Jude Stansfield

Purpose Increases in prevalence of mental health conditions and widening inequalities suggest that public mental health (PMH) should be a growing public health priority within the UK and globally. Whilst it remains an under-developed field within national public health systems, there is much to learn from practice over recent decades. This study aimed to identify learning from a national PMH programme within England’s public health institution between 2013 to 2021 and consider implications for future direction. Approach Six stakeholders engaged in the programme provide a reflection of their experiences of leading, delivering and advising the programme throughout its duration. The Health Policy Analysis triangle is applied to analyse the programme context, content, process of delivery and actors engaged. Findings Decades PMH development in England informed a comprehensive public health programme to promote mental health, prevent mental health problems and improve the lives of people with mental health conditions. Strengths include national-regional infrastructure, a broad network of actors and tools to guide practice. Action on the social determinants of mental health and co-production remain challenges. Originality This is an original and unique account of Public Health England’s PMH programme. Practical implications Given the absence of a national PMH policy or programme in England, renewed action is required to address the current population mental health crises. The seven recommendations are relevant to future public health policy decisions in England and elsewhere and include cross-government policy, multi-disciplinary coalitions, insight and data monitoring, research, infrastructure, community and public involvement, and delivery strategy.

The European Commission green paper Improving the Mental Health of the Population, published in October 2005, is essentially a public mental health strategy for the European Union. In this short article Jude Stansfield outlines the main elements of the strategy and discusses its relevance and implications both for the European Union as a whole and for policy and practice in England and the other individual member states. While the green paper is in many ways welcome in that it will raise the profile of public mental health at national and international government level, it has a number of flaws ‐ not least its primary focus on mental illness and mental illness services.

This article suggests some dilemmas in producing local mental health promotion strategies, as experienced by a mental health promotion specialist in England. It argues that, because of the misconceptions and misunderstandings associated with mental health and mental health promotion (MHP), some groundwork is needed to communicate a common and clear understanding. The author explains how she has communicated MHP among organisations in her locality. This includes exploring definitions of mental health and its relationship to mental illness, the rationale and effectiveness of promoting mental health and the use of a framework to plan or assess mental health promotion.

Purpose This paper aims to use systems mapping as a tool to develop an organisation-wide approach to public mental health to inform strategic direction within a national public health agency. Design/methodology/approach Two workshops were facilitated with internal staff from a wide range of public health policy teams working in small groups to produce paper-based maps. These were collated and refined by the project team and digitised. Findings The approach engaged a range of teams in forming a shared understanding and producing a complex system map of the influences on population mental health and well-being, where current policy initiatives were addressing them and what the gaps and priorities were. Participants valued the approach which led to further study and organisational commitment to the whole system working as part of national public mental health strategy. Research limitations/implications The approach was limited to internal stakeholders and wider engagement with other sectors and community members would help further the application of complex system approaches to public mental health. Originality/value It was a valuable process for developing a whole-organisation approach and stimulating thinking and practice in complex system approaches. The paper provides a practical example of how to apply systems mapping and its benefits for organising public mental health practice.

Background Social circumstances in which people live and work impact the population’s mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198). Results We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk. Conclusion This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health.

The COVID-19 pandemic has reminded us that mental, physical and social wellbeing are closely interconnected and that the disciplines of health promotion, health protection and healthcare public health need to work in harmony. As the virus becomes more controlled and our physical health protected there is potential for a mental health crisis to unfold unless public health attention is given to it (The Lancet Public Health Editorial Citation2020).

