Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health

Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health

Our place
Local authorities and the public’s mental health

                                                   Louis Allwood
Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
Centre for Mental Health REPORT Our place

                                                Foreword										 3
                                                Executive summary									 4
                                            1   Introduction								                                6
                                            2   Evidence for prevention								 7
                                            3   The role of local authorities								 9
                                            4   National policy and legislative context						11
                                            5   Key themes from case studies							13
                                            6   Prevention and promotion during the pandemic					   15
                                            7   Case studies										19
                                                Basildon Borough Council								19
                                                Birmingham City Council								21
                                                Bristol City Council									24
                                                Camden Council and Islington Council						27
                                                Leeds City Council									30
                                                Sandwell Metropolitan Borough Council						32
                                                St Albans City and District Council							35
                                                Surrey County Council								37
                                                Tameside and Glossop Strategic Commission					40
                                                References										44

Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
Centre for Mental Health REPORT Our place
I am delighted that the Local Government Association (LGA) has worked with Centre for Mental
Health to share just some of the innovative work that councils are leading to promote good mental
health and wellbeing.
Councils’ role in improving and maintaining people’s mental wellness across the life course – from
childhood to old age – has always been important, but it has been further highlighted by the
Covid-19 pandemic. We commissioned this research before the pandemic, and the learning that
we share feels even more relevant now. I’m grateful to colleagues who took the time to share their
valuable experiences.
The unprecedented restrictions on people’s lives that were introduced in March 2020 had a sudden
and profound impact on everyone. Many of us were unable to go to work or school, meet family and
friends, go to the shops or take part in leisure and culture activities. In other words, at a stroke the
very things that support our mental wellbeing and we often took for granted were taken away.
Councils worked hard with the NHS and other local partners, especially the voluntary and
community sector, to support the mental health and wellbeing of their residents. Actions across
the mental health spectrum included continuing to meet statutory responsibilities for adults and
children’s mental health, supporting the mental wellbeing of frontline staff, bereavement support,
suicide prevention, helping residents to stay connected, and supporting people who might need
additional help such as carers and new parents. As well as promoting mental wellbeing through, for
example, safe access to parks, open spaces and expanding public libraries’ online offer.
Whilst we cannot lose sight of the challenges, I have also been heartened by the positive changes
that we have seen. There is much greater awareness about the effect of personal behaviours on
mental wellbeing, such as sleep and exercise. The flourishing of community and neighbourhood
activity has provided vital support to people in vulnerable circumstances and for some resulted in
stronger social connections. We have found that some people prefer to access support and stay
connected digitally. Councils can help to embed and sustain these positive developments.
Of course, the pandemic and its effects are far from over. Mental health issues will be one of the
key legacy impacts and are central to local planning for the next phases and recovery. We know
that some people are more at risk than others of developing mental health issues and that mental
wellness is inevitably affected by other factors, including housing, money, relationships and jobs.
Councils are in the unique position of being able to harness all of the services and assets they are
responsible for, to reduce inequalities and effectively target interventions to meet local needs. Of
course, to maintain this vital preventative work it is essential that local government services, and
the voluntary and community sector, are properly funded now and in the future.
I hope you find the examples shared in this publication as inspiring and informative as I do.
Councillor Ian Hudspeth, Chair of LGA Community Wellbeing Board

Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
Centre for Mental Health REPORT Our place

                                            Executive summary
                                            Actions that promote positive mental wellbeing        •   St Albans City and District Council – A
                                            and prevent mental health problems help                   strategic approach in a district level
                                            us stay healthy, live productive, meaningful              authority
                                            lives and avoid serious and sometimes
                                                                                                  •   Surrey County Council – Developing a long
                                            lifelong distress. Local authorities play a
                                                                                                      term strategy at county level
                                            key role in improving the mental health of
                                            their communities, bringing together and              •   Tameside and Glossop Strategic
                                            supporting partners and citizens to address the           Commission – Living Well: integration and
                                            determinants of our mental health and reduce              neighbourhood support.
                                                                                                  Four common principles emerged during our
                                            This report presents learning from local areas        analysis:
                                            alongside an overview of the evidence for
                                            prevention and the national policy context. The       Public mental health as everybody’s business:
                                            councils involved seek to improve population          health and wellbeing of the local population is
                                            mental health, reduce inequalities and prevent        the responsibility of every part of the council
                                            mental ill health in their communities through        and the wider community.
                                            a combination of strategic and practical                  “A workforce for prevention”
                                            approaches. Nine case studies were examined:
                                                                                                  Collaboration: councils working together with
                                            •   Basildon Borough Council – Health in all          other parts of the system (such as the NHS) and
                                                policies                                          closely involving community groups and other
                                            •   Birmingham City Council – Prioritising            stakeholders.
                                                upstream mental health support                        “Get people together and have the
                                            •   Bristol City Council – Thrive Bristol: Thriving       conversation”
                                                at Work                                           Place-based approaches: using the concept of
                                            •   Camden and Islington Council – Addressing         ‘place’ to galvanise residents and organisations
                                                determinants of poor mental health using          to engage with the broader health and
                                                Making Every Contact Count (MECC) and             wellbeing agenda.
                                                Psychologically Informed Consultation and             “The best place to live for health and
                                                Training (PICT)                                       wellbeing”
                                            •   Leeds City Council – Mentally Healthy             Taking a holistic approach: using a wide range
                                                Leeds: a whole city approach                      of approaches and strategies to tackling the
                                            •   Sandwell Metropolitan Borough Council –           determinants of mental health.
                                                Stronger Sandwell: asset-based community              “Addressing multiple needs instead of
                                                development for better mental health                  channelling people down single condition

Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
A number of key enablers surfaced across            Mental health is interwoven with other agendas

                                                                                                       Centre for Mental Health REPORT Our place
different case studies:                             – housing, employment, social inclusion,
                                                    economic development, safety. Local authorities
•   Leadership – including senior officer and
                                                    are uniquely placed to connect all parts of the
    political support
                                                    system and to knit together their own policies
•   Relationship development – building             and strategies to work towards fewer health
    mutual trust with other agencies and taking     inequalities and better mental health for all.
    time to engage the local voluntary and
                                                    Most of the research for this report was carried
    community sector
                                                    out before the outbreak of Covid-19 in the
•   Community engagement – learning from            UK. The pandemic has seen a seismic shift in
    communities and engaging them in                resources to contain the virus and support those
    everything from strategy development to         who have become ill. At the time of writing,
    service delivery                                much of this work is still ongoing.

