Supporting perinatal mental health: from peer-support to specialist services

There is a societal expectation that pregnancy and the arrival of a new baby are happy and exciting times.  However, it may come as a surprise to learn that up to 1 in 5 women develop a mental illness during pregnancy or within the first year after having a baby (also known as the ‘perinatal period’).

Up to 1 in 10 women may develop postnatal depression, however, there are actually a number of other mental illnesses that can affect women during pregnancy or following birth.  These include:

  • Antenatal depression
  • Perinatal anxiety
  • Perinatal obsessive compulsive disorder
  • Post-traumatic stress disorder (PTSD)
  • Post-partum psychosis

These illnesses can range from mild to severe.  Left untreated, perinatal mental illnesses can have a devastating effect on mental and physical health.  In fact, suicide is the leading cause of death for mothers during the first year after pregnancy.

The wider impact on children and families

Perinatal mental illnesses can also impact upon children, partners and significant others.  Research shows links to depression in partners, higher rates of divorces, lower levels of emotional and cognitive development and higher levels of behavioural problems and psychological disorders among children.

As well as the high human cost, there are also a number of economic costs associated with failing to address perinatal mental health needs. Research commissioned by the Maternal Mental Health Alliance found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.

Access to specialist services is a ‘postcode lottery’

The good news is that most mothers who experience mental ill health can and do make a full recovery.

At present, mild to moderate cases of mental ill health in pregnancy and following birth are treated by the GP through anti-depressants, talking therapies and/or support from a community mental health team.  For more complex or serious illnesses, GPs can make a referral to specialist perinatal mental health services for expert advice and support.  This may involve staying in a specialist psychiatric Mother and Baby Unit (MBU) – where mothers and their baby can be admitted together.

However, despite the high prevalence of, and risks associated with, perinatal mental illness, access to specialist perinatal mental health services across the UK is a postcode lottery.

Maps by the Maternal Mental Health Alliance show that women in around half of the UK have no access to specialist perinatal mental health services.  There are currently no MBUs in Wales or Northern Ireland, meaning mothers with more serious or complex mental illnesses often face either being admitted to a MBU far from home, or being admitted to a general psychiatric ward without their babies, in order to receive treatment.

For those with mild to moderate mental illness, waiting times for NHS talking treatments can be many months.  Lack of awareness means that many cases of mild to moderate mental ill health go undiagnosed and untreated.  There is an urgent need for both greater awareness of mental illness and better access to mental health services across the country.

The role of peer-support

In recognition of and response to the need for better access to mental health support for pregnant and new mothers, a number of local ‘grassroots’ peer-support projects have been established by dedicated volunteers and campaigners.

One such project is Blank Canvas.  Blank Canvas is a creative journaling workshop in Lanarkshire, aimed at women during pregnancy or in the first two years since birth, who are experiencing mental health difficulties.

The project was set up earlier this year by midwife Elaine Connell, together with some of her midwife colleagues, who shared her dedication to improving mental health support for women in the perinatal period.

Elaine was keen to start her own peer support group following her own personal and professional experiences of perinatal mental ill health, and was inspired by the success of other projects focusing on art and creativity, such as Maternal Journal.

As Elaine explains:

It is free… …to access, and each attendee is given their own art kit to keep. We have a different theme each week and have guest speakers coming to do sessions also. During the group they can explore new art materials and create reflections in their journal, whilst chatting over some tea and cake. Each session they will take home a prompt card which can inspire their journalling during the week until the group meets next.”

Blank Canvas is free to access and works on a self-referral basis, with advertising mainly through Facebook.  A local shop and community space (Swaddle in Hamilton) donated a venue space, and all other costs (including materials) have been raised by volunteers committed to the project, through fundraisers such as coffee mornings and participation in the Kiltwalk.

Elaine has conducted an evaluation of the first 10-week block and feedback from participants has been extremely positive.  Word about the project has spread and the next block of Blank Canvas – which started on the 18th September – is fully subscribed (with a waiting list).  As Elaine notes, this is fantastic for the project, but highlights the high level of demand that exists for mental health support among new mothers.

The long term plan is to run 6-week blocks frequently throughout the year, moving to separate antenatal and postnatal sessions in 2020.  Elaine also hopes to start up a creative journaling group aimed at fathers too – noting that father’s mental health is often overlooked.

One of the key things Elaine has learned from the creation of Blank Canvas is that there is a lack of support available for people who want to establish their own peer-support groups:

What has been clear when forming the group, is that there is very little support to establish peer support. There are lots of people who want to help others but who won’t because they don’t know where to begin, or how to access funding, or lack of training opportunities.”

