Putting wellbeing and mental health at the heart of progress
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Welcome to the LSE Events Podcast by the London School of Economics and Political Science. Get ready to hear from some of the most influential international figures in the social sciences. Ladies and gentlemen, welcome to the LSE for this event, which is part of the LSE Festival, Visions for the Future. The festival has been going on all week. There's still many events today and there is going to be a lot of events also tomorrow. So do check out the programme if you haven't already done so.

So this year's festival is about threats and opportunities in the near and distant future and how a better world could look like. And this event particularly is about well-being and supporting mental health as a key to building a better world. My name is Christian Kreckel. I'm an assistant professor in behavioral science here at the LSE. I'm a member of the Center for Economic Performance.

at the LSE as well as the Department of Psychological and Behavioral Science and I'm very happy today to be sitting here and discussing putting well-being and mental health at the heart of progress with Professor Lord Richard Layard, Professor Martin Knapp and Dr. Laura Taylor. Richard here is a Professor Emeritus in Economics at the LSE and he is the

the founding director of the Center for Economic Performance. He's also the program co-director of the Community Wellbeing Program at the CEP. And in his long academic career, he has written a lot of very interesting papers, was very prolific. He's written many books, six amongst which is "Happiness," which has been translated into 20 languages. And he's currently writing his seventh book, which is called "The Value for Money." With him. With me.

Value for money, which is the new cost-benefit analysis in which he argues that we should prioritize policies according to how much way being they generate per pound invested.

And being a member of the House of Lords, Richard has also been very persuasive to government and he has persuaded the British government to improve access to psychological therapies which has led, with the joint work of David Clark at the University of Oxford, has led to the NHS Talking Therapies programme which now treats more than 700,000 patients every year.

So that's Richard. Then we have Martin here. Martin is not only Professor of Health and Social Care Policy, but he's also a Professorial Research Fellow at the LSE Care and Policy Evaluation Center, as well as Research Director at the Research Director for Social Care at the National Institute for Health Research in England. And before that, for a very long time, I think 15 years, he was professor

director of the NIHR School for Social Care Research in which he has made important contribution on arguing for an economic case of preventing mental health problems and mental health diseases that is actually very good value for money to actually invest into preventing rather than curing later.

Even before that, it's noteworthy that he was very sportly active. He was an international marathon runner for Team Britain and in this capacity also won the Barcelona Marathon in 1981 at a speed of actually time of below two hours and 20 minutes at the age of 29, which is also an achievement.

Last but not least, Dr. Laura Taylor leads the Well-being in Childhood and Adolescence research stream at the Well-being Research Center at the University of Oxford. She works with various prominent global organizations and helps them sort of leverage the latest

scientific insights into child and adolescent well-being for their operations and devises strategies on how to improve youth mental youth well-being on a global scale. It's just one example of what she is doing. She's currently working with the International Baccalaureate Organization, IB organization on

redesigning their strategy to student well-being and this involves around 1.2 million students worldwide and more than 5,000 schools globally. So that's really a huge endeavor. So we have an excellent lineup, pretty much some of the best lineup we can offer to you here at the LSE when it comes to well-being and mental health.

For those social media users in the audience, the hashtag is LSE Festival and I kindly ask you now to put your phones on silent mode because we would like to record this event and put it up as a podcast later on.

So in terms of format, first of all each of our panel members has 10 minutes to talk about their research. Then we have a 10 minute discussion here in the panel about the research and then we open the discussion to the floor and then you can ask the panel members questions about their work. So without further ado, I would hand over to Richard as our first speaker.

Well, thank you very much, Chris. And thank you for being here. We're in the middle of a revolution in what is the goal for our society. Increasingly, people are saying the goal should be the quality of life as people experience it, not just wealth or any other particular thing, but how people feel about their lives. Are they satisfied, fulfilled, enjoying their lives?

This is quite an old idea going back to the 18th century enlightenment. But now for the first time we can make it operational because we've got the science of happiness and we can put numbers on these things. So if that's the goal for society, of course it should be the goal for every organisation within the society.

and for each of us as individuals. So the fundamental concept here is that for government, what is the goal? The goal is the well-being of the people. What is the rationale for education? The well-being of the people being educated and the people that they then affect.

a goal for business, similarly, and a goal for each of us. So I don't want to talk mainly about government, though I'll come back to each of us at the end. So let's just remind ourselves of the basic idea here. So there's the basic idea, the happiness principle, that the best state of society is where there's the most happiness, especially among those who are least happy.

And that gives you the basic principle for politics: the government should create the conditions for the greatest possible happiness, and when it comes to us for our private ethics, we should be trying to produce the most happiness that we can in the world. So let's focus for the moment on politics.

