Guidance

2. Mental health: environmental factors

Updated 25 October 2019

© Crown copyright 2019

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This publication is available at https://www.gov.uk/government/publications/better-mental-health-jsna-toolkit/2-understanding-place

1. Introduction

The purpose of the mental health and wellbeing JSNA toolkit is to support people developing the mental health and wellbeing content of their local joint strategic needs assessment. This chapter helps consider factors related to the promotion of mental wellbeing and the prevention of mental health problems. It provides easy access to nationally available topic focused information, guidance and knowledge. The chapter text aims to be plain English and ready to be cut and pasted. The numerous links to external sites should all be current, relevant, and provide access to material that contributes to the JSNA process.

One aim of a JSNA is to understand the determinants of health in an area and consider social and contextual factors that affect mental health, such as employment, crime, safety and housing. The mental health of each individual is influenced by their social setting, such as having the ability to earn enough money and feeling part of a community[footnote 1]. This chapter considers these determinants which lead to unfair and avoidable differences in health within and between populations.

Understanding these social factors in a local area can help to quantify levels of risk, protection and resilience within a community. It can help to identify vulnerable groups and consider what interventions could help to reduce vulnerability and develop resilient communities. Greater community resilience has the potential to:

  • reduce the prevalence of mental health problems
  • increase the prevalence of good mental health
  • improve recovery and support for individuals who have become unwell

Understanding these ‘place’ effects on health, and particularly the effect of measures of deprivation, may have been considered elsewhere within the wider JSNA process. This should be drawn upon and used to consider which factors are important to mental health.

Interventions which affect the social determinants of mental health require joint working and collaboration across a range of partners, for example the education sector working with health and wellbeing boards.

Type of questions a JSNA could address include[footnote 2]

  • what local social, economic and other factors encourage good mental health?
  • what local social, economic and other factors damage mental health?
  • how are these changing over time?
  • how do they affect different groups of people or cause inequalities?
  • what are the community’s main assets and how strong are social networks?
  • what do local people feel about the area and what are they concerned about?
  • how do these wider factors affect the need for mental health services?
  • how can these wider influences on health be tackled by prevention initiatives?

2. Deprivation and inequality

It is well established that deprivation (a lack of money, resources and access to life opportunities) or being in a position of relative disadvantage (having significantly less resource than others) is associated with poorer health, including mental health.

2.1 Overview

Mental health is closely related to many forms of inequality, with a particularly pronounced gradient for severe mental illness[footnote 3]. The prevalence of psychotic disorders among the lowest fifth of household income is 9 times higher than in the highest and double the level of common mental health problems between the same groups.

Explaining the relationship between deprivation and mental health is complex and it is hard to unpick cause and effect. Experiencing disadvantage can increase the risk of mental health problems. People with mental health problems can be affected by a ‘spiral of adversity’[footnote 1] where factors such as employment, income and relationships are affectedby their condition. People who live in deprived areas are more likely to need mental healthcare but less likely to access support and to recover following treatment[footnote 4]. This compound and worsens mental health problems.

Deprivation is about more than lack of money. It can include lack of access to resources such as adequate housing and exposure to negative stressors such as violence, crime or lack of public green space. A growing body of evidence suggests the relationship between deprivation and mental health is not just about absolute lack of resource for individuals. Populations with large differences in wealth and resource between individuals are associated with higher levels of poor health and mental health problems for the population as a whole[footnote 5].

2.2 Data sources

Metrics in the profiling tool relating to deprivation and inequality are:

In risk factors:

  • children in income deprivation (county and UA)
  • income deprivation affecting children index (UK) (ward)
  • deprivation score: IMD 2015 (county and UA, district and UA, CCG, GP, ward)

Other important data sources include:

Local data

Local analyses will be able to draw upon additional local data about deprivation and inequalities to further profile risk and map inequalities. For example, use of different services (primary care, accident and emergency (A&E) and mental health services) by local deprivation measures.

2.3 Evidence and further information

The topic specific sections which follow will include additional relevant information on:

  • poverty and financial security
  • housing and homelessness
  • education and lifelong learning
  • employment and working conditions
  • crime and justice
  • community wellbeing
  • social capital

The following documents and supporting materials are useful sources of further information on this topic:

Health Matters: reducing health inequalities in mental illness is a publication by Public Health England describing the drivers of inequalities associated with mental health particularly in understanding the social inequalities and disadvantages in severe mental health illness.

