1. The need for skilled workforce to support wellbeing and mental health needs

Wellbeing, broadly construed, has rightly attracted increasing policy and clinical attention. Wellbeing is both an individual and societal concern, and its neglect carries serious costs.

There are at least four principal, and interlocking, challenges in this domain: psychological resilience (supporting individuals in maintaining identity and agency); service integration (ensuring health and social care address the whole person, not just medical or mental health conditions); evidence translation (making sure interventions with proven benefit reach those who need them); and equity of access (preventing wellbeing becoming a privilege rather than a right).

I would like to argue that, whilst each of these is important, there is a further cross-cutting issue that is receiving insufficient attention: the systematic protection and development of the psychological skills base within health services. Each of the challenges set out above rests upon ensuring that the UK maintains a sufficient supply of professionals able to deliver evidence-based psychological and wellbeing interventions, and that these skills are recognised as essential rather than optional.

It is obviously important that the UK invests in neuroscience and cutting-edge therapeutics. UK research councils and charities have indeed supported significant advances here. But whilst large, randomised control trials often attract funding and prestige, the slower, patient-facing work of embedding wellbeing approaches in practice receives far less attention.

Where my concern is much greater is in areas that are not seen as “hot topics,” but which are nevertheless vital: the provision of accessible psychological support to those who don’t reach certain clinical thresholds, the integration of mindfulness and third wave approaches, and the co-creation of services with people who might use these services. In fact, the 5-year forward view for mental health taskforce strategy underlines that all new models must be developed in partnership with experts-by-experience, carers and community and voluntary organisations. These interventions may not always be glamorous, but evidence shows they can prevent crises, reduce healthcare costs, and preserve quality of life. We cannot rely upon overstretched health and social care systems, already battling resource constraints, to safeguard these capabilities unaided. Parternships with primary care, community and voluntary sector are essential.

This is not a UK problem. ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, set a research agenda that covers the need of understanding causal mechanisms, international collaborations, intervention development and reducing stigma and empowering people.

To illustrate in the UK access to talking therapies for people with long-term conditions, other than cardiac, chronic obstructive pulmonary disease (COPD) and diabetes remains inconsistent and fragile. Specialist nurses and clinicians do not have appropriate referral routes. The consequence is predictable: rising distress, preventable hospitalisations, and a loss of independence for thousands.

The challenge is, of course, that the erosion of wellbeing provision shows up slowly, and by the time its effects are visible, in carer burnout, in lost independence, in spiralling health costs, it may be too late.

We need urgent steps to protect and grow the wellbeing skills base. We need to expand access to digital services to enable more people to receive effective care and provide greater responsibility and choices. In fact, the NHS choices is a good start to digital mental health but policy now needs to focus on the uptake of those services.

This is an area where government should act, but not government alone. Charities, professional bodies, and service providers all have a role: investing in training, prioritising co-created services, and ensuring these roles are attractive and sustainable.