Public Mental Health; Determinants and Approaches


Public Health England – East Midlands, Nottingham, United Kingdom


Public mental health (PMH) is the promotion of positive mental health and wellbeing, the prevention of mental ill health and the effectiveness of treatment and recovery and is interested in reducing exposure to risks and increasing exposure to protective factors. PMH is socially defined and culturally located, follows a life course dimension and harnesses the concepts of mental capital and mental wellbeing.

The social, physical and economic environments in which people are born, grow, live, work and age have important implications for health and in particular, MH. The biggest lifelong gains in PMH are achieved from reducing risks and increasing protective factors starting prenatally, through to infancy, childhood and onwards. The key modifiable risk/protective factors for mental health are relationships and parenting. Relationships are two way and therefore the individual plays a part but less so when they are an infant when the relational is most potent. Over 75% of all MH problems have emerged by the age of twenty five, making childhood determinants primary in future mental wellbeing.

However MH problems are not equally distributed across the population. Understanding inequalities is essential for working out how to allocate public mental health interventions in an evidenced based, meaningful way to ensure proportionate investment. 

A proportionate universalism approach which addresses whole population mental wellbeing promotion and provides additional support for high risk groups is the optimum approach coupled with a ‘Positive Focus’ i.e. moving the focus away from illness and towards promoting mental wellbeing. A life course approach that reduces inequalities and which is multisectoral and multidisciplinary is needed to make a difference. There are various examples of interventions that have been shown to work in the UK, focusing on prevention, promotion and evidence based treatment that are embedded across the system with a strong emphasis on local ownership and strong leadership.