Grassroots peer-support groups are an important source of support for mothers in the perinatal period, particularly in cases of mild to moderate mental ill health, where NHS capacity is strained.

Attending peer-support groups such as Blank Canvas may also have a preventative effect for mums who attend during pregnancy. Statistically, women who experience antenatal anxiety are more likely to develop postnatal depression, and so early intervention could help to reduce that risk.

Urgent need for better access to specialist services

While these projects have been successful, they are aimed predominantly at women experiencing mild to moderate mental ill health.

For those experiencing more complex or serious mental ill health, there remains an urgent need for better access to specialist treatment and support.  The Maternal Mental Health Alliance ‘Everyone’s Business’ campaign calls for all women throughout the UK who experience perinatal mental ill health to receive the care that they and their families need.  Specifically, it demands that:

  • perinatal mental health care should be clearly set at a national level and complied with
  • specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK
  • training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth

Promising signs of progress

There have been some promising signs of progress.  NHS England recently announced their plans to rollout specialist perinatal community services across the whole of England, including the opening of four new Mother and Baby Units.

And in Scotland, the Scottish Government recently announced the rollout of an initial £1 million for perinatal mental health services, as part of a wider £50 million investment in mental health services.  This initial investment will support a range of areas, including supporting the third sector to provide counselling, befriending and peer support for women and their families.  It will also help provide more consistent access to psychological assessment and treatment, by increasing staffing levels and training at Mother and Baby Units, for women with the most serious illnesses.

The Scottish Government also established a Perinatal and Infant Mental Health Programme Board earlier this year.  The PIMH Programme Board aims to help implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland.

Clare Thomson, Everyone’s Business Co-ordinator for Scotland, says “It’s fantastic to see the evidence-based approach to developing community perinatal mental health services and look forward to hearing about the first steps – particularly in the North of Scotland“.

Perinatal mental health is Everyone’s Business

However, there is still much to do, including ensuring that this funding translates into services on the ground.  Wales and Northern Ireland are still without MBUs and there is a pressing need to raise awareness of and address mental illness among fathers.

The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.  It clearly makes sense to invest in improving this care – not only from an economic perspective, but to help improve the lives of women, their children and families across the country. And while more funding is essential to achieve this, raising awareness of the importance of perinatal mental health really is ‘everyone’s business’.


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Gardens of the dead: cemeteries as spaces for nature

The cemetery is an open space among the ruins, covered in winter with violets and daisies.Percy Bysshe Shelley, Preface to Adonais (1891)

Percy Shelley’s description of the Protestant Cemetery in Rome perfectly illustrates how the cemetery, often negatively associated with death and decay, can in fact be a place where nature flourishes.

In this blog post, we highlight some of the great work being done to promote and conserve biodiversity in cemeteries, and the wider benefits of this.

Cemeteries as ‘green oases’

The importance of cemeteries as urban green spaces is often overlooked.  Relatively untouched by surrounding urban development, cemeteries often act as green oases, providing a range of important natural habitats for many different – and often rare – plant life and animals.

Indeed, as the 2000-01 Select Committee Report on Cemeteries observes:

Cemeteries support a wide range of habitats, including relict grasslands, heath, ancient and secondary woodland, scrub, hedges, ponds and flushes, as well as more artificial features such as high maintenance lawns, stands of trees, ornamental flower beds, and shrubberies. In addition, buildings, monuments, tombs and headstones, made from a variety of rocks, can provide support for lichens, mosses and ferns, as well as providing geological interest. A large number of rare species of trees, plants, fungi, invertebrates, reptiles, birds and mammals are found in cemeteries. Cemeteries are often designated as local Wildlife Sites, and sometimes as Nature Reserves.

Green space such as that provided by cemeteries, churchyards and other burial sites is important for a number of reasons.

From an environmental perspective, green space can help to address the negative effects of climate change, including the catastrophic decline in the number of insects. And from a human perspective, research has consistently shown the health and wellbeing benefits of access to green space.

Thus, cemeteries have an important role to play in both supporting the environment and promoting the health and wellbeing of local people.

Case study: Glasgow Necropolis

The Glasgow Necropolis is an impressive example of a Victorian garden cemetery, designed to be both inspiring and aesthetically pleasing.

Today, it is the second largest greenspace in the centre of Glasgow and provides a diverse range of habitats for wildlife, including sandy slopes, ivy-covered rock, wooded areas and unmown areas of grass and wildflowers.

