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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How empowering the community can help us create better places to live

Places can be defined in a lot of different ways: the geographic location, the physical buildings, the people who live there and the relationships that are formed. Central to places should be the people who live and interact there. Putting people, and communities at the heart of placemaking can benefit the physical infrastructure of a place, by identifying what is needed. And allowing residents a say in their local area can also give communities a sense of empowerment and ownership of their place, somewhere they can be proud to call home and somewhere they feel safe, included and valued.

Can places empower people?

In short… YES! Positive places have the power to lift the community up, give them a sense of empowerment, worth and inspiration. But places also have the power to alienate and dis-empower.

Places which are run down, with no or low levels of community engagement can contribute to communities becoming disparate, isolated and can reinforce negative stereotypes, particularly those which relate to poverty, deprivation and social exclusion. Making places that are thriving hubs for communities to be built upon can have a significant impact on the experiences and quality of life for communities living within them. Work being done by organisations like SURF show how important effective regeneration projects can be in revitalising places and the people who live there.

A recent RTPI blog post emphasised the importance of place on helping to reduce the impact of poverty and break some of the more significant socioeconomic barriers marginalised groups within communities can face. It emphasises the importance of place-based urban policy and how core policy features like the planning of a space or the design of a building can actually have a significant impact on the people who interact with that space.

A national standard for community empowerment

As important as the physical space are the people who live and work within it.

In the policy context of the Community Empowerment (Scotland) Act 2015, What Works Scotland, along with others drafted a set of ‘fit for purpose’ national standards for community empowerment, to build on those published in 2005. It was hoped that the new standards would provide clarity and focus on ways to help strengthen and improve participation and engagement at a local level. There are seven standards: Inclusion; Support; Planning; Working Together; Methods; Communication; and Impact.

Identifying and making the most of community assets

Asset based development was originally created as a description of how local residents grow collective efficacy and what they use to do so. It involves paying attention to what is in a local place – not what we think should be there, or what is not there. These ‘assets’ are found within a community and can be physical, such as infrastructure, but can also be the skills and knowledge of local people.

The key concept centres on the fact that everyone has something positive that they can contribute to a community. It follows that, if everyone does or is given the opportunity to contribute positively to their community, then there will be less requirement for spending on services from local government. It can also mean greater accountability at a community level for making changes that actually impact positively and directly on the lives and experiences of people who live and work there. Taking time to identify these assets and feeding this into how places are created can be a key part of ensuring communities feel empowered and valued.

Community anchors are an important tool

Community anchors have been identified as vital in many instances to ensure the continued development and capacity building of communities within a place. Their roles can extend across the community from building capacity and resilience, to supporting local democracy and helping to drive social change within a community. Community anchors play an important role in empowering communities and getting them involved in the design and delivery of services in their area.

A report published by What Works Scotland in 2018 examines the developing roles of community anchors within communities. The report explores the developing discussions between the community sector, public services and policymakers and considers how they might work more closely together to deliver bespoke and localised community driven policies.

Summing up

Empowering communities to feel valued and engaged is a key part of developing places that are inclusive and enjoyable places for people to live. Promoting communities as key agents of change within the areas in which they live not only improves the community, but can also help on an individual level, fostering a sense of pride and value. Creating better places is a key strand to regeneration and planning policy. Putting communities at the heart of creating places will ensure that places not only meet the needs of local people but are inherently connected to them.


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Creating caring places: placemaking in our town centres

What do caring places look like? How can planners, developers and project organisers contribute to the discourse around creating caring places? And what responsibility do they have to communities to help develop places that put people at their heart?

They are just some of the questions being increasingly raised by organisations in Scotland, trying to identify if there is a new way to focus on place and wellbeing in Scotland’s towns. Projects such as Carnegie Trust’s Kindness, Scottish Towns partnerships’ Town Centres First, or Architecture and Design Scotland’s Creating Caring Places are all exploring the importance of the quality of a place to the wellbeing of people who live there. But what does this mean for people who actually plan these areas, and what could they consider in the future to help develop more caring places?

