What works?

[link] Webinar 2: Serious about wellbeing: what works?

There is a growing evidence base on effective interventions to improve mental health and wellbeing, to prevent mental health problems and to improve recovery in people experiencing mental health problems. The efforts of health and wellbeing boards (HWBs) to strengthen action on the social determinants of health will contribute centrally to improving population wellbeing and reducing inequalities in mental health and wellbeing.

Because action on wellbeing is often focussed on individual level interventions, it's important that Health and Wellbeing Strategies reflect a more comprehensive approach:

DIAGRAM

Source: [link] Friedli 2011 Serious about wellbeing Webinar 2

Effective approaches

Trends in effectiveness include the following:

  • Meaningful opportunities for individuals, families and communities to influence, participate in and contribute their expertise to ‘what works' to support wellbeing
  • Greater emphasis on promotion, prevention and early intervention
  • Life course approaches with a focus on points of transition e.g. starting school, moving to secondary school, starting work, first child, redundancy, retirement
  • Social context i.e. whole life, whole family, whole community
  • Total place i.e. targeting at a very local level (lower Super Output Area c. 1500 population) to address the clustering of poor outcomes in areas of deprivation
  • Commissioning for social value/social return e.g. how can each £1 spent on delivery also produce wider community wellbeing?

Needs assessment; asset mapping

Improving mental wellbeing should form part of Joint Strategic Needs Assessment (JSNA)
Joint Strategic Needs Assessment

and can also be included in Joint Strategic Assets Assessment, where these are being developed.
JSAA

Resources such as A fair deal for wellbeing can be used to increase understanding of the underlying factors associated with wellbeing and to identify clear links between determinants of wellbeing and planned interventions.

Fair Deal for Wellbeing Discussion Kit

Effective (and cost effective) interventions

Many examples of effective interventions, e.g. the effectiveness of parenting skills training, promoting wellbeing in the workplace, school based interventions to prevent bullying, screening for alcohol abuse in primary care, debt services and befriending for older adults are included in the cost effectiveness literature.
[link] Mental health promotion and mental illness prevention: the economic case

‘Best buys' across a locality could aim to include a balanced range of interventions that target and support wellbeing at different levels. In each case, interventions should reflect the evidence on the social determinants of health: the impact of poverty, deprivation and inequality

  • Supporting family life: health visiting; parenting; home learning environment; reading
  • Supporting lifelong learning: health promoting schools; social and emotional learning; reading recovery; continuing/adult education
  • Improving work: training; employment; workplace mental health promotion
  • Health and welfare: screening; brief interventions (diet, exercise, sensible drinking); social support; social prescribing; debt advice; befriending for older adults
  • Supporting communities: environmental improvements: green space, ‘stop and chat' public space; sporting and cultural activities

Economic case for investment 2009
Workplace wellbeing charter

Economic modelling for wellbeing: social space

Economic modelling has been used to show the economic impact of community capacity-building, compared to what would have happened in the absence of such programmes. Economic modelling seeks to:

‘mimic the pathways that people might follow, whether through services or through ‘life events' (such as getting a job), or in terms of changes in their wellbeing - and costs and outcomes associated with them' (Knapp et al 2010).

Building community capacity: making an economic case

Economic modelling shows that programmes like community navigators, referral to debt or benefits advice, befriending and time banks have shown good levels of cost effectiveness, based on a range of indicators e.g. reduced GP visits, improved mental wellbeing, quality of life and employment. The benefits of a debt problem becoming ‘manageable' following support are estimated at about £900 per person, per year, with Timebanks producing a return of around £3:1. Both alleviating social isolation and loneliness and preventing or reducing depression can increase independence, reduce health service use, notably by older people and lead to substantial savings.

There is robust evidence for the contribution of social support and social integration to health. The magnitude of these factors is comparable with quitting smoking and exceeds many other risk factors for mortality (e.g., obesity, physical inactivity and alcohol).

Social relationships and mortality risk

There is a growing case for weighing up the effectiveness (and cost benefits) of ‘single outcome' interventions like smoking cessation, in comparison with social approaches that by improving wellbeing, may influence a broader range of health outcomes

Wellness Services - Evidence based review

Other outcomes might include generating additional resources from within a community (e.g. community members taking on the organisation of a project or activity) and making better use of the totality of resources within a community to meet needs, as well as offering people a wider range of options for coping with and overcoming problems.

Social prescribing for mental health

Resilient relationships in the North West: what can the public sector contribute

Economic and social benefits: green space

Populations exposed to the greenest environments (parks, woodlands, open spaces) also have the lowest levels of income-related inequality in health (Mitchell and Popham 2008). The health gap was roughly halved compared with those with fewest green spaces. Possible mechanisms include physical activity, stress buffering and the direct relationship between contact with nature and reduced blood pressure.

Green space reduces income related health inequalities

Mental health and wellbeing benefits of contact with nature

  • Quality of life and relaxation
  • Recovery from stress
  • Relief of symptoms
  • Therapeutic and healing; spiritual
  • Physical activity, sport, adventure and challenge
  • Learning, intellectual and creative development
  • Sense of meaning/purpose/perspective
  • Social contact, cohesion, belonging and identity

Liverpool City Green Infrastructure Strategy

Greenspace and Quality of Life: A Literature Review 2008

Be inspired by

Creative approaches to promoting wellbeing using museums, football clubs, libraries, ‘parish plans', tourist information centres (Brighton & Hove, Lincolnshire, Shropshire)
Local authority case studies: culture and sport

Increasing financial capability - credit unions, debt advice, using trading standards powers
Local authority case studies: financial capability

Neighbourhoods - Back to Front in Leeds
Generating a whole new approach to food production - using front gardens

Local authority case studies: neighbourhoods and housing

What works? Everything you ever needed to know....

Promoting mental health and preventing mental illness

Five ways to wellbeing

Five ways to wellbeing is a framework for improving wellbeing based on five actions:

  • Connect
  • Be active
  • Take notice
  • Keep learning
  • Give

Originally designed to provide pathways for individuals to improve their own wellbeing, 5 ways has also been used as an organising framework for promoting wellbeing at different levels and to raise questions about ‘what needs to be in place' to enable people to ‘connect', ‘be active' ‘keep learning' etc. An inequalities perspective might include discussions about who does and does not ‘give' or contribute in our society and how ‘take notice' might apply to being aware of poverty and issues of social injustice.

Five Ways to Wellbeing

Be inspired by

Five to strive

1 January 2012

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