Helping people to reconnect: positive projects for people with dementia

This Photo is licensed under CC BY Via Microsoft Word images

Every three minutes, someone in the UK develops dementia. Over 850,00 people in the UK are currently living with a form of the disease; 40,000 of these are people under the age of 65.  This week (20th– 26th May is Dementia Action Week 2019. This year the focus is on encouraging people to talk about dementia, and to talk to people with dementia in order to help tackle loneliness and isolation among those who suffer from the condition, as well as to raise awareness and improve understanding around the condition and the impact it can have.

The power of music

You may have recently come across the BBC programme featuring Line of Duty’s Vicky McClure Our Dementia Choir (if you haven’t you should try and find a copy).  The documentary follows a group of people who suffer from varying degrees and types of dementia and highlights in sometimes painfully sad detail the changes and challenges that can occur when someone develops the disease. However, it also shows the great joy and relief that music brings to dementia sufferers and their families. We blogged a few years ago about the benefits of music therapy in dementia care – and since then the literature and research on its usage in different settings has only grown.

Research shows that music, in various forms can help encourage participation and trigger positive associations which can be really helpful for people suffering from dementia, particularly if they feel like a lot of other things may have changed. In our previous blog we highlighted a Care Inspectorate backed scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

Tackling isolation with art, culture and the natural environment

Research has shown that it is not only music that can have a positive impact on quality of life for people with dementia. Painting and drawing, making use of the natural surroundings by encouraging gardening or light walking in safe spaces, and games like dominoes and draughts can all help in their own way to improve the quality of life for people living with dementia and provide an opportunity for loved ones to re-connect.

In a 2014 study researchers examined the experiences of people with dementia and their carers when they participated in an 8 week programme based in an art gallery designed specifically to tackle social isolation and improve quality of life for both the person suffering from dementia and their carer. The study found that while the impact in terms of qualitative measures was negligible, participants were unanimous in their enjoyment and satisfaction with the programme. They highlighted that the interventions at the galleries helped to foster social inclusion and social engagement, enhance the caring relationship between the carers and people with dementia, and stimulate cognitive processes of attention and concentration. In a similar study, looking at the impact of art and gallery settings and programmes delivered within these settings, similarly positive emotional effects on study participants were found.

In Liverpool, they are making the most of their city landscape and the fact that specific locations, building and objects around the city can act as positive triggers for people who suffer from dementia, stimulating memory and interest. Those individuals who are mobile enough can participate in “memory walks” (different from the Memory Walks convened by the Alzheimer’s Society, which are sponsored walks designed to help raise money and offer a public show of support for people with the illness). This not only helps to improve physical activity, it can also be an opportunity for people with dementia to connect with other people as the walks are usually carried out in small groups, they are also linked to befriending schemes across the city to help reduce social isolation among multiple groups.

Similarly, many care homes now also promote interaction with nature and outside spaces for residents with dementia, with many developing specifically landscaped “sensory” gardens for residents, while other innovative supported living accommodation projects have gone a step further and created entire villages on site, which allows residents to perform tasks such as shopping or visiting a hairdresser. (This project is based in the Netherlands, but there are suggestions that a similar scheme could also come to the UK in 2020.)

VR and creating virtual experiences for people

Using digital technologies has also become increasingly popular, particularly in care homes. Apps and VR headsets which allow people to be immersed in an experience they perhaps once enjoyed, such as flying (if for example they had previously been a pilot or air crew) or driving have been shown to have a significant positive impact on people’s wellbeing allowing them to reconnect with their past and memories and freeing them from the sense of being trapped and losing their independence which can sometimes come with moving away from home into supported accommodation.

Tablet computers and touchscreen technology can also sometimes be easier for people with dementia to use as they do not require the same level of dexterity as writing. Apps have been developed which can help with word association or use pictures which can be helpful in allowing people with dementia to communicate when their use of language becomes more of a challenge. While the technology its self is relatively new, research has shown definite scope and benefit of further development of this in the future, as well as relevant training for staff and carers on digital literacy to help support users.

A support to clinical interventions

Dementia is a cruel illness – 1 in 3 of us in the UK will develop a form of the condition at some point in our lives. As yet there is no cure and as the population ages, and life expectancy improves more generally, the number of cases is expected to rise dramatically in the coming years. However, where science is trying to cure, art and culture is trying to supplement and support the clinical interventions and, where possible, provide opportunities to improve the quality of life for people suffering with the condition and provide opportunities for people to re-connect with loved ones.

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Museums as facilitators of health and wellbeing in communities

GNM Hancock, Newcastle

Great North Museum Hanckock, Copyright Rebecca Jackson

It’s estimated that there are over 2500 museums in the UK, ranging from world-famous collections in major cities to small local ones on niche themes. Over 50% of adults have visited a museum or gallery in the last year and there were an estimated 7.5 million visits by children and young people under the age of 18 to the major museums in England.

