Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK.
Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK.
BMC Public Health. 2021 Sep 16;21(1):1691. doi: 10.1186/s12889-021-11741-5.
Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention.
We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers' insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020.
407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated.
There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.
公共精神健康（PMH）旨在提高人口的幸福感并预防不良精神健康。这是一个全球性的挑战，也是英国行动的优先领域。社区在提供 PMH 干预措施方面发挥着重要作用。然而，关于基于社区的 PMH 干预措施的证据基础有限，这意味着难以将服务提供与需求进行比较。没有这种比较，就会阻碍服务的高效和公平提供。在这里，我们试图绘制目前在英格兰提供的改善精神健康和幸福感的各种基于社区的干预措施图，为政策和服务干预的优先领域提供信息。
我们采用了一种既定的映射练习方法，将服务提供情况与人口统计学和贫困统计数据进行比较。根据人口统计学、精神健康需求和更广泛的挑战性情况（即高贫困），选择了英格兰的五个地方当局地区。通过以下方式确定基于社区的干预措施：1）基于桌面的研究；2）建立专业网络；3）参与当地精神健康促进和预防的个人的连锁转介抽样；4）同行研究人员的洞察力。我们包括了所有在 2019 年 7 月至 2020 年 5 月期间运营的、针对成年居民的、非临床的、基于社区的干预措施。
在五个地区共确定了 407 项干预措施，针对 16 种 PMH 的风险/保护因素。针对社会孤立和孤独的干预措施最为普遍，最常见的是通过社交活动和/或交友服务。最常见的目标亚人群是老年人和少数族裔背景的人。针对更广泛的结构和环境决定因素的干预措施并不常见。有一些证据表明服务提供是针对当地需求定制的，但这种情况并不一致，这意味着一些处于危险中的群体，如男性或少数族裔背景的 LGBTQ+人士，被忽视了。干预措施并未得到一致评估。
有证据表明对国家和地方优先事项的部分响应。提供的服务主要针对 PMH 的社会和个人决定因素，这表明需要更广泛的整合，以使更广泛的服务提供者和决策者参与社区一级的 PMH 战略和实施。急需解决改善 PMH 服务的全面评估问题，以确定其在服务社区中的有效性程度。