The 3 P’s: place, people, practice

Many of the discussions around creating places which foster wellbeing and wellness centre around 3 key concepts:

Place: Understanding place and the impact that it has on wellbeing is a significant part of this agenda. The environment in which people live day-to-day has a significant impact on individuals and can be both a positive or negative influence. It can help to facilitate positive community interaction, creating stronger community ties and helping organisations and people to feel more valued within their community.

In order for places to be caring a number of factors have been identified, and these are common across research done by a number of organisations including Architecture and Design Scotland and the Carnegie Trust. These include: a sense of support (from people); a sense of purpose (stuff to do); a sense of place (familiar surroundings); and a sense of worth (feeling wanted).

People: Loneliness or social isolation has the same impact on health and mortality as smoking 15 cigarettes a day. Traditionally, it has often been assumed that older people are most often victims of social isolation (as they are less mobile and less willing or able to participate in community activities). Recently however more research has been produced which highlights the growing isolation of younger people. Understanding the nature of isolation, which impacts across the whole community, can help us to identify effective solutions which benefit and engage multiple groups.

Practice: This particularly relates to care within communities. The process of deciding where and how we care for the old or ill is a vital part of how we function as a society. Effective care extends far beyond the physical act of caring for someone, although this is obviously a key element. It also includes creating more and better jobs within the sector, and encouraging people to enter the profession as a worthwhile career choice; shifting the focus from acute to primary care settings and away from hospital-based emergency care; and giving people greater choice about how and where they receive care through increasing and improved personalisation of services.

There is a responsibility on both spatial and community planners to identify need and to create places which facilitate wellness, choice and care at home. This could be through the building of new infrastructure or more effective transport, or it could be through the creating of a community centre which offers recreational classes to someone who would otherwise have no contact with the outside world. Putting place at the centre of discussions provides an opportunity for a community approach to wellbeing, with strategies on placemaking being linked to other approaches such as asset-based, or strengths-based, planning.

Thinking about people like we think about the environment

Even as little as 10 years ago, the prevalence of environmental impact assessments for development projects was limited. Now we take for granted that we measure the impact of a project on the environment. What if we thought about people and in particular the risk of isolation, in the same way during planning processes? What if developers, planners and project organisers considered the “isolation impact” of a project, how it would impact the people of a local area, and whether it would specifically impact one group more than another (either for good or for bad), and reported on the steps they were taking to mitigate any adverse impact?

It is a striking notion, but creating a set of criteria to measure the social impact of developments, may be hugely useful if we are trying to place an increasing emphasis on inclusion and community within our town centres.

In fact, planners are beginning to realise the critical role they play in connecting services to people, and the necessity of understanding which services are needed in an area and how to make them as accessible for the whole community as possible. And while it is down to the community to use the resources they are given by planners to create connections and networks that help to combat things like poor mental health and social isolation, the decisions that planners make about how and where to plan in services and infrastructure can be the difference between someone leading an active and engaged life, and someone living a life where the only human contact they have in a day is a carer.

Planners can and should recognise the significant role they can play in making someone’s life more livable.

Final thoughts

Creating caring places for people to live and grow old in is vital to the success of our communities. Effective and thoughtful decisions on investments such as infrastructure and community planning projects can have a significant positive impact on wellbeing and reduce loneliness not only among older people, but throughout the community.

Increasingly, policy makers in Scotland are being asked to consider the human element of planning in their work. Creating places that allow people to feel safe, valued and happy is key for planners to help bridge the gap between the creation of places, and the wellbeing of people who live in them.


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Youth participation and citizenship: hearing young people’s voices in North Ayrshire

2018 is the year of young people in Scotland. The idea is to inspire Scotland through its young people, celebrating their achievements, valuing their contribution to communities and creating new opportunities for them to take the lead.

Research published by the Scottish Government in 2018, Young people’s participation in decision making in Scotland: attitudes and perceptions showed that while many thought “adults” were good at listening to their views, many other barriers to having their views and opinions heard existed for young people. One of the main challenges was a feeling that young people’s views are discarded because “‘it doesn’t fit with what they (adults) want to hear”.

