Conceptualising the role of community assets in addressing inequalities in mental health

Background

Increasing proportions of individuals are recognising themselves as mentally ill. Workplaces, schools and universities are encouraged to help identify illness. A major problem however is that interventions such as antidepressants and psychological therapies are of only modest benefit compared to other medical interventions. Communities are now being asked to identify ‘assets’ (such as community groups, informal gatherings, hills, sea, parks) which might help address or prevent mental health problems and reduce inequalities.

Method

Examination of literature. Observational and interview work in three communities in South-west of England to understand the nature, role and sustainability of community assets. Workshops and discussions in communities and with academics to develop theories and models as to how community assets might address mental health inequalities. Reflection as a family doctor in a low-income setting.

Results

The nature of assets varied. Voluntary run groups were seen as important for people with mental health problems, but were often not led from low-income communities; resourcing groups was often a challenge. In an urban setting mental health need was very great despite large numbers of voluntary organisations; there was no consensus as to whether services or communities should be responsible for mental wellbeing, with some people more concerned about structural causes such as poverty.

Conclusion

A model for sustaining mental wellbeing and addressing inequalities needs to start with open dialogue with communities – acknowledging the limitations of medicine and potential for communities to have a key role. Communities should be supported to identify strengths. Current rapid access pathways to mental health care  need disrupting; instead individuals with mild-moderate problems should be kindly directed to a range of self-help, tech based therapy and community assets. And people with ongoing severe mental health problems need communities to help identify them and be given proactive ongoing engagement.