•   Harnessing external resources – making          We followed up with some of our participating
    use of national programmes, research and        councils to understand how the pandemic had
    funding, and sharing learning with other        affected progress on mental health prevention
    local areas.                                    and promotion. While Covid-19 has interrupted
                                                    all of our lives, we heard evidence that local
These case studies demonstrate promising            authorities have been able to sustain a focus on
practice and good ideas. Evidencing impact          mental health by using digital technology, by
for prevention is complex. It can be difficult      commissioning flexibly and by developing new
for initiatives which are in the early stages of    resources. More than that, existing approaches
implementation. However, local authorities are      to health promotion and the prevention of
well positioned to learn, to work arm in arm with   mental health problems have been important
communities, local providers and grassroots         enablers for quickly bringing together wider
organisations, and to adapt to new insights and     networks of stakeholders to learn how
respond to the needs of their residents in the      communities have been affected and to make
present.                                            mental health a key part of Covid-19 recovery

Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
Centre for Mental Health REPORT Our place

                                            We all have mental health. Like our physical        Other factors and circumstances can protect
                                            health, this can be anywhere on a spectrum          our mental health. Relationships, supportive
                                            from healthy to unwell. Success in prevention       families, secure childhood experiences, good
                                            and promotion means supporting people to stay       housing, economic and social opportunities,
                                            as close as they can be to the healthy end of the   education, and easy access to help can all boost
                                            spectrum. Efforts to promote positive mental        our resilience in the face of stress and hardship.
                                            health can aim to help people whether they are
                                                                                                Preventing mental health problems and
                                            healthy, coping, struggling or unwell – although
                                                                                                promoting positive mental wellbeing normally
                                            the greater a person’s mental health need, the
                                                                                                involves initiatives designed to address these
                                            more intensive support they will need to attain
                                                                                                various individual, interpersonal, or societal
                                            better mental health.
                                                                                                factors (McDowell et al., 2019). There is often
                                            There are several known risk-factors which          significant overlap between these initiatives
                                            make people more likely to experience               and those aiming to improve physical wellness
                                            mental health difficulties. These include           – the two are intertwined. As the range of risk
                                            unemployment, low income, racism and                factors is broad, so too is the range of agencies
                                            discrimination, traumatic experiences, violence     and organisations which can make a difference.
                                            or abuse, genetics, physical illness, and a lack
                                            of access to support.

                                                                               Mental health spectrum

                                             © Centre for Mental Health 2017                                          www.centreformentalhealth.org.uk

Centre for Mental Health REPORT Our place
Evidence for prevention
The established evidence base                           billion a year in sickness absence, reduced
                                                        productivity and staff turnover. A number of
The most recent estimate for the total cost to          interventions to help employees stay at work
society of mental health problems in the UK             and fulfil their productive potential have
was £119 billion per year. This figure includes         been shown to have potentially significant
the costs of health and social care for people          savings for businesses and the economy
with mental health problems, lost output in the         (Tan et al., 2014; Hamberg van Reenen et al,
economy, and reduced quality of life. Most of           2012)
these costs are not borne by the health system
(O’Shea & Bell, 2020). Preventative programmes      •   Suicide prevention – one initiative
bring about a range of benefits not limited             increasing the use of psychosocial
to health and wellbeing: these may include              assessment (i.e. considering the wider
improved community cohesion, management                 factors affecting wellbeing) for people
of physical health, reduced crime and                   who have self-harmed and present at
improved feelings of safety, better educational         hospitals was modelled to deliver a return
attainment, improved earnings or more secure            of investment of £2.93 for every pound
employment.                                             spent in health, local authority and police
                                                        costs over a ten-year period, rising to
Various studies summarise a range of                    £39.11 when increased productivity and
preventative interventions and their estimated          other wider, long-term costs are considered
costs and benefits (Australian Government               (McDaid et al., 2017)
National Mental Health Commission, 2019;
McDaid et al., 2017). While there is a growing      •   Tackling social isolation and loneliness
body of research on preventing mental illness,          amongst older adults through non-medical
some areas are more advanced than others in             interventions – a randomized control trial
evidencing impact. Approaches considered by             of a community choir group showed a
health economists to have a good evidence base          significant improvement in mental health
include:                                                scores over six months and a 60% chance of
                                                        being cost-effective (Coulton et al., 2015).
•   Supporting maternal and infant mental
    health – economic evaluations demonstrate       Only a relatively small number of preventative
    the cost effectiveness of preventing or         approaches benefit from being so well
    intervening early on perinatal depression       researched. Given the many determinants
    through improving access to psychological       of mental health and the broad range of
    therapies or increasing health visitor          opportunities to support communities and
    support for mental health and wellbeing         individuals with mental wellbeing, there are
    (Gurung et al., 2018)                           many more possible approaches and innovative
                                                    interventions that have yet to be robustly tested.
•   Improving children and young people’s           For example, our understanding of impact and
    mental health – evidence-based parenting        economic evaluation evidence is still emerging
    programmes, for example, are estimated to       in many key areas: school-based antibullying
    generate savings in public expenditure of       programmes; mindfulness; improving
    nearly £3 for every pound spent over seven      employment, education, and training outcomes
    years, with the value of savings increasing     for young people at risk of poverty or social
    significantly longer term (Khan et al., 2015)   exclusion; housing, urban planning, and access
•   Improving mental wellbeing and preventing       to nature; and addressing the psychological
    mental illness in the workplace – mental        impact of job loss and job insecurity (McDaid et
    health problems cost UK employers £35           al., 2019).