Hearing young people’s voices

The North Ayrshire Youth Participation and Citizenship strategy is a “unique and transferable” youth-friendly children’s rights engagement process, which informs local policy, corporate priorities and strengthens the voices of young people in local communities.

The framework “values and respects” youth participation as fundamental in the ongoing work to enable all aspects of community life to prosper. The programme of youth engagement undertaken at North Ayrshire saw them awarded a COSLA Gold award in a ceremony at the end of 2017.

The Youth Participation and Citizenship strategy sets out how young people across North Ayrshire can play an active role in their schools and communities. The framework encourages and supports the engagement and participation of young people across a range of areas including:

  • YouthBank YouthBank Scotland is a grant making and empowerment initiative run by young people for young people. It builds on young people’s skills and experiences to enable them to give cash for action, funding young people’s ideas for the benefit of the wider community.
  • Participatory budgeting initiatives  where young people can help to decide on funding applications for local projects.
  • Local participation initiatives – including Youth Forums, Pupil Councils, North Ayrshire Youth Council, Youth Groups, Eco Committees, Sports Leadership and Peer Education schemes.
  • National participation initiatives  the Scottish Youth Parliament, British Youth Council and the Lesbian, Gay, Bisexual, and Transgender (LGBT) National Youth Council.

In December 2017, North Ayrshire launched its Year of Young People 2018 plan. Activities include ‘Joint Cabinet Live’ which will bring together young people from all over North Ayrshire via a live video link, to interact with the Council’s Cabinet Members on the issues faced by young people living in the area.

Co-production and giving young people a choice

There is a strong focus on co-production, facilitating decisions to be made with, not to young people. There is also an understanding that engaging young people in all aspects of community life, both at a social and an administrative level can have positive consequences for the whole community, not just for the young people who participate.

The council engages with young people to ensure that they know their voices are heard and that council policy reflects their needs and aspirations for the future. It builds the skills and confidence of young people who have the opportunity to participate and can strengthen community engagement and cohesion as more people become involved.

As part of the North Ayrshire participatory budgeting initiative, funding was allocated to youth projects across North Ayrshire, and young people given the opportunity to vote for where they thought the money should be spent. Each young Scot in North Ayrshire, was able to vote for three projects they thought would most benefit from receiving funding (projects varied depending on which North Ayrshire locality they lived in, but were all organised either by or for the benefit of young people in the region). They were able to vote in school, as well as in colleges, local youth clubs, or from home using their Young Scot card number to go online and register their choices. The results were announced on 9 February 2018 and saw funding allocated according to the votes of young people, with almost 7000 young people taking part, almost 50% of those eligible.

Award winning approach

In 2017, the North Ayrshire youth services team were awarded the COSLA gold award for their efforts. The award recognised the work of  the Youth Services team in creating a culture of participation, which allows young people to have a real impact in shaping the services the Council delivers. For example, the Council operates a joint Youth Cabinet, which allows young people to work alongside Elected Members and be directly involved in the decision-making process.

North Ayrshire’s engagement approach has been seen as a blueprint for engagement across the community within towns and cities across Scotland. Three months into the “Year of Young People”, other local authorities are being encouraged to follow suit and rethink how they engage and use the voices and opinions of young people within their communities to support inclusive decision making.

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Housing models for the future

Housing is one of the challenges of our time. The task for architects and designers is to create affordable, robust housing that can accommodate the needs of a rapidly growing, but also ageing population. And it’s not as easy as simply building. The demands and expectations on house builders to also be community builders and the architects of mental and physical wellbeing through design have led architects and designers to consider alternative ways to house us in the future. This includes innovative use of materials and construction methods, addressing the issue of financing through co-operative living models and using bespoke design to create lifetime homes which can be adapted to accommodate the changing needs of our population.

Large-scale development

One of the big challenges for urban areas is large-scale development strategies for designing and delivering housing to meet need. For developers and planners going forward there are a number of factors to consider: the type of investment introduced to an area; how the schemes fit with a wider development plan for the city; and the importance of engaging the community in any plans to develop or regenerate an area.

