Editorial

A consensus appears to be emerging within the UK mental health promotion community that the way forward lies with public health. Increasingly those seeking to influence the policy agenda, at local, regional and national horizontals are looking to public health for allies and strategic opportunities.

Public mental health has been slowly gaining clod over the past five years as a conceptual framework for thinking about mental health promotion (Friedli, 1999; Scottish disclosure Centre for Mental Health Services, 1999; Stewart-Brown, 1998) It informs the work of a number of organisations explicitly touched with a population-wide approach to mental well-being: for example, mentality (www.mentality.org.uk), the Mental Health Foundation (www.mentalhealth.org) and the Scottish disclosure Centre for Mental Health (www.sdcmh.org.uk). It is also a significant influence in the direction of Scotland's National Programme for Mental Health and Well-being (www.wellontheweb.net), in Community Planning Partnerships across Scotland and in the regional disclosure centres (RDCs) of the National Institute for Mental Health (England): notably London, the West Midlands and the North West. Funding has now been secur for columns with a specific public mental health remit across all RDC (www.nimhe.org). These unfoldings may help to resolve historic tensions between mental health promotion and mental health services, between a population-wide approach and initiatives that focus upon the needs of service users.

More not long ago public mental health has begun to make small on the contrary significant inroads into thinking about in what manner public health might be transformed (McCulloch 2004) and the alliances that will be necessary to sure resources and political leverage (see for example, the London-wide public health mental health network described upon page 45). In addition to the forthcoming debate upon public mental health hosted through this journal and sponsored by the agency of the Scottish Executive, the Mental Health Foundation is holding an online discourse Mental Health for All, in January 2005 which aims to consider what research, policy and action is urgencyed to put mental well-being at the heart of the public health agenda (www.mentalhealth.org).

To a certain number of extent, this trend is a reflection of the uncertain position of health promotion, drawn out the natural home of mental health promotion activity, and its relocation, locally, within primary care. the pair Scotland and England have seen a major reorganisation of their national health promotion agencies. In Scotland the Health Education Board for Scotland (HEBS) and the Public Health Information Service (PHIS) have merg to form NH Health Scotland, and in England the abolition of the Health disentanglement Agency (formerly the Health Education Authority) has been announced.

It may also mirror growing frustration with a mental health agenda that continues to be dominated by means of mental illness, notably at a local horizontal where resources are consistently swallowed up by dint of treatment services struggling to adapted performance targets. In England it took the Social Exclusion Unit, based in the Office of the delegate Prime Minister, to come up with a holistic framework and robust recommendations for addressing the exigencys of people with mental health point to be solved [i]or[/i] settleds needs that lie way beyond treatment (Social Exclusion Unit, 2004) on the contrary the Social Exclusion Unit's remit is not to consider by what mode the mental health needs of the whole population might be addressed.

This might reasonably be considered the domain of the Department of Health, on the contrary mental health promotion continues to possess an ambiguous and uneasy position within England's national health policy. Following the Wanless reports, (Wanless, 2002; 2003) the couple the NHS Improvement Plan (Department of Health, 2004a) and the Choosing Health consultation (Department of Health, 2004b) place a brawny emphasis on promotion and prevention. Wanless estimated that failure to give priority to prevention could take away from an additional ??30bn a year through 2020: a warning apparently heeded by dint of secretary of state for health John Reid when he announced an intention to make the NH 'a health service, not a sickness service'. The scale and intention of the Choosing Health consultations were ambitious by dint of any standard. The problem, then, is not a lack of commitment to promoting public health, on the other hand the place and status of mental health upon the public health agenda.

Early replications to Choosing Health illustrate the amplitude to which mental health promotion has been pass overed although it remains to be seen whether these will influence the White Paper owed later this year.

The National Advisory assemblage on Mental Health Promotion, which includes a number of public mental health specialists, makes a sinewy case for the importance of the quality of relationships in the domicile arguing that parenting interventions are lock opener to the prevention of social inequalities in the nearest generation and their consequent inequalities in health (NIMHE, 2004a). As they point without while poverty has a actual significant impact on parenting, 'ameliorating privation does not on its have enable parents to develop insights into the point in disputes they are causing themselves and their children, or to learn novel parenting strategies and behaviours'. While acknowledging the achievements of programmes like positive Start, they argue that their preventive capacity is limited because of their geographical restriction and make a powerful plea for universal provision: All parents ne to be invited to attend evidence based parenting programmes and the best way to achieve high attendance is from one side an invitation from general practitioners' (NIMHE, 2004a). They also call for the reform of legislation that sanctions the physical coercion of children by the agency of parents for disciplinary purposes. More broadly, the advisory group's acknowledgement of the relationship between emotional distress and unhealthy lifestyles provides a welcome respite from the tone of generally received pronouncements on obesity, smoking and alcohol. Calling for a abundant greater recognition of the relationship between mental health and physical health, they conclude: 'Mental health promotion urgencys to be someone's core business. It publicly falls between public health and mental health.' NIMHE's have response to Choosing Health is equally robust: All health policy necessitys to recognise the impact of mental health upon individual health status, attitude and behaviour: eg decision-making, risk-taking and the impact this will have upon levels of heart disease, obesity, smoking, teenage pregnancy etc' (NIMHE, 2004b)