Centre for Mental Health REPORT Our place

                                            Inequalities                                        Economic evidence demonstrates that
                                                                                                straitened public finances tends to lead to
                                            All of us have multiple layers of identity and      higher cost services being favoured. The
                                            belong to communities of geography, gender,         rationing of lower cost services which take place
                                            ethnicity, social class and many more. The          further ‘upstream’ (i.e. through waiting times or
                                            determinants of mental health interact with         the imposition of thresholds) mean people do
                                            these inequalities in ways that put some people     not get help until they reach crisis point. This
                                            at a far higher risk of poor mental health than     is more likely to involve the police, ambulance
                                            others:                                             services, and worse outcomes which can affect
                                            •   Children from the poorest 20% of                individuals longer term (O’Shea, 2019).
                                                households are four times as likely to have     With a limited evidence base, it can be difficult
                                                serious mental health difficulties by the age   to make the case to invest in preventive
                                                of 11 as those from the wealthiest 20%          programmes. And often such programmes are
                                            •   70% of children with autism and 80% of          required to innovate while also demonstrating
                                                adults with autism have at least one mental     short-term and directly attributable returns on
                                                health condition                                investment. While enabling positive mental
                                                                                                health is linked to tackling a range of social
                                            •   Children and young people with a learning       determinants including deprivation and
                                                disability are three times more likely than     discrimination, it can be difficult to draw direct
                                                average to have a mental health problem         associations between the activities carried out
                                            •   Men and women from African-Caribbean            and the outcomes they ultimately help people
                                                communities in the UK have higher rates of      achieve. Robust and independent evaluation
                                                post-traumatic stress disorder and suicide      can be expensive and monitoring the impact
                                                risk and are more likely to be diagnosed        of prevention requires time for new initiatives
                                                with schizophrenia                              to be embedded in communities and for their
                                                                                                effects to become visible – this can be several
                                            •   Women are ten times as likely as men to         years. Population level outcomes are also not
                                                have experienced extensive physical and         immune to confounding factors. In the context
                                                sexual abuse during their lives: of those       of Covid-19, this includes major economic
                                                who have, 36% have attempted suicide,           uncertainties and the legacy of months of social
                                                22% have self-harmed and 21% have been          distancing and isolation for many.
                                                made homeless.
                                                                                                Most of the local authorities featured in this
                                            (Summary of multiple sources from the               publication are on the journey of embedding
                                            Commission for Equality in Mental Health, 2020)     their approaches and finding ways to track or
                                                                                                measure the difference they make. Most have
                                            It is increasingly evident that preventing
                                                                                                in place some monitoring of outputs, activities
                                            mental ill health cannot be achieved
                                                                                                and engagements. Some are still in the process
                                            successfully without addressing these stark and
                                                                                                of talking to communities about the changes
                                            longstanding inequalities. Taking a ‘universal’
                                                                                                they want to make. Others have worked with
                                            approach to promoting mental health may even
                                                                                                external partners to develop sophisticated
                                            exacerbate inequalities by benefiting those who
                                                                                                outcomes matrices which overlap social,
                                            have the least need.
                                                                                                physical and mental health outcomes. Where
                                                                                                they have been running for sufficient periods
                                            Evaluating prevention                               of time, certain projects – some of which form
                                            Shifting public spending from high-cost late        part of much wider strategies and approaches
                                            intervention services (such as hospitals and        – have been subject to internal and external
                                            prisons) towards lower cost prevention and          evaluations.
                                            earlier intervention is notoriously difficult.

An overarching message from promising case          predetermined metrics and performance

                                                                                                       Centre for Mental Health REPORT Our place
studies is the importance of learning. This is      management can make it harder to improve
not just about external evaluations, figures        outcomes for individuals and communities
and validated measures: it is about listening       (Lowe & Wilson, 2017); Davidson Knight et
to communities and system partners and              al., 2019). In some cases, commissioners and
understanding how approaches can be adapted         service providers benefit instead from using
or adjusted to meet a growing understanding         first person narratives, qualitative evidence,
of local need. The use of outcome measures is       and ongoing learning to demonstrate their
the subject of some debate in mental health         value (Bell & Allwood, 2019).
and all public services. Adhering to strict

The role of local authorities
Community leadership                                resource has recently been published (Davie &
                                                    Garzonis, 2020) and a range of guidance and
Local authorities of all types have roles to play   tools is available through the Local Authority
as guardians of population mental health and        Mental Health Challenge.
wellbeing. Many are rising to the challenge of
promoting good mental health and preventing         Councils can lead on the creation of mentally
poor mental health with the potential to make       healthy places in different ways. They can
a big difference in their communities. We           influence the wider system by: enabling high
have seen during the Covid-19 pandemic that         people in public and high profile roles to share
councils have stepped up to lead efforts to         their personal experiences and challenge
respond to the crisis, taking unprecedented         stigma; creating spaces where communities
steps to save lives, protect public health and      can share issues which affect them; working
support people who face the biggest risk.           closely with NHS and clinical commissioners;
                                                    and convening local groups comprising
Most health problems and inequalities are           stakeholders from statutory services, voluntary
caused by a complex mix of environmental and        and community sector organisations and local
social factors which play out in a local area.      businesses. Local authorities are uniquely well
Councils deliver services and carry out duties      placed to build relationships across systems,
directly relating to health, but leadership on      establish effective governance, understand and
mental health is not limited to public health       respond to the circumstances of the populations
or social care directorates. All areas and          they serve, and lead culture change for better
all levels of local government – children’s         mental health.
services, housing, community safety, culture,
leisure, parks, planning, employment – can
                                                    Health and Wellbeing Boards
impact mental health in communities (Local
Government Association, 2017).                      Health and Wellbeing Boards are the main
                                                    formal platform through which many councils
Leadership takes many forms. Elected members,
                                                    exert strategic influence over the health of
for example, are uniquely well placed to embed
                                                    their communities. Established in all local
a strong voice – and bring scrutiny – to ensure
                                                    authorities with adult social care and public
that policies and decisions are made with
                                                    health responsibilities, they bring together
mental health in mind. Councillors can listen to
                                                    councillors with social care and public health
concerns from residents and communities and
                                                    leaders, NHS commissioners (from each Clinical
seek to address them. Support is available for
                                                    Commissioning Group in the area), and public
councillors in this role: a new distance learning

representation from the local Healthwatch.           for example transport, libraries and education.
Centre for Mental Health REPORT Our place