The Friends of Glasgow Necropolis is a charity staffed entirely by volunteers dedicated to the conservation of the cemetery.

As well important monument conservation and restoration projects, and hosting walking tours to engage and educate the public, they also work to support the cemetery’s role as a space for nature.  One key aspect of this is recording and monitoring the flora and fauna within the cemetery.

Recent surveys have found that the Necropolis supports over 400 species of animals – including a variety of species of birds, bees, butterflies, insects and spiders, as well as deer, foxes, squirrels and rabbits, and a variety of other small mammals. Some of these species are particularly rare, including the aptly-named hoverfly, Eumerus funeralis.

There is also a wide diversity of plant life.  In total, 180 species of flowering plants and trees have been recorded in the Necropolis, and there are also at least 15 species of lichens – including one rare species (Lecania cyrtella).

Other key projects have sought to actively enhance the biodiversity of the cemetery – such as the creation of a wildflower meadow, planted with the help of local school children, and the creation of the ‘Green Man’ – a 3D grass head sculpture, in collaboration with the Glasgow School of Art, Glasgow City Council, Dennistoun Community Council, Dennistoun Conservation Society and Foundation Scotland.

There are also plans underway to create a ‘tree map’ for the Necropolis – a visual representation of the different tree species that exist within the cemetery grounds.

Engaging local communities

Across the UK there are a number of examples of other grassroots projects working to promote, conserve and engage local communities in cemeteries’ rich natural heritage.

Some notable examples include:

There have also larger-scale projects and campaigns to promote the role of cemeteries as havens for wildlife.

Caring for God’s Acre is a charity working to “support groups and individuals to investigate, care for, and enjoy burial grounds”.

For a week in June each year, they run a national ‘Love your Burial Ground’ campaign, which encourages people to connect with and celebrate their local churchyards, cemeteries and burial grounds through a variety of local events.

They are also responsible for running the ‘Beautiful Burial Grounds Project’ – a £600,000 Heritage Lottery Fund project that aims to “inspire, engage and support interest groups, communities and individuals to learn about, research and survey the natural, built and social heritage of their local burial grounds”.

The project includes collecting, collating and disseminating data on the importance of burial grounds for biodiversity, providing training events on recording biodiversity and disseminating a variety of resources such as short films, toolkits and pop ups to encourage communities to value their burial grounds as refuges for wildlife.

The Green Flag Award scheme has also been involved in the promotion of cemeteries as spaces for nature.  The scheme “recognises and rewards well managed parks and green spaces” and at present, over 80 cemeteries have received this award, including Tipton Cemetery in Sandwell, and the new Dumbarton Cemetery – the first cemetery in Scotland to be awarded a Green Flag.

Challenges to address

There are of course a number of challenges to be addressed if the full potential of cemeteries as green spaces are to be realised.

Firstly, there is a lack of data on the plant and animal species that exist within cemeteries.  This lack of ecological awareness can mean that sometimes burial ground management and maintenance can be well-intentioned, but inappropriate or damaging.  Thus, projects to record species – such as those conducted by the Friends of Glasgow Necropolis and other cemeteries’ friends groups – are incredibly important.

There is also a need to find an appropriate balance between allowing nature to flourish and ensuring that the cemetery remains accessible.  For example, there have been complaints that long grass around headstones can make it difficult for some people to visit family graves.  The Select Committee Report on Cemeteries notes that: “conservation must not be confused with neglect. A neglected cemetery does not become a haven for flora and fauna.”

Health and safety is another key consideration.  Unstable memorials can cause serious – and sometimes fatal – injuries.  Any project operating within cemeteries needs to be aware of this risk, particularly if it involves children or young people.  The Scottish Government recently published guidance for local authorities on inspecting and making safe memorials and headstones.

Other potential barriers to the use of cemeteries as green spaces include the lack of onsite facilities, such as toilets and bins, physical constraints, such as steep stairs, lack of vehicle access/wheelchair access, and concerns about visitor safety and anti-social behaviour.  These issues, however, are not insurmountable – for example, the Friends of Glasgow Necropolis have recognised these accessibility concerns and raised funds from grant applications to resurface many of the paths on the lower levels of the cemetery to make it easier for people with mobility problems to get around.

‘Living places’ that inspire

It is worth remembering too that cemeteries were set up not just to bury the dead but to stir the Muses among the living.” Fiona Green, a landscape historian, quotes John Strang‘s Necropolis Glasguensis (1831)

Cemeteries are not just for the dead.  They are in many ways ‘living places’ – havens for a range of plant and animal species in the midst of urban housing and development.  They also have an important role to play in the wider community, providing opportunities for local people to connect with and be inspired by nature.

