we allocate resources between dierent lie stages? There is a strong

case to invest in young people as this will set the course or their uture wellbeing

and productivity. However, it also makes sense to ully use the mental capital that

exists already in people o older ages. Since most people in todays society have

a high likelihood o reaching advanced age, investing at later lie stages has the

potential to benet many.

In deciding priorities, appropriate weight needs to be given to actors such as social

inclusion, social cohesion and individual wellbeing, as well as to economic prosperity.

This will be particularly important or allocating resources or mental capital and

wellbeing policies across dierent age groups, though the general case or acting

early in the liecourse will remain. However, more work is needed to understand

and quantiy the value o such benets in the assessment o particular courses o

action.

When Government allocates resources or interventions relating to mental capital andwellbeing, how broadly should it value impacts across society, and how should it value very

long-term benets?35

For example:

There is a common tendency or people to discount unduly heavily the (known)

long-term eects on their uture mental capital and wellbeing o liestyle choices

such as: ailing to exercise; taking drugs and the excessive use o alcohol; and o

ailing to enhance skills and take advantage o training opportunities over the

liecourse. Government policy should adopt measures which help correct or

that tendency, and give greater weight to longer-term benets, using the standard

approach to social discounting.

Interventions that enhance the learning, development and resilience o children

could have substantial economic and social implications over many decades:

reducing later costs or the cr iminal justice system, the social and healthcare systems,

mental health at work, improving lietime earnings, and even in protecting against

cognitive decline in old age. These need to be taken ully into account.

There is also a very strong case or more intensive adoption o best-practice

treatments or common mental disorders; and well-tested programmes or helping

those with mental illnesses into work which oer the prospect o high returns over

many years.

Early identication o mental health risks and conditions, or example, through

biomarkers, has the potential to enable earlier and more eective interventions

which deliver benets over longer periods. This potential needs to be given ull

weight in the allocation o research unding.


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To what extent should wider policy choices across Government take account o mentalcapital and wellbeing?36

The pervasive impacts o socio-economic, cultural and environmental conditions on mentalcapital and wellbeing illustrate the need to widen the range o circumstances in whichimpacts on mental health are actored into economic appraisals o public sector policies

and projects. However, more evidence is needed to do this eectively.

Several examples illustrate the need to take better account o implications or mental

capital and wellbeing when developing policies across Government:

Common mental disorders are extremely costly e.g. depression in England accounts

or about 9 billion per year, mainly in lost productivity. However, the evidence

shows that they are crucially aected by actors which are infuenced by policies in

diverse areas unrelated to mental healthcare e.g. employment and the economy;

housing; welare; and criminal justice.

There is a good case to intervene in areas such as personal debt and nancial

literacy, specically to break the cycle with mental ill-health. Similarly, interventions to

improve the physical environment could oer benets to mental health. However,

such cases oer particular challenges, since the principal beneting Government

department would be dierent rom the departments that would resource the

intervention.

New evidence conrms that early child-parent and child-carer relationships are

particularly impor tant to later fourishing, both socially and cognitively. It has also

inormed understanding o causal mechanisms. However, these relationships are

aected by many actors, including lack o knowledge by some parents and teachersregarding eective parenting and child development, teenage parenting, sub-optimal

child care settings and low pay levels or childcare workers.

There is a need to improve coordination and to align better incentives in the implementationo policies or mental capital and wellbeing37. For example, the incentives acing dierentdepartments (at present through the Public Sector Agreement system) need to be alignedas ar as possible to embody a consistent and comprehensive approach in this context.

Crucially, success in managing this agenda and delivering real improvements in mental

capital and wellbeing will require strong political leadership and coordination at the centreo Government.

At the level o central Government, at least hal o the 30 departmental Public Sector

Agreements (PSAs), led by eight separate departments, have potential implications or

mental capital and wellbeing, but not all o them recognise this explicitly. Inclusion o

mental capital and wellbeing explicitly in these PSAs, supported by appropriate Key

Perormance Indicators and monitoring rameworks, should be considered.



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More radical possibilities that should be explored include:

The development o a joint PSA across Government geared to improving mental

health and wellbeing; and

The development o an over-arching mental capital and wellbeing measure, akin to

the Communities and Local Government Index o Multiple Deprivation.

How might we address uture challenges in those cases where todays sciencedoes notprovide clear advice?