So here's the problem for the government, it's wanting to maximise the wellbeing of the people, but it's only got a certain amount of money to do it. We just had the spending review last week and we're all too conscious how little money there is to do things that can produce the effects on people's wellbeing. But obviously the way the money should be spent

is on those policies which produce the most well-being per pound, because that's the best use of the money. So the fundamental concept when the department is making its case to the Treasury should be what is the benefit-cost ratio? High ratio means you've got a good case. So this idea is now...

officially accepted in Britain, it was well spelled out by Chris and the colleague in a handbook, it was then embodied in the so-called Treasury Green Book, and this is what's increasingly being used throughout the civil service in making their cases to the Treasury.

Because this was new, we thought it was our job to show that this was feasible, so we produced a report last September where we went through a whole range of policies across the board to show how to do it. And I will just show you some of the results because I think they are quite thought-provoking.

So remember the criterion is the ratio of benefit to cost. Obviously if there's no cost that's the best thing of all and there are many policies which save more money than they cost. So they're the first claim on public funds.

and these are the ones that we looked at: NHS Talking Therapies for anxiety and depression, a new psychological therapy service for addiction which we're hoping to get commissioned later this year, mental health support teams in schools, obviously important, employment support,

a proper opportunity to get skills for people who don't go to university and freeing up the greenbelt near commuter stations. So these are things which are no brainers, aren't they? They don't cost anything and they should go through. But then there are other things, most things do cost something.

So here are some of the things we looked at which cost something, well-being lessons in schools, small parks, greenery in cities, R&D, tax credits, police. We didn't know how these would come out and it's very interesting. I mean this is quite an exciting research project actually.

because you don't know what you're going to find when you go into this. But you can go into it, there's enough evidence to do so. I didn't expect police to come out that effective, nor actually R&D, but they do come out effective. Things which come out as very ineffective are most road projects, certainly the HS2, and smaller class sizes in schools. So

You can see we've got a really powerful tool here for looking at policies. One other point I want to make on public policy, which I made at the beginning, that ministers may want to give extra weight to improving wellbeing if it's accruing particularly to people who start off in a bad way. And of course,

We need to include that in this procedure, we need to identify what the original situation was of the people who are beneficiaries from a policy and we also need to seek out new policies that benefit people with low wellbeing. So the next and final question on that is who are these people with low wellbeing?

I'm a sort of pseudo-politician, and everybody assumes that poverty is the main cause of low wellbeing. These are the factors that explain the most of the prevalence of low wellbeing in Britain. Mental health problems, that's a very simple yes/no question. Have you ever

suffered from being diagnosed with depression or anxiety disorder, physical health, having a partner, quality of work.

being unemployed. All of these are more important than income, but income of course is important. But you'll see that this is opening up a really different way of thinking about policy when we are balancing services versus cash redistribution. We're balancing current spending versus capital spending. Let me just end

on that ethical note with which I started there. What is our job in life? Why are we here? We're here to produce the most happiness that we can in the world. And that follows directly, if you accept the earlier part of the slide, that's what we should be doing. If there's any concept of should, this is what it should be.

and I think it's an incredibly powerful and inspiring concept of why we're here. And it's something which I think can plug that great void which has developed where people have so little sense, many people, of what should be the purpose of their lives. We founded a movement called Action for Happiness. Action for Happiness.

to help people live in this way, I would urge you to go into the web, find Action for Happiness. It provides wonderful courses, individual ones, group courses. It has a fortnightly meeting online. It's a powerful movement. It's got half a million members. I've always been hoping that groups would spring up at LSE.

So if there's anybody interested in doing that, please come and talk to me afterwards. But I just end by saying I think that this basic idea that what we want is a society with high well-being is an idea whose time really now has come. The culture that we have, prevalently, is that people's aim, if there is a culture,

you'd have to say the predominant aim is that people should think they should be more successful than other people that's a zero-sum game anyone goes up somebody else goes down we need the positive some culture there it is so please join in thank you right thank you very much so

So Richard just said the biggest driver of low well-being is mental illness and that's what I want to focus on in my short presentation here. I want to focus on particularly the links between childhood experiences and adulthood outcomes and I'm going to just give you a couple of illustrations from research that we've been doing here at LSE, one project very recently and one a few years ago. So I'm going to address three questions.

firstly what is the effect of mental illness in adolescence because 75 of mental health problems emerge before the age of 25 so that's a very key life stage so what is the effect of that mental illness in adolescence on future earnings in particular there's lots of consequences that's my focus secondly what is the effect of an adverse childhood experience bullying in fact

on mental health and adulthood and its economic consequences? And then thirdly, can we do something about it? What's the economic case for some preventive action? So the first one then, I want you to be super impressed with my diagram because I did it myself. So what we're interested in is that in the top right-hand corner, cumulative earnings in adulthood, what earnings do people get?