Purpose Mental health is an emerging health policy priority globally. The emphasis on closing the treatment gap in psychiatric services is now being complemented by an increasing focus on prevention and health promotion. The purpose of this paper is to describe the programmes and delivery of public mental health in England led by Public Health England (PHE), an arms-length body of the Department of Health and Social Care. Design/methodology/approach This technical paper outlines the general approach PHE has taken in delivering national work in public mental health and describes several key areas of work: children and young people, suicide prevention, workplace and workforce, strategic engagement with stakeholders, data and information and evidence synthesis. Findings A description of the various programmes and guidance documents that PHE have produced are described and referenced, which form a substantial body of work in public mental health. Practical implications The outputs from PHE may assist in informing the approach to public mental health that other government agencies could consider adopting. The resources described and signposted within this technical paper are publicly available for readers. Originality/value England is one of a small group of countries that have a track record in delivering public mental health at a national level. This paper gives a unique and detailed insight into this work.

BACKGROUND: Public mental health (PMH) is a global challenge and a UK priority area for action. However, to progress, practitioners require a stronger evidence base regarding the effectiveness of approaches, particularly regarding promotion and prevention through community-centred interventions. In addition, policy-makers need to understand what is being delivered, particularly in areas of high need, to identify promising practices or gaps in PMH provision. Finally, and importantly, the public need better information regarding what approaches and services are available to them. We report a protocol designed to (1) identify the types of community-centred interventions used in purposively selected diverse geographical areas of England to improve PMH outcomes and (2) describe the type, target population, content and outcome measures of each intervention. METHODS AND ANALYSIS: Five local authority areas of England were selected based on either high social deprivation or differing ethnic population statistics and geographical locations. Community-centred interventions in each area will be identified through: (1) desk-based data capture from standardised searches of publicly-available information (eg, policy, strategy and intervention advertising), (2) established professional networks and service contacts, (3) chain-referral sampling of individuals involved in local mental health promotion and prevention and (4) peer researchers, who will use their personal experience and local knowledge to help identify potentially relevant organisations. Data on the key features of the interventions will be extracted from individuals either by structured interviews or by electronic questionnaires with information regarding the intervention(s) of which they have knowledge. Initial data analysis will involve tabulating descriptive information and grouping interventions according to intervention type, target population, risk/protective factor and intended primary outcome. A descriptive comparison will be made between selected geographical areas. ETHICS AND DISSEMINATION: Ethical approval was obtained from Durham University's Department of Sport and Exercise Sciences Research Ethics Committee. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals. We also plan to disseminate to the public and intervention providers through social media and/or newsletters.

BACKGROUND:: Mental health can help explain how social inequalities impact on health. Many current public health challenges are shaped by social, economic and environmental conditions that take a mental toll on society. PURPOSE:: This article describes a conceptual framework illustrating the psychosocial pathways that link the wider conditions to health behaviours and outcomes. It draws out implications of this framework for mental health practice that aim to support policy and decision-making on future action to reduce health inequalities and presents practical examples of what can be done. METHODS:: This article expands on a report commissioned by Public Health England. A narrative review and synthesis of relevant evidence built on existing research by the Institute of Health Equity. A conceptual framework was developed and a consultation exercise with stakeholders helped to revise and illustrate it with practice examples. CONCLUSIONS:: The field of mental health has much to contribute to prevention, not just of mental illness but also of physical health conditions and reduction of inequalities in life expectancy and healthy life expectancy, especially through collaborative public health action.

Background: Improving life satisfaction (LS) and mental wellbeing (MWB) is important for better public health. Like other health issues, LS and MWB are closely related to deprivation (i.e. lack of resources). Developing public health measures that reduce inequalities in wellbeing requires an understanding of how factors associated with high and low LS and MWB vary with deprivation. Here, we examine such variations and explore which public health measures are likely to improve wellbeing while reducing related inequalities. Methods: A self-administered questionnaire measuring LS and MWB was used with a cross-sectional sample of adults from the North West of England (n = 15,228). Within deprivation tertiles, analyses examined how demographics, health status, employment, relationships and behaviours (alcohol, tobacco, physical exercise) were associated with LS and MWB. Results: Deprivation was strongly related to low LS and MWB with, for instance, 17.1% of the most deprived tertile having low LS compared to 8.9% in the most affluent. After controlling for confounders, across all deprivation tertiles, better self-assessed health status and being in a relationship were protective against low LS and MWB. Unemployment increased risks of low LS across all tertiles but only risks of low MWB in the deprived tertile. For this tertile, South Asian ethnicity and higher levels of exercise were protective against low MWB. In the middle tertile retired individuals had a reduced risk of low MWB and an increased chance of high LS even in comparison to those in employment. Alcohol's impact on LS was limited to the most deprived tertile where heavy drinkers were at most risk of poor outcomes. Conclusions: In this study, positive outcomes for LS and MWB were strongly associated with lower deprivation and good health status. Public health measures already developed to promote these issues are likely to improve LS and MWB. Efforts to increase engagement in exercise are also likely to have positive impacts, particularly in deprived communities. The development of future initiatives that address LS and MWB must take account of variations in their risk and protective factors at different levels of deprivation. © 2012 Bellis et al.; licensee BioMed Central Ltd.