In general, interventions need to be evidence-based and include a careul appraisal o

costs and benets. However, whilst science tells us a great deal, many uncertainties

remain. In particular, evidence on the cost-eectiveness o mental capital and wellbeing

interventions is generally sparse, certainly or the UK. A very high priority should

thereore be assigned to improving that evidence base.

Where uncertainties remain, it is oten desirable to trial new approaches in ways that

urther understanding. Also, more emphasis on rigorous evaluation o existing and

proposed new interventions is required. Both will require a high-level commitment to

careul planning and, where relevant, a step-by-step roll out.

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12 Conclusion: next steps for Government38

Promoting mental capital and mental wellbeing or everyone will be vital in meeting diverseuture challenges acing our changing society. This report and its supporting papers identiya large number o evidence-based suggestions or new policies and interventions. Thendings have already begun to inorm a number o Government reviews and activities: the

Projects Stakeholder Engagement document39

provides a list and includes others that areplanned.

However, the ull benets oered by this report cannot be realised by a piecemealapproach by individual parts o Government. Instead, a step change in both social andeconomic outcomes could be achieved through a more strategic and visionary approachinvolving:

Better use o scientic and other evidence to plan and link interventions that aect

mental capital and wellbeing through the liecourse.

Better decision making, drawing upon better economic analysis o interventions, to take

account o wider and longer-term benets.

Improving the promotion o cross-Government action and central coordination.

Realising this new approach and the ull benets rom this Project will not be easy.

There will be substantial diculties that would need to be overcome, particularly

relating to the three areas listed above. For this reason, the ollowing suggests a number

o practical steps that constitute a roadmap or urther action by Government:

a. There needs to be a high level commitment and lead in Government to overseethe development and eective implementation o this new approach.

This will be vital to integrate policies and interventions eectively across the

liecourse, and across the interests o delivery departments. It will also be important

to mesh this over-arching approach with the many existing initiatives and policies.

The intention would not necessarily be to require new resources, but rather to

bring the many existing initiatives together within a common vision and ramework,

to reassess the balance o priorities, and to identiy and address gaps.

b. Government needs to act now to prepare society or uture challenges, and to prevent

problems aecting individuals becoming long-term40.

For example:

We need to prepare todays children so that they are set on the best possible

trajectories to meet the challenges ahead. The early years o development are

critical.

In some areas where the situation is set to worsen, such as the growing number

o older people at risk o dementia, we need to act decisively new treatments

could take years to become available, and protective liestyles need to be

established now or those in middle age.


39 The Stakeholder Engagement document will be made publicly available through www.oresight.gov.uk

40 See Chapters 3 6 o the nal Project report

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We need to address problems aecting peoples mental capital and wellbeing

(e.g. relating to learning diculties and mental health), so that they do not

become entrenched and so that we avoid their impact over coming decades.

c. The new strategic approach needs to be inormed by an early debate to decide itsbreadth, and the values and expectations o society that it will seek to address41.

For example, issues such as the balance o roles and responsibilities between the

State, the individual and employers will be important. Also, there is a case or

Government to engage with the wider society to agree priorities. For example, it

will be important to be clear about the relative value o issues such as economic

prosperity, wellbeing, social cohesion and inclusion so that clear pr inciples or the

division o resources can be determined.

d. Work should be commissioned to provide economic assessments o potentiallyworthwhile interventions42.

This will be crucial so that benets o policies and interventions are maximised

both across society (or example, to include the impacts on carers and business),and across the liecourse. This may require the development o new economic

evidence relating to the values that the strategy will target (see above).

e. New ways o incentivising Government departments need to be worked out, so that

eective and sustained action results43.

In particular, it will be important to build upon the existing Public Sector Agreement

ramework to better address the issue o a given department resourcing

interventions that address the priorities and interests o other departments.

. Where possible, the development and implementation o the new approach should be

inclusive.

This suggestion recognises the trend towards more active citizenship. A particular

example concerns older adults: they should play a central role in developing and

implementing the components o the strategy that aects them.

g. A mechanism should be adopted to oversee the rigorous use o science and otherevidence.

This would be important to inorm choices made within the new approach; and to

promote the eective use o economic analysis and randomised control trials to

assess interventions.

h. When new policies and interventions are developed or optimising mental capital andwellbeing, their implications or social equity and social inclusion should besystematically assessed.