And we're interested in two things that might drive those earnings. So one of them in the middle says adolescent mental health, and then in the top left, family socioeconomic status. So we're particularly interested in adolescent mental health, but what we were keen to know is whether those effects of mental health on earnings are filtered in some way by the socioeconomic status of the family that the child, the adolescent grows up in.

So what we did was to take data from one of these beautiful birth cohort data sets. This is the National Child Development Study, which is all people born in one week in 1958, and they're still being followed up today, so we're able to access those data. And then what we did was to, firstly, on the slide there, first, to define somebody's socioeconomic status in childhood, you usually take the father's job, father's job to indicate social class, and we took the father's job at age 11, or the

or the child's when the child was age 11. Mental health problems at age 16 particularly behaviour and emotional earnings up to age 55 and then some analyses which I won't go into the details here but trying to understand what these effects might be and in the analysis adjusting for anything else that we can find in the data set that we think might be driving what happens in adulthood in terms of earnings. So let me show you what we found

So two slightly complicated diagrams. So on here this is people with either conduct problems or no conduct problems and males and females separate lines and I apologise it's a bit small I see you staring at this but

What this shows you is the hit on earnings coming from either having a conduct problem, a behavioural problem in adolescence, or coming from a low socioeconomic status family, or the combination of the two. So to think about it in this, I'll just put this little green line in here. This is the reference group. So the green line is individuals without this conduct problem in adolescence and from a high socioeconomic status family. OK?

And what you can see is below that line, that's the earnings hit, and the biggest hit is for those adolescents who display conduct problems, behavioural problems at age 16, who come from low socioeconomic status families. For females, there's also an impact, a significant impact, but it's smaller.

So that's the conduct problem side. On emotional problems, the same thing I had to show you here, these two green lines, that's the reference category of people who don't have this particular problem, emotional problem, and don't come from a low socioeconomic status family. And again, you can see the impact on earnings. So that impact...

which is filtered through many things, but particularly because of the mental illness, that impact is going to hit the individual in terms of their earnings. It's going to hit the exchequer in terms of lower tax revenue and probably reliance on welfare benefits of many of those people. So that's one study that shows you this link between early life experiences in relation to mental health and later economic consequences.

So the second one is focusing on bullying and I'm going to show you a couple of slides from a study that we weren't involved in and then we added something onto it. So again it's using this 1958 birth cohort so it's you can see the little

calendar, the top left there, people born in that week in 1958. And they've been followed up at various ages, they're continuing to be followed up today. And what this research team at King's College London did was to identify children at ages 7 and 11 whose parents reported they were subjected to bullying. So it's a parent's report of the child being a victim of bullying. And they defined three groups of people from that. Those

children who were never bullied, those occasionally bullied and those who were frequently bullied. And what they were interested in was what happens to those people as they get older. And this slide shows you some of the results that they found. So there are four outcomes here if you like. Any depression, any anxiety, suicidal ideation and then alcohol dependence.

And in each breach of the four, you've got three columns which says what is the likelihood that somebody who was never bullied in red, occasionally bullied in yellow, frequently bullied in bluey gray, would have those problems. And the little star says this is a statistically significant difference. So people who as children were bullied

40 years later are still experiencing mental health problems in adulthood in relation to depression, anxiety and suicidal ideation. So again what this does is wash out as many of these other factors which might be influencing those adulthood experiences.

So what we then did was to say, okay, so what are the consequences of this in terms of economics? And we looked at two things. Firstly, what contacts do these people have with mental health services over their lives up to age 50? And again, so the never bullied group is the reference group.

The reference group did use some services but the statistical analysis is saying what's the likelihood that somebody in the other groups would have more service use than the never bullied group. And what you can see is a very high rate of use for the frequently bullied group and it stays statistically significantly better, or better, bigger, worse if you like, bigger than the never bullied group right up to age 50. And in addition to that we looked at other things that might impact

be economic factors in people's lives. We've got the costs of the services they use, productivity losses because they have disrupted employment that would then lead to lower tax contributions to the exchequer, lower status jobs, lower earnings and less likely to be homeowners. So we've got an adverse experience in childhood, it's just one, there are many, but an adverse experience in childhood which is associated with

Maybe not lifelong, maybe perhaps we'll come back to this cohort in 20 years time and see what the impact is, but certainly for a long period into adulthood. So my third question then is can we do something about this? What can we do to address these issues? To be a slightly more positive ending to my short presentation. Now there's this very interesting program developed in Finland called Kiva.

and don't ask me to tell you what it is in full in Finnish because I'm not quite fluent in that language. But it's a programme, a whole school programme, which is part of the regular curriculum, which has been found in evaluation studies in Finland and in the UK to be effective. It's effective, the third bullet down there says, it enhances empathy, self-efficacy and anti-bullying attitudes of classroom peers and it aims to reduce the incentives for bullying.

And it addresses what I call traditional, I couldn't think of a name for it, but also cyberbullying. And it works, okay? It reduces victimisation, it reduces perpetration of bullying, and it's low cost because it's embodied, it's included within the regular social skills curriculum within schools.

