“We Want People To Have A Better Life, A Happier Life, So .
“We want people to havea better life, a happierlife, so there’s more, notjust years in your life,but life in your years.”Director of Public HealthBuilding resilient communitiesMaking every contact countfor public mental healthAugust 2013for better mental health
2 - Building resilient communitiesThis report is one of a series produced on behalf of the Mental HealthStrategic Partnership with funding from the Department of Health.The Mental Health Strategic Partnership comprises:for better mental healthFor the additional resources accompanying this report,please see www.mind.org.uk/publicmentalhealthContents1. Executive summary. 32. Summary of recommendations. 53. Introduction. 84. Methodology. 95. Scope.106. Mental health as part of public health.137. What makes resilient people?. 208. What makes resilient communities?. 379. Making it happen. 4310. Conclusion. 47Appendix A. 48References. 49
Building resilient communities - 31. Executive summaryMental health should be a key part of everypublic health strategy. There is a strong moraland economic case for tackling the rising challengeof mental health problems for communities and thepeople who experience them. There are also clear,evidence-based and cost-effective steps that canbe taken to build resilience, promote wellbeing andhelp to prevent mental health problems.This report focuses on resilience; setting outthe types of services, resources and infrastructurethat need to be in place locally to support resilientcommunities, helping people to ‘feel good andfunction well’. It will be of interest to those whocommission (or aim to influence the commissioningof) local services, those who provide services thatimpact on the wellbeing and resilience of their localcommunity and those who use these services.Resilience should be central to any public mentalhealth strategy but is only one element; it is essentialthat structural inequalities, like income or access toaffordable housing, are also tackled. Evidence forthis report was gathered through interviews, focusgroups and a selected literature review.1.1 What makes resilient people?Resilience is the capacity of people to confrontand cope with life’s challenges; to maintain theirwellbeing in the face of adversity. From theliterature in this area and the personal experiencesof our focus groups and interviewees we identifiedthree key factors that affect resilience:person’s individual responsibility, but can beinfluenced by ‘upstream’ interventions; shapingexisting services or providing new services insuch a way that they encourage behaviours thatpromote the five ways to wellbeing.This report sets out the evidence for each of thefive ways to wellbeing, as well as examples ofupstream interventions that can support people totake part in these activities locally. The five waysto wellbeing are: connect, be active, take notice,keep learning, and give.Building social capitalRelationships are a key component of socialcapital and there is strong evidence that theyare a major factor in promoting wellbeing andpreventing mental health problems. Buildingsocial connections is also an area where localauthorities, community groups and serviceproviders can make a significant impact. Effectivestrategies to promote social connections include: targeted interventions to build socialrelationships amongst isolated groups changes to the way existing (non-wellbeingfocused) services and support are run tofacilitate social connections interventions that encourage social connectionsbetween people with similar experiences toprovide peer support Activities that promote wellbeingDeveloping psychological coping skills Building social capitalThere is a growing evidence base around the useof psychological treatments (including cognitivebehavioural therapy) and psychological educationfor the prevention of mental health problems.This is particularly important for people duringperiods of stress or change, such as following adiagnosis of a long-term condition, after birth orfollowing a move into a residential home. Simple,cost-effective interventions have been shown tosignificantly reduce the likelihood of developingdepression and reduce stress and anxiety. Developing psychological coping strategies.Promoting wellbeingWellbeing is made up of two key elements;‘feeling good’ and ‘functioning well’1. The NewEconomics Foundation’s (NEF) report Five Waysto Wellbeing sets out five actions that promotewellbeing2. Importantly, these are not just a
4 - Building resilient communities1.2 What makes resilient communities?1.3 Making it happenAs well as providing the right services, facilitiesand resources that help to build resilience,local communities must have the capacity andinfrastructure to support people to access them.It takes more than a dedicated Director of PublicHealth to implement an effective strategy to buildresilience, it takes a whole community.Mental health awareness Every member of frontline staff, every councillor,faith leader, volunteer or manager can play arole supporting the wellbeing of the people thatthey work with. However, too many have hadno mental health training at all and told us thatthey aren’t sure how to make a difference. Mental health awareness training can supportstaff to ensure that every contact with theirlocal community counts in terms of improvingwellbeing and signposting people to support. This report is accompanied by a trainingpresentation and booklet on this topic.InformationLeadership Strong leadership from public health teamsand senior staff in local authorities is essential.Councillors can also act as powerful advocatesfor public mental health in their local area.Joint working Building strong regional and local networks andworking jointly with other teams is important toovercoming some of the barriers to commissioningand providing effective public mental healthservices. Health and Wellbeing boards have animportant role to play, opening up new waysof working, enabling more joint funding andencouraging a wellbeing focus across all localauthority policies and departments. Without comprehensive, accessible and wellpromoted information people are often unableto access support and professionals struggleto signpost people on to different services. Agood information service is essential to making‘every contact count’ in promoting wellbeing andresilience.Local networks A closely integrated network of serviceproviders, including voluntary, statutory andprivate sector organisations, will enable peopleto be referred easily between services, allowfor the sharing of intelligence and best practiceand help to prevent duplication of provision.Accessibility Mental health, communication or mobility issues,as well as stigma, discrimination and a lack ofconfidence can both increase people’s needfor wellbeing support and present additionalbarriers to accessing it. It is important towork with local communities when developingservices, facilities and resources to ensure thatthey are open and accessible to everyone.Involvement Involving local people in the co-production ofservices not only provides an opportunity forpeople to take part in the five ways to wellbeing,but will result in better services that are moreappropriate for and appealing to the localpopulation, as well as being more effective.Mental health impact assessment Understanding the relationship between factorslike social connectedness, physical activity,volunteering and mental health will help togain a fuller appreciation of the impact thatcommissioning, or cutting, any service may havelocally and who may benefit from accessing it.Wherever possible, wellbeing outcomes shouldbe measured and evaluated robustly.