Background: Community-centred approaches to health and wellbeing seek to mobilise the assets within communities, promote equity and increase people’s control over their health. Public Health England (PHE) has evidenced a diverse range of models for use in public health practice. Scientific knowledge needs to be complemented by experiential learning because approaches are rarely standardised and should develop in response to community priorities. Problem: PHE identified a growing demand for examples of local implementation. A project was established (2015-6) to pilot a system for collecting public health practice examples to address this knowledge gap. The multi-disciplinary team comprised information specialists, topic experts and regional leads. One aim was to gather a set of community-centred practice examples in the North of England. Community projects completed a template covering context, project rationale, activities, outcomes and learning. Further work ensured each practice example met quality criteria. Feedback was collected at two workshops at a regional conference. Results: 16 community-centred practice examples were produced from local public health projects. Examples were mapped to the PHE framework of community-centred interventions and included community asset mapping, community involvement in health planning, peer support and community-based physical activity projects. Projects were working in disadvantaged neighbourhoods or with marginalised groups. Feedback from the workshops highlighted the value of practice examples to inform programme development and the need for contextual information. Lessons: There were some challenges in collecting information from practice and this required coordination and support. Overall the pilot confirmed the value of practice examples as a means to share learning not always captured in the formal evidence base. Results illustrate diverse ways to build resilient and healthier communities.

This paper brings together all the PHE outputs from a 10 year collaboration on Healthy Communities. This will help to retain the knowledge during organisational and government change.

Research and knowledge outputs to support the scaling of community-centred approaches and system working as part of action to reduce health inequalities, promote health and wellbeing and prevent illness; Originating from LBU’s Centre for Health Promotion Research and partnership with Public Health England and the Office for Health Improvement and Disparities, Department for Health and Social Care UK.

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital?A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria.The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities.Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

A summary of how asset-based methods contribute to community-centred public health. Discussion of the work of Public Health England to support community-centred approaches. Opportunities and challenges are discussed.

This paper examines the development and impact of a national knowledge translation project aimed at improving access to evidence and learning on community-centred approaches for health and wellbeing. Structural changes in the English health system meant that knowledge on community engagement was becoming lost and a fragmented evidence base was seen to impact negatively on policy and practice. A partnership started between Public Health England, NHS England and Leeds Beckett University in 2014 to address these issues. Following a literature review and stakeholder consultation, evidence was published in a national guide to community-centred approaches. This was followed by a programme of work to translate the evidence into national strategy and local practice. The paper outlines the key features of the knowledge translation framework developed. Results include positive impacts on local practice and national policy, for example adoption within National Institute for Health and Care Evidence (NICE) guidance and Local Authority public health plans and utilisation as a tool for local audit of practice and commissioning. The framework was successful in its non-linear approach to knowledge translation across a range of inter-connected activity, built on national leadership, knowledge brokerage, coalition building and a strong collaboration between research institute and government agency.

Abstract

The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital? A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering community resilience or social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria. The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method of measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities. Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring community resilience or social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

BACKGROUND: Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. METHODS: The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. RESULTS: The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. CONCLUSIONS: This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared.