                                            While a Health and Wellbeing Board may               County councils and unitary authorities
                                            engage other stakeholders, voluntary sector          receive direct funding for population health
                                            providers for example, they are not obliged to       and wellbeing from the Better Care Fund (HM
                                            do so.                                               Government, 2019) and the Public Health Grant
                                                                                                 (Department of Health and Social Care, 2020).
                                            The role of Health and Wellbeing Boards is
                                            not to commission services, but to oversee           Unitary and upper tier councils have statutory
                                            provision and ensure that local needs are            responsibilities to provide support for people
                                            met. They have a statutory remit to produce a        experiencing mental health problems, including
                                            Joint Strategic Needs Assessment (JSNA) and          care assessments and planning, crisis
                                            a Joint Health and Wellbeing Strategy for their      intervention, advocacy, and the provision of
                                            local population. The JSNA uses local data to        a number of roles, such as Approved Mental
                                            assess current and future health and social care     Health Professionals who are directly involved
                                            needs. These are often created in consultation       in the safety and support of people in urgent
                                            with local communities and can cover a range         mental health distress. These are detailed in
                                            of areas including demographics, economic            the Mental Health Act, Care Act, and Mental
                                            factors, and wider social or environmental           Capacity Act.
                                            considerations. This intelligence, and the
                                                                                                 Much of this work is delivered in partnership
                                            oversight role of Health and Wellbeing Boards,
                                                                                                 with the NHS. Health and Wellbeing Boards
                                            can help local authorities use their influence
                                                                                                 and other structures, such as Sustainability
                                            to focus both their own resources and wider
                                                                                                 and Transformation Partnerships (STPs) and
                                            investment from system partners on prevention
                                                                                                 Integrated Care Systems (ICSs), support
                                            (Bell, 2016).
                                                                                                 integration and enable local authorities to
                                            Where there are two tiers of local government,       collaborate on and scrutinise mental health
                                            statutory responsibility for Health and              provision.
                                            Wellbeing Boards lies with the upper tier.
                                            County councils should, however, engage              District, borough and city councils
                                            with district councils to understand local need
                                            and implement strategies, and some district          Although councils at the district level lack
                                            councils may create Health and Wellbeing             statutory responsibilities to deliver public
                                            Boards or Partnerships to influence work taking      health services or social care, they hold
                                            place at county level.                               several key functions which affect community
                                                                                                 health and wellbeing. They are responsible
                                                                                                 for housing, leisure, culture, green space and
                                            Unitary authorities
                                                                                                 environment, benefits and licensing. District
                                            In local areas where there isn’t a two-tier system   level councils are also responsible for economic
                                            of local government, the unitary authority holds     development, for example, assessing planning
                                            responsibility for all the activities outlined       applications, managing business rates and
                                            below. This includes London boroughs and             relief, encouraging investment in local areas
                                            some metropolitan and non-metropolitan areas.        and developing local infrastructure through
                                                                                                 the use of the Community Infrastructure Levy
                                            County councils                                      (Ministry of Housing, Communities & Local
                                                                                                 Government, 2019a).
                                            In addition to their strategic role leading
                                            Health and Wellbeing Boards, county councils         District councils are closely involved with
                                            directly commission a range of services related      community-based activities and neighbourhood
                                            to mental health and wellbeing. Key services         management, where prevention and health
                                            include public health, social care, drug and         promotion work takes place, so are well
                                            alcohol support, and others which affect             placed to bridge communities with Health and
                                            population wellbeing and access to support,          Wellbeing Boards and service providers.

Centre for Mental Health REPORT Our place
National policy and legislative context
The majority of policy attention in recent years    The green paper cited a range of risk factors
has focused on investment in mental health          which can contribute to poor mental health,
services. Prevention has been much less of          such as adverse childhood experiences,
a priority, and national investment in public       poverty, financial and housing insecurity, social
mental health has been negligible. But there are    isolation, and discrimination. However, it largely
signs of a shift and of growing recognition from    focused on individual choices, like smoking
policymakers that preventing mental ill health is   cessation and weight management, rather
both desirable and possible.                        than addressing the psychological stresses
                                                    undermining people’s ability to stay healthy.
Prevention                                          This is an area where local authorities are well
                                                    positioned to understand the needs of their
The Secretary of State for Health and Social        communities and test innovative approaches
Care’s vision statement (2018) described            which go further than national strategies.
prevention as ‘better than cure’. The vision
asserted that:
                                                    System change, the NHS and local
The NHS and local authorities need to put           authorities
prevention at the heart of everything they do:
tackling the root causes of poor health, not just   The NHS Long Term Plan was published in
treating the symptoms, and providing targeted       January 2019, setting out NHS England’s
services for those most at risk.                    priorities for the next decade. The Plan
                                                    determines funding, organisation and objectives
It recognised the wider determinants of mental      for the next ten years. Annual funding for mental
health and the need to support those at risk of     health services is earmarked to grow by £2.3
developing mental health problems, including        billion by 2023-24. These were enshrined in
by meeting young people’s needs earlier. This       law in March 2020 through the NHS Funding Act
echoed proposals of the Transforming children       2020.
and young people’s mental health provision
green paper (2017) to develop mental health         The Plan has a prominent focus on community
support teams and supervision in schools.           mental health support, with almost £1 billion
                                                    per year (of the additional funding) to be
The vision for prevention developed into the        invested in community provision by 2023-
Government’s Advancing our health: prevention       24. This is intended to support local areas to
in the 2020s green paper (2019). The prevention     ‘redesign and reorganise core community health
green paper pledged to give more attention to       teams to move to a new place-based, multi-
improving mental as well as physical health. It     disciplinary service across health and social
made proposals to invest in protective factors      care’. The community mental health framework
for mental health – for example by supporting       calls for NHS commissioners and providers
wellbeing and social connection using social        to deliver integrated, place-based support by
prescribing and ‘nature-based interventions’.       collaborating with colleagues in social services,
Other actions included additional investment        drug and alcohol teams, education, housing,
in suicide prevention, encouraging local            employment and public health (National
authorities to sign up to the Prevention            Collaborating Centre for Mental Health, 2019).
Concordat for Better Mental Health, national
programmes to raise awareness and challenge         Several proposals under the heading of
stigma, and new grants targeting innovations in     ‘prevention’ were put forward in the Long Term
student mental health.                              Plan. Pledges to scale up the use of personal
                                                    health budgets and extend access to social