So is it worth investing in Kiva? So what we did, none of that research about the evaluation of Kiva was ours. What we did was take that and then say what would be the economic case for investing in Kiva in British schools. So we had two analyses. The first one was for Public Health England, as it used to be called now, the Office for Health Improvement and

development, I forget, anyway, OHID. So we were interested in the short-term impacts and what you can see is if you convert those impacts from these other studies into money terms, you get a return on investment of £1.58 per pound spent. So it's a different way of presenting the similar figures to Richard in terms of what return you get on your investment.

And then in the second piece of work, what we were interested in was we take that data I showed you on the impacts up to age 50 and all those other consequences and turn those into monetary measures. And if we do that, we get this huge return on investment of £146 to £1 spent. Now, 146 is a very precise number.

And I'm prepared to bet it's not quite that number or not exactly that number. But even if we had committed huge errors in this, it's absolutely clear there's a very positive return on investment for this kind of scheme. So that's the argument here. So cautious in there, but still economically attractive.

Okay, so to finish then, these are my three questions. What are my three answers? Firstly, the effect of mental illness in adolescents on future earnings, considerable, long term, almost certainly go beyond the age that we were able to look at, 55, and those impacts are exacerbated by the socioeconomic status of the family in which the child grows up.

Number two, what is the effect of an adverse childhood experience on mental health and its economic consequences? What we see is bullying worsens mental illness for many decades and we can convert that, if you like, into the economic impacts which are enormous.

What's the economic case for preventive efforts? Very strong. We still need somebody to commit to this because particularly the efforts, the investment might be now and the payoff might not be very quick to come along and politicians, decision makers are generally impatient for results. But there'll be very important long-term benefit. That's it. Thank you very much. Hi, I'm interrupting this event to tell you about another awesome LSE podcast that we think you'd enjoy.

LSE IQ asks social scientists and other experts to answer one intelligent question. Like, why do people believe in conspiracy theories? Or, can we afford the super rich? Come check us out. Just search for LSE IQ wherever you get your podcasts. Now, back to the event.

So thank you for inviting me to speak today. It's a pleasure to join such a timely and important conversation. Richard and Martin have guided us through the UK context and given some excellent examples of their ongoing work around identifying and evaluating cost-effective policies to improve societal wellbeing and mental health. My own work focuses on child and adolescent wellbeing and today I'm going to offer a global perspective on identifying cost-effective wellbeing policies for young people and some challenges which are slowing progress.

As we know, many governments regardless of their GDP are facing complex resource constraints, so now more than ever how they spend matters. As Richard, Chris and colleagues highlight in their Value for Money report, when governments decide how to best allocate public funds they should prioritise what delivers the greatest wellbeing benefit per pound or equivalent, including reducing misery, not just what boosts GDP.

So if we want to shape futures that are not only stable and productive, but also inclusive, equitable and peaceful, we need to move beyond GDP and more clearly understand and invest in what makes life worth living. Of course, to do this, we need to measure wellbeing and its drivers and ultimately put wellbeing at the heart of government decision making. Looking at this from a global perspective, we have made progress.

Adult well-being is now regularly measured in dozens of nations thanks to efforts to measure and spotlight the importance of well-being like the OECD well-being metrics, national surveys and the World Happiness Report. Some countries are even integrating well-being into their budgeting frameworks including Scotland's national performance framework in New Zealand's well-being budget and others are actively in the process of attempting to do so such as Finland's cross ministerial well-being indicators. However,

People under 18 account for a third of the global population. The UN Convention on the Rights of the Child, the most universally endorsed human rights treaty in history, affirms a child's right to be heard, to thrive and to reach their full potential. It states that all decisions and actions affecting a child should prioritise their wellbeing and that children are not merely passive recipients of care but active holders of rights.

Yet their thoughts and opinions remain largely invisible in the data that shapes national priorities. The OECD, UNICEF and Save the Children have all emphasised this gap. Children's voices are underrepresented in national data systems, especially in low and middle income countries.

Most countries do not systematically track how children feel about their lives, nor what actually supports their wellbeing, despite strong evidence that children can reliably report on their own experiences and quality of life from an early age, and despite the availability of guidance on measuring the wellbeing of young people from intergovernmental organisations such as the OECD, the WHO and UNICEF. In our chapter for the World Happiness Report last year, we highlighted the global paucity of subjective wellbeing data collected from young people.

There are very few major international studies, PISA, Children's World and HVSC, that systematically collect data from young people about their wellbeing using nationally representative samples in multiple countries. Each does contribute important insights but they vary in age range, depth and focus, making it challenging to build a global picture of how young people feel about their own lives and what drives this in different contexts for different populations.