For example, the promotion o mental capital and mental wellbeing could be used

explicitly as a tool to reduce divisions and exclusion in society. However, it could

have the opposite eect i only certain groups were able to benet. Access to

new technology or learning is a clear example: i available to all, it could unlock

opportunities or the disadvantaged, but i only available to the privileged, it could

widen social divisions.




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47

i. There should be a long-term commitment to build upon the existing scientic and otherevidence base44.

Addressing gaps and uncertainties will be important and specic areas o urther

research are suggested in the nal repor t. However, a strategic need that cuts across

Government would be to update and strengthen the long-term strategy or large-

scale, longitudinal studies.

In conclusion, when a Foresight project is started, it is not known where the scientic andother evidence will lead. Here, it has provided a vision o a uture that is beset with manymajor challenges and uncertainties. However, two consistent themes have emergedthroughout: on the one hand the considerable vulnerability o our mental resources andmental wellbeing to those challenges; but on the other hand, the potential o those sameresources to adapt and meet those challenges, and indeed to thrive. This central

importance o mental capital and mental wellbeing to the uture o individuals and towider UK society argues strongly or them to be considered at the heart o policy

development in Government.


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49

Appendix A: Structure of the Project reports and supporting papers

The accompanying chart details the reports and papers produced by the Project. The

various repor ts are available in the ollowing ormats through www.oresight.gov.uk:

All are available by download.

All are also all available on CD ROM.

The reports in the accompanying chart that are represented by icons o their ront

covers are also available in hard copy.

In addition to the reports and papers in the accompanying gure, a number o other

discussion papers, economics papers, and workshop reports will also be made available

in due course through the above website.

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51

Mental capital through lie:

Future challenges

SR-E1: Neuroscience oeducation

SR-E2: Human reward

SR-E3: Neuroeconomics

SR-E4: Cognitive reserve

SR-E5: The adolescent brain

SR-E6: Behavioural economics

SR-E7: Resilience

SR-E8: Adolescent drug users

SR-E9: Pharmacologicalcognitiveenhancement

SR-E10: Stem cells in neuralregeneration andneurogenesis

SR-E11: Early detectiono mild cognitiveimpairment and

Alzheimers disease:An example using theCANTAB PAL

SR-E12:Anxiety disorders

SR-E13: Neurocognition andsocial cognition inadult drug users

SR-E14: Normal cognitiveageing

SR-E15: Social cognition inteenagers inclusion

SR-E16: HPA axis, stress, andsleep and mooddisturbance

SR-E17: Nutrition, cognitivewellbeing andsocioeconomic status

SR-E18: Nutrition andcognitive health

SR-E20: Eect o chronicstress on cognitiveunction through lie

SR-E21: Depression and its tollon mental capital

SR-E22: Fitness and cognitivetraining

SR-E24: Eects o exercise oncognitive unction andmental capital

SR-E25: Technology solutionsto prevent waste omental capital

SR-E27: Housing as adeterminant omental capital

SR-E29: Cognitive neuralprosthetics

SR-E31: Cellular and molecularlogic o neural circuitassembly

Learning through lie:

Future challenges

SR-A2: Learning at work

SR-A3: Skills

SR-A4: Participation inlearning

SR-A5: Evidence-inormedprinciples rom theTeaching and LearningResearch Programme

SR-A7: Estimating the eectso learning

SR-A9: Sel-regulation andexecutive unction

SR-A10: Lielong learningacross the world

SR-A11:Non-cognitive skills

SR-A12: Future technologyor learning

Mental health:

Future challenges

SR-B1: Genetics andsocial actors

SR-B2: Mental healtho older people

SR-B3: Positive mental health

SR-B4: Mental disordersin the young

SR-B5: Prisoners

SR-B6: The homeless

SR-B7: Children in localauthority care

SR-B8: The costs o mentaldisorders

SR-B9: Serious and enduringmental illness

SR-B10: Personality disorders

SR-B11: Violence

SR-B12:Ageing

SR-B13:Migrants

SR-B14: Substance abuse

SR-B15: Depression

Mental Capital andWellbeing:Making the mosto ourselves in the21st centuryFinal Project Report

Wellbeing and work:Future challenges

SR-C1: Work

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