As well as their educational and leisure value, and their role as drivers of the tourism economy, there is a growing body of research which is considering the wider societal role of museums and in particular, their potential positive impact on health and wellbeing.

Museums and the rise of social prescribing

Within health and social care, we have seen increasing recognition and interest in the role of psycho-social and socio-economic determinants on health and wellbeing. Treatments now often look at the whole person and their lifestyle, not just at the specific medical condition to be treated. This awareness of the impact of lifestyle has led us to view spaces like museums and theatres in a new way and consider how they can be used as a tool to help people to live well.

March 14th was social prescribing day in the UK. And Museums on Prescription is one of a number of culture-led projects which encourage people to use assets in their local communities such as museums, galleries and theatres to help manage conditions linked to depression and social isolation, in combination with traditional clinical medicine.

Arts-for-health settings can have an impact across a number of different areas, including supporting children who have been exposed to trauma and abuse, helping communities integrate and improve social cohesion through the co-production of exhibitions, and helping support people with mental or cognitive illnesses, as well as those who suffer from dementia and Alzheimer’s.

V&A Dundee

V&A Dundee, Copyright Rebecca Jackson

Helping people feel better

As the number of projects increase so does the evidence of positive benefits. There is a growing body of literature highlighting examples of how cultural experiences are supporting both physical and mental health.

A report from Art Fund looking at the calming impact of museums and galleries found that 63% of people surveyed have (at some point) used a visit to a museum or gallery to ‘de-stress’, however, only 6% visit a museum or gallery regularly (at least once a month). Over two thirds of survey respondents (67%) agreed that taking time out for ourselves and choosing to pursue a leisure activity is good for our personal wellbeing and this is where museums and galleries, along with a whole host of other providers like theatres, music venues, public gardens and parks can step in.

Funding is a challenge

A report (2018) from the English Civic Museums Network highlights that services often deemed  “non-essential” (like museums and libraries) actually encourage and foster personal and communal resilience: they stop the crime, the illness, the loneliness from happening in the first place.

However, despite the significant and positive preventative role that participation in cultural activities can play, over the past five years spending on culture in England and Wales has fallen by over 30%, and this has had an impact on museums and the services they can provide.

Natural History Museum, London

Natural History Museum, London, Copyright Rebecca Jackson

Galleries and museums must keep striving to do more

The growing realisation of the potential of museums and galleries to have a positive impact on the health and wellbeing of communities presents a significant opportunity for them to develop programmes and exhibitions which reflect the diversity of experiences within communities and look to develop new ways to engage new audiences. Ensuring that people feel represented and that exhibitions appeal to a broad base of the community is also important in making sure people feel they are able to visit exhibitions and can feel the benefits of doing so.

In their 2015 report, the National Alliance for Museums, Health and Wellbeing, led by UCL, outlined the priorities of the alliance and showcased some examples of the work being done by partner organisations. In February 2019 it was announced that some schools in London are planning to give pupils “theatre vouchers” which entitles them to one free theatre visit per year. Museums themselves are also trying to do more to help engage members of the community and encourage them to engage with new exhibitions.

Are healthy people more culturally active, or does being culturally active make people healthier?

Museums and galleries have the potential to make an enormous contribution to improving people’s lives and enhancing physical health and mental wellbeing. The body of research around the role cultural activities like attending museums can have on health and wellbeing is growing, but there is still scope to do more, and work is ongoing with a number of high profile museums across the UK to promote the link between cultural activities and health and wellbeing.

The question of which comes first – being well initially which allows you be more culturally active, or cultural activities facilitating wellbeing in their own right – will be discussed and disputed by academics and clinicians. But the existing studies highlight the significant positive impact that engaging with museums and exhibitions has had on study participants, particularly those who suffer from mental ill health or degenerative cognitive diseases like dementia.

Museums and galleries, it is clear, have a far greater communal role to play and can evidence their value far beyond being a source of knowledge transfer or a leisure activity. Museum curators and funders need to recognise this as they prepare and plan for exhibitions and outreach projects in the future and clinicians need to be aware of the potential positive impacts for patients when considering care and treatment plans.


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This April get free access to the Social Policy and Practice database!

Social Policy and Practice is a database supporting the smarter use of evidence and research within the UK. The key strengths of the database lie in the area of health and social care – it’s not a medical database, but instead examines social issues such as health inequalities, care of the elderly, children and family social work, and community health.

Social Policy and Practice is exclusively available via Ovid – the internationally-recognised leader in information services – and this April they are offering librarians, academics and researchers the chance to trial it for free!