Underrepresented particularly in the available data are children under age 10 and young people from low and middle income countries. Importantly, we're also lacking international longitudinal data on well-being that we can use to explore well-being trajectories of young people in different countries and contexts over time. Without reports from young people about how they feel about their lives, we risk missing crucial information which could make lives better. This gap matters and it's slowing progress.

Well, we know that wellbeing in childhood and adolescence is predictive of a range of positive outcomes, be it mental health, sleep patterns, physical health, adult wellbeing. And economically, improving wellbeing reduces long-term public costs in health, education and justice, and strengthens future labour market participation.

And while we have strong evidence that there are already successful wellbeing interventions which work across diverse geographies and populations like early childhood education, group-based parenting programmes, social and emotional learning programmes, conditional and unconditional cash transfers and school-based mental health prevention programmes, internationally we still face challenges translating research into widespread policy and practice.

Policymakers, even if they want to prioritise wellbeing, often contend with short political cycles, limited local data and effectiveness, competing budget priorities and difficulty of adapting global evidence to local contexts. In many cases, a lack of longitudinal and contextualised data limits their ability to track long-term outcomes, assess cost effectiveness in real time or tailor interventions to the populations most in need.

Collecting well-being data across countries rather than within them offers an opportunity to learn from diverse experiences, to understand how different environments support young people's well-being and strengthen the cultural and contextual relevance of interventions. International data can complement local knowledge helping to build a shared evidence base that honours diversity, fosters collaboration and informs better decision making at all levels.

It also supports the work of international organisations like the OECD, the WHO and UNICEF by strengthening the evidence that underpins their guidance, funding priorities and coordination efforts around the world.

We must also recognise that children's wellbeing is shaped by broad systems: poverty, discrimination, displacement, gender inequality and disability among them, and that these factors influence both outcomes and access to support. If our data doesn't reflect these realities, our policies risk reinforcing rather than reducing injustice.

One way we can support policymakers to identify cost-effective policies and make more meaningful progress is by addressing this data gap. So we can understand not just whether interventions and policies work, but when, where and for whom.

It helps distinguish short-term improvements from lasting impact, clarify how different interventions interact with social, economic, cultural, legal and education systems, and identify the most equitable and cost-effective strategies across diverse populations. Without this, we have limited capacity to adapt, scale and sustain interventions that could truly transform young lives.

Longitudinal global data, if collected and analysed in a responsible, considerate and collaborative way, will give us critically needed insights into the lives of young people and aid societal progress. For the past four years we've been working on a series of wellbeing projects with the International Baccalaureate Organisation,

And in an effort to contribute to filling this global data gap, we're currently in the conception stages of exploring the feasibility of a new global wellbeing initiative, which would track young people's wellbeing and its drivers over time, following them initially from ages 11 to 18.

This type of data collection is not without its challenges. Once you aim to collect data both cross-nationally and longitudinally, you're met with substantial operational and legal challenges around data transfer, protection and use. This is one of the main reasons there's a paucity of this kind of data, that and of course it's very expensive to do this kind of data collection.

Despite these challenges, we've just completed a successful pilot in IB and non-IB schools across diverse geographies and are now in the early planning stages of a freely accessible, open, scalable system to collect and analyse data on youth wellbeing globally. The aim is the platform will allow schools and other youth organisations to collect wellbeing data, both quantitative and qualitative, elevating the voices of young people.

It would allow schools, youth organisations, researchers and policy makers to understand how wellbeing evolves over time and what drives it in their own context, protecting the confidentiality of the individual and delivering group level insights.

By providing robust and context-specific data, this platform could enable schools and policy makers not only to understand wellbeing, but also to identify which interventions are most effective, scalable and cost efficient for their unique settings and populations. We hope the platform will become a public good, a shared global infrastructure for measuring, understanding and ultimately improving youth wellbeing.

This type of longitudinal child-centred data is essential. It can help us answer the question, which policies offer the greatest wellbeing return for our investment and crucially, for whom and in which settings? It also helps us craft policy that's equitable, culturally grounded and participatory because wellbeing looks different in Bhutan, Nigeria and the UK and children themselves are the best experts in their own lives. Without measuring what matters, we cannot improve it.

If we fail to track, understand and invest in what makes life better for young people, we risk designing policies that miss the mark. Not because of bad intentions, but because we lack the evidence to do better. Longitudinal wellbeing data, rooted in children's lived realities, gives us that evidence. It's not just about better systems, it's about a better future. Built with and for young people, not around them. Thank you. And if you want to see more of the work, I've put the website up there.