LGA: Being mindful of mental health: The role of local government in mental health and wellbeing sets out the important role councils play in supporting the mental wellbeing of their communities, including the Local Government Association’s (LGA) vision of what a ‘mentally healthy’ place looks like.

The Royal Town Planning Institute’s Poverty, place and inequality sets out a place-based approach to addressing poverty and inequality by understanding how local environments shape people’s behavior and enhance wellbeing.

Marmot review report - Fair society, health lives 2010 proposes an evidence-based strategy to address the social determinants of health which can lead to health inequalities.

3. Poverty and financial insecurity

Low income and debt are risk factors for mental illness. Personal and family financial security is a protective factor. Improved understanding of financial circumstances can help identify and target vulnerable groups and support the recovery of people with mental health problems.

3.1 Overview

Poverty can be both a causal factor and a consequence of mental ill health. Across the UK, both men and women in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems as those on an average income. The cumulative effects of poverty are present throughout the life course, starting before birth and continuing into older age[footnote 6].

Unmanageable financial debt is associated with poorer mental health[footnote 7],[footnote 8]. A quarter of people experiencing common mental health conditions also have financial problems, 3 times more than the general population[footnote 9]. Half of adults with a debt problem also have a common mental health condition. A survey of 5,500 people with mental health problems found that 86% of respondents said their financial situation had made their mental health problems worse[footnote 7].

Mind has a dedicated section on its website outlining the relationship between money and mental health problems. Mental health problems can effect an individual’s motivation and ability to attend work or rehabilitation programmes which can affect income and recovery.

Additionally, a number of mental health conditions can lead to periods of impulsivity in spending, and anxiety is often exacerbated by money concerns. When people do not have enough money they may struggle to afford ‘essentials’ such as heating, housing, food and medication. Social activity is often an area where people look to save money, which can lead to increased social isolation and have a negative effect on people’s relationships and mental health.

Since 2008, the UK has experienced the effects of a prolonged economic downturn. Policy decisions in response to the economic downturn have resulted in reductions in some public spending, and there is concern that this could negatively affect the mental health of the population[footnote 10].

3.2 Data sources

Metrics in the profiling tool relating to poverty and financial security include:

In risk factors:

  • fuel poverty (county and UA, district and UA)
  • housing affordability (county and UA)

Other important data sources include:

3.3 Local data

Local analyses may be able to draw upon additional data about financial circumstances and associated supportive interventions. Local Citizens Advice Bureaus, Credit Unions, food banks and relevant local charities may hold data.

3.4 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic:

Citizens Advice: A debt effect? How is unmanageable debt related to other problems in people’s lives? investigates the relationship between high levels of debt and a range of wider issues including unemployment, low pay, physical health problems and poor mental health.

Joseph Rowntree Foundation’s We can solve poverty in the UK sets out recommendations on actions to solve poverty.

The Mental Health Foundation’s Poverty and mental health review examines the relationship between poverty and mental health.

Money and mental health policy institute’s ‘The missing link – how tackling financial difficulty can boost recovery rates in IAPT’ puts forward the case that the adult improving access to psychological therapies (IAPT) programme should seek to recognise, and develop ways to mitigate, the effects of financial difficulty.

PHE’s Commissioning cost-effective services for promotion of mental health and wellbeing and prevention of mental ill health includes a section on the effectiveness of providing debt advice to encourage mental health.

4. Housing and homelessness

Housing is critical to the prevention of mental health problems and the promotion of recovery[footnote 11]. Homelessness and poor quality housing are risk factors for mental health problems. Stable, good quality housing is a protective factor for mental health and can be a vital element of recovery.

Overview

Insecure, poor quality and overcrowded housing causes stress, anxiety, and depression, and exacerbates existing mental health conditions[footnote 12] . 19% of adults living in poor quality housing in England have poor mental health outcomes[footnote 13]. For example, adolescents living in cold housing are at a significantly greater risk of developing multiple mental health conditions[footnote 14]. A cold home also contributes to social isolation which may be a particular issue for older people[footnote 15].