“Placemaking”, not just house building is central to large scale development discussions, emphasising to planners, architects and developers the fact that they are not just building houses, but creating communities. As a result, designers and developers should be mindful of their important role in community building, to build the right sort of homes in the right places, at affordable prices and with a legacy in mind. They should, create high quality, long lasting units, which will stand the test of time but that also can be easily adapted to accommodate people’s changing needs.

Alternative construction and design

Innovative models and options for future builds have been discussed for a number of years but they are becoming an increasingly mainstream way to build affordable housing that meets the current need, particularly of students and young professionals, and of older populations looking to downsize or move into assisted care accommodation.

Offsite manufacture or modular homes  Offsite manufacture of timber framed houses is becoming increasingly common, with the constituent pieces of the house manufactured off site, then transported to the site and constructed on a concrete block where foundations and services such as plumbing have already been created. Offsite housing can either be open panel, which requires the finishing such as bathroom and kitchen installation to be done on site, or closed panel which provide the entire section complete with decoration and flooring (this is becoming a common way to build cheap, efficient student housing).

Custom build  Custom build projects are similar to self-build in that they give clients flexibility to select their own design and layout, However, custom build provides slightly more structure and certainty which can make it easier when considering elements like financing and planning applications. In essence, customers select the spec of their house in the same way they might make custom modifications to a car.

Build to rent  This model has been adapted from the United States, where build to rent is popular. The model is based on self-contained flats, with central and shared amenities, entrance and communal space. Designed to attract graduates and young professionals, these are being increasingly designed using a “user first” approach. Developers identify the sort of person they want to live in the development, identify what sort of things they might look for in a development, including floor type, furniture, layout, amenities, gadgets, and then build the development around that.

Dementia friendly – Building homes that are safe and affordable, but allow for independence in old age, is one of the major demands on house builders currently. Housing stock is seen as not suitable for current need, but building bespoke sites for people with illnesses like dementia has been seen as a bit of a niche previously. Virtual Reality (VR) is being used by some architects and developers to try to help them understand the needs and requirements of people with dementia and how they can build homes suitable for them to be able to live as independent and full lives as possible. Building dementia friendly homes not only means making them accessible and open plan, but also adapting the layout, adding signage where appropriate and if possible locating the homes within a wider community development. Dementia villages like those seen in Amsterdam are being used as the model for this.

Co-housing

Co- housing offers an alternative to communities in Scotland, and while lessons can be learned from elsewhere in Europe, where co- housing models have been successful, there are also pockets of good and emerging practice in the UK too. More traditional examples include Berlin, where almost 1 in 10 new homes follow the Baugruppe model, and Amsterdam (centraal wonen) where some of the oldest co-housing projects originate. In Denmark, 8% of households use co-housing models.

Co-housing provides the opportunity for groups of people to come together and form a community which is created and run by its residents. Each household has a self-contained, private home as well as shared community space. Residents come together to manage their community, share activities, and regularly eat together. A “Self-build Cooperative Group” is a joint venture between several private households who plan and build their own house together. Usually they are supported by an architect. Often co- housing groups are able to realise high-quality living space at prices below local market rates, although it is not really considered suitable for large-scale development within the current UK market.

Opportunities for a new way forward

Practitioners are often challenged to push the boundaries of design and building in their field. Looking to new models for future building design provides an opportunity to think creatively about alternative uses of materials and space and to consider options for construction, funding and investment in the built environment that challenge the norm. Learning lessons and exchanging ideas from elsewhere, architects and planners have the opportunity to come together to consider how the built environment in Scotland can help to create places  not just buildings  and how this can contribute positively to the wider wellbeing and happiness of people living in Scotland in the future.


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Using an asset based approach to support people with learning disabilities into work

This blog is based on discussions from the Scottish Commission for Learning Disability conference, held in Perth in September 2017.

Introducing an asset-based approach

The term ” asset-based” is commonly used within community development and public health. It is used to mean an approach that identifies and emphasises the strengths and abilities of people within a community.

Instead of focusing on what people are unable to contribute, asset-based approaches instead focus on finding the value and potential of each individual, regardless of their background or personal circumstances.