Objectives The aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities. Design A mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England’s (PHE) People’s Panel and a round-table discussion with 23 stakeholders. Setting Local government in England. Results Eleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles. Conclusion Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.

There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.

Community resilience is the ability of communities and groups to adapt and thrive in response to external stressors. Building resilient communities as a strategy for population health requires assessment of personal and collective capacities alongside vulnerabilities. This report examines what quantitative and qualitative methods can be used to measure health-related community resilience at national and local levels. Evidence from a rapid review of 33 studies highlighted various methodological challenges. Measurement strategies, mostly drawn from the field of community disaster resilience, include population-level frameworks, mixed methods assessment tools, and qualitative and participatory case studies. The main conclusions are that measurement of health-related community resilience should cover multiple domains (economic, social, health, skills, political and environment) and consider local context and assets. Three stages of policy development are suggested: selection of a set of key indicators to collect data on community resilience, creation of a learning network to share knowledge and tools, and development of a comprehensive measurement framework.

Resilience is a dynamic process of coping, adaptation and growth in response to threats and can be an attribute of individuals, communities or systems. ‘Creating resilient communities’ is a Health 2020 priority, reflecting the importance of the social environment as a determinant of population health. This is an emergent field for research, with questions of how best to define and measure this complex concept at a community level. This presentation reports on a rapid review and synthesis of measurement strategies conducted for WHO Europe Health Evidence Network (HEN). The review question was: ‘What quantitative and qualitative methods can be used to measure health-related community resilience at a national level?’ The rapid review used HEN Evidence Synthesis guidance. A systematic search of academic and grey literature databases and 73 websites combined key terms for community resilience and measurement. Included languages were English, French and German, and Russian (via an independent search). Study selection was in 2 phases, with an initial focus on Europe. Inclusion criteria were articles that reported outcomes involving measurement of health-related community resilience in all population groups, study designs and settings. Studies on individual/system resilience and those not specifying health and wellbeing measurement were excluded. Data extraction fields included theoretical framework, methods and indicators. Findings were summarised in tables and a narrative synthesis. In total, 3,753 publications were identified and following screening, 33 studies were included; 27 from WHO European Region. The map of literature showed various measurement frameworks in use, however most related to community disaster resilience. We grouped measurement strategies into: Frameworks providing population profiles of resilience factors, using quantitative data Mixed method assessments incorporating stakeholder views, used mostly for local planning & evaluation Qualitative and participatory approaches, which involved marginalised communities. There was a dearth of validated measures and insufficient evidence on national-level indicators, but socioeconomic measurement domains were categorised. Key methodological challenges were highlighted, including definitional issues, data aggregation and lack of attention to equity. Notwithstanding these challenges, the review identified some common principles for measuring community resilience. This review contributes to new understandings of health-related community resilience and its measurement. Using rapid review methods limited the scope of the search, and the focus was mainly on European literature. While there is learning from community disaster resilience methods, transferability to population health needs to be tested.Based on review gaps, recommendations are made for future research topics.

Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognised that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A ‘family of community-centred approaches for health and wellbeing’ was then produced as way of organising the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) Strengthening communities (ii) Volunteer and peer roles (iii) Collaborations and partnerships and (iv) Access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organising and synthesising evidence from a range of participatory methods.

BACKGROUND: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.

Community champions (also known as health champions) are community members who volunteer to promote health and wellbeing or improve conditions in their local community. Champions use their social networks and life experience to address barriers to engagement and improve connections between services and disadvantaged communities. Findings from this rapid review show that community champion approaches have high relevance to reducing health inequalities, whether the context is one of an emergency, or of longer term prevention. Community champions can be key connectors in communities but these roles do not operate in isolation and need to be embedded in effective community engagement strategies. As public health interventions, community champion approaches can be applied flexibly dependent on local needs and community assets. This review identifies different models and ways of building champion programmes