prescribing focus on helping people with long-         Public health
Centre for Mental Health REPORT Our place

                                            term conditions to self-manage and preventing
                                            emerging problems from worsening. There were           Public Health England is responsible for
                                            also proposals to improve the physical health          improving the nation’s health and wellbeing
                                            of groups with a higher risk of long-term illness      and reducing health inequalities. It delivers a
                                            (The NHS Long Term Plan, 2019).                        number of programmes to share information
                                                                                                   and support local authorities, the NHS, and
                                            The NHS Long Term Plan established a shift             others to improve population health and tackle
                                            towards Integrated Care Systems (ICSs) over            public health problems. Mental health is one of
                                            large geographical areas (covering about a             its five priority areas for 2020-25 (Public Health
                                            1 million population each) and Primary Care            England, 2019).
                                            Networks (at a much more local level). ICSs
                                            should bring together commissioners, providers         The Prevention Concordat for Better Mental
                                            and local authorities to make decisions that are       Health, developed in 2018, is a key vehicle for
                                            in the best interest of the entire health economy      promoting prevention-focused approached
                                            (Bell, 2020).                                          to improving public mental health.¹ It was
                                                                                                   one of the recommendations of the Five Year
                                            Health and Wellbeing Boards can form a key             Forward View for Mental Health (2016) and
                                            part of the local infrastructure on prevention by      brings together guidance for local councils with
                                            working with ICSs. Some of the key tools that          information, data and other resources in order
                                            are needed – such as flexibility to pool budgets       to spur action to improve mental health and
                                            – already exist. However, while ICSs are               reduce inequalities. The Prevention Concordat
                                            intended to provide ‘even closer collaboration’        is underpinned by a consensus statement which
                                            between the NHS, local councils, and other             states a shared commitment to shifting to
                                            organisations, evaluations of the early models         prevention, addressing the wider determinants
                                            have demonstrated variable local authority             of poor mental health. The Prevention
                                            involvement at ICS level, and there are some           Concordat has been signed by over 90 councils
                                            concerns that ICSs may develop to ‘eclipse’            and is endorsed by more than 60 statutory
                                            the role and influence of more local Health and        organisations, professional bodies, voluntary
                                            Wellbeing Boards (Humphries, 2019; Hunter et           sector organisations and others.
                                            al., 2018).
                                                                                                   Every Mind Matters (2019) is Public Health
                                            Future reform, system change, new ways of              England’s most recent public-facing mental
                                            working, expectations for greater collaboration,       health initiative. Developed in partnership with
                                            and investment brought about by the NHS Long           the NHS and other stakeholders, it is intended
                                            Term Plan will have significant implications for       to give people easy access to information and
                                            local authorities. However, unlike the long-term       the opportunity to learn skills to cope with sleep
                                            funding settlement for the NHS, now enshrined          problems, anxiety, low mood and stress, both to
                                            in law, future financing of social care and public     support their own wellbeing and to help family
                                            health is still arranged on a rolling annual basis.    and friends. This is delivered online through a
                                            A sustainable plan for funding adult social            range of digital apps with a focus on self-care
                                            care appears to be some way off yet. And the           and staying well.
                                            coronavirus pandemic has put progress towards
                                            this and other health and care system change
                                            on hold.

                                            ¹To sign up to the Prevention Concordat, contact publicmentalhealth@phe.gov.uk to request an action plan