UK-focused evidence and research

Social Policy and Practice is produced by a consortium of key organisations within the UK:

  • Centre for Policy on Ageing – Originally established in 1947 by the Nuffield Foundation, the Centre has a long and distinguished record as an independent charity promoting the interests of older people through research, policy analysis and information sharing.
  • Idox Information Service – Set up 45 years ago to support the use of research within local government, it now works with government and the private sector to increase understanding of public policy issues.
  • National Society for the Prevention of Cruelty to Children – The UK’s leading children’s charity, campaigning and working in child protection in the United Kingdom and the Channel Islands.
  • Social Care Institute for Excellence – A leading improvement support agency and independent charity working with organisations that support adults, families and children across the UK, by supporting the use of the best available knowledge and evidence about what works in practice.

A valued resource

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Social Policy and Practice was also identified by the Alliance for Useful Evidence in a major mapping exercise in 2015, as a key resource supporting evidence use in government and the public sector.

Unrivalled scope

Social Policy and Practice covers all aspects of public health and social care. It is a must-have resource for anyone interested in the following topic areas:

  • Social work and social care services
  • Children and young people
  • Adults and older people
  • Families and parenting
  • Safeguarding
  • Health promotion
  • Health inequalities
  • Community development
  • Physical and mental health
  • Education and special educational needs

It also offers a holistic view of wider policy areas that impact on health, such as homelessness and deprivation.

The database brings together research and evidence that is relevant to researchers and practitioners in the UK. A large proportion of material relates to delivery and policy within the UK and the devolved nations of Scotland, Wales and Northern Ireland, but the database also covers material that is transferable from Europe and across the world.

Social Policy and Practice boasts over 400,000 references to papers, books and reports and about 30% of the total content is hard-to-find grey literature.

The importance of geographical focus

Research studies have shown that people searching for social science evidence tend to neglect the question of geographical and coverage bias within research sources. And that the geographical focus of databases is a potential source of bias on the findings of a research review.

In the last ten years many UK-produced databases have ceased – funding has stopped, publishers have closed or databases have been taken over by international publishers (which reduces the balance of UK content and the use of UK-relevant keywords).

So as a UK-produced database, Social Policy and Practice is uniquely placed to provide relevant results for UK-based researchers.


To see for yourself why so many UK universities and NHS bodies rely on Social Policy and Practice as a resource, visit Ovid Resource of the Month for instant access.

To find out more about the history of the database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share.

Banning fast food outlets near schools: have takeaways had their chips?

A number of organisations – including the Academy of Medical Royal Colleges, Public Health England and the Royal College of Paediatrics and Child Health – have called for the creation of ‘fast food exclusion zones’ – banning fast food outlets from opening within 400m of schools and other places where children congregate.

In this blog post, we consider the arguments in favour of restricting the growth of such fast food outlets near to schools, and whether the evidence supports this.

More children becoming obese, earlier and for longer

The UK is now ranked among the worst in Western Europe for childhood obesity. Not only are more young people overweight or obese, they are also becoming obese at earlier ages and staying obese for longer.

Indeed, recent statistics show that nearly a quarter of children in England are obese or overweight by the time they start primary school aged five, rising to one third by the time they leave aged 11.

Increased risk of social, psychological and long-term health problems

In addition to the social and psychological problems associated with obesity, obese children are at a greater risk of developing serious diseases, including coronary artery disease, high blood pressure and type 2 diabetes.  They are also 20% more likely to develop cancer as adults than those of a healthy weight.

There is also a financial incentive for addressing obesity in both adults and children – recent estimates suggest that obesity-related conditions cost the NHS around £6.1 billion per year.  The total estimated cost to society is even greater – at least £27 billion per year.

Indeed, the annual spend on the treatment of obesity and diabetes is greater than the amount spent on the police, the fire service and the judicial system combined.

Deprived areas have greater levels of both obesity and fast food outlets

There are also strong reasons to address obesity from an equalities angle.

Recent data compiled by Public Health England shows that there is a strong association between area level deprivation and the density of fast food outlets.  Some areas, such as Blackpool, and parts of Manchester and Liverpool, have up to five times more fast food outlets than more affluent areas.

The evidence is generally clear that deprivation is associated with higher levels of overweight and obesity, and lower levels of vegetable consumption.

The evidence suggests that the food environment does influence food choice

During the past 10 years in the UK, there has been a significant increase in the number of fast food outlets, and the consumption of food away from the home has increased by 29%.

Researchers and policymakers have sought to understand whether unhealthy food environments – such as those with a high density of fast food takeaways – may encourage unhealthy food choices, and thus contribute to obesity.

Last year, the Scottish Government published a research paper on the link between the food environment and the planning system.