Building resilient communities - 51.4 ConclusionThere is clear evidence and a convincingeconomic case for investment in public mentalhealth. We know what makes a difference, andwe now know what a successful public mentalhealth strategy looks like. Every local areashould be supporting its community to take partin activities that promote wellbeing, build socialconnections and improve psychological copingskills – building community resilience and ‘futureproofing’ wellbeing. In particular, a targetedapproach is needed to support people living in themost difficult life circumstances.To be successful, public mental health strategiesmust touch a whole community and involve thewhole community in both their development anddelivery. If we are going to build communityresilience in such challenging times, it is essentialthat we make every contact count for wellbeing.For the additional resources accompanyingthis report, please seewww.mind.org.uk/publicmentalhealth2. Summary of recommendations2.1 Local authorities and publichealth teams Ensure good provision of local facilities,resources and services to support people totake part in activities involving each of the fiveways to wellbeing. Ensure that an effective strategy is in placeto support the wellbeing of local authorityemployees. Consider how existing local authority servicescan be reconfigured to support people totake part in activities involving the five waysto wellbeing, in particular building socialconnections. Provide targeted support to build socialconnections for isolated people, for examplethrough befriending services. Provide specific groups or facilities to buildsocial connections between people experiencingsimilar challenging life circumstances. Provide training on mental health, wellbeingand resilience to all frontline staff as well ascommunity groups, faith groups and serviceproviders. Where appropriate provide forthis training to be delivered by other localorganisations. Ensure that frontline staff across the communityunderstand the importance of making ‘everycontact count’ for wellbeing. Provide a comprehensive information toolcovering all wellbeing and resilience activities,resources and services, accessible to peoplewith visual impairments and other disabilities,as well as people without access to the internet. Actively promote this information resource togroups most likely to benefit and to frontlineprofessionals who can signpost people tofurther support. Work with the local community to understandand overcome barriers to accessing wellbeingand resilience services. In collaboration with your local community,assess the accessibility of all services, facilitiesand resources in your area and make anynecessary adjustments. Where possible, co-produce services with thelocal community to ensure that they are asaccessible as possible. Support local providers to evaluate thewellbeing impacts of their services using theMental Wellbeing Impact Assessment Tool.