And hopefully, after reading about the many ways in which people across the country are getting involved with nature at their own local burial grounds, you may be similarly inspired.


If you’ve enjoyed this blog, take a look at some more posts on the subject of biodiversity:

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.


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

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“The ‘frustrated’ housing aspirations of generation rent”

house prices

A key change in the UK’s housing market over the past twenty years has been the growth of the private rented sector (PRS), with more living in the sector than ever before. This growth has led to the view that there is now a ‘generation rent’ who are priced out of home ownership and stranded in insecure short-term lets for prolonged periods of their lives – fuelling concerns about intergenerational inequality.

At a recent seminar, hosted by the Public Services and Governance research group at the University of Stirling, Dr Kim McKee, a co-investigator for The UK Collaborative Centre for Housing Research (CaCHE), presented the key findings from her research on ‘generation rent’ and precarity in the contemporary housing market.

Who are ‘generation rent’?

The UK 2011 Census highlighted that 40% of private renters were young people under the age of 35. With a challenging labour market, rising student debt and welfare reforms, home ownership and social housing is increasingly out of reach for these young people, who end up stuck private renting for much longer than the previous generation.

It was noted by Dr McKee that there is a clear age dimension to the recent shifts in housing tenure, but that the ‘generation rent’ label is more complex than portrayed. Income and family support were emphasised as just as critical in the understanding of young people’s experiences and future plans, as was geography.

Indeed, other research has highlighted that income and family background have a huge impact on young people’s housing market experiences. The Resolution Foundation’s recent report highlights that young people from wealthier families are more likely to become homeowners, suggesting that there are also intra-generational inequalities.

Dr McKee’s study focused on the inequalities facing these young people through qualitative research with 16 young people aged 35 and under living in the PRS in Scotland or England. Those on low incomes were explicitly targeted with the aim of giving them a voice, which was considered to be largely absent in previous research.

Aspirations vs expectations

There was a long-term aspiration for home ownership among the majority of participants, with a smaller number aspiring to social housing. But private renting was seen as the only short-term option as a host of challenges thwart them from realising their ambitions:

  • mortgage finance
  • family support
  • labour markets
  • student debt
  • welfare reform

The fact that housing tenure was highlighted by respondents rather than housing type or location, as previous research has highlighted, suggests there is a general dissatisfaction with living in the PRS. Indeed, it was noted that the PRS was discussed largely negatively, perceived as the ‘tenure of last resort’.

Despite the continued aspirations for home ownership, there was a marked difference between aspirations and expectations. There was a levelling down of expectations to own and a gap emerging between what the young people aspired to as their ideal and what they expected to achieve. A small minority even remarked that a more realistic goal may in fact be improvements in the PRS. The study showed that such expectations were due, mainly, to low earnings and insecure employment, combined with a lack of family financial support.

While the short-term nature of private renting makes it a very flexible rental option, it also makes it insecure and precarious, creating barriers for tenants who want to settle into a home and community. This is particularly worrying for families with children, who can be greatly affected by the upheaval of having to regularly move.

Emotional impacts

The study was particularly interested in the more intangible and emotional impacts on ‘generation rent’ and how the frustrations in realising their aspirations impacted negatively on their wellbeing.

It was stressed that issues in the PRS are having serious negative impacts on the wellbeing of young people – insecure, expensive and poor quality housing are contributing to depression, stress and anxiety. Moreover, for those on the lowest incomes, such issues are even contributing to homelessness.

Not only is mental wellbeing affected but their physical health has also been impacted by poor quality housing. Problems with rodents, damp and mould, broken white goods and poor quality accommodation in general were all reported by participants.

The experiences of the young people in the study were described as a “sad reflection of housing in the UK today” and raises questions over whether the PRS can really meet the needs of low income groups in particular.

Geography matters 

Another key finding was that where people live really matters, not only because of the spatial nature of housing and labour markets, but also as tenancy rights and regulations vary across the UK.

Recent reforms in Scotland have provided tenants with greater security of tenure and more predictable rent increases. England was highlighted as lagging behind the rest of the UK in terms of regulation and tenants’ rights as it lacks any national landlord registration scheme. Letting agent fees in England were also highlighted as a real issue in relation to affordability.

It was suggested that the rest of the UK could learn much from the Scottish experience, although there is a need to go further, particularly in relation to affordability.