In relation to the link between the food environment and obesity in general, the report concludes that while the evidence is mixed, “overall the evidence would suggest that increased exposure to outlets selling unhealthy food increases a person’s likelihood of gaining weight”.

In relation to the effect of the food environment around schools on children and young people specifically, the evidence is less clear cut – with some research showing a link to obesity while other research does not.

Interestingly, there was evidence that access to outlets selling healthy food decreased the odds of being overweight or obese.

Research by Brent Council, involving seven secondary schools – four of which were within 400m of a fast food outlet – found that 27% of students said they would not bother going out at lunch if they had to walk more than 8 minutes.

It does seem like common sense – make fast food less readily obtainable and children will be less likely to consume it.

Prof Russell Viner, of the Royal College of Paediatrics and Child Health, has said “This food is tasty and cheap – it’s easy to blame the individual, but humans, particularly children, will find it hard to resist tempting food.”

England already making progress, Scotland likely to follow

In England, the National Planning Practice Guidance (PPG) outlines the role that planning can have in reducing obesity by limiting over-concentration of fast food takeaways, particularly around schools.  It also encourages planning authorities to limit takeaways in areas with high levels of obesity, deprivation and general poor health, and in areas with over-concentration and clustering of outlets within a specified area.

Similarly, the Child Obesity Strategy commits to developing resources to support local authorities who want to use their planning powers to restrict fast food takeaways, and providing up to date guidance and training for planning inspectors on the creation of healthy food environments.

A number of councils have already implemented 400m exclusion zones.  Some notable examples include St Helen’s Council, Sandwell Council, Dudley Council, and Milton Keynes.

Sadiq Khan has included proposals for a 400m exclusion zone around schools in the new Draft London Plan, and plans to limit the number of fast food takeaways near schools in Luton were approved in 2018.

At present, there are no powers to restrict fast food outlets on health grounds in Scotland – however, it is likely that this will change in the near future.

As well as the aforementioned research project, last year, the Scottish Government published the consultation, ‘A Healthier Future’, which commits to exploring the opportunity for the planning system to contribute to an improved food environment:

We will research precedent, evidence and good practice on the relationship between the planning system and food environment, including exploring how food outlets in the vicinity of schools can be better controlled, with a view to informing the review of Scottish Planning Policy”.

In the December 2018 issue of Scottish Planning and Environmental Law (SPEL), Neil Collar of Brodies LLP concludes that:

Taking account of Action 2.12 in ‘A Healthier Future’ and the research project, it seems likely that the draft National Planning Framework, expected to be published by the Scottish Government in 2019, will contain policies to control hot food takeaways and the food environment around schools. An evidence base to justify controls in local areas will be important”.

Creating a robust evidence base is crucial

Children have a right to grow up in an environment that supports them to attain the highest possible standard of health – and the planning system has a key role to play in facilitating this.

Of course, the planning system cannot address obesity on its own, and the causes of obesity are far wider and more complex than just the food environment.

Other approaches are also being put in place – including supporting food outlets to provide smaller portions and healthier options – some of which have been very successful already.

The creation of a robust evidence base upon which to make informed decisions regarding the location of fast food takeaways and the creation of healthy environments is essential.

There are already a number of useful datasets available for local authorities to use, including the Food environment assessment tool (Feat) and guidance on the creation of healthy food environments.

As more local authorities make use of their powers to restrict fast food outlets, it will be interesting to see whether more evidence emerges of the link between fast food and childhood obesity. We at the Information Service will, of course, be watching this with interest.


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Treating violence as a disease: can a public health approach succeed?

Knife crime, especially deaths of young people, has been making the headlines in recent weeks. And an approach which has a proven track record in Glasgow is now being adopted by the GLA, MOPAC and the Met police to try to tackle the growing levels of violence being seen on London’s streets. Learning from the experience in Glasgow, the police and other agencies are being encouraged to see violence as a public health issue, related to poverty, wellbeing and social deprivation and which, if identified and tackled early, can be prevented.

Contagion: a new way to think about violence

The Violence Reduction Unit was pioneered by Strathclyde Police (now part of Police Scotland), working with health and social care practitioners. Launched in 2005, the approach aims to make earlier identifications of those at risk of becoming involved in violence, and to take a more holistic view of the reasons for violence of all types. The long-term strategy looked at more social and wellbeing interventions to tackle gang violence in Glasgow, which at the time was among the worst in Europe.

The VRU in Glasgow took its inspiration from a scheme in Chicago, which sought to use a World Health Organisation (WHO) approach to tackling the spread of disease but applied it to communities in the hope of curbing the significant rise in homicides in the city. The approach was three-pronged: interrupt transmission, prevent future spread, and change group norms.

