Community interventions for improving adult mental health: mapping local policy and practice in England

Abstract

Background Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention. Method We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers’ insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020. Results 407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated. Conclusions There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.

Mental ill health experiences of female sex workers and their perceived risk factors: A systematic review of qualitative studies

“…One review has suggested that some community-based interventions result in a reduction in health inequalities; however, over one-third of studies found no changes between the intervention and control areas (Nickel and von dem Knesebeck, 2020). There is little further research as to whether community-based initiatives work longterm, so the exact effectiveness of this implementation cannot be weighed up (Duncan et al, 2021).…”

Policies on mental health in the workplace during the COVID-19 pandemic: A scoping review

“…During the context of the COVID-19 pandemic, different governments worldwide have deployed a variety of policies to reduce infections and deaths from the virus within the workplace [ 32 ]. However, the number of policies that have directly or indirectly aimed to improve workers’ mental health or address mental health needs in the workplace during the pandemic is still limited [ 25 , 30 , 31 , 33 ], and their actual impact on workers has yet to be assessed. Policies that have been implemented to indirectly improve mental health include, for example, increasing the number of resources for the mental health sector; reducing barriers to accessing mental health care during the pandemic context; and training lay staff in basic mental health care and self-care tools [ 30 , 31 ].…”

It takes a village: what lessons can the UK learn from rural community mental health services in Ghana?

“…Following the WHO definition of health, we define community interventions as "those that involve multi-sector partnerships, emphasise community members as integral to the intervention, and/or deliver services in community settings" (Castillo et al, 2019, p. 35). There are various types of community mental health interventions employed across the UK, but their implementation is quite fragmented and limited (Duncan et al, 2021). Moreover, they generally focus on individual risk factors (e.g.…”

“…, 2019, p. 35). There are various types of community mental health interventions employed across the UK, but their implementation is quite fragmented and limited (Duncan et al. , 2021).…”

“…loneliness, stigma) and protective factors (e.g. community safety) (Duncan et al. , 2021), rather than empowering the whole community to support people affected by mental illnesses.…”