SPHR research published in BMC Public Health has explored the reasons why co-locating services improves mental health and reduces health inequalities. Researchers call for policymakers to develop and expand community-based co-located services.
A wide range of factors affect our mental health – as such public mental health interventions take on a variety of forms – from knowledge and skills training and social and peer support groups to financial and legal advice services. Over the last decade in England the provision of public sector services has become more fragmented, with increased demand and reduced budgets straining services. These changes have particularly affected deprived areas – exacerbating health inequalities. In response to this, an increased number of voluntary and charity organisations are taking on service provision that was previously public sector.
‘Co-location’ refers to the delivery of distinct services in the same physical space. In the UK, there has been an expansion of service co-location as a potential solution to improve the coordination of care for individuals. Despite this expansion, there is limited evidence about how co-location in community settings may facilitate improved public mental health outcomes and reduce health inequalities.
In this study, researchers carried out an evidence review across six sites in England. In-depth interviews were conducted with service users, providers and other key stakeholders such as funders, policymakers and members of the public.
Five overarching co-location theories were identified and supported.
Improved provision of holistic and person-centred support
It was found that co-location facilitates regular and informal interactions between services enabling them to learn from each other, design coordinated services and achieve more effective signposting. Community organisations also tended to be smaller and less bureaucratic and hierarchical than more formal, statutory sector services, enabling a more flexible and tailored approach.
“Being a small organisation, there is a lot of freedom because you don’t have a big bureaucracy bearing down on you. …I think in the community sector, people have got more experience of being able to adapt very quickly…, we’re not sitting around waiting for the latest guidance to come out, we just go out often and do something.” [Service provider]
Reduced stigma by creating non-judgemental environments
There were significant levels of mistrust and fear towards statutory providers. Co-locating services in community settings helps dispel fear and address stigma in seeking support. Being distinct from formal services, they provide a ‘softer’ access point for people to seek support.
“I think it is just a lovely, safe place for everybody. You know that you can walk through the door and there’s no judgement. If you want to sit and not have a conversation, it’s absolutely fine. When you do your classes and drop-ins there’s no pressure”. [User of Service]
Delivering services in psychologically safe environments by creating a culture of empathy, friendliness and trust
Co-locating services facilitates a positive, friendly and relaxed environment. People reported that statutory services were cold and clinical, whereas the décor in community spaces was more informal, colourful and personal.
“You want it to have a warm feel to it, colourful things on the walls and things to look at. Something to be a bit uplifting about the place, not just a cold miserable building because I think if I walked into somewhere like that I’d probably walk back out again.” [Service Provider]
“Even though people are struggling, it’s just so calm. It’s brightly coloured…you would walk in and there’s fairy lights up and things…. they’re really trying to make it look like a happy place.” [User of Service]
Overcoming barriers to accessibility
Accessing co-located services was less costly and more time efficient.
“When you have to travel between places it can be frustrating, can be difficult. Financially, it’s not feasible because going back and forth and then waiting, you just don’t have time. And then you just feel like, if you get there and it’s not as beneficial as you want it, you feel deflated. You don’t want to bother using the service again…Whereas here, I had to come here for more than one reason.” [User of Service]
“[co-location] stops all the leg work. I’m 58 now, and I can’t manage the walking around to different places, so when you come to one place and you can get it all done at one time, in the morning, or in the afternoon, it makes it a lot easier…” [User of Service]
Enhance sustainability of services through better pooling of resources
Pooling resources, such as office and venue space, mean services are better able to share financial risk and spend more time focusing on delivering services. Co-location also increased reputation and impact from the perspective of funders and community members, increasing the chance of receiving funding.
“I think having the umbrella organisation, instead of having 12 different charities all competing for the same money, all competing for the same volunteers, all competing for the same board of trustee members, we’re all under that one umbrella.” [Service provider].
“My job would be a nightmare because I wouldn’t be able to do the things I do if I had to spend at least 50% of my time trying to find funding to keep us going. Independently, we could probably exist, but on a much, much, much reduced scale and be a lot less effective.” [Service provider]
Researcher on the study, Dr Fiona Duncan from Fuse, says:
“This was a fascinating piece of research to work on as we unravelled the puzzle of which often overlooked psychological processes and subtle changes in circumstances can make a difference to whether a service actually works or not.”
Challenges were found such as conflicts of interest between users of different services within the same space and service providers having different goals and values. This issue led to some people being discouraged from using a service as well as straining the relationships between the staff and volunteers of each service.
While there is no single model of community co-location, different approaches can positively impact mental health. Researchers recommend that policymakers and commissioners should develop and expand community based co-located services, recognising their value and removing barriers.