6 - Building resilient communities Consider wellbeing as part of impactassessment of any new service or proposedservice cut. Provide access to interventions that buildpsychological coping skills, particularly forthose at increased risk of poor wellbeing.activities involving each of the five ways towellbeing, particularly facilitating building socialconnections between people. If possible, robustly evaluate the wellbeingimpact of your service. Otherwise ensurethat you have a clear understanding of therelationship between the service and thewellbeing of the people who access it.2.2 Health and Wellbeing Boards2.4 Clinical Commissioning Groups Ensure that Health and Wellbeing Strategiesprioritise building resilience and preventingmental health problems, including throughprovision of services that support people to takepart in activities involving each of the five waysto wellbeing. Gather effective public mental healthintelligence through a local Joint StrategicNeed Assessment (JSNA), as set out in theJoint Commissioning Panel for Mental Healthguidance. Ensure that isolation and social connectednessare considered in local Joint Strategic NeedsAssessments and Health and WellbeingStrategies.Sign up to the Local Authority Mental HealthChallenge run by national mental health charitiesand appoint an elected member as ‘mentalhealth champion’ across the council, to provideleadership and ensure public mental health isprioritised: www.mentalhealthchallenge.org.uk As Lead Member for health or adult services,prioritise mental health in your portfolio andacross all areas of the council’s work. Ensure all elected members are provided withmental health awareness training to supportyour strategic role in promoting public mentalhealth and your community role in engagingwith people who may be at risk of or havemental health problems. As members of the Overview and Scrutinycommittee or the Health Scrutiny panel, ensureyou include mental health and wellbeing inyour work to scrutinise how well the councilpromotes wellbeing, builds individual andcommunity resilience and prevents mentalhealth problems. Ensure the budget affords appropriate priorityto public mental health by investing in evidencebased interventions and that all fundingdecisions are assessed for their impacts onindividual and community wellbeing. Facilitate joint working between public healthteams and clinical commissioning groups toallow for the joint provision of preventativepsychological therapies. Ensure that Health and Wellbeing Strategiesincorporate making ‘every contact count’ forwellbeing. Facilitate connections between local voluntary,statutory and commercial service providers. Prioritise facilitating joint working around publicmental health. Ensure that the local community, voluntarysector and providers are represented on Healthand Wellbeing boards.2.3 Local community groups andservice providers Review how services are provided to ensurethat they support people to take part inProvide access to interventions that buildpsychological coping skills, particularly forthose at increased risk of poor wellbeing.2.5 Councillors
Building resilient communities - 7“To me, [resilience]is about the abilityto bounce back fromthe problems and thehassles that we all havein life and your ability tocope with it and not getoverwhelmed.”Focus group participant
8 - Building resilient communities3. IntroductionThe case for taking action to prevent heartdisease, cancer and many other physical healthconditions has long been accepted. However,there is also strong evidence for practical stepsthat we can take to reduce the prevalence ofmental health problems and promote wellbeing.Mental health problems make up 23 per cent ofthe total ‘burden of disease’ in the UK comparedto 16 per cent for cancer and 16 per cent forheart disease3. It costs the economy an estimated 51.6 billion every year4 and yet the most recentestimate showed that, before the responsibility forpublic health was transferred to local authoritiesin April 2013, only 0.03 per cent of the annualNHS mental health budget had been spent onthe promotion of good mental health and theprevention of mental health problems5.how we can build resilience within people andcommunities to deal with this.A failure to address mental wellbeing andresilience will be an important opportunity missedto improve the lives of local communities andwill undermine other work to address healthinequalities and improve physical health.Through this report, Mind and the Mental HealthFoundation have worked together to set out thetypes of services, resources and infrastructurethat need to be in place locally to support healthyand resilient communities, reducing the prevalenceof mental health problems and making significantsavings both to the local and national economy.There is clear evidence that broad social andeconomic inequalities have a profound impacton health inequalities. In England, people livingin the poorest neighbourhoods will, on average,die seven years earlier than people in the richestneighbourhoods and will spend more of theirshorter lives living with a disability, including mentalhealth problems6. There is a clear link betweensocial and economic inequalities and mental healthproblems7; people living on the lowest fifth ofhousehold incomes are twice as likely to developcommon mental health problems as those onthe highest incomes8. This was described by theDepartment of Health as a ‘shameful inequality’9.Addressing these broad, structural inequalities,including issues like tackling abuse and violence,access to affordable housing, secure andmeaningful employment and a reasonable incomeare all essential to reducing the prevalenceof mental health problems10. However, whilstthere are significant inequalities that we can,and should, be challenging, people will alwaysexperience adversity and difficult circumstances.It is essential, therefore, that we also considerTo be successful local partnerships haveto address the root causes of poor healthand languishing but recognition of theinterconnectedness of feeling good andfunctioning well may enable policy makers,commissioners, providers, communities andindividuals to work together to mitigate theworst effects and to build resilience for thefuture.Smith and Corlett, The Lambeth Wellbeingand Happiness Programme11.The report looks at how we can support people inEngland to ‘feel good and function well’, buildingresilience to cope with difficult circumstances,which is an essential component of any successfulpublic mental health strategy. However, it is justone component, and must also be accompaniedby targeted action to address structuralinequalities that are some of the greatestdeterminants of health outcomes.People living with mental health problems areone of the groups most likely to experiencelow levels of wellbeing. Many of the servicesand resources set out in this report that havea key preventative role will also be beneficialfor recovery, resilience building and wellbeingpromotion for people living with existing mentalhealth problems. While this is not the primaryfocus of this report, public health teams do havea role in working with other health professionalsto ensure that mental health services (includingwellbeing and resilience services) are effectiveand accessible for everyone who needs them.
Building resilient communities - 94. MethodologyThis report brings together the experiences ofpeople who commission, deliver and use servicesand resources which influence wellbeing at a locallevel throughout England. We conducted: Five focus groups, three with people accessingwellbeing and resilience services and two withpeople with
4 - Building resilient communities Building resilient communities - 5 1.2 What makes resilient communities? As well as providing the right services, facilities and resources that help to build resilience, local communities must have the capacity and infrastructure
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