In this blog Dr Fiona Duncan, Postdoctoral Research Associate in Fuse (Durham University) talks about her work researching community interventions aimed at improving public mental health in adults.
Imagine, the year is 2030 and you are on the phone to your local authority. However, you’re not complaining that the bins have not been picked up, you’re not complaining that the street lights aren’t working or that your parking permit hasn’t arrived. You are complaining because you and several others in your community are feeling depressed, anxious, sad, or “just okay”. Over the phone, you assertively demand that if the council does not do something about this, you will not be voting for them in the next local elections as it is their responsibility to fix this!
In 2021 this scenario may feel inconceivable, but it is not as “out there” an idea as it may first seem. Mental health and wellbeing are often considered to be the responsibility of the individual. If someone develops a mental health problem, then many people feel that it was their own fault and indeed, many current mental health services offer treatments that are focused on the individual’s thoughts, behaviours and previous experiences. However, potentially a shift in attitudes may be on the horizon. A new viewpoint is that the prevention of mental illness and the promotion of good mental health can be influenced and dealt with at a population level, with community leaders and the community as a whole taking on some of the responsibility for getting everyone feeling mentally better.
This new viewpoint is termed “Public Mental Health” and it focuses on not just preventing mental illness from happening in the first place but also on how our communities can improve our mental health and wellbeing: providing opportunities to experience happiness and joy and enabling people to be better than ‘just okay’.
Improving public mental health is an appealing notion, but what can actually be done to improve it? What can local authorities, third sector organisations and communities actually do to make us all feel better and prevent us from developing a mental illness?
We attempted to answer this question as part of a recent NIHR SPHR public mental health programme project which investigated what was already being delivered on the ground in local communities right now to improve public mental health. We got some fascinating results.
The study focused on five local authority areas of England. The areas were Hammersmith and Fulham; Camden and Islington; Blackburn with Darwen; Redcar and Cleveland and Cambridgeshire and Peterborough. We chose these local authorities because they offer a relatively broad mix in terms of deprivation statistics, ethnic minority populations, geographical location and urban and rural areas.
Our methodology for this study was relatively simple – a combination of google searching and visiting these local authority areas in person to speak to people face-to-face (data was collected before the pandemic). We asked a wide variety of people, for instance, people who worked at each local authority public health department, third sector organisations and/or community groups whether they were currently organising or delivering any interventions, services or projects which explicitly aimed to improve mental health and/or wellbeing or prevent mental illness. This included interventions that aimed to reduce stress, social isolation, increase happiness, increase self-esteem, and/or address low mood, as well as interventions that aimed to improve general wellbeing.
From the point of view of a researcher, I always find it very enjoyable doing this part of the project. I get out and about and get to meet a variety of people and listen to them talk about what they do. I had the opportunity to explore areas of the country that I had never been to before (Redcar and Cleveland, Blackburn with Darwen) and many of the people I spoke to were very passionate about the projects they were involved with and cared a lot about the wellbeing of the communities that they served.
Across all five local authority areas, we identified 407 different interventions that aimed to improve the mental health and wellbeing of the local population.
We were able to group these into 12 different types of intervention which aimed to address 16 different risk factors or protective factors.
The most common type of intervention was classified as social activities and/or befriending and these interventions generally aimed to prevent social isolation and loneliness. Examples of these interventions were:
- The Men’s Shed, a place where men can go to attempt some woodwork, but perhaps more importantly can, in their own time and without any pressure, talk about things that may be bothering them with other participants or members of staff.
- Social groups aimed specifically at carers so that they could get some respite from their caring responsibilities and meet with others in a similar position.
- A community café with a specifically assigned “chat and natter” table where anyone from the local community can come in and interact with others.
There were also many interventions available that aimed to alleviate financial stress, unemployment or job insecurity in members of the community by offering education and training workshops, signposting to appropriate help or by offering advice.
There were also several interventions that aimed to support people who were facing discrimination either due to being a member of an ethnic minority or being a member of the LGBTQ+ community. This support was offered in a number of ways including advocacy and legal advice, social activities, advice services and through the implementation of various policies and strategies, and by allocating funding and using relevant networks.
We also identified interventions that promoted physical activity, offered practical help to older adults or people with long-term conditions, improved food security, facilitated peer support and mentoring or used animals and/or green space to improve wellbeing.
It was reassuring to find that such a wide variety of interventions were available which attempted to meet the needs of the community. It was also interesting to see that improving the mental health and wellbeing of the whole community wasn’t just something that the third sector or informal community groups were trying to achieve, it was clear from our study that improving public mental health is something that these local authorities take seriously and they have funded and delivered many projects or interventions to try and address this.
Having said that, not all determinants of public mental health were being addressed across the local authority areas. For instance, we did not identify interventions aimed at structural and environmental determinants, such as air and water quality, population density, walkability of local environment and urban decay, economic recession, climate change, natural disasters, media and advertising, the welfare system and political structures.
The most likely explanation for this is that interventions aimed at structural and environmental determinants probably do not describe themselves as mental health and wellbeing interventions and consequently do not consider themselves as playing a role in public mental health. If this is true, then consideration should be given to expanding the scope and abilities of community-led responses as evidence suggests that community approaches play an important role in increasing people’s self-efficacy and confidence, helping them to develop a sense of control over their own lives, reducing health inequalities, improving health outcomes and increasing resident’s sense of wellbeing. Surely this is the type of community we would all like to be a part of in the future?
The next stage of the research is to delve more deeply into one or two types of intervention and examine in detail how they improve public mental health. There are two NIHR SPHR projects in progress which are undertaking an in-depth investigation into how co-locating different services in community settings such as churches, community centres, libraries, foodbanks or heritage sites can help to improve public mental health and reduce health inequalities in adults and in older adults.
The final paper was published in BMC Public Health in September 2021:
Duncan, F., Baskin, C., McGrath, M. et al. Community interventions for improving adult mental health: mapping local policy and practice in England. BMC Public Health 21, 1691 (2021). https://doi.org/10.1186/s12889-021-11741-5
Find out more about Fiona and her work on the public mental health programme here.