Thank you so much. Thank you all three. It was excellent presentations. I mean, really, really interesting. We have 10 minutes now for like a panel discussion about what we have heard. And I thought I'd kick us off with a question. So the title of our session is Putting Wellbeing and Mental Health at the Heart of Progress, which sort of like suggests we're not doing this enough, right? And so I wanted to ask, why do you think is it the case that we are not

investing enough into way being and mental health and is this something where, you know, this might be some sort of like demand side issue that people might not be interested in that or sort of like don't know what they want or is it sort of like a supply side issue that, you know, maybe we don't give people the tools like analysts in government or the charitable sector to actually like look at their policies in terms of a way being perspective. What is sort of, what's the issue? Where's the problem? The issue is materialism.

politicians and maybe the electorate are biased towards things that can be touched and seen. In fact there's this extraordinary language which is used at the moment to discuss the budget. There's something called capital expenditure which means something that you can touch and feel.

And there's something which is then called day-to-day expenditure. Now, that's the expenditure which, as Martin shows, has an effect 40 years later. I mean, it's absolutely extraordinary that things which are done for people, service-type investments, are counted as current expenditure. And this is an international convention, but the result of it is...

that politicians, I think, and the public fail to understand the incredibly fundamental and long-term implications of many services for children, but also for adults, mental health interventions and other interventions, community interventions and so on, which can be done. So I think on the mental health side, what we've seen in the UK and in many countries is an increased...

on the part of health systems to invest in mental illness. I can see in the room at least two students on my course last year, and I'm going to give you a 30-second summary of what was a whole lecture in that course. But I think some of the barriers to this

I think firstly I think there's still stigma around mental illness so I think that governments, societies generally still do not either believe that mental illness is a real illness or that people with those experiences deserve the support that clearly they should have. So there's that sort of reluctance.

Secondly, I think there's a problem of multiple sectors. So mental health services are delivered in health systems, but the biggest impacts are probably going to be in other systems. That's work that Richard's done, I've done and so on. So if you can help somebody to avoid mental illness or to get treatment quite quickly, biggest payoff is going to be in terms of their work and their earnings and their tax contributions and so on. So we need to persuade one system, the health system, to invest in something which is going to have biggest payoffs elsewhere.

Secondly, those payoffs, as I said in my talk, can be very long-term, and that's difficult for inpatient decision-makers. And thirdly, and finally where I haven't got to, there's something which I call diagonal accounting, which is a term that I heard once in a meeting and I can't find who coined it, so I'm now going to copyright it. But it's where the question is, why should I spend my money...

when the benefits are going to be for your budget and five or ten years into the future. And it's sort of double disincentive for people to invest in services. So I think those are the reasons why I think we've got this lack of adequate investment. I think from the wellbeing perspective rather than mental health, wellbeing has been seen historically as fluffy, a fluffy term. You know, it is an academic scientific discipline with mounting evidence. And I think people are now starting to understand that.

I think when thinking about the child and adolescent focus on improving well-being, we have to sort of remember they aren't voters and historically that has been important and I think people are now, policymakers are sort of having this more child-centered approach but because there's now evidence of the impact in adulthood

So I think things are changing and things are becoming more child-centred and hopefully it will be for the good of the children themselves in the long run, not just because of the impact in the long run.

So it seems to be like many of these things actually boil down, I mean materialism which is sort of like values right or lack of understanding which you also mentioned stigma and sort of even diagonal accounting and the sort of like fluffiness of the term well-being or happiness right, so it seems to be boiling down to like maybe lack of understanding or education in that field.

that we don't really educate people enough in the science of well-being. Is this something which you think? Just a quick on the mental health side. I mean what we've seen in the UK, in many countries, we've seen the same pattern which is in the last three, four, five years there's been a very marked increase in apparent injuries in mental illness among young people particularly, adolescents and young adults.

And I think there's lots of things going on there. I think probably underneath it all there is probably an increase. But a lot of that is to do with the greater awareness of what mental illness is. And so that's a good thing. People are recognizing that the experiences they're having are not just, you know, distressing, but actually there might be something that could be done about them. And so people are more willing to talk about their challenges in relation to their mental health

more willing to seek services, and I think services, in many countries at least, have been more willing then to provide people with some kind of support. So I think awareness has been improving. We've still got a way to go, but I think awareness, that's a good thing. I mean, yes, it puts pressure on services, but in terms of at least people coming out of their shells, if you like, and seeking support, that's got to be a good thing.

So it's not more like a revolution in well-being or mental health, but it's more like a step-by-step, slowly evolution and gradual approach. Yes, I mean, just to follow what Martin said, a great British institution is now the National Institute for, what are its names? Health and Care Excellence. Health and Care Excellence, different from its initials.

which was set up actually by the first Labour government that we had in the late 90s. So this gives guidelines which are meant to be followed by the NHS for treatment of physical conditions and mental health conditions. By and large, they are followed for physical health conditions and by and large they're not followed for mental health conditions. And it's...

If you've got diabetes, something like 90% of people with diabetes will be in treatment. People with mental health problems, something like 40% maximum will be in treatment. Even now, after all the efforts that have been made, there is just an enormous bias away from it. And I think...