In addition to changing the approach to tackling violent crime, the VRU also used a multi-agency approach, involving social services, health care, housing and employment support, to give people a route out of violence and opportunities to find work or training opportunities. One of the key elements to ensuring the VRU is successful are the relationships these people build with individuals in communities.

Identifying young people at risk

Another important aspect of the VRU strategy is to intervene early to identify children and young people who are at risk of joining gangs or becoming involved in gang violence. Research supporting the creation of the VRU suggested that violence (like a cold) is spread from person to person within a community, that violence typically leads to more violence, and that one of the key identifying factors in someone becoming a perpetrator of violent crime is first being the victim of violent crime themselves.

In order to prevent this, staff from the VRU regularly go into schools and are in touch with youth organisations. They also provide key liaison individuals called “navigators” and provide additional training to people in the community, such as dentists, vets and hairdressers to help them spot and report signs of abuse or violence.

There is also a broad view of what a culture of violence is. Work in schools focuses strongly on contemporary issues such as sexting, bullying and gender-based violence. It challenges the attitudes and beliefs that underpin such violence, and encourages young people to recognise and reject these.

A new approach to drug abuse too …?

In November 2018, the Scottish Government launched its new drug and alcohol strategy. One of the notable additions to the strategy was the acknowledgement that (like violence) drug abuse and addiction should be seen, not as a crime, but as a public health issue – an illness which people need support and treatment for.

Looking at how drug abuse is tackled within the criminal justice system and the interactions of addicts, policymakers have identified that many have had adverse childhood experiences, are exposed to drugs and/or alcohol at a young age, and are also at significant risk of being unemployed and homeless.

Creating a holistic package of support which seeks to identify those at risk and directs them towards a range of services to tackle not just the addiction but other trauma or socioeconomic barriers earlier, will, in a similar way to the VRU, give people a sense of purpose and value, and help them to see an alternate route that will allow them to contribute positively to society and improve their own outcomes.

A new way to tackle social issues in the UK?

Tackling the spread of violence through communities is not an easy task, nor is breaking the cycle of crime that many find themselves trapped within, often as a result of family allegiances or geographic location. It is often the case that either you participate, or you become the next victim yourself. More and more young people are feeling the need to carry knives for protection, due to the high levels of fear of becoming a victim.

Identifying those young people who are at risk of turning towards a life of violence at the earliest possible stage is difficult, but has been shown to be effective in helping to tackle violent gang-related crime. Although it is not the only tactic available to police, used effectively in conjunction with other outreach programmes it can be an effective tool in preventative policing, helping to keep communities safe.

The outcome in Glasgow has been largely positive, following the roll out of the Violence Reduction Unit programme. Whether this approach has the same success in London, operating on a larger scale, with different economic and social variables, and in a very different budget climate, remains to be seen. In particular it is worth noting that the Glasgow approach recognised there were no quick fixes, and was based on long-term planning covering ten year periods.

It is to be hoped, though, that changing the way we think about violence within communities may offer a route to tackling it.


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Zoning in on air pollution: low emission zones to tackle our dangerously dirty air

Image by Mike Malone

At the start of this year, the World Health Organisation (WHO) announced that air pollution posed the greatest threat to global environmental health in 2019. The UN’s public health agency estimates that nine out of ten people worldwide breathe polluted air every day.

Most of the pollutants in our air today come from traffic. Nitrogen dioxide and microscopically small particles emitted by motor vehicles can penetrate respiratory and circulatory systems, heightening the risks of heart attacks, lung cancer and respiratory conditions.

In the UK, poor air quality is estimated to cause the early deaths of 40-50,000 people each year, while in London 9,500 are believed to have died prematurely in 2010 due to air pollution.

The road to cleaner air

Across Europe, national and local authorities have been responding to the health risks posed by air pollution with measures to tackle emissions from vehicles. Many have introduced low emission zones (also known as clean air zones). These regulate vehicles with higher emissions, banning the most polluting vehicles from entering the zone and requiring them to pay a fee if they enter the area.

In various countries, low emission zones have different rules according to the type of vehicle and whether it meets EU emissions standards. In Germany, for example, there is a national framework of low emission zones affecting all motor vehicles except motorcycles. In Denmark, a similar framework applies to all diesel-powered vehicles above 3.5 tonnes. In Paris, all vehicles entering the low emission zone are required to display a sticker according to their emissions standards. The most heavily polluting vehicles are not allowed in. In addition, any vehicle can be refused entrance to the city centre in response to high levels of pollution on a given day.

A growing number of UK cities, such as Leeds and Birmingham have been working on the introduction of low emission zones, and some have already been implemented in Norwich, Oxford and Brighton.