Everybody who experiences homelessness will feel stress and anxiety, and many report depression[footnote 13]. Mental health problems among people experiencing homelessness are more prevalent than in the general population, particularly among people caught in the ‘revolving door’, between hostels, prison, hospitals and the streets[footnote 16]. Compared with the general population, homeless people are twice as likely to have a common mental health condition, and psychosis is up to 15 times more prevalent[footnote 11]. They are also over 9 times more likely to complete suicide[footnote 17] . People experiencing homelessness find it difficult to access health services, including mental health care[footnote 18] ,[footnote 19] .

4.1 Data sources

Metrics in the profiling tool relating to housing and homelessness include:

In risk factors:

  • statutory homelessness (county and UA, district and UA, region)
  • fuel poverty (county and UA, district and UA)
  • housing affordability ratio (county and UA)
  • landlord home repossessions (district and UA)

In protective factors:

In quality and outcomes:

  • stable and appropriate accommodation for adults in contact with mental health services (County and UA)

Other important data sources include:

4.2 Local data

Local analyses may be able to draw additional data about housing policy likely to have a beneficial effect on population mental wellbeing. This may include metrics on topics such as: numbers of supported accommodation places available, rental stability and security, affordable housing units planned/built in last year(s) and numbers of people with mental illness in receipt of direct payments or services to support them remaining in their own home. There may also be locally conducted surveys to assess housing needs and data from third sector organisations working with people who are homeless.

4.3 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic.

Centre for Mental Health’s More than shelter presents a series of important themes for consideration in the future development of supported accommodation for adults with severe mental health problems, including those with multiple needs and substance misuse and those facing homelessness.

Homeless link website provides resources including audit tool for needs assessment and a prevention opportunities mapping and planning toolkit (PrOMPT) which supports gathering information that can be used to redesign services and improve prevention.

The Mental Health Foundation’s Mental health and housing report on types of supported accommodation that successfully meet the needs of people with mental health problems - to recommend effective housing solutions.

PHE’s Homelessness: applying all our health provides an overview of the issues that are associated with homelessness and highlights interventions that can be implemented at population, community, family and individual levels.

PHE’s Homes for health provides resources on housing conditions, suitability and homelessness, and building healthy communities to help local authorities, health and social care commissioners and decision makers make plans to improve health and wellbeing through the places people live.

PHE’s Spatial planning for health: an evidence resource for planning and designing healthier placesCommunity based provides public health planners and local communities with evidence informed principles for designing healthy places.

5. Education and lifelong learning

Education is an important determinant of later health and wellbeing. It improves peoples’ life chances, increases their ability to access health services and enables people to live healthier lives.

Overview

Education develops skills that help people to function and make decisions in life. It increases peoples’ ability to get a job and avoid living in poverty. It helps people to understand how social and health systems work allowing them to improve their health and wellbeing[footnote 20].

Schools have an important role in promoting mental health among children[footnote 21]. Well implemented interventions can encourage resilience and develop the coping skills of all pupils while also targeting help to those with mental health problems[footnote 22] .

Pupils with emotional and conduct disorders are more likely to fall behind in their learning[footnote 23]. Those not in education, employment or training (NEET) after the age of 16 are at increased risk of depression and suicide and the damaging effect of unemployment at this stage of life lasts into later life[footnote 24]. Successful interventions exist which reduce the proportion young people who are NEET. These are more likely to be effective if the intervention is early and if they tackle the barriers faced by children and young people in accessing education and training. They must also work across organisational and geographic boundaries[footnote 24].

For adults, lifelong learning opportunities can increase the ability of those with low educational attainment to exert control of their lives[footnote 25]. Participation in adult learning can help encourage wellbeing and protect against age-related cognitive decline in older adults[footnote 26]. Community-based adult education programmes can be a form of social prescribing for mild to moderate anxiety and depression and have been found to reduce symptoms by offering access to social networks and activities[footnote 27].

Education can also improve levels of health literacy. This can be defined as ‘the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health’[footnote 28]. People with low health literacy experience a range of poorer health outcomes and are more likely to engage in behaviours that risk their health[footnote 29]. Practitioners can increase levels of health literacy by improving people’s access to health information, for example by using accessible language.