I think there are two reasons. I think Martin, one really important reason which is technological lag, that people haven't realised that there are treatments and there's not sufficient pressure to deliver these treatments because there's not sufficient confidence in these treatments. As you know, the majority of counselling given

in Britain is not evidence-based. So it's the evidence-based treatments

which are recommended in NICE and they are ones which we know have an effect and we know there are lots of other fluffy things which actually don't have very much effect and which have a negative spillover on the potential for mental health services to get financial support. So I think that's one thing but the other thing is obviously that although

half of all morbidity of people working age is mental illness. Of course the vast bulk of morbidity is physical illness among people after working age. So

the weight of morbidity is greater on the physical side than on the mental health side and the weight of numbers, I mean the hospital doctors have got a lot of voting power essentially. Given the interest of the time, if there's nothing else, I'll open the floor for questions. If you can state your name and your affiliation and wait until the steward comes with a microphone for you.

Thank you very much. Ewan Grant, UK Defense Forum. The reason I'm here is because much of my work involves looking at and reporting on trends and what the implications are.

I certainly haven't had my time wasted, thank you. And I have read on trauma in adolescence. I have read Ira Levin's book, The Boys from Brazil. My question for all of you is, who is starting to listen to your messages?

and who is still reluctant to listen to your messages? And by who, interpret that as you wish. I mean, presumably it would probably be a bias towards the UK, but that could be anywhere. Thank you. - Maybe we take a second one.

Hi, so my name is Anushka. I'm a student in the Master's in Management Program at LSE. I'm also building a mental health startup right now, but we're using AI and technology. So I'm very curious to learn

from all of you to think of what is the impact of such technologies because there's a large growing number of people who rely on AI as talking therapy. So is that something that is economically beneficial? What is your sort of thought on that? That's an excellent question. I think we stop here and who wants to answer, give an answer for the first one? Who listens and who doesn't?

I mean I think the civil service is very open to this in Britain. I think politicians, I think they're not so much resistant but they're not confronted with this. And I think my biggest disappointment, to be honest, is in the media. The media, because this is such a big idea, affecting everything,

They can't think of any way of handling this idea and it's been a big disappointment that the BBC or the FT and other outlets have not started the debate on what would be different if you adopted this as a criteria.

Pick up on the media, I'm just thinking, so there was that terrible school shooting in Austria last week or in the last couple of weeks.

and the immediate coverage on the BBC website at least was the police are not aware that the alleged perpetrator had been in contact with mental health services. So the perception that people will get from the general media, BBC is a pretty responsible reporter generally speaking,

they always see the negative side of things and the very extreme negative side of things and there's always an assumption that something terrible happens it might be to do with mental illness so I think there is a challenge with the media, I absolutely agree with that. There was a case about 30 years ago, there was a heavyweight boxer in the UK, Frank Bruno, who was a very popular character in boxing and in media

He had a psychotic breakdown and was taken into hospital under compulsory treatment. The Sun newspaper next day on the front page had Bonkers Bruno locked up.

and for many mental health charities that was the last straw and they got all the newspaper editors and other editors together and gave them a day of education about mental illness and that did change things for a while but I still worry that the media and of course we can't control social media now is so horribly negative and sees the negative sides rather than the positive sides about prevention and possible treatment so getting the media to listen would be really helpful.

I think from the child and adolescent perspective, I think this government is starting to listen on what's needed around measurement of child and adolescent wellbeing. But it's taken a sort of Herculean effort from sort of private funders, say things like the Be Well Study, which is partially privately funded and partially, I think, funded by National Lottery, actually.

So, yeah, I think measurements like Be Well, which, for those of you who don't know, is a child and adolescent well-being measurement out of Greater Manchester, and they're doing incredible work in trying to get that rolled out nationally. And I think the government is starting to listen to that, so I think the tide is changing in terms of child and adolescent well-being.

What about the role of technology and apps in measuring well-being, mental health? So treatment, but there's also social media, right? Isn't that an additional application? Well, I think we have the next edition of the World Happiness Report will be on the impact of social media on well-being. We put out a call for papers, and

We thought that the people who are sceptical about this might put in, but there seem to be so few people sceptical about it any longer. I mean, if you look at the wellbeing trends worldwide, there's been this extraordinary fall in the wellbeing of people between about 15 and 25. Otherwise, wellbeing has been fairly flat in most countries in recent years.

And, I mean, if you think, well, what's particularly specific to that group? I mean, this is something. There have also been lots of experiments, you know, getting people not to use Facebook and they become happier and so on. So I think it's pretty convincing. Jonathan Haidt's book is good and he's also writing an article. If you put it in your diaries, March the 20th next year, you'll get the answer to your question.

