Our place - REPORT - Local authorities and the public's mental health - Louis Allwood - Centre for Mental Health
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REPORT
Our place
Local authorities and the public’s mental health
Louis Allwood
Centre for Mental Health REPORT Our place
Contents
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
2
Centre for Mental Health REPORT Our place
Foreword
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
3
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.
inequalities.
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
pathways”
4
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
planning.
5
Centre for Mental Health REPORT Our place
Introduction
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
6Centre 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).
7Centre 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.
8An 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
9representation 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.
10Centre 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
11prescribing 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
template.
12Centre 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.
13Drivers 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.
14Centre 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
15the 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
16Reflections
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
establish.
17Implications 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.
18Crisis card distributed as part of Mentally Healthy Leeds
Centre for Mental Health REPORT Our place
FEEL LIKE YOU’VE HAD ENOUGH?
All the services
listed on A place for calm
this poster are
Can help with legal, mon LGBT+
ey, welfare and with money inclusive. words when you
g problems
housing issues by pro
viding free, If you’re havin dealing with
debt, need them most.
su pp ort Find local and nat
independent and confide or need free, ional
y Buddies for
ntial advice. contact Mone partial advice.
im
organisations tha
t support 0300 330 0630
confidential, LGBT+ communiti
0113 223 4400 0276 www.mindwell-le
es at: Open 10am – 10pm
0113 235 eds.org.uk/ (every day)
lgbt
If you are worried about money problems,
find help and support at:
www.mindwell-leeds.org.uk/money-worries
O P T IO N S
O U S IN G If you are 19 or under, you can contact
LE E D S H
le who are
ChildLine about anything.
MindWell is the mental health websit
ice for peop e for No problem is too big or too small.
Advice serv ho m elessness,
or people in Leeds. Funded by the NHS,
it brings Speak to a counsellor straight away on
at ris k of
homeless, e ab ou t housing.
together information about local and
national 0800 1111 (Freephone).
vic
would like ad
services as well as self-help tools and
4412
resources.
0113 222 www.mindwell-leeds.org.uk
1 2 7 3 939*
07895pm - 8 am, emergency only
urs
*out of ho Are you struggling to cope or feeling overwhelmed?
Talk to someone about how you’re feeling. elling for
Support, information and couns
11-25.
young people in Leeds aged
You are not alone and it is okay to ask for help.
0113 2461659
leeds .org.uk
IS PROBLEM GAMB www.themarketplace
LING
AFFECTING YOU OR
THOSE Andy’s Man Club
CLOSE TO YOU? Peer support group for
support
Advice, information and men If you’re a young person, MindMate can help
t your Speak to an advisor Come have a brew and
if you are concerned abou on the a chat – it’s okay to talk you understand the way you’re feeling and
alcohol or drug use or some one National Gambling
Helpline Meets every Monday at
Freephone 0808 8020 7pm (Except Bank Holid find the right advice and support. MindMate
else’s. You can also call
to refer 133 Leeds College of Build ays)
s. 24/7 ing, North Street, LS2 also has information for parents and carers.
yourself to servic es in Leed www.andysmanclub. 7QT
www.gamcare.org co.uk www.mindmate.org.uk
Open Monday and Friday
, 9am - 5pm .uk info@andysmanclub.
- 7pm co.uk
Tuesday to Thursday, 9am
0113 887 2477
Suppor t in times Feeling anxious or
stressed? Need to
of crisis Connect
talk about things?
Need to talk about thing Need to vent about
Dial House Need to hear a frien
s? school? Anything
dly and
Dial House @ Touchstone understanding voice
? else on your mind?
A place of sanctuary Support and sanctuary Confidential, non-judg
, a social for people mental tal emotional
space, one-to-one supp
ort. from Black and Mino
rity Ethnic emotional support over Confidential, non-judgmen
the in Leeds, over the
Open every day exce
pt Tuesday
backgrounds. phone and online, prov
ided by support for 13-18 year olds .
and Thursday 6pm–2am
. Open Tuesdays and staff and volunteers. phone, online, or by text
Thursdays
Call 0113 260 932 6pm–12am. Open every day 6pm
8 or text –2am. – Friday: 3.30 pm-2am
07922 249 452 to Call 0113 249 467 Call 0808 800 121 Open Mon day
make a 5 or text 2 (free- -2am
referral. Taxis provided
, parents 07763 581 853 to
make a phone) or go to lslc
s.org.uk Saturday and Sunday: 6pm
in crisis able to bring referral. to find the online chat
children, . phone), go to
BSL support available
. Call 0808 800 1212 (free
text 0771 566 1559.
teenconnect.org.uk, or
Deaf Connect
Is open Mondays 7-11
pm.
WELL-BEAN
Glide/ Text: 07500
870 987 ‘HOPE IN A CRISIS’ CAFÉ In a medical emergency
Skype/ FaceTime:
sur vivor.led@lslcs.o
The café is a safe space open CALL 999
rg.uk to all experiencing crisis.
When you need urgent
medical help but you’re
Are you struggling after SATURDAY, SUNDAY, TUESDAY, WEDNES- THURSDAY, FRIDAY not sure what to do
the death of someone clos MONDAY 6pm-12am DAY 6pm-12am
e? 6pm-12am CALL NHS 111
Lincoln Green Community Touchstone House, 2-4 New Wortley Community
Centre, 29 Cromwell
e close Middleton Crescent,
If someone you wer
Centre, 40 Tong Rd, Leeds
Mount, LS9 7JB Beeston, LS11 6JU
own life LS12 1LZ
to has ended their
-to-one
you can access one Ring or text 07760 173 476
port, family
support, group sup
SARSVL
lling. on the day you’d like to visit.
provides support, informat support, or counse
ion
and practical advice. rg.uk
info@leedssbs.o provide confidential
0113 234 4150 Leeds Domestic
leedssbs.org.uk emotional support for wom
en
0808 808 1677 and girls affected by sexual
www.cruse.org.uk 0113 305 5800 Violence Service violence of any kind.
Provides confidential support, information, CALL 0808 802 3344
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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