Can putting distinct services under one roof prevent mental illness? We (cold) called in the experts to find out

In today's Fuse blog post, Fiona Duncan, Postdoctoral Research Associate from Durham University, writes about co-locating services to improve mental health and the perils of pulling together an expert panel during a pandemic. 

'Cold Calling' by Darren Tennant

This past year has been tough for many of us.  Financial worries, feeling socially isolated and lonely, facing unemployment, and missing opportunities for physical activity are just some of the things that have impacted on mental health and wellbeing during the pandemic.  This means that finding ways to improve mental health and prevent mental illness in our communities is more important than ever.

Over the past few months, I have been working on a NIHR School for Public Health Research (SPHR) project which aims to investigate how “co-located” services based in the community can be used to promote wellbeing.  A co-located service is where two or more distinct services are in the same physical space and the staff of each service interact with each other, either formally or informally.  Co-located services are often found within traditional health services like GP practices when welfare, legal and/or mental health services are delivered in the same building.  The project will investigate the benefits and disadvantages of co-locating in community spaces, rather than within traditional health services.  For example, a debt service within a faith institution, a welfare service in a library, a mental health support service in a sports centre, or a money advice service within a foodbank.  We are interested in finding out exactly how co-location helps to improve mental health and whether they work for all people in all circumstances, or just some people in certain circumstances. For instance, does co-location increase access, reduce stigma, or encourage a higher quality of service by allowing professionals to work together better?

To start this research, I was given the task of setting up and facilitating an expert panel workshop. The idea being that if we want to gain a deep understanding of how co-located services may or may not work then we should ask the people who actually design, fund or deliver these services in the real world.  We hoped that this workshop would consist of service practitioners, policy-makers, and commissioners at local authorities and people who work for organisations that provide funding for community projects. 

My first challenge in setting up the workshop was getting people to take part.  Where was I going to find these experts and would they be able to give up two hours of their time in the middle of a pandemic?  I was planning on the workshop being small (5-8 people) but, in the circumstances, I realised that I was probably going to have to ask a lot of experts to even hit this target!

I used a variety of approaches to find my experts.  I asked members of the wider research team to email any suitable contacts, we approached the other NIHR Schools and we advertised the study on twitter.  I also personally contacted some people that had participated in a previous research project and my colleague, Dr Emily Oliver from Durham University, mentioned the workshop during a webinar at which she was presenting. Through these methods, three experts signed up.  To get a few more people, I then started to ‘cold call’ potentially suitable people and organisations, including almost 40 local authority Directors of Public Health in England.  Despite the pressures that this group of people are currently under due to COVID, this ‘cold calling’ led to three more people agreeing to attend.

Having six people confirmed still felt like a very precarious position to be in, and it turned out that I was right to be nervous, as one person unfortunately had to pull out on the morning of the workshop. However, luck was on my side as at the last minute another expert who had found out about the workshop from a colleague at one of the organisations I had contacted, asked if they could come along.  Panic over!

Selfridges

The nerves kicked in again at the start of the event, as I had never facilitated a Zoom workshop before and it was clear that some of our experts were feeling nervous too.  This could have been a problem as we wanted them to freely and openly talk about the benefits and disadvantages of co-located services.  Luckily, Gillian Samuel, a member of our research team from the McPin Foundation, was able to facilitate a brilliant icebreaker exercise.  She asked everyone to talk about something that we all had in common, specifically, what we are looking forward to most when lockdown ends?  Everyone had some great answers to this question (the re-opening of Selfridges was my personal favourite answer) and this made for a more relaxed atmosphere.

This almost certainly helped the workshop discussions flow as our experts provided rich and detailed information about co-located services.  However, in some ways the workshop did not go as I had expected.  I thought the experts would talk about the benefits of their co-located services and the mechanisms involved in how these services work. I had prepared a long list of questions to prompt such a conversation, but it soon became clear that the panel had a lot to say about how co-located services quite often don’t work.  They were all clearly very passionate about what they do but expressed frustrations surrounding service delivery.  One theme to emerge was that co-located services are dependent on different types of professional working together, but the reality is that they often don’t communicate well with each other at all.