I'd like to take more questions. One more, this lady over there. Yeah. So it's kind of a build on the first question, that there are consequences of reporting a mental health issue in the biases that you encounter at a societal level, in employment, in insurance, and in relationships.

and this is prevalent not only in the more obvious ones but also when you're measuring there are people who are high performing but have mental health issues underlying and they put more pressure on themselves because they are almost forced because of the biases to hide those illnesses. What do you think beyond policy and media that you have already spoken on?

needs to be done and how can policy influence employers and insurances and society at large? What was your question? The question is, you know, people have too much stress in the workplace and leading to mental health issues and that sort of like perpetuates stress and so what can we do to break the circle?

I think there is an intrinsic challenge I think, so take a workplace like a university, that you would hope a university will be good, an LSE is good at trying to provide support for people in terms of their mental health needs. But if you're relatively early in your career you might be a bit reluctant to talk about that because it might then put a brake on your development and people say well

she's struggling a bit with her mental health, I won't put more pressure on her by giving her those responsibilities and without those responsibilities she doesn't get the opportunity to develop. Whereas somebody old like me, I can talk about whatever experiences I'm having and it won't have any effect on my career.

So we've got to find a way of breaking that down. There isn't a simple way of doing that, but I think many employers are much better at providing opportunities for people confidentially to contact the central administration and get some support. So the more we can do that, the better. But we still have this societal attitude, which is not all negative. I mean, it is correct. You don't want to put more stress on somebody who's already experiencing horrible problems with their mental health.

On the other hand, we don't want to be disadvantaging them in terms of their career development. So I don't have a simple solution, but I think we just have to increase our overall awareness about what mental illness is and what we can do to support people without labelling them as unable to take on those additional responsibilities and stresses. A question online maybe? Yeah, if you've got the microphone. How many do you want? I can give you three. Give us...

I've done my best anyway. These are probably interrelated questions here. Valentina Lemmy asks, what challenges are there in using well-being and GDP as key metrics for government planning? And possibly hinting at a

one of the answers there, Anne Watt asks, can we ensure that political cycles don't prevent well-being initiatives from being fully realized? - Whether political cycles can prevent well-being initiatives from being realized. - So, there we go. The question is, in some sense, about growth versus well-being as the objective. And I think that,

there is a huge body of support for looking at well-being. So Britain was the first country to use well-being, not to displace GDP, but in parallel. So well-being numbers are published with the GDP numbers each quarter, though they don't get the same reporting yet, a question to do with media.

The OCD followed this. The questions that we devised for Britain are now being used throughout the OCD. There's now a UN Commission on measurement of well-being worldwide, which hopefully will come up with the right kind of proposals for the next General Assembly meeting.

things are moving in the right direction but a comment on this growth thing I mean growth

Of course it's helpful for wellbeing, it's one of the things which can be helpful for wellbeing in two ways. One, some of it goes to ourselves and that's one of the things I showed you, not the only thing at all that helps to reduce wellbeing. But of course some of the money from growth goes back into services and that enables us

to produce services, though there are various fallacies about the extent to which that makes a difference. I don't think I've got time to go into those fallacies, but there's an overestimate often of the benefit of productivity growth in the private sector for our ability to deliver services, because we'll have to pay people more in the public services as well.

Growth has to be seen as a means to an end and we cannot have growth as the end. I don't think even when Keir Starmer says that's our top priority, he thinks it's the end. He doesn't. I could have given you a quote from him where he said, well, it's the end. He's basically in the right place and I think probably both ministers are in the right place, but they're in this fiscal...

and they think that growth will get them out of it probably a bit more than it probably will. I was just going to go to this kind of political cycles question, and I think, yeah, political cycles, and also in the work that I do, obviously we're dealing with the DfE, and you've got education ministers changing every other week, so we have issues with that. And I think one of the answers is to either go above

that with global data kind of how I was discussing in the presentation or kind of go at the school level and try and collect data with young people and try and do as much as we can through governments but yes the constant cycles do cause an issue. I've been at dinner with an education secretary really interested in pushing well-being forward and really interested in his schools and they were out a week later and it's like and we start again and that's it so yeah that would be my

But there's actually another point about the political cycle, that politicians ought to know the following fact, that what determines whether they get re-elected, more than anything, is the life satisfaction of the people. It's the best predictor, just in answer to one question.

They think that it's the economy, and Clinton said it's the economy, stupid, but actually it's wellbeing. So politicians ought to learn that this is the way to get re-elected, to promote wellbeing.

Can you find the words? OK. I think we're just right on time. And well, thank you so much to our speakers for this very interesting discussion. And we hope you enjoyed it. Do take a look at the program. We still have very interesting events of the LSE Festival today and all day tomorrow. And yeah, please join me in thanking these speakers.

Thank you for listening. You can subscribe to the LSE Events podcast on your favourite podcast app and help other listeners discover us by leaving a review. Visit lse.ac.uk forward slash events to find out what's on next. We hope you join us at another LSE Events soon.