In Scotland, the Scottish Government plans to create low emissions zones in the country’s four biggest cities by 2020, and the first of these is now up and running in Glasgow. The first phase was launched in January, targeting buses, which are among the most polluting vehicles. Glasgow’s biggest bus operator, First Bus, has purchased 75 new buses fitted with low emissions systems complying with the EU’s Euro VI standards. The scheme will be extended to other vehicles in stages.

London’s LEZ and ULEZ

Since 2003, when the congestion charge was launched, London has taken the lead with measures to tackle what Mayor of London Sadiq Khan calls the city’s “filthy, toxic air”.

In 2008, London created a low emission zone, and in 2017 a Toxicity Charge (T-Charge) introduced a surcharge for the most polluting vehicles entering central London. But levels of pollution in the capital remain stubbornly high, and so new measures have now been developed.

From 8 April 2019, an Ultra Low Emission Zone (ULEZ) will be in place in London, imposing tighter exhaust emission standards. The ULEZ will cost £12.50 for diesel cars manufactured before 2015, as well as most pre-2006 petrol cars cars, motorcycles and vans up to 3.5 tonnes. Vehicles over 3.5 tonnes will have to pay £100 to enter central London. These charges are on top of the £11.50 congestion charge. Failure to pay the ULEZ will result in fines of £160 upwards.

By 2021, the ULEZ will be extended to the north and south circular roads, taking in more London boroughs, including Brent, Camden, Newham, Haringey and Greenwich. By that time, it’s expected that 100,000 cars, 35,000 vans and 3,000 lorries will be affected per day.

There have been mixed responses to the incoming ULEZ. Health organisations such as the British Heart Foundation and the British Lung Foundation, have welcomed the measure, and environmental bodies also see the ULEZ as a step in the right direction. Sustrans, the sustainable transport organisation, commended the Mayor for “showing welcome leadership on tackling toxic air pollution.” Friends of the Earth welcomed the expansion of the ULEZ as “a promising step towards clean air in the city centre”, and called for further moves to protect the health of people living in Greater London.

However, motoring organisations voiced their concerns about the new zone. The RAC has argued that expansion of the ULEZ into residential areas will hit those on low income backgrounds hardest:

“…many now face the daunting challenge of having to spend substantial amounts of money on a newer vehicle or face a daily charge of £12.50 to use their vehicles from October 2021.”

The Road Haulage Association has voiced its opposition to the early application of the ULEZ to Heavy Goods Vehicles, claiming that the measure will have limited impact on improving health and air quality in central London.

Final thoughts

Striking a balance between environmental, health and economic pressures was always going to be a challenge. Even in London, which has led the way in tackling poor air quality, longstanding policies aimed at reducing air pollution have failed to bring it below legal levels. The new ULEZ may go some way to doing that, but it might also antagonise drivers faced with ever-rising costs. Cities on the journey to cleaner air are in for a bumpy ride.


Further reading on tackling air pollution

“For many children we are the first point of contact”: supporting children’s mental health in schools

A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.


If you liked this article, you may also be interested in reading:

Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

Follow us on Twitter to find out which topics are interesting our research team

Reeling in the year: a look back at 2018

It’s been another busy year for The Knowledge Exchange Blog. We’ve covered a variety of subjects, from housing and the environment to education and planning. So as the year draws to a close, now’s a good time to reflect on some of the subjects we’ve been blogging about during 2018.

Bibliotheraphy, walkability and family learning

We started the year with health and wellbeing in mind. Our first blog post of 2018 highlighted the increasing application of “bibliotherapy”:

“The Reading Agency’s Books on Prescription scheme has been running nationally in England since 2013 and since it started has been expanded to cover Books on Prescription for common mental health conditions, Books on Prescription for dementia, Reading Well for young people and Reading Well for long term conditions. 635,000 people are estimated to have benefited from the schemes.”

In February, we blogged about family learning, where parents engage in learning activities with their children. This can involve organised programmes such as Booksmart, but activities such as reading to children or singing with them can also be described as family learning:

Research from the National Literacy Trust, suggests that “parental involvement in their child’s reading has been found to be the most important determinant of language and emergent literacy”.

In recent years, growing numbers of cities and towns have introduced “shared spaces”, where pedestrians, cyclists and drivers share the same, deregulated space. As we reported in March, the practice has proved divisive, with supporters claiming that shared spaces can improve the urban environment, revitalise town centres, and reduce congestion, while opponents believe that shared space schemes – particularly the removal of kerbs and crossings – are dangerous and exclusionary for vulnerable groups of pedestrians, people with disabilities and those with reduced mobility.

In April, we took the opportunity to promote the Idox Information Service, highlighting a selection of the hundreds of items added to our database since the beginning of 2018. All members of the Idox Information Service have access to the Idox database, which contains thousands of reports and journal articles on public and social policy.