5.1 Data sources

Metrics in the profiling tool relating to education and lifelong learning include:

In protective factors:

  • school readiness (county and UA)
  • average attainment 8 scores (county and UA)
  • GCSEs achieved 5 grades A* to C (ward)

In risk factors:

  • 16 to 18 year olds not in education, employment or training (county and UA, region)

Other important data sources include:

5.2 Local data

Additional local data from education providers and local authorities will be available and should be used to gain insights on provision, access and needs in the local area. This could include data on availability of and access to life-long learning.

5.3 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic.

Department for Education’s Mental health and behaviour in schools: departmental advice for school staff gives strategies to encourage resilience and support pupils at risk of developing mental health problems in schools.

Mental Health Foundation’s Learning for life: adult learning, mental health and wellbeing outlines evidence for adult learning interventions for anxiety and depression.

Social and emotional wellbeing in primary and secondary education are NICE guidelines to promoting social and wellbeing in children in the educational setting.

PHE’s Commissioning cost-effective services for promotion of mental health and wellbeing and prevention of mental ill health includes sections on the effectiveness of school-based social and emotional wellbeing programmes and programmes to address bullying of young people.

PHE and the Institute for Health Equity’s Reducing the number of young people not in employment, education or training (NEET) outlines interventions to reduce the number of young people NEET and evidence for the cost-effectiveness of interventions.

PHE’s Supporting mental health in schools and colleges provides a survey and case studies with schools on activities to support pupils’ mental health and wellbeing.

6. Employment and working conditions

Stable and rewarding employment is a protective factor for mental health and can be a vital element of recovery from mental health problems. Unemployment and unstable employment are risk factors for mental health problems.

6.1 Overview

There are strong links between employment and mental health[footnote 1]. The workplace provides an opportunity to encourage well-being and support people to ‘build resilience, develop social networks and develop their own social capital’[footnote 30]. People who are unemployed are between 4 and 10 times more likely to report anxiety and depression and to complete suicide[footnote 31].

The right to work is universal and protected by the Equality Act 2010, yet there is a known employment gap between people with mental health problems and the general population[footnote 15]. Analysis of a national survey found people with a common mental health condition are four to five times more likely to be permanently unable to work and three times more likely to be receiving benefits payments[footnote 32].

Being in work is beneficial to health and well¬being. However, it is important to distinguish between ‘good work’ (characterised by fair treatment, autonomy, security and reward), and ‘bad work’ in which individuals feel unsupported, undervalued and demotivated[footnote 33]. Flexible employment practices, such as zero-hours contracts, can be abused by managers and lead to financial insecurity, anxiety and stress[footnote 34].

Challenges remain for people with mental health problems in gaining and maintaining employment, sometimes because of negative attitudes and stigma, and concerns from employers who know little about mental health. Between 30% and 50% of people with schizophrenia are thought to be capable of work given appropriate support and opportunity, yet only 9% of people with a probable psychotic disorder are working full-time and 19% part-time[footnote 35]. There is an emphasis on the doubling of access to individual placement and support (IPS) interventions aimed at enabling people with severe mental illness to find and retain employment[footnote 36].

Mental health problems also have a significant effect on employers. Nearly one sixth of the workforce is affected by a mental health condition[footnote 37] and mental health related absences cost UK employers an estimated £26 billion per year[footnote 38] . Employers have a responsibility to provide a healthy workplace[footnote 39]. This can be achieved through providing a culture of participation, equality and fairness and developing the role of line managers[footnote 40],[footnote 41].

6.2 Data sources

Examples of metrics in the profiling tool relating to employment and working conditions include:

In risk factors:

  • employment deprivation (county and UA, district and UA)
  • allowance and benefits (county and UA, district and UA)

In protective factors:

  • employment (county and UA, district and UA)

In quality and outcomes:

  • employment of people with a mental illness or learning disability (county and UA)
  • gap in employment rate for those in contact with secondary mental health services and the overall employment rate (county and UA)

Other important data sources include:

  • NOMISWEB labour market statistics provided by the Office for National Statistics includes data on benefit claimants, including those recorded as being on benefits due to mental and behavioural disorders.
  • benefits statistics are also available on Stat-Explore
  • Public Health England ROI tool provides assessment of the ROI of interventions to encourage health and wellbeing in the workplace and workplace interventions to prevent stress, depression and anxiety problems
  • Understanding local needs for wellbeing data from the What Works Centre for Wellbeing provides recommended relevant indicators

6.3 Local data

Additional local data may be available from local authorities, from relevant local agencies and from analysis of ad-hoc surveys which include questions about employment status and mental health state. There may also be local knowledge about changes in large employers and how these relate to employment at a sub-local authority level and data from programmes that support people into employment.