Although I wasn’t expecting the panel to say these things, I’m glad they did.  It helps us to understand how co-located services are working, or not, and is very important if we want to improve services and therefore improve mental health and prevent mental illness in our communities. This information will also be very helpful in the next part of our study where we will be interviewing people who work at and use selected co-located services.

Fiona works on the NIHR School for Public Health Research (SPHR) Public mental health programme through Fuse's membership of the School.

Images:

1. 'Cold Calling' by Darren Tennant via Flickr.com, copyright © 2014 (Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)): https://www.flickr.com/photos/10678076@N03/16001016758

The mental health of the nation has never been so under threat

Posted by Fiona Duncan, Postdoctoral Research Associate, Durham University

Lockdowns and self-isolation, increasing care demands, concern for others, and ongoing uncertainty are exacerbated by a reinforcing 24-hour news and opinion cycle, playing havoc with our stress and anxiety levels and battering our overall sense of wellbeing. The coronavirus crisis.

However, for many people across the country, a feeling of their wellbeing being under attack is not new. Experiences of overwhelming debt, long-term unemployment, insecure housing, poverty, food insecurity, social isolation lasting months or years and/or discrimination are common and can collectively chronically diminish the mental health of the public as a whole.

These normal and extraordinary circumstances raise the question of how the mental health of an entire population can be supported, or in other words, how can we improve public mental health (PMH)? Over the past year, I have had the privilege of investigating this complex question in detail within Fuse.

My work has primarily involved mapping interventions currently being delivered to improve PMH, exploring models of good practice and searching for emerging innovative ideas. This focused on two areas – Blackburn with Darwen, and Redcar and Cleveland – which were selected on the basis of mental health statistics and varying characteristics (e.g. rurality, deprivation etc.).

I found this mapping exercise a great opportunity to get out and about and talk to people who organise and deliver projects to improve PMH on the ground in their local area. I spoke to a lot of very helpful people who were very passionate about the work they did and it was inspiring to hear about the variety of innovative projects that were being provided for people in these local authority areas to promote good mental health and prevent mental illness.

One of our main findings was that interventions to prevent social isolation and loneliness by providing various social activities were most common. This may reflect how recent campaigns surrounding reducing social isolation in older adults have influenced policy. Although a multitude of individual, family, community and structural factors influence PMH, not all of these were addressed. Does this suggest a wider variety of interventions are required in the future or would it be better to develop interventions which have the ability to target multiple factors at the same time? For instance, interventions which increase social networks within society, self-confidence or self-efficacy may enable people to deal with many different threats to their mental health without having to use a specific service.

An interesting finding of this mapping exercise was that a lot of these interventions either hadn’t been evaluated at all or only a very basic evaluation had been carried out so there was very little objective evidence regarding their effectiveness. This is something we hope to address in the next phase of the project by carrying out in-depth evaluations of promising interventions, including their potential to be delivered on a larger scale.

One final finding from this mapping that seems more relevant now than a month ago is that very few of the public mental health interventions could be delivered exclusively online. The implications of this are that the vast majority of the projects that we identified will most likely be suspended and many people who depended on this support will be left to cope alone. Moreover, people who are currently struggling with the isolation of lockdown have reduced options for help. Although Public Health England has published online guidance for the public on the mental health and wellbeing aspects of coronavirus there is an urgent need for supporting remote delivery or new online interventions within the next few weeks (of course, recognising that not everyone has access to these).

We also need to consider what we are all going to do when the COVID-19 situation is over. Will the country’s mental health bounce back to normal levels without any help, perhaps benefitting from the shared sense of community and new ways of living and working developed during the crisis? Or, will we need to work hard to develop and deliver services at the individual, family, community and structural levels to repair the damage that has been done to the mental health of the nation?


This work was part of WP4 of phase one of the NIHR SPHR Public Mental Health programme.  Information about the wider programme is on the SPHR website and was a collaboration of researchers based at Fuse, UCL, Imperial College London and Cambridge University.