Way forward

A key message from the study was that security of tenure really matters for those living in the PRS but reform of the housing system can only go so far. Participants identified more affordable housing, more protection for renters and income inequalities as areas where the government could intervene to improve things.

Based on the findings, six key policy recommendations were made:

  • ensure security of tenure;
  • take action on rents;
  • provide better education for tenants on their rights, and indeed for landlords;
  • provide more affordable housing; and
  • ensure greater understanding of intra-generational inequalities.

If the wider inequalities within society are also addressed, perhaps the PRS could become an aspiration rather than the ‘tenure of last resort’.


If you enjoyed reading this, you may also be interested in our previous posts on build to rent and meeting demand and improving data in the private rented sector.

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“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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Science in the city: applying neuroscience to urban design

Cities have long been considered primarily in terms of their buildings and infrastructure.  However, in recent years, a more ‘human-centric’ view has been adopted – focusing on the people who inhabit the city, and how they perceive and respond to the city that surrounds them.

Research from a variety of disciplines agree that buildings and cities have a significant impact upon the people – from their physical and mental health, cognitive development, and wellbeing to their levels of productivity.

Neuroscience offers a new way to further explore this impact – and by doing so, help urban design professionals to create places that promote human health and wellbeing, whilst mitigating the negative impacts of the city environment as far as possible.

 

What is neuroscience?

But what exactly is neuroscience?  And how does it relate to urban design?

A recent report by FutureCatapult looks at how neuroscience can be used to improve the design of urban places, and thus increase human wellbeing and productivity.

It defines neuroscience as “a multidisciplinary branch of biology and is the scientific study of the brain and nervous system, including its interaction with the other parts of the body”.

There are various ‘scales’ or ‘levels’ of neuroscience – from cognitive psychology, right down to the study of individual cells in the brain.  Each level of neuroscience studies different aspects of how the brain functions, and thus offers different ways to explore and understand how humans perceive, respond to and are affected by their surrounding environments.  It has many applications in real life – and one such application is informing city strategy, design and policy.

 

Applying neuroscience research to urban design

Take mental health, for example.  It is a prime example of an area in which neuroscience can be used by city planners and policymakers to help improve human wellbeing.

As FutureCatapult point out in their report, cities have a greater prevalence of mental health problems than rural areas.

They note that several factors associated with cities have been found to contribute to mental health problems. These include certain toxins (produced by traffic, industrial parks), environmental stressors (noise and light pollution), climate conditions (urban heat islands) and social conditions (isolation).  Neuroscience offers a greater understanding how these factors impact on human health and wellbeing, thus creating an evidence base for the design of healthy places.

There are many other ways in which neuroscience research can inform city design.  For example, it has been found that:

  • poor air quality has serious detrimental effects on the natural developments of children’s brains
  • social isolation can accelerate cognitive decline in older people
  • an increase in noise decreases worker productivity
  • light influences brain function during specific cognitive tasks, especially those requiring sustained attention

Such findings can help inform the decisions made by city planners and policymakers, and help create cities that maximise human health, wellbeing and productivity.

Research into the brain’s ‘wayfinding’ processes – that is, how the brain processes visual information and makes sense of unfamiliar environments – is also of interest.  For example, how do people choose which paths to follow?  Are they influenced by street size, shape, colours, noise, or the number of cars? Such information could be used to inform the design of streets and places that are easier to navigate. This is of growing importance given the drive towards the design of inclusive and dementia-friendly places.

Relatedly, neuroscience offers a way to gain a deeper understanding of how non-neurotypical brains process and respond to different environments – for example, people with dementia or autism.  Understanding these different perspectives and responses is key to the creation of spaces that are truly inclusive.

 

Neuroscience in action

But how exactly does one go about examining how brain cells respond to an urban environment?

There are a variety of neuroscience tools that may be used to gather information about human’s experience of the city.

A key tool is mobile electroencephalography (EEG).  Previously, EEG involved equipment that could only be used in a laboratory.  However, technological advances have seen the development of mobile EEG ‘headsets’ that can be worn as research participants navigate different streets and environments of the city.

Mobile EEG enables researchers to measure brain function and activity, as well as the responses of the autonomic nervous system (heart rate, skin conductivity, endocrinological levels).  This can be used to understand how individuals experience urban environments.

For example, mobile EEG has been used to help understand the urban experiences of people with visual impairments.  Other mobile EEG studies have looked at whether using quiet, low traffic streets has a different effect on pedestrians than using streets busy with shops, traffic and other pedestrians.