Centre for Mental Health REPORT Our place
Key themes from case studies
A number of commonalities and shared drivers           Collaboration
of success emerged during analysis of our nine
                                                       Collaborating with other parts of the system and
case study examples. Each of the case studies is
                                                       with the community is a common element of all
profiled in full in the last section of this report;
                                                       case studies. Joined-up approaches with other
the summary below presents the shared and
                                                       councils (especially in two-tier areas) and NHS
similar elements and enablers which were
                                                       providers and commissioners enable the whole
identified across the various sites.
                                                       system to focus on upstream approaches to
                                                       health and wellbeing. Community organisations
Common approaches                                      and local residents have been closely involved:
Everybody’s business                                   community groups and voluntary organisations
                                                       are vital whether they are giving input for
Approaches to prevention and promotion can             strategies, beneficiaries of grants or lead
make clear that the health and wellbeing of            providers of contracts.
the local population is the responsibility of
every part of the council and every council            Place-based
worker. Basildon Borough Council, for example,
has pursued a health in all policies approach          Case studies recognise the range of settings
which has helped make mental health and                which can influence people’s wellbeing – such
wellbeing a part of its Corporate Plan and             as parks, leisure facilities, and workplaces.
Housing Strategies. In Camden and Islington,           Promising strategies use the idea of ‘place’
meanwhile, Making Every Contact Count training         to galvanise residents and organisations to
aims to equip every frontline worker in the            engage with the broader health and wellbeing
council and community with the skills and              agenda. Some approaches, such as Stronger
confidence to link individuals with the support        Sandwell, prioritise ‘asset-based’ prevention
they need.                                             work. This means understanding and utilising
                                                       the many resources (places, people, groups,
Holistic support                                       communities) which are already present in
                                                       communities, and which can be empowered to
The case studies demonstrate a range of                make a bigger contribution to keeping the local
support and strategies to tackling the broad           population well.
determinants of mental ill health. This includes
early signposting to support offers, expanding         Accessibility is an important part of place-
access to activities and the outdoors, improving       based work – in Tameside and Glossop, for
opportunities for creativity and artistic              example, Neighbourhood Mental Health Teams
expression, offering employment support,               are deployed in community settings, including
group social activities, and advocacy and advice       a high street drop-in centre run by a local
around benefits, finances and housing.                 charity. Similarly, Mentally Healthy Leeds runs
                                                       arts, music, food and exercise programmes in
Holistic support can be targeted towards               community spaces.
specific groups who are considered at risk or
unlikely to access support. St Albans’ Shape
Up programme, for example, works to improve
men’s mental wellbeing through an exercise
offer, while Leeds’ whole-city approach
prioritises grants for public health work in areas
of high deprivation and low engagement.

Drivers of success                                 range of local groups and organisations which
Centre for Mental Health REPORT Our place

                                                                                               are well placed to make a difference. Engaging
                                            Leadership                                         communities from strategy development to
                                            Interviewees from all areas cited senior and       service delivery is critical to ensure that the
                                            political support as key drivers for mental        right areas are being targeted and that new
                                            health prevention. Senior endorsement              initiatives have the best chance of reducing
                                            empowers officers to have conversations about      inequalities and improving outcomes for at risk
                                            mental health within the council and with          groups. Birmingham City Council, for example,
                                            external stakeholders. Leaders, especially         has sought out links with other areas to help
                                            elected members, can bring insights into the       develop culturally appropriate support for
                                            needs and preferences of communities and offer     specific communities.
                                            valuable connections with other stakeholders
                                            such as employers and business groups. In          Harnessing existing evidence and resources
                                            two-tier systems, mirrored priorities and mutual   Several approaches have been inspired by
                                            support between county and district level          national programmes. Bristol’s Thriving at
                                            councils was another important enabler.            Work initiative builds on national evidence on
                                                                                               the impact of mental health in the workplace.
                                            Relationship development                           Many other councils have signed up to Time to
                                            Relationship development is a key element of       Change as employers and have embedded this
                                            success, particularly where local authorities      into their work in communities. Others have
                                            seek to engage voluntary and community             been inspired by learning from approaches
                                            groups with which they have previously             elsewhere. Birmingham City Council, for
                                            had more direct commissioner-provider              example, has made links with Lewisham Council
                                            arrangements. Surrey County Council, for           to help develop its offer for young black men,
                                            example, opened up membership of its               while Tameside and Glossop was inspired by the
                                            Health and Wellbeing Board to a broad              Lambeth Living Well programme to develop its
                                            range of organisations, and is moving from         own neighbourhood offer.
                                            scrutinising mental health provision to more       Sharing learning and harnessing the existing
                                            of a partnership approach. In other examples,      evidence base for prevention and health
                                            as in Basildon Borough Council, councils work      promotion can strengthen local business cases
                                            collaboratively with NHS commissioners and         and persuade commissioners and system leaders
                                            providers, producing funding bids together.        that it is worthwhile – and possible – to take new
                                            Building mutual trust with other organisations     approaches. We heard from some local teams
                                            – whether they are from the NHS or voluntary       that they are already sharing learning across
                                            sector – can take time and requires patience       regional and national communities of practice.
                                            and understanding. This is another area where      These case studies were gathered before the
                                            political leaders can help open doors.             Covid-19 pandemic. We followed up with a
                                                                                               limited number of participating case study areas
                                            Community engagement                               during May and June of 2020 to understand
                                            Promising strategies have sought out and           how they were responding to the virus and
                                            learned from communities, exploring both           what impact it had made on prevention and
                                            individual experiences of support and the          promotion activities.

Centre for Mental Health REPORT Our place
Prevention and promotion during the pandemic
Approaches                                          deliver food and informally check on the welfare
                                                    of potentially isolated and vulnerable residents.
Going digital                                       At the same time, they have distributed crisis
There were several examples of services             cards so that information on where to get
adapting to lockdown and social distancing          help is accessible and easily available. This
rules by focusing on online and other remote        includes information regarding broad reaching
support. The St Albans Healthy Hub focused on       local services such as debt advice, housing,
sharing resources online, including a number of     bereavement services, and support for young
free videos and webinars, and links to local Hub    people.
partner organisations’ online services. Leeds       The importance of the Mindful Employer
Suicide Bereavement Service moved to 1-1            Network, also in Leeds, has been reaffirmed
remote counselling, during which practitioners      in light of the pandemic, and the Public Health
have noted an increase in the quality of some       team has been actively seeking to engage
sessions.                                           employers and individuals who might be at
Stronger Sandwell is promoting physical activity    greater risk of stress and anxiety. This includes
despite the suspension of group meetings,           care home workers and food delivery drivers
including by partnering with local sports           working in the ‘gig economy’. The latter are
personality ‘Blind Dave’ Heeley to produce          known to experience health inequalities, be
a video to encourage people of all ages and         less likely to access support for mental and
abilities to exercise. Birmingham City Council,     physical health, be more likely to come from
too, has commissioned local professionals to        BAME communities where Covid-19 has been
record accessible videos on a range of activities   more prevalent, and be part of the young, lower
aimed at boosting mental wellbeing: such as         paid and underemployed workforce where
yoga, mindfulness, creativity and planting.         livelihoods are at greater risk in a recession.
Links to local support, self-help resources, and    In Bristol, £100,000 previously secured from
tips for employers to create mentally healthy       West of England Combined Authority (WECA) for
workplaces have also been shared online             the Thrive programme has been redirected to
through Birmingham’s Mentally Healthy City          support the Covid-19 mental health response
Forum.                                              to adapt to new circumstances and restrictions,
Bristol City Council continues to focus on          including by moving services online.
workplace mental wellbeing online, offering
a range of remote access resources such as          New resources
mental health training for line managers, tools     Local authorities have worked with communities
and training for staff to manage their own stress   to develop and disseminate new resources on
and anxiety, platforms for peer support and         mental health and wellbeing. The Covid-19
suicide awareness training.                         mental health response in St Albans City and
                                                    District has benefits from close working with
Adaptations and targeted work                       Hertfordshire County Council, which supported
Covid-19 responses have not just focused on         the development of a mental health resource
meeting the challenges of delivering existing       for individuals. This was produced by Centre
programmes within the restrictions of lockdown,     for Mental Health and made widely available
they also address the specific impact of            through the range of organisations brought
Covid-19 on the wellbeing of communities.           together by St Albans City and District Council
The Mentally Healthy Leeds main provider,           (Centre for Mental Health, 2020a).
Touchstone, has been unable to run groups           Leeds City Council, responding to feedback from
in neighbourhoods, but has instead carried          local volunteers, has produced an accessible
out socially distanced home visits where staff      suicide awareness guide to help improve

