The value of community-led health approaches
The current situation, with increased pressures on mental health and wellbeing, demand on services and funding, is taking away from the things that make community-led health approaches so valuable. Namely, the ability to build health and wellbeing at a community level so that people are happier, healthier and feel part of a community. These are the building blocks to good health and wellbeing and what early intervention and prevention is all about.
Community-led health approaches to mental health and wellbeing share a lot with the ‘peer support’ model. The Scottish Recovery Network offers the following definition of peer support:
“Through peer support people living with mental health challenges are seen as part of the solution. They have a significant and active role to play in supporting their own and others’ recovery. Walking alongside someone who understands, who ‘gets it’ helps people to feel less alone. It offers them the opportunity to explore their feelings and what will help them live the life they choose.”
Whether community-led organisations subscribe to this model or not, and many do, community-led, and peer support approaches share a valuing of lived experience, shared understanding, mutual trust, equal relationships and empowerment. As a result, both approaches make support more accessible, reduce stigma and give people a sense of connection and even control over their own lives and wellbeing.
Community-led approaches
The community-led health organisations we spoke to gave some helpful insights into what community-led approaches bring to the table when it comes to prevention and early intervention. The importance of being valued and the feeling of belonging to a group as an equal member, not as a service user (see the Trieste Model for an example of this kind of approach), was emphasised.
“Our members love coming together because they feel they're doing something that might just be their voice, but they feel important. They feel heard, they feel valued, it builds their confidence or motivation. And it's nothing other than coming together once a week, time out, having a laugh, having a bit of fun, having a cup of tea. Not being isolated or lonely in your house, you might feel that when you go back. But for those three hours you've been around people who get you, and you can't really put a price on that. You know, it's simple, but it's effective.” (Local mental health charity worker).
A community-led organisation supporting people with complex mental health challenges said their programme of activities enabled people to “get out of their own heads for a wee while” and connect with people with similar experiences. A person working in public health who spoke to us pinpointed ‘connecting’ and ‘feeling valued’ as being essential to tackling root causes of poor mental health and wellbeing such as social isolation and loneliness.
Community-led health practitioners described how they used their expertise and experience to frame and tailor activities appropriately depending on the communities they were working with. The emphasis of some community-led organisations was on taking part as members, contributing to something rather than being recipients of services. Although these organisations had a hugely positive impact on mental health and wellbeing, effort was made so that people did not feel they were accessing a service related to ‘mental health’.
“We have a formula that works for people at any stage on a mental health journey, providing that they're not symptomatically unwell at the time. If they're ready to engage with us, we're seeing real success in how people can grow in confidence and their ability to make choices and follow through on that and set goals and all that kind of stuff which when they’ve come to us they’ve flat lined.” (Manager of community-led health organisation)
Community-based support
Stepping through the doors of the community-led organisations we visited, it was immediately apparent how accessible and comfortable the venues and reception areas were. The staff who worked there stated that this reflected their wider provision, with one organisation adding that that community organisations can be people’s first port of call and, equally, somewhere other agencies can be confident about referring people to. This was apparent in one rural context.
“We're the easier gateway, you know, for people to access those additional services if they need that [...] There's something about being community based, being trusted, being known, that makes it easier for people to approach us, to engage with us. Referrers are confident about what will be available. Whereas the outreach services, they come in and they go away. And I think that community-based, where it's local people working in the service, you know, I think it makes it more accessible for families, particularly young people.” (Manager of community-led health organisation)
A note to make is that a number of people we spoke to described how NHS and council services in the rural area they worked in were primarily ‘outreach services’, where “it's done over phone calls or over like they send forms in and get help to fill them in over the phone.” (Manager of family support charity).
Another quality of community-led provision is its holistic nature, with people being supported in a range of areas of their lives. We heard how community organisations support people around things as diverse as managing their finances to supporting women from asylum seeker and refugee communities around issues such as post-traumatic stress disorder and female genital mutilation.
This kind of support could make a huge difference to people’s lives in a number of ways. For instance, the manager of a community-led mental health project recounted how they had supported one member to deal with a letter about a utilities bill which had caused the individual so much anxiety they had been contemplating suicide. Another community-led health project reported the simple but hugely effective difference having access to tools and equipment made to families they work with.
“So being able to give people the tools and resources to do DIY or have a birthday party for their kids or go camping or just these things that are not accessible to people you don't have the money for it, you're not doing it. And the feedback we get through that, like the woman who borrowed the movie projector and popcorn machine and had a movie night for her three kids because she couldn't afford to take them to the movies. So they made a real event of it: big screen, popcorn under a duvet, great night, for no money.” (Manager of community-led health organisation)