6.4 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic:

Business in the Community and PHE’s Mental health toolkit for employersaimst to help organisations support mental health and wellbeing of employees.

The Centre for Mental Health’s Individual placement and support (IPS) outlines the IPS approach, including links to the relevant evidence base and examples of successful implementation.

Department for Work and Pensions’ Work, health and disability green paper is a government consultation paper highlighting the important relationship between work and health. Includes proposed improvement strategies.

The Cochrane review’s Flexible working conditions and their effects on employee health and wellbeing evaluates the effects of flexible working interventions on the physical, mental and general health and wellbeing of employees and their families.

Mind’s mental health at work web resources provide training information and webinars for individuals and employers. Includes resources about supporting staff who are experiencing a mental health problem.

Mental wellbeing at work and workplace health are NICE guidance publications developed to encourage mental wellbeing at work. Recommendations vary according to organisation type and size and links to relevant related guidance are made within the pathway. A comprehensive resource page is also available along with an accompanying guide.

PHE’s Commissioning cost-effective services for promotion of mental health and wellbeing and prevention of mental ill health includes sections on the effectiveness of interventions to encourage health and wellbeing in the workplace and prevent stress, depression and anxiety problems.

PHE’s Workplace health: applying ‘All our health’ provides evidence and guidance to help healthcare professionals encourage people to live healthy lifestyles at work. Also includes a wide range of references to relevant NICE publications and sources of employment indicators.

SCIE: Mental health, employment and the social care workforce summarises evidence on what prevents people with mental health problems from working or retaining work in social care and what can be done to enable them to work.

Workplace wellbeing charter is an online resource providing information for workplaces on how to assess and improve their workplace wellbeing.

7. Crime, safety and violence

The relationship between crime and mental health problems is complex. It can also be controversial, as public perception about the relationship can contribute to stigma, discrimination and social exclusion.

Overview

While there is public perception that people with mental health problems are offenders, the vast majority of these individuals are not violent and the most crimes are committed by people who do not have mental health problems[footnote 42]. People with mental health problems are three times more likely to be a victim of crime than the general population and five times more likely to be a victim of assault (rising to 10 times more likely for women)[footnote 42].

There is high prevalence of mental health needs among people in contact with the criminal justice system. 16% of prisoners report symptoms indicative of psychosis, a much higher proportion than in the general population[footnote 43]. These disorders are more severe and complex[footnote 44], and are often combined with poor physical health and substance misuse. There are high levels of mental health conditions amongst people on probation[footnote 45]. There are also high levels of mental health conditions (including psychosis, antisocial personality disorder and anxiety) among British male gang members[footnote 46].

People in contact with the criminal justice system have substantially more risk factors for suicide (increased prevalence of mental health conditions, substance misuse and socioeconomic deprivation) and are recognised as a priority group in the cross-government suicide prevention strategy[footnote 47]. The risk of suicide is highest in the 28 days following release from prison48. Suicide and self-harm is covered in more depth in Mental health: population factors.

Liaison and diversion services have received strong government backing in recent years[footnote 30]. The ambition is to divert people with mental health and/or substance problems away from custodial settings wherever possible, enable access to health and social care in the community and reduce likelihood of re-offending. Since 2017, parts of England have been testing a new Community Service Treatment Requirement (CSTR) programme. In some instances where short-term custodial sentences have been ineffective, offenders with mental health, alcohol and substance abuse issues are diverted towards treatment that aims to tackle the root cause of their criminality. The NHS Long Term Plan reaffirms the commitment to expand provision of the scheme[footnote 49].

Many people in contact with justice services with mental health problems will additionally be experiencing other issues such as difficulty accessing good quality homes, employment and income. This may result in their mental health deteriorating. Many have been victims of abuse and crime themselves. Those in prison need to have their needs identified and addressed during their time in prison and support should continue when they return to their local community. The care after custody service, RECONNECT, starts working with people before they leave prison and helps them to make the transition to community-based services by providing the health and social care support they need[footnote 49].