Voters, apprentices and city trees

Local elections in May prompted us to blog about the voting rights of those with age related degenerative mental conditions such as dementia and Alzheimer’s.

“Many people with dementia still hold strong political feelings, and know their own opinion when it comes to voting for political parties or in a referendum. However, the process of voting can often present them with specific challenges. It is up to local authority teams and their election partners to make the process as transparent and easy for people with dementia and Alzheimer’s as possible. Specific challenges include not spoiling the ballot, and the ability to write/ see the ballot paper and process the information quickly enough.”

A year after the launch of the government’s Apprenticeship Levy in June, we highlighted a report from the Reform think tank which suggested that significant reforms were needed to improve England’s apprenticeship system. Among the recommended changes were a renewed focus on quality over quantity, removal of the 10% employer co-investment requirement and making Ofqual the sole quality assurance body for maintaining apprenticeship standards.

The shortage of affordable housing continues to exercise the minds of policy makers, and in July we blogged about its impact on the private rented sector:

“In many cases people view the private rented sector as being a stop gap for those not able to get social housing, and not able to afford a deposit for a mortgage. Although in many instances they may be right, the demographic of those renting privately now is changing, and becoming more and more varied year on year, with many young professionals and families with children now renting privately.”

The long, hot summer of 2018 was one to remember, but its effect on air quality in urban areas underlined the need to combat the pollution in our air. In August, we blogged about an innovation that could help to clear the air:

“Designed by a German startup, a City Tree is a “living wall” of irrigated mosses with the pollution-absorbing power of almost 300 trees. A rainwater-collection unit is built into the City Tree, as well as a nutrient tank and irrigation system, allowing the assembly to water itself.”

Planning, polarisation and liveable cities

September saw another highly successful Scottish Planning and Environmental Law conference. It opened with a thought-provoking presentation by Greg Lloyd, professor Emeritus at Ulster University, and visiting professor at Wageningen University in the Netherlands, who challenged delegates to consider what might happen if the current planning system were to be abolished altogether, to clear the way for a new and more fit-for-purpose planning system.

In October, we focused on the ever-increasing job polarisation affecting the labour market:

In the EU, data shows that between 2002-2014 medium skilled routine jobs declined by 8.9%, whilst high skilled roles rose by 5.4%, and low skilled jobs grew marginally (0.1%). As a consequence, wage inequalities have grown.”

More than half the world’s population now lives in urban areas, presenting significant challenges to local authorities who have to try and make their cities work for everyone. In November, we reported from The Liveable City conference in Edinburgh, which showcased ideas from the UK and Denmark on how to make cities more attractive for residents and visitors:

“A great example of the reinvention of a post-industrial area came from Ian Manson, Chief Executive of Clyde Gateway, Scotland’s biggest and most ambitious regeneration programme. When it comes to recovering from the demise of old industries, the East End of Glasgow has seen many false dawns. As Ian explained, when Clyde Gateway was launched ten years ago, the local community were sceptical about the programme’s ambitions. But they were also ready to engage with the project. A decade on, the area has undergone significant physical generation, but more importantly this has taken place in partnership with the local people.”

Although much has been made of the government’s claim that austerity is coming to an end, many local authorities are still struggling to provide services within tight financial constraints. One of our final blogs this year reported on local councils that are selling their assets to generate revenue:

“In a bid to increase affordable housing supply, for example, Leicester City Council has sold council land worth more than £5m for less than £10 as part of deals with housing associations.”

Brexit means….

Overshadowing much of public policy in 2018 has been the UK’s decision to leave the European Union. Our blog posts have reflected the uncertainties posed by Brexit with regard to science and technology, local authority funding and academic research.

As we enter 2019, those uncertainties remain, and what actually happens is still impossible to predict. As always, we’ll continue to blog about public policy and practice, and try to make sense of the important issues, based on evidence, facts and research.

To all our readers, a very happy Christmas, and our best wishes for a peaceful and prosperous new year.

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

It’s shocking that 12.5% of men in the UK are suffering from one of the common mental health disorders (estimated by The Men’s Health Forum). And men are as much as two and a half times more likely than women to die by suicide each year, with one of the most at-risk groups being men in their 40s to early 50s.

Other key statistics which show the scale of the problem include:

  • three in four deaths by suicide are by men
  • the highest suicide rate in England is among men aged 45 to 49
  • men living in the most deprived areas are ten times more at risk of suicide than those living in the most affluent areas.

Despite this, men are significantly less likely to access mental health services than women. The Mental Health Foundation found that 28% of men had not sought medical help for the last mental health problem they experienced, and 35% of men had waited over two years or have never disclosed a mental health problem to a friend or family member. Another survey, from the Men’s Health Forum, found a majority of men would take time off work to seek medical help for physical symptoms, but less than one in five said they would do the same for anxiety (19%) or feeling low (15%).

