Today is World Mental Health Day –an annual day when the World Health Organization recognises mental health and provides a focus for promoting a better understanding of mental health issues globally. I was asked to write a blog to mark this day, particularly from a social care perspective, drawing on my role as Research Programme Manager for the NIHR School for Social Care Research. This is slightly different to the usual Elf blogs (which discuss specific research papers); my aim here is to initiate discussion about social care research and mental health, rather than attempting to summarise the current evidence in this area. This is also chiefly a perspective from England; I’d welcome thoughts on these topics from beyond England.
What can social care and mental health learn from each other?
It seems to me there are tremendous possibilities right now, with synergies between mental health care and developments in social care practice. There are some common goals: the objectives of both mental health and social care might be described broadly as helping people to live as independently as possible and achieve a good a quality of life. Beyond this, adult social care is grappling with new concepts aimed at improving how it operates; this for me, resonate with debates that have been underway in mental health care for some time.
Two of these ideas are ‘strengths-based working’ and ‘prevention’. Strengths-based working is about focusing on a person’s abilities and resources (for example, their skills, hobbies, friends, family, neighbours and other social supports), and working with the person to maintain and bolster these strengths; helping them to maintain independence, and even interdependence. A connection with the idea of recovery in mental health is an easy one to draw conceptually. Prevention, a more commonly used concept in health care and public health, is a relatively new idea in adult social care. This is about trying to promote independent lifestyles and delaying the development of care needs. Primary prevention (to prevent the development of care needs in the first place) is one dimension, but secondary prevention (to manage care needs and prevent dependency) is also important. Of course, there has been interest in these dimensions of prevention in public mental health for several years.
Despite similar concepts developing in mental health and social care, we are still a long way from establishing a good evidence base and embedding these ideas into adult social care practice, let alone within the specific context of mental health I do see cause to be optimistic about addressing this need for more high quality research evidence to support developing practice, with growing research activity in this area for a few years now.
For example, the overview report of National Institute for Health Research (NIHR)-funded mental health research titled ‘Forward Thinking’ provides a good illustration of the volume and range of current and recent research on mental health. The NIHR School for Social Care Research has also funded research in this area, including work by: Bryn Lloyd-Evans of University College London on Community Navigators, which connect people with enduring anxiety or depression to community resources; Martin Webber of the University of York to develop the evidence to help social workers in mental health to enhance the social capital of people they support; and Frank Keating of Royal Holloway who is examining approaches to social recovery and social care for people from ethnic minority groups. There are others researching social networks and developing community capacity to support people. UK Research and Innovation (UKRI) recently announced eight new research networks covering topics such as: social assets for mental health care, loneliness, violence, and health inequalities.
What are the opportunities for mental health and social care research?
While there are significant and promising projects underway, the need for high-quality evidence to support practice is great. Major research funders like the NIHR and UKRI continue to be very supportive of mental health research, as does ESRC with their appointment of Professor Louise Arseneault as Mental Health Leadership Fellow. This provides new opportunities and scope to build some momentum. In addition, and very encouragingly, many of these major research funders are becoming more interested in social care research. Recent calls by the NIHR Research for Patient Benefit Programme and UKRI focused specifically on social care. We need to capitalise on these opportunities, and I would urge researchers to explore proposals addressing the connections between mental health and social care. It seems likely that the new UKRI Mental Health Networks will also be key arenas in which to explore these connections between social care ideas and mental health.
Children and young people
It is particularly encouraging to see that several of the new UKRI Mental Health Networks are concerned with the mental wellbeing of children, young people and students. This brings me to the theme for this year’s World Mental Health Day: ‘Young people and mental health in a changing world’. In considering young people and mental health I am moving further from my comfort zone. Some of what I know is from the excellent series of blogs about research on youth mental health, published by our sibling, the Mental Elf. There have been huge developments in our knowledge of how to help people with psychosis, which is often developed in adolescence, and the importance of accessing a range of support, including social resources. There are major concerns about the mental health impacts of the pressures faced by young people and about the ability of services to respond to their needs. There is also the challenge of addressing loneliness and isolation among young people and adverse outcomes, including mental health issues. Concern around student mental health has also risen in prominence.
We need more investment in: understanding how to manage these pressures; better services; and research to ensure resources are allocated efficiently. However, news of cuts in services for young people (including on early intervention, on education and in helping families give children a good start) do not offer comfort that support to improve the mental wellbeing of children and young people is being valued. These investments could be crucial in preventing further social care or mental health needs developing.
I am an optimist (mostly) and I try to hold a balanced view of opportunities and risks. I am so impressed by young people that I meet, and have faith in their determination and abilities. We have to balance a risk-driven perspective (for example, educating young people about risks from other people), with a more positive view (such as helping people to develop good relationships and adopting positive roles in society). As an example, young people and the effects of social media is a topic that is often portrayed in a negative light, but, as this briefing from the Centre for Mental Health highlights, there is also evidence of benefits for young people and their mental health. It is encouraging that people are discussing a more focused understanding of where problems are inherent in technology and where the problems may lie in our wider social experience with unhealthy links to technology being a symptom (see for example this blog by Martin Webber).
There are many topics I haven’t been able to cover here, which I know are vital to enhancing the role of social care in mental health, especially for young people. I would like to have discussed peer workers and social prescribing as non-medical means of delivering support, potentially through a social care system. How we can ensure a good start for all young people, address income inequalities (see the recent Mental Elf blog on this), and manage inequalities in life expectancy are some of the other topics at the top of this long list. I’d be pleased to hear from readers on these topics and others, in connection with social care research and mental health; I encourage you to share your thoughts in the comments section below, or to participate in the discussion on the Social Care Elf Twitter and Facebook.
Conflict of interest
I have no conflicts of interest. I am very grateful to colleagues for discussions that helped inform this blog, especially Professor Martin Webber at the University of York, Dr. Brynmor Lloyd-Evans at University College London, and colleagues at Research into Practice for Adults, but the blog reflects my views and not necessarily theirs.
NIHR Dissemination Centre (2018). Themed review: Forward thinking. Research on support for people with severe mental illness (PDF). Published Mar 2018. Accessed online 09 Oct 2018.