Future Generations Commissioner for Wales Sophie Howe provides advice to the Government and other public bodies in Wales on delivering social, economic, environmental and cultural wellbeing for current and future generations, and assessing and reporting on how they are delivering. Here the Commissioner talks to Matt Pearce about the future of mental health services for young people in Wales – and a need for a shift towards prevention…


What do you think are the key ways that mental health services and support for young people in Wales can be improved in future?

Mental health is a pressing concern for future generations and in the production of our Future Generations Report, mental health, and concerns about the impact of mental illness, was the issue most raised.

The challenges many people face have become suddenly starker with the pressures of Covid-19 and the scale and impact of poor mental health need tackling as a matter of urgency. One in four adults in Wales are likely to experience a mental health problem each year. The growing prevalence of mental health problems is putting an unsustainable strain on the NHS as well as other public and voluntary sector services.

Tackling mental health is a priority for Welsh Government and other public bodies, but there needs to be more join-up or consideration of the wider determinants of health to enable a whole system preventative approach.


You have often spoken about the importance of prevention within healthcare. How could this work with regard to young people’s mental health? For example, would it require a ‘whole government’ approach? And what might the benefits be?

There is compelling evidence that we’re not investing in the best balance of services to keep people well and to enable them to live healthy and fulfilled lives. Future generations are facing different problems from when the NHS was designed 70 years ago, such as air pollution, extreme weather, a growing obesity problem, disconnect with nature, feelings of loneliness and isolation and declining mental health. The issues that we face today cannot just be treated in a healthcare or clinical setting and for too long, we’ve been focusing on treating people when they’re ill, rather than keeping them well.

I’ve proposed a shift to prevention and a national wellness system that would ensure services would support people to understand behaviours and choices that benefit future health, enabling people to live the highest quality of life they can, easing strain on the NHS. I want to see a whole government approach to keeping people mentally well, where the importance of good mental health is fully recognised and prioritised in people’s everyday lives, so it’s part of how we design transport, housing and public spaces.

There needs to be consideration of alternative ways of keeping people well and wider determinants of health such as access to nature, air quality, housing, food, the negative knock-on effects to mental health from housing provision or lack of employment opportunities. It’s a more proactive approach to staying well and prevention.


Patients and carers are concerned that funding for mental health should not be diverted away from those in greatest need (e.g. towards supporting the responsibilities of general services to protect the mental wellbeing of their clients). What do you think the mental health funding priorities should be?

Good health is one of the main building blocks of wellness and opportunity. Enabling people to have the highest quality of life they can includes supporting them to have a lifestyle that maintains good physical and mental health. One of the elements of prevention is progressive universalism, which is a determination to provide support for all, giving everyone and everything a voice and vested interest, but recognising more support will be required by those people or areas with greater needs.

We know that 50% of people with enduring mental health problems present symptoms before the age of 14, so how can public bodies intervene earlier and what changes are needed so that our children and adolescent services can prevent further problems during adulthood?

Practices that support good mental health must be understood from an early age. We also need to scale up the role of digital technology and broader service and community interventions towards identifying opportunities to promote mental wellbeing and encourage a whole system approach and clear leadership with pace.


Find out more about the commissioner’s work for future generations @

Matt Pearce, Hafal