A Realist theory of how voluntary sector programmes improve community support for underseved groups

Introduction

In England there is pressure for mental health support to include community/voluntary sector provision.  Such provision may be lower for some locations/groups, creating concern that this further disadvantages people belonging to disadvantaged, minoritized, or stigmatized groups.  Two statutory providers in England set up voluntary sector run projects to tackle this.  It is unknown how, why and under what circumstances these projects work. 

Methods

We have created and are refining Realist programme theories of change: to what extent is change created, how it is created and what are the barriers/enablers to change.  Data includes interviews, observations, internal documents and workshops.  During analysis we noted convergences in ways of working and mechanisms and contexts of change, allowing for importing of programme theory between the two programmes.  Here we compare the two programme theories and discuss a possible overarching theory.

Results

The projects differ in funding sources, initial aims, length, ways of working, and type of employee.  One project deploys an Asset Based Community Development approach, the other has no formal framework.  However, mechanisms converge: needing to build trust with the groups, utilising existing key persons within the community, creating an understanding of what it was like to be a member of that group and how they thought and talked about mental health.  Enablers were similar: employees who belonged to groups enhanced ability to understand the group; employees with a varied career history were more resilient in this challenging, undefined, role.  Disablers diverged: limited time scale in one project, distrust between different community providers in the other location. 

Conclusion

Inequalities of access to community mental health support may be tackled by voluntary sector projects.  Utilising formal theories of community development may not impact changes created in these projects.  Understanding how to build trust with groups is key to creating change.