The major determinants of violence are socio-economic factors and substance misuse, whether they occur concurrently with a mental health condition or not[footnote 50]. Violence prevention strategies should include early identification and treatment of substance abuse problems and greater attention to the diagnosis and management of concurrent substance abuse disorders among people with a severe mental illness (see Mental health: population factors).

Being a victim of crime, or exposure to violent or unsafe environments can increase the risk of developing a mental health problem. The most serious example at a young age is child abuse, which can have a sustained detrimental effect on mental health through to adulthood[footnote 51].

Being a victim of intimate partner violence or domestic abuse increases the risk of mental health problems[footnote 52] and there are high rates of mental health conditions (particularly post traumatic stress disorder(PTSD)) among people who have been raped and among immigrant women who have undergone female genital mutilation[footnote 53].

Addressing the links between mental health and crime requires partnership work between a range of agencies including education, health, public health, police, the judiciary, places of custody and the range of community organisations which help people in contact with justice services. National partnership agreements for improving health in prisons[footnote 54] and other places of detention55 aim to help this. NHS England are working with the Ministry of Justice, Home Office, Department of Health and Public Health England to develop a complete health and justice pathway, delivering integrated interventions in the least restrictive setting as appropriate to the crime committed. This will include work with the secure estate for children and young people to improve the delivery of services and transition back to the community[footnote 11].

7.1 Data sources

Examples of metrics in the profile relating to safety, violence and crime:

In risk factors:

  • first time entrants to the Youth Justice System (county and UA)
  • re-offending levels (county and UA, district and UA)
  • violent crime (including sexual violence) – violence offences (county and UA, district and UA)

Other important data sources:

National Drug Treatment Monitoring Service (NDTMS) provides data on adult and children and young people’s community substance misuse treatment services including referrals from criminal justice pathways. NDTMS also provides data across the adult prison and CYP secure estates in England. (NB: aggregate data prison-level data are not in public domain).

Ministry of Justice (MoJ) Prison Population Data: prison population demographics and population flows includes data provided directly from prisons and other datasets including ONS data.

Health and Justice Indicators of Performance (HJIPs - not in public domain) - this NHS data asset has been co-produced with PHE and NOMS and collects data on a broad range of health needs and health services including prisoner mental health.

Relevant indicators are recommended in the What Works Centre for Wellbeing’s Understanding local needs for wellbeing data.

7.2 Local data

Local areas may be able to access relevant data which are not nationally available, eg for domestic abuse, additional local data may be obtainable from the police, Multiagency Risk Assessment Conferences (MARAC) and from services that provide interventions. Local data may be available directly from the prisons, probation services, and from youth offending services, including statistics from initial assessments about mental health and drug and alcohol use.

Depending on the local population and data availability, areas may choose to focus their needs assessment work on specific topics, for example gang culture, cyber bullying, female genital mutilation, slavery, child exploitation and forced prostitution. Local areas may choose to include more detailed information on prison populations if they have a prison within their area.

7.3 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic.

Mental Health Crisis Care Concordat website aims to improve responses to people in mental health crisis, many of whom come into contact with the police. It brings major partners together to agree shared actions.

Police and Crime Bill contains provisions that prohibit people aged under 18 being held in police custody under the Mental Health Act, ensures adults are only detained in exceptional circumstances and also reduces the maximum permitted detention time to 24 hours.

NHS England’s Liaison and diversion resources: offers a wide range of information on the liaison and diversion approach, including resources for services to use.

NICE guideline on Mental health of adults in contact with the criminal justice system covers assessing, diagnosing and managing mental health problems in adults (aged 18 and over) who are in contact with the criminal justice system.

Victims strategy offers a cross-governmental strategic framework to improving support for victims or witnesses to crime during their journey through the justice system. Often traumatic experiences can leave physical and mental scars that can endure many years after the events.

Understanding victims of crime by Victim Support offers quantitative and qualitative look at the effect of crime and the victims’ needs, identifying the effects of victimisation and recognise victims’ expressed needs.

PHE’s annual health and justice report focuses on health in prisons and other places of detention.