It’s clear, then, that there are strong cultural barriers facing men in relation to mental health diagnosis. Perceived stigma and ideas of masculinity can cause them to avoid seeking help or fail to acknowledge mental health issues.

Changing attitudes in changing rooms

We’ve written previously about the success of Men’s Shed projects in providing a safe, social space for men’s mental health issues to be addressed. We were interested, therefore, to hear about another scheme which is also using a community-based approach to explore men’s health.

The Changing Room Initiative is a two year pilot project which sees the Scottish Professional Football League (SPFL) Trust and Hibernian (Hibs) football club working in partnership with the Scottish Association for Mental Health (SAMH) to engage men in their community around issues of mental health and wellbeing. The project uses football and sport as a tool to encourage men to discuss their mental health and wellbeing and to help direct them to additional support and services within their community.

The initiative is part of a wider program from SAMH which is using sport to improve equality and reduce stigma around mental health. In February 2018, SAMH launched Scotland’s mental health charter for physical activity and sport. Signatories of the charter include Sport Scotland, SPFL Trust, Jog Scotland and Glasgow Life.

In October 2018, following the success of the initial pilot scheme, SAMH announced a second changing room initiative was due to be rolled out at another Edinburgh football club, Heart of Midlothian FC (Hearts).

Using sport to engage and improve mental health

There is a lot of research available which highlights the links between positive mental health and physical activity. Even low-level physical activity has been found to have a positive impact on our mood and general wellbeing. Activities like walking, cycling or gardening have been shown to reduce stress improve self-esteem and have a significant positive impact on depression and anxiety. However, research has also shown that people with mental health issues are also more likely to have poor physical health, and often face additional barriers to participating in sport and becoming active.

The Get Set to Go programme was launched with the support of Sport England and the National Lottery in July 2015 to help people with mental health problems benefit from being physically active. An evaluation of the project published in 2017 showed that physical activity has an important role to play in building resilience, enabling and supporting mental health recovery and tackling stigma and discrimination.

New support networks

There is a continuing push among healthcare and third sector professionals to stress that mental health is just as important as physical health. However, funding for mental health is comparatively low and research shows people are far more willing to acknowledge or accept help for physical illness.

With the roll-out of projects like the Changing Room Initiative to promote mental health in familiar environments, it’s hoped that those struggling with poor mental health will receive the support and treatment they need.


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Free access to Social Policy and Practice … only available this November!

Social Policy and Practice is the only UK-produced social science database focused on public health, social care, social services and public policy. It is exclusively available via Ovid – the internationally-recognised leader in medical information services – and this November they are offering librarians and researchers the chance to test drive it for free!

UK-focused evidence and research

Social Policy and Practice is produced by a consortium of key organisations within the UK. Currently these are:

  • Centre for Policy on Ageing
  • Idox Information Service
  • National Society for the Prevention of Cruelty to Children
  • Social Care Institute for Excellence

A valued resource

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Social Policy and Practice was also identified by the Alliance for Useful Evidence in a major mapping exercise in 2015, as a key resource supporting evidence use in government and the public sector.

Unrivalled scope

Social Policy and Practice covers all aspects of public health and social care. It is a must-have resource for anyone interested in the following topic areas:

  • Social work and social care services
  • Children and young people
  • Adults and older people
  • Families and parenting
  • Safeguarding
  • Health promotion
  • Health inequalities
  • Community development
  • Physical and mental health
  • Education and special educational needs

It also offers a holistic view of wider policy areas that impact on health, such as homelessness and deprivation.

The database brings together research and evidence that is relevant to researchers and practitioners in the UK. A large proportion of material relates to delivery and policy within the UK and the devolved nations of Scotland, Wales and Northern Ireland, but the database also covers material that is transferable from Europe and across the world.

Social Policy and Practice boasts over 400,000 references to papers, books and reports and about 30% of the total content is hard-to-find grey literature.

The importance of geographical focus

Research studies have shown that people searching for social science evidence tend to neglect the question of geographical and coverage bias within research sources. And that the geographical focus of databases is a potential source of bias on the findings of a research review.

In the last ten years many UK-produced databases have ceased – funding has stopped, publishers have closed or databases have been taken over by international publishers (which reduces the balance of UK content).

So as a UK-produced database, Social Policy and Practice is uniquely placed to provide relevant results for UK-based researchers.


To see for yourself why so many UK universities and NHS bodies rely on Social Policy and Practice as a resource, visit Ovid Resource of the Month for instant access.

To find out more about the history of the database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share.