Mentally healthy communities are communities where people feel safe, respected, and supported; with access to a well-maintained physical environment; with opportunities for social interaction, using and acquiring skills, participating and influencing as they wish to and with ease, and accessing resources as and when required and without barriers.Promoting mental wellbeing means ensuring that each of us is supported in being as mentally well as possible. Improving the quality of life for those who experience mental health problems will mean communities can function well and contribute to a healthy society, in terms of behaviour, social inclusion, community safety and prosperity. See the Foresight website [external site].A community which is focused on mental wellbeing is a community contributing to positive relationships and social cohesion within its population. A sense of belonging is created when people feel they are contributing to their environment, with opportunities to participate and engage in local activity.Issues such as the level of inequality, discrimination, poverty, alcohol consumption, substance abuse, concerns about safety and crime, and tensions between groups can be contributing factors in the mental health of a community as well as more positive factors such as civic engagement (e.g. volunteering and voting). See the Foresight website [external site].back to top
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The physical environment: A number of reviews have suggested that the physical environment has an important role to play in mental health improvement. A state-of-science review called The Effect of the Physical Environment on Mental Wellbeing [PDF: 1.40mb] was undertaken for the Foresight Project, Mental Capital and Wellbeing. Among the significant factors identified are noise and light levels, building layouts and way-finding, access to nature; and the design of everyday products, buildings, transport systems and information and communication devices. These factors can contribute to levels of stress or contentedness, a sense of inadequacy or self-efficacy, and feelings of isolation from or connection to others. A critical review of health and the physical characteristics of urban neighbourhoods concluded that people who see their neighbourhoods as hostile, dirty, poorly maintained, and lacking in safe places to play, are more likely to experience anxiety, depression, and poor health. See the Glasgow Centre for Population Health, Health and the Physical Characteristics of Urban Neighbourhoods: A Critical Literature Review [PDF: 196kb] Health Impact Assessment of greenspace [PDF: 1.4mb], published by Greenspace Scotland in 2008, concluded that there is evidence that access to nature and green space can have a positive impact on levels of stress. The mechanisms by which green space has a positive impact are unclear. Effects occur even after brief exposure to a view of nature but less is known about the impact of long-term exposure to nature or the influences of different types of nature.
See the greenspace and quality of life: a critical literature review for more information. There is a body of evidence which considers how natural environments encourage and support physical activity, which in turn is associated with mental wellbeing. Informed by reviews of effectiveness evidence, NICE public health guidance 8: Promoting and creating built or natural environments that encourage and promote physical activity [external site], has seven recommendations, each with a number of action points, relating to five areas: strategies, policies and plans; public open spaces; transport; buildings; and schools. NHS Health Scotland considered the recommendations in the Scottish context and the NHS Health Scotland Commentary [external site] on this guidance supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangements. Details of, and links to, relevant Scottish policies, strategies, action plans and resources are also provided in the commentary.
Access to cultural experiences:Reviews of the literature suggest that there is evidence that access to cultural and sporting experiences, including the arts, can enhance mental health improvement.
A Literature Review for the Evidence Base for Culture, the Arts and Sport Policy [PDF: 1.0mb] undertaken by Janet Ruiz for the Scottish Executive examined the national and international research evidence for the social and economic impact of culture, the arts and sports. Some of the key findings include:
Access to the arts in schools, workplaces, health service settings and communities can increase personal empowerment through self-expression, gaining of skills and building relationships.
Creating strong communities: Mental Health and Social Exclusion [external website] draws on a review of literature and research as well as consultations and field studies. It concludes that social isolation and loneliness are important risk factors for mental health problems and suicide. Strong social networks, social support and social inclusion can play a significant role in preventing mental health problems and improving outcomes. There is some evidence, from a review undertaken to support the development of NICE public health guidance 9: Community engagement to improve health [PDF: 462kb], to suggest that community engagement activities may impact on social capital and volunteering. Informed by reviews of effectiveness evidence, this guidance has 12 action recommendations which together are intended to present the ‘ideal scenario for effective community engagement’. These include recommendations about the prerequisites for effective community engagement, the infrastructure, the approaches and evaluation of community engagement programmes. NHS Health Scotland considered the recommendations in the Scottish context and the NHS Health Scotland Commentary [external site] on this guidance supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangements. Details of, and links to, relevant Scottish policies, strategies, action plans and resources are also provided in the commentary. An evidence briefing (commissioned by the Health Development Agency and subsequently published by NICE called Public health interventions to promote mental wellbeing and prevent mental health problems among adults found review level evidence that:
Preventing social isolation and loneliness among older people: a systematic review of health interventions [PDF: 680kb] concluded that group activities with educational or support input can be effective in addressing social isolation and loneliness in older people – programmes that enabled older people to be involved in planning and delivering activities are most likely to be effective. Promoting mental health and well-being in later life [PDF: 680kb] draws on a comprehensive literature and policy review, and the views of nearly 900 older people and carers, together with the views of nearly 150 organisations and professionals. The report identified five key areas for action to promote mental wellbeing in later life, including supporting the development and maintenance of positive relationships.
Access to services: An essential part of any community is the provision of, and fair access to, a wide range of services. These services should be easily accessible for all sections of the community and, for mental health benefits, go beyond health services to include banks, post offices, libraries and culture and leisure facilities. See The Scottish Government’s building community well-being report [external site]. Mental Health and Social Exclusion [PDF: 1.1mb], a report by the Social Exclusion Unit [external site] indicates that there is an association between mental health problems, impoverished social networks and low participation in sports, arts, leisure and community activities. The report identified six areas of action. ‘Getting the basics right’, refers to the need for people with mental health problems to access decent and stable housing, basic financial and transport services and practical information and advice about opportunities in their communities. Debt is a particular risk factor for mental health and people with mental health problems are more likely to experience debt. Mental Capital and Well-being [external site] makes a number of suggestions to prevent and support people, including those with mental health problems, to manage uncontrolled debt. These actions include: building financial capacity; acting early to prevent and support management of debt; and championing changes in practice in financial services, utility and mortgage companies.
The physical environment:The aim is to address the physical environment of communities by:
Access to cultural experiences:‘The power of the arts…to catalyse personal and social transformation and deliver on social policy should not be underestimated. The arts may well be fun, bring aesthetics, promote inclusion and facilitate growth in self-esteem but they do much more than that in a community development, social transformation context.’The Social Inclusion website [external site].The aim is to promote equal access to cultural experiences by:
Creating strong communities:The aim is to build and strengthen community participation and relations by:
Access to services:The aim is to ensure fair access to services by:
The physical environment:Information relating to sharing practice can be found at:
Access to cultural experiences: Advice on best practice can be found on the Community Health Exchange (CHEX) website [external site].
Creating strong communities: See $mall Change, Big Impact [PDF: 203kb] for best practice guidelines.
Access to services: See $mall Change, Big Impact [PDF: 203kb] for best practice guidelines.
A particular focus on deprived communities is needed, as people living in such areas are more likely to:
Physical and social regeneration of communities has an important role to play in mental health improvement. Objectives are to improve employability, education, health, access to local services, safety and the quality of the local environment in the most deprived neighbourhoods. Improvements in the 15 per cent most deprived areas in Scotland are to be achieved through use of a Community Regeneration Fund [PDF: 53kb]. back to top