At the SCLD conference in September, the audience heard examples of how asset-based approaches are being used within the field of employment support. A number of projects across Scotland are creating opportunities for people with learning disabilities to participate and contribute to their local community through meaningful work that recognises their abilities, and not the barriers created by their disabilities.

Facilitating a culture change

Research by Mencap found that although around 8 in 10 working age people with a learning disability have one that’s mild or moderate, fewer than 2 in 10 are actually in employment. Overall employment rates are also much lower than for the rest of the population or for people with physical disabilities – although recent data is lacking, in 2008 a study suggested that only about 17% of all working age people with a learning disability have a paid job.

Enabling people with a learning disability to enter employment is something that requires more than a change in policy or increased funding to improve skills and access to employment schemes (although that is also invaluable). To successfully integrate adults with learning disabilities into the workforce requires a change in employer attitudes. More generally it also requires a transformation in how we perceive learning disability within society.

One of the biggest barriers to participation in employment, are the attitudes and perceptions of other people. Increasing the understanding of how much people with learning disabilities can bring to a job and a workplace is crucial. This is where asset-based approaches can really help. They focus on identifying and making the most of someone’s abilities, and allowing individuals to offer these skills and abilities as a part of a positive contribution to their community through work.

Projects that put people at their heart

The Scottish Commission for Learning Disability (SCLD) has supported a range of projects for people in Scotland with learning disabilities. In September 2015, SCLD announced that the Scottish Government was seeking applications for development funding to support the refreshed delivery approach for The Keys to Life (Scotland’s learning disability strategy).

Of the projects awarded funding, two focussed specifically on tackling underemployment among the learning disabled population.

  • Wee enterprizers (a project that aims to increase employment opportunities for adults with learning disabilities) helped a group of aspiring entrepreneurs with learning disabilities to progress their micro business ideas. Events and workshops allowed participants to come together and share business plans, marketing ideas, and resource strategies. It also helped to identify suppliers and trading opportunities. The Yunus Centre at Glasgow Caledonian University conducted an evaluation of the project. It found that as well as helping business ideas to get off the ground, it also helped to encourage personal growth and independence in participants, improved communication skills and provided an opportunity for entrepreneurs to form a network of their own to help support each other.
  • Tayberry Enterprises provided creative art activities, volunteer opportunities and training placements in catering for people with significant health barriers to employment. The Multi-Storytelling Project offered adults with a learning disability, experiential training apprenticeships in techniques that would help them communicate effectively in a variety of different ways.

More than just work

What these projects had in common was their ability to promote the holistic benefits of training and employment. Like anyone else, opportunities to work allow people with learning disabilities to form new and engaging relationships, and to feel that they are making a positive contribution to their community. This in turn helps them to feel valued as people, not limited by their condition or circumstances.

The use of asset-based approaches adds an extra layer, as they often highlight the advantages of bringing people from different backgrounds together. For example, a project that helps to get people with learning disabilities into employment by offering training opportunities, could also double as a centre for older people who suffer from loneliness, with both communities bringing unique perspectives and contributions to the table. This enriches the experience for everyone and helps to create stronger and more resilient bonds within the community.

Final thoughts

Employment opportunities are limited for people with a learning disability. However, schemes which take into account and actively seek to make the most of a person’s assets, can go some way to reducing negative perceptions and prejudice within society.

Everyone should have the opportunity to learn, form relationships and live their dreams and aspirations, while demonstrating how they can thrive and positively contribute to their local communities.


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Joining up housing and mental health

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing  stable, safe housing  also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people  to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.


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Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

 

Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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Read more about innovative building design in our other blog articles.

“Business is an act of citizenship”: using BIDs to promote inclusive economic growth in communities

The key to inclusive place based economic growth?

The principle of Business Improvement Districts (BIDs) is pretty straightforward, and the legislation in Scotland is flexible enough to ensure that pretty much anyone can create and act on a BID-based idea. There are currently over 30 live BID projects in Scotland, with BIDs Scotland stating in their latest annual report that they believe this number could almost double to 65 by the end of 2017 if upcoming and scheduled BIDs are also taken into account. The report found that, despite continuing tough economic conditions, there appears to be little evidence of a decline in interest in the BID model. If anything, more people are turning to BIDs as a way of improving local high streets using limited local funds, private investment from local businesses, and other local assets.