the confidence and knowledge of the wider           people’s concerns about returning to school,
Centre for Mental Health REPORT Our place

                                            volunteer workforce to respond to distress in the   and adults’ concerns about returning to the
                                            community (Leeds City Council, 2020). This has      workplace; awareness of isolated groups, such
                                            been shared through a broad network, including      as older adults; and the need to support and
                                            NHS volunteer responders, carer groups,             manage volunteers through difficult times.
                                            voluntary sector organisations, adult social        This learning will inform the St Albans Health
                                            care, the Mindful Employer network, and the         & Wellbeing Partnership and will be shared
                                            local NHS mental health and learning disability     with the County Council. Future meetings are
                                            provider trust.                                     planned – the forum will continue to gather
                                                                                                insights and connect local government to a
                                            As part of Stronger Sandwell’s ‘asset-based
                                                                                                range of relevant stakeholders.
                                            community development’ approach, Sandwell
                                            Metropolitan Borough Council has been active in     Birmingham City Council has launched an
                                            engaging its diverse local community about how      online Covid-19 impact questionnaire to
                                            to respond to the pandemic. Public health has       understand the experiences of different
                                            met with local faith groups and organisations       communities across the city. The survey asks
                                            including the Yemeni Community Association          questions about participants’ backgrounds,
                                            and West Bromwich African Caribbean Resource        views on Covid-19, and the impact that
                                            Centre to understand the key issues for them.       lockdown measures have had on mental
                                            They heard that people from some BAME groups        health, physical activity, employment and
                                            have concerns about the disproportionate            relationships. Findings will inform the Council’s
                                            impact of Covid-19 on their communities, both       recovery response, proposals and priorities.
                                            from the illness itself and being discriminated     Birmingham’s Mentally Healthy City Forum
                                            against based on a perceived vulnerability.         has shared other opportunities for community
                                            One concern has been that this could lead to        involvement, notably a youth community
                                            BAME people being offered shorter contracts         roundtable hosted by the West Midlands Police
                                            or not being employed at all. In response, the      and Crime Commissioner which sought views
                                            Stronger Sandwell team is working with local        from young people about experiences of the
                                            communities to develop a post-Covid risk            police, education and mental health during
                                            assessment tool for employers that builds on        lockdown. During the pandemic, the Council
                                            national guidance on considerations of age and      convened meetings with wider system partners
                                            clinical vulnerability, expanding on the guidance   including public health and the local CCG to
                                            by also addressing ethnicity.                       rapidly facilitate and answer over 600 questions
                                                                                                directly from the community, and has been
                                            Learning from communities                           proactively sharing information to keep the
                                                                                                public informed about the issues that are most
                                            St Albans City and District Council brought
                                                                                                important to them.
                                            together a group of senior representatives
                                            from 18 local organisations for a meeting on        Leeds Public Health is working with Mentally
                                            the ‘Impact of Covid-19 on Mental Health:           Healthy Leeds provider, Touchstone, and other
                                            Recovery’. This was led by the council’s            third sector organisations to explore and
                                            ‘member champion’ for mental health, Cllr           understand experiences of grief, loss and social
                                            Anthony Rowlands. Attendees represented a           isolation during Covid-19, and the wider impact
                                            broad group of local voluntary sector providers,    this has had on communities. Community
                                            schools, faith groups, district and county          based providers are recognised as being able to
                                            council representatives and NHS organisations.      engage residents from diverse backgrounds and
                                            Issues raised included increasing demand for        the project has been made possible as part of
                                            employment support and expected need for            the Mentally Healthy Leeds programme through
                                            money advice; funding challenges for voluntary      flexible commissioning.
                                            sector organisations; children and young


