A critical analysis of prevention and population health discourses in mental health policy

Discourses around prevention and population health have been gathering momentum in UK mental health policy for over a decade. This trend has been influenced by an economic rationale, prominent reports into the social determinants of health and mental health, and pressure from national and international organisations to take a population based approach to address them. And yet despite this, there are indications that the political focus on mental health prevention has not resulted in clear preventative action.

The current study aimed to address the social problem of prevention through a critical appraisal of the discursive features of recent mental health policy. The intention was to facilitate clinical psychologists’ engagement with the political context of their work. A 5 stage framework for Critical Discourse Analysis (Fairclough, 2001) was utilised to explore the underlying conceptual frameworks of relevant policies, and the impact these had on the way preventative action was operationalised. This was undertaken from a critical realist epistemological position.

On the basis of a historical analysis into prevention and population health discourses, two representative policies were selected for more detailed discursive analysis. These were Advancing our Health: Prevention in the 2020s (Department of Health and Social Care, 2019) and the NHS Mental Health Implementation Plan 2019/20 – 2023/24 (NHS England, 2019a). The analysis indicated that potential discursive obstacles to preventative action could be found in; how the target of prevention was conceptualised, conflicting notions of responsibility for prevention, and the malleability of the concept of prevention itself. This was discussed in reference to the network of policy structures and practices that also present a barrier to prevention. Implications for clinical psychologists in terms of individual, community and policy level actions were considered.