Mental health is 'made in communities'

Connecting the dots: tackling mental health inequalities in Wales

This is the fourth chapter of the Health and Social Care Committee ‘Connecting the dots: tackling mental health inequalities in Wales’ report.

 

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On this page:

— Mental health is 'made in communities'.

— The role of communities

— Funding

— Our view

— Report contents

 

 

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Mental health is 'made in communities'

The role of communities

82. Communities have a vital role to play in preventing mental ill health, promoting and protecting mental wellbeing, and supporting people who are living with mental ill health. Dr Jen Daffin described relationships and connections as key conditions required for people to thrive, saying that safe and supportive relationships with families, friends and communities provide “security, meaning, purpose and trust”.[132]

83. We have heard calls throughout our work for greater investment in communities, and to build the capacity of local voluntary and community groups to develop and deliver services, including improving access to community hubs. Andy Bell spoke for many when he said:

“…put simply, mental health is made in communities. We often think about mental health as being a deficit—you either have perfect mental health or you have mental illness. And, of course, the reality is much more complex than that, and good mental health is something you have to go out and make—it doesn't just happen in the absence of mental illness, if you like. And one of the things that we observe is that it's in communities where you create the conditions for people to have good mental health, when that community is a local area or a neighbourhood, whether it's a school, whether it's a digital community—whatever it is, that's where we protect and promote good mental health”.[133]

 

84. We heard calls for a whole-communities approach to supporting wellbeing to build on the whole-school approach already being implemented in Wales. This would see all partners working more effectively together, including statutory services and the voluntary and community sector. The Welsh Local Government Association suggested that the role of local government should feature more strongly in discussions about improving and delivering mental health support:

“…for example, broadening the use of parks and green space, championing wellbeing in new planning requirements, supporting adult learning, improving access to leisure centres and sports facilities, or improving community links with local artists and cultural events”.[134]

 

85. The Welsh Government published its Connected Communities strategy in February 2020.[135] The strategy notes that the Welsh Government can foster environments where community links are broadened and deepened by “making sure the necessary foundations are in place to bring them together and to provide the services we all need to stay healthy, to learn, to access employment, and to build prosperity”. It highlights that all parts of Government have a role to play in tackling loneliness and social isolation, and commits to setting up a cross-government loneliness and social isolation advisory group to oversee the strategy’s implementation. When asked about this, the Deputy Minister for SS said that the Welsh Government was also working with stakeholders such as PHW, Samaritans and Mind Cymru. She added, however, that “tackling loneliness and isolation is such a huge agenda that we can, really, only make steps in it”.[136]

 

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Funding

86. There are already many community and third sector projects and initiatives, led by and meeting the needs of different groups and communities. However a lack of sustainable long-term funding was a significant concern. Diverse Cymru said:

“Longer term funding of services, including services commissioned from third sector and community groups and organisations, is vital to ensuring that services can focus on meeting the needs of different groups and communities and developing specialist services, rather than winding up and down every 3 years”.[137]

 

87. During our visit to EYST Cymru, we were told that significant staff resource has to go into preparing new funding bids as projects reach the end of their funding period, even when projects have been proven successful. Insecure funding also risks losing valuable members of staff, and the relationships and trust they have built with their communities.[138]

88. The Deputy Minister for SS told us that the three year £1.5m Connected Communities loneliness and isolation fund was focused on supporting grass-roots community groups and organisations aimed at bringing people together to make social connections in their local areas. She acknowledged that short-term funding could cause significant issues for voluntary bodies. She said that Connected Communities grants would be for up to three years, and grants under the Health and Social Care Regional Integration Fund (“HCRIF”) could be for up to five years.[139] The Deputy Minister for MHW agreed on the importance of longer term sustainable funding, but noted this depends on the provision of multiyear budget settlements from the UK Government. She said that following a mapping exercise to identify local third sector organisations providing mental health services, £5m had been allocated to health boards for spending on third sector service provision in their areas to improve funding sustainability.[140]

 

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Our view

89. Mental health and wellbeing is not just a matter for the NHS or specialist services; it is a much broader public health issue. Improvements to mental health services are necessary, but we also need much more focus on prevention, on tackling the issues that are making population health and wellbeing worse in the first place, and on supporting communities to build, sustain and nurture positive mental health and wellbeing. This is because mental health is made in communities. Communities play a vital role in prevention—building and protecting mental wellbeing—as well as supporting those living with mental ill health.

90. While there is information available in some parts of Wales about the community-based services that are available, this can be patchy across Wales and it is not always clear who has collated information, how up to date it is, or who is responsible for maintaining it. This, combined with a lack of a national and/or regional strategic approach to community service development, makes it difficult for individuals and health professionals to know what services or support may be available or where there may be gaps that need to be addressed. It can also lead to duplication, if different bodies do not work together to collate or maintain information. Our advisory group highlighted issues regarding the accessibility of community facilities and activities, and the need to improve the advertising and promotion of what services are available. Similarly, WYPMs told us there was a need for an online, anonymous chat service to support young people.[141] Such services do already exist, for example those provided by Papyrus and Meic Cymru, but it is clear that if WYPMs who are themselves exploring issues relating to mental health are not aware of them, more needs to be done to promote them and raise awareness.

91. In relation to services for children and young people, the new NEST/NYTH framework[142] developed by the Together for Children and Young People Programme may help contribute to a more strategic approach, but this does not extend to adults. It is positive that a mapping exercise has been undertaken to identify local third sector organisations providing mental health services to inform funding allocation.[143] However, the information gathered could and should also be used to improve understanding and awareness of the organisations and services that exist to support people with their mental health and wellbeing, and to identify whether the organisations active in each area meet the full range of their communities’ needs. This should include, for example, whether there are sufficient spaces and activities for children and young people across the age spectrum.

92. In our Waiting well? report we asked for assurance that the return to multiyear Welsh Government budgets would result in longer-term funding certainty for third sector organisations.[144] The Welsh Government accepted our recommendation.[145] This is welcome, as the detrimental effects of funding uncertainty are considerable, including disproportionate time and resources being spent on funding applications rather than service delivery, the risk of losing key personnel and their knowledge, expertise and relationships, and damage to trust between services and the communities they serve. We also share the views of our advisory group that community organisations should be able to access adequate support to help with set up and running costs, and that work is needed to improve the accessibility of the application process. The steps taken by the Deputy Ministers to increase funding sustainability and stability for third sector organisations by providing longer-term grants, including those from the HCRIF, are welcome. However, one-off grant funding, even over longer periods, should not be a substitute for continuous core funding for organisations or services able to evidence the ongoing benefits of their work for their communities.

93. We are not yet persuaded that the issue of funding sustainability for third sector and community organisations has been resolved, and will continue to monitor this issue.

 

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Table of Contents

— Chair's foreword

— Recommendations

— Summary

— Introduction

— Mental health inequalities

— Person-centred services

— Mental health is 'made' in communities

— Social prescribing

— Workforce

— Coordinated cross-government action

— Reform of the Mental Health Act 1983

— Annex: Mental health and emotional support