Rebalancing act produced by Revolving Doors Agency and PHE, working with the Home Office and NHS England, supports collaborative work to improve health, reduce offending and health inequalities among people in contact with the criminal justice system.

Standards for Prison Mental Health Services is a framework by which to assess the quality of prison mental health services through a process of self and peer review.

8. Community wellbeing and social capital

Good mental health and wellbeing is an important health outcome in its own right and can improve resilience to mental and physical illness. Measures of good social capital are associated with better population-level health and wellbeing.

8.1 Overview

Mental wellbeing is more than the absence of mental illness. It is linked with an individual’s emotional, physical and social wellbeing and the wider social, economic, cultural and environmental conditions in which they live. Mental wellbeing is a combination of an individual’s experience (such as happiness and satisfaction) and their ability to function as both an individual and as a member of society[footnote 56]. It includes sense of control, resilience, self-efficacy and social connectedness.

Mental wellbeing is of particular importance to children and young people, influencing the way in which they cope with important life events. Children and adults with better mental wellbeing are likely to deal better with stressful events, recover more quickly from illness, and be less likely to put their health at risk[footnote 57].

The mental wellbeing of individuals is influenced by factors at a community level such as social networks, sense of local identify, levels of trust and reciprocity and civic engagement. The benefit of this “social capital” can be felt at an individual level (for example, through family support) or at a wider collective level (for example, through volunteering). Social capital is associated with values such as tolerance, solidarity or trust. These are said to be beneficial to society and are important for people to be able to cooperate[footnote 58].

Whilst disadvantaged communities have higher health need, they may also have assets within the community that can improve health and build resilience[footnote 59]. Community assets improve the health and the quality of the community. They include physical assets such as public green space, play areas and community buildings and social assets such as volunteer and charity groups, social networks and the knowledge and experiences of local residents. These assets have potential to protect and increase community wellbeing and thus strengthen resilience.

The wellbeing of young people is increasingly influenced by modern day technology. The significance of technology in peoples’ lives have led to debate on the effects of social media on young people’s mental and physical wellbeing[footnote 60]. The effects of substituting social media activity for other forms of social interaction is not fully understood. Cyberbullying is increasingly an issue in young people (see Children and young people).Understanding the use of this sometimes ‘problematic’ technology may help to manage the risks and instead be used to help improve wellbeing and health[footnote 61].

8.2 Data sources

Examples of metrics in the profiling tool relating to individual and community wellbeing include:

In protective factors:

  • wellbeing in 15 year olds (county and UA)
  • enough physical activity (county and UA, district and UA)
  • self-reported wellbeing (county and UA)

Other important data sources include:

Local data

Local areas may focus on collection of metrics around wellbeing and community assets to help understand local resilience. This may include local surveys to measure social capital including aspects of trust, group membership, social connections and participation in decision making processes. Inclusion of locally collected metrics could form an important element of a JSNA.

Guidance documents on potential metrics include:

8.3 Evidence and further information

The following documents and supporting materials are useful sources of further information on this topic:

9. References

  1. Faculty of Public Health, Mental Health Foundation. Better Mental Health for All: A Public Health Approach to Mental Health Improvement (2016) ↩ ↩2 ↩3

  2. Local Government Association. Joint Strategic Needs Assessment Data Inventory (2011) ↩

  3. Marmot M. Fair Society, Healthy Lives: A Strategic Review of Inequalities in England (2010) ↩

  4. Delgadillo J, Asaria M, Ali S, Gilbody S. On poverty, politics and psychology: the socioeconomic gradient of mental healthcare utilisation and outcomes. The British Journal of Psychiatry (2015) ↩

  5. Pickett K, James O, Wilkinson R. Income inequality and the prevalence of mental illness: a preliminary international analysis. Journal of Epidemiology and Community Health (2006) 60(7):646-7 ↩

  6. Mental Health Foundation. Poverty and Mental Health (2016) ↩

  7. Fitch C, Hamilton S, Bassett P, Davey R. The relationship between personal debt and mental health: a systematic review. Mental Health Review Journal (2011) 16(4):153-66 14p ↩ ↩2

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  9. Money and Mental Health Policy Institute. The missing link: how tackling financial difficulty can boost recovery rates in IAPT (2016) ↩

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