Community interventions for improving adult mental health: mapping local policy and practice in England

Exploring the Operational Status and Challenges of Community-Based Mental Healthcare Centers in Taiwan: A Qualitative Analysis of Healthcare Professionals' Insights

Psychological disorders have become more prevalent in the presence of modernization and societal changes. Community-based mental health is important in healthcare. Taiwan has passed the Mental Health Act, and county governments have established community-based mental healthcare centers. This study aimed to fill the research gap regarding the operational status of these centers. A qualitative study design using semi-structured interviews was used to obtain data from a purposive sample. Seventeen healthcare professionals who were front-line workers of a community-based mental healthcare center in Taiwan were interviewed individually. This study uses the organizational analysis structure as the research base. The data were analyzed using qualitative content analysis. The theme-"operational status and difficulties"-and two categories with twelve subcategories emerged. The findings demonstrate (1) unclear objectives and imprecisely defined roles, (2) incomplete services provided, an overly defined area, and ineffectiveness, (3) the central government lacking clear objectives and operational strategies, (4) the public being ignorant of mental diseases and the operation of the centers, and (5) the lack of local resources for mental and social welfare. The government should immediately form clear policies to improve community-based mental healthcare, clarify the structure and models, increase resources for the centers, and provide direct services.

How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation

BACKGROUND

Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities.

METHODS

A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates.

RESULTS

Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources.

CONCLUSION

Co-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.

Kailo: a systemic approach to addressing the social determinants of young people's mental health and wellbeing at the local level

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

Policies on mental health in the workplace during the COVID-19 pandemic: A scoping review

Background

The COVID-19 pandemic has had a profound impact on both mental health and working conditions. Workplaces are conducive spaces for implementing strategies and interventions to promote mental health. In addition to this, they are preventing, identifying, and managing mental disorders effectively. Although international agencies have identified some guidelines for the management of mental health in the workplace in the context of the COVID-19 pandemic, a more precise characterization of both the components of the policies, their implementation, and evidence of the outcome is required to provide useful information for decision-makers.

Objectives

This study aims to synthesize scientific information regarding national and local policies focusing on preventing or improving, directly or indirectly, mental health problems in the workplace during COVID-19 pandemic.

Methods

Our study is a scoping review. The Scopus, Web of Science, and Embase databases and PubMed search engine were used. Original and reviewed articles published from January 1, 2020 to October 14, 2021 were included in the research. Articles with abstract or full text in English, Spanish, German and Portuguese were also included. Our strategy is based on identifying policies (intervention) which focuses on directly or indirectly preventing or ameliorating mental health problems in the workplace during COVID-19 pandemic (participants).

Results

A total of 6,522 records were identified, and only four studies were included in the scoping review, which were of low quality. That is, we found limited evidence evaluating mental health policies using primary or secondary data (empirical evaluation). Among the policies that have been identified are the increase of mental health resources, the promotion of mental health and self-care support programs, and the reduction of barriers to access to mental health treatment.

Conclusion

Our research finds that there is limited evidence available to evaluate national and local policies aimed at directly or indirectly preventing or ameliorating mental health problems at work during COVID-19 pandemic. This forces decision-makers to use different criteria to guide the allocation of resources and budgets. Therefore, there is a need for health intelligence teams in health systems to be able to assess the impact of policies as an important input for decision-makers.