                                                                                                         Centre for Mental Health REPORT Our place
A system designed for prevention
A Mental Health and Wellbeing Cell has been         Councils’ roles in harnessing the social fabric
established in the West of England to develop       of communities has been evident during the
a whole system response to meeting mental           pandemic. A key part of this has been bringing
health needs once lockdown eases. This is           stakeholders together quickly to learn about
co-chaired by Bristol Public Health and Bristol,    diverse experiences and to plan appropriately
North Somerset and South Gloucestershire            to support those who might be facing mental
CCG. It brings together 60 partners and local       health difficulties.
experts from across the NHS (including Avon
and Wiltshire Mental Health Partnership NHS         Case study areas have benefited from having
Trust), local authorities, voluntary sector,        invested time and resources into developing
emergency services such as the police, user-        relationships across communities as part of
led organisations and academia. The Cell has        their pre-Covid approaches to preventing mental
adopted prevention-focused principles in            health problems and promoting good mental
planning for Covid-19 recovery.                     wellbeing. Public health teams have been able
                                                    to consult rapidly and effectively with diverse
Modelling has predicted a 30% increase in           community groups (as in Sandwell and Leeds),
mental health problems over the next 2-5 years.     and to bring together groups and organisations
The Cell recognises the potential for community-    to understand the mental health of communities
based, preventive approaches, early help and        and plan to meet their needs (in St Albans
targeted work to improve population mental          and Bristol). Where new resources have been
health and enable de-escalation, with a view        produced, relationships across communities
to reducing the severity of new mental health       have allowed them to be relevant to the people
problems, alleviating system pressures and          they intend to reach and shared across the
tackling health inequalities.                       broadest possible networks.
A business case for the reprioritisation of         These examples demonstrate the convening
local health and local authority funding into       power of local authorities at all levels – county,
community-based mental health support               district, and unitary. Mental health is a key
and prevention work has been developed at           issue emerging from Covid-19, and while
an STP-wide level, with discussions ongoing         councils have been busy managing practical
around how this may be supported nationally.        measures to contain the virus, they have also
Proposals include specialist mental health debt     been successful in bringing wider stakeholders
and benefits advice, mental health specialists      together to consider how their roles and
for schools, trauma-informed support, a mental      responsibilities can protect the mental health of
health literacy programme, and community            the population.
grants for grassroots organisations, with a focus
on health equality (including black-led mental      Flexibility has also been important. Local
health support). This business case has been        authorities and their partners have been quick
agreed by local leaders and implementation has      to embrace digital to safely connect with people
already begun to quickly protect and promote        in their communities. Digital technology is not
mental health and ensure that the health and        accessible for everyone, however, and we have
care system is able to respond effectively to the   seen services adapt to safely support people’s
challenges to come in the wake of the virus.        welfare face to face (Mentally Healthy Leeds).
                                                    Flexible commissioning has enabled resources
                                                    to be redeployed, supported new approaches
                                                    to be delivered quickly, and created pathways
                                                    for learning about community experiences
                                                    which may otherwise have taken much longer to

Implications                                      struggling to be heard. System working will
Centre for Mental Health REPORT Our place

                                                                                              be achieved where NHS commissioners and
                                            Covid-19 has been a shared trauma in all          leaders recognise the value of local authority
                                            communities, and it has hit the most deprived,    contributions to supporting prevention and
                                            marginalised and isolated the hardest. There      health promotion in communities, as well as
                                            is a real risk that many more people will         the impact this can have on NHS services for
                                            experience mental ill health (and more serious    physical and mental health.
                                            mental health difficulties) in the wake of the
                                            pandemic. But, by taking affirmative action       Community assets – including voluntary and
                                            to reduce the risk of serious and long-lasting    community groups and local employers –
                                            mental health problems, it will be possible to    should be mapped and engaged as part of any
                                            help individuals and communities to recover.      prevention strategy. These groups provide vital
                                            While it’s not possible to prevent all mental     insights into local need and opportunities.
                                            ill health either now or at any other time, it    They can increase the reach of, and encourage
                                            is possible to boost communities’ resilience      access to, prevention initiatives through sharing
                                            and help people to ‘bounce back’ from the         information at a neighbourhood level and can
                                            crisis. The nine case studies in this document    directly participate in service delivery.
                                            demonstrate promising approaches to               Local authorities should be willing to take
                                            achieving this.                                   risks as compassionate commissioners, learn
                                            The local authorities we have profiled in         about the successes and challenges alongside
                                            this report have demonstrated the value of        community providers, and adapt monitoring
                                            collaborative working with NHS commissioners      requirements as knowledge and understanding
                                            and providers. As partners, local councils and    across the system improves. Evidencing impact
                                            the NHS should acknowledge that addressing        is important. But reporting to specific outcome
                                            people’s needs holistically and helping           indicators can be a burden on services that are
                                            individuals to avoid mental health difficulties   operating with limited resources, especially
                                            requires a joined-up approach, particularly       where an independent evaluation hasn’t been
                                            around psychosocial needs where local             commissioned and routine data collection isn’t
                                            authorities and community-based organisations     resourced. This is especially challenging for
                                            can make a significant contribution. Covid-19     mental health prevention work, where outcomes
                                            has, in many areas, provided the catalyst for     could be broad and only recognisable over time.
                                            that to happen very quickly.                      All local authority directorates should recognise
                                            Fully integrated arrangements such as those in    that mental health is interwoven with other
                                            Tameside and Glossop are rare, but by engaging    priorities and agendas – physical health,
                                            with other structures, such as Integrated Care    housing, economic development, estates and
                                            Systems and Integrated Care Partnerships,         green spaces and social inclusion. Taking a
                                            local authorities can have an active voice        mental health informed approach can help
                                            in wider health provision. However, these         tackle inequalities in a number of areas and can
                                            systems can be experienced as dominated           unlock opportunities for multiagency work or
                                            by NHS organisations, with local authorities      external funding.

Crisis card distributed as part of Mentally Healthy Leeds

                                                                                                                                                                                                                             Centre for Mental Health REPORT Our place
                                  FEEL LIKE YOU’VE HAD ENOUGH?
                                                                                                                   All the services
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               0113 222                                                                 www.mindwell-leeds.org.uk
                    1  2  7 3   939*
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                     Developed by Public Health, Leeds City Council.                                    and access to emergency accommodation.                                     TEXT 07860 022 880
    If you are a professional and would like to order more posters please ring the Public
    Health Resource Centre on 0113 37 86200. Information correct as of February 2020.                     24 hour Helpline           0113 246 0401                               EMAIL support@sarsvl.org.uk

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