Eye tracking machines are another tool providing research findings of interest to urban designers.  They study gaze behaviours and cognition, which are in turn related to attention, memory, language, problem solving, and decision making.  Eye tracking can help researchers to understand which features catch and hold attention, visual preferences and experiences. For example, one eye-tracking study found (perhaps unsurprisingly) that humans prefer lush greenery in urban environments.

As these neurological research and related technologies advance, their application will undoubtedly become more sophisticated and widespread.

 

Building upon evidence

The urban population around the world is expanding rapidly and finding solutions to the mental and physical health challenges that cities present is crucial.

By understanding the insights that neuroscience can provide, city planners, policy makers and others involved in urban design can access a growing evidence base upon which to build future cities that are healthy, attractive and inclusive places to live.


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

 

“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”


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The year that was: looking back on a year of policy and practice on The Knowledge Exchange blog

Before bidding farewell to 2017, there’s just time to reflect on some of the issues we’ve been covering in The Knowledge Exchange blog during the past twelve months. There’s been no shortage of subjects to consider, from health and social care and devolution to  universal credit and town planning.

Missing EU already?
Of course, the major issue dominating policy in the UK this year has been Brexit. In July, we reviewed a new book by Professor Janet Morphet which assessed the UK’s future outside the European Union. While not claiming to have all the answers, the book provides a framework for making sure the right questions are asked during the negotiation period and beyond.

One important consideration concerning Brexit is its potential impact on science, technology and innovation. In August, we noted that, while the UK government has been making efforts to lessen the concerns of researchers, anxieties remain about funding and the status of EU nationals currently working in science and technology roles in the UK.

Home thoughts, from home and abroad
Throughout the year, we’ve been looking at the UK’s chronic housing crisis. In May, we considered the potential for prefabricated housing to address housing shortages, while in August, we looked at the barriers facing older people looking to downsize from larger homes. In October, we reported on the growing interest in co-housing.

The severe shortage of affordable housing has had a significant impact on homelessness, and not only in the UK. In April, we highlighted a report which documented significant rises in the numbers of homeless people across Europe, including a 50% increase in homelessness in France, and a 75% increase in youth homelessness in Copenhagen.

One European country bucking this trend is Finland, and in July our blog looked at the country’s success in reducing long term homelessness and improving prevention services. Although the costs of Finland’s “housing first” approach are considerable, the results suggest that it’s paying off: the first seven years of the policy saw a 35% fall in long term homelessness.

Keeping mental health in mind
A speech by the prime minister on mental health at the start of the year reflected growing concerns about how we deal with mental illness and its impacts. Our first blog post of 2017 looked at efforts to support people experiencing mental health problems at work. As well as highlighting that stress is one of the biggest causes of long-term absence in the workplace, the article provided examples of innovative approaches to mental illness by the construction and social work sectors.

A further post, in August pointed to the importance of joining up housing and mental health services, while in September we explored concerns that mobile phone use may have negative effects on the mental health of young people.

Going digital
Another recurring theme in 2017 was the onward march of digital technologies. In June, we explored the reasons why the London Borough of Croydon was named Digital Council of the Year. New online services have generated very clear benefits: in-person visits to the council have been reduced by 30% each year, reducing staffing costs and increasing customer satisfaction from 57% to 98%.

Also in June, we reported on guidance published by the Royal Town Planning Institute on how planners can create an attractive environment for digital tech firms. Among its recommendations: planners should monitor the local economy to get a sense of what local growth industries are, and local authorities should employ someone to engage with local tech firms to find out how planning could help to better facilitate their growth.

Idox in focus
Last, but not least, we’ve continued to update our readers on new and continuing developments at the Idox Information Service. Our blog has featured articles on the Research Online, Evaluations Online and Ask-a-Researcher services, as well as the Social Policy and Practice database for evidence and research in social care. We were proud once again to sponsor the 2017 RTPI Research Excellence awards, and highlighted the winning entries. And following an office move, in September we explored the fascinating history behind the building where we now do business.

Back to the future
2018 is already shaping up as an important year in policy and practice. One important issue exercising both the public and private sectors is preparing for the General Data Protection Regulation. The Knowledge Exchange blog will be keeping an eye on this and many other issues, and the Idox Information Service, will be on hand to ensure our members are kept informed throughout 2018 and beyond.

Thank you for reading our blog posts in 2017, and we wish all of our readers a very Happy Christmas and a peaceful and prosperous New Year.


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