BIDs themselves can be seen as a cross section – a mix of the entire economic ecosystem of a place. They can encompass economic, business, local, political and social elements and bring them together in a strategic way to build revenue to support the different aspects of the BID area, including aesthetics, security and commerce. They are locally developed, locally managed, locally financed and locally delivered, giving a sense of authenticity which is becoming increasingly popular among consumers. This popularity is evidenced by the successful renewal of all of the BIDs in Scotland who have gone to reballot to date, with many actually increasing their majority in favour of the BID model.

Collaboration and embedding BIDS within their local communities

As BIDs have been developed, and new models, partnerships and ways of co- operating have been established, BID coordinators and councils in particular are thinking about how to ensure the legacy of the BID within their locality and, more importantly, how to ensure that the economic benefits of the BID are felt across the BID area, not just within the businesses.

This area-wide benefit can be created by for example, re-investing money in security, street lighting, Christmas lights, and flower baskets to improve the feel and aesthetics of a place – actions which are commonplace in BID areas. However, there are some who feel that BIDs could and should go even further in increasing their social value within a community, while not losing sight of the interests of levy payers. This balance, which requires recognition of the wider roles and responsibilities of BIDs, is something which will have to be carefully managed by BID managers in order to ensure that BIDs do not try to do too much, but at the same time act in a way which makes them a key part of their local community and economy. It is an interesting and, at times, difficult place for progressive BIDs to be.

In many areas, BIDs have provided an opportunity for increased community development, and it has been suggested that there could be a formal role for BIDs to play in the wider community development partnerships within localities. BIDs are now being developed to sit alongside existing community anchor bodies, helping to create strong local partnerships and independent communities.

Through collaboration and co-ordination, BIDs are working alongside other services and organisations to help develop sustained community empowerment, helping communities to lobby, providing work experience placements to local young people and acting positively in the form of events to promote increased community cohesion and empowerment, as well as continuing with “normal practice”- increasing footfall in their local area to benefit businesses.

Not all about the money

While generating additional income for the local economy is one of the biggest drivers of support for BIDs in communities, in some instances one of the biggest assets they bring to a community (especially once they are firmly established) is their leverage and collective bargaining power. They have the power to campaign and support other groups in the community on issues that are important to them, as well as offering greater bargaining power with local authorities or other businesses.

As well as commitment to the levy payers’ interest and to improving the local area for people living nearby, another of the potential roles of BIDs is not to act as direct income generators, but as catalysts or facilitators, to encourage new investment and wider growth beyond the BID area – to engage strategically with other partners to encourage investment.

 

Where next for BIDs

As we have already seen, the flexibility of the BID model in Scotland (there are some legislative differences in England) is such that groups may only be limited by their own ambition. Currently Scotland has what is thought to be the world first food and drinks BID and the first tourism BID this side of the Atlantic. Another innovation is the Borders Railway BID, which seeks to maximise the collective benefit to businesses that are located along the railway route.

It has been suggested that the BID model could be used in a more flexible way to generate income for other public service projects, including the suggestion of a BID for health and a BID for schools. Although the intricacies of how these would work in practice are still being considered, there is much that can be taken from how the existing models use community empowerment, and engagement between the public, third and private sectors to create sustainable and inclusive local economic growth in an area.

As well as their commercial enterprising side, BIDs are also realising their potential as agents of community development and improvement beyond that of economic input. The future currently looks bright for BIDs, which will hopefully mean that it also looks brighter for our local communities.


Business Improvement Districts Scotland is the national organisation for BIDs in Scotland, providing support, advice and encouragement to business groups, communities and local authorities considering and developing a business improvement district.

BIDs Scotland held its Annual Gathering on 28th March 2017 at Perth Concert Hall  with the theme of People – Place – Business: Business Improvement Districts – the key to economic growth.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you enjoyed this article, you may also be interested in our other article on BIDs.

Information Service members can also access a research briefing on BIDs here (login required).