A universal preventative approach to mental health in community settings

Problem

There is a clinical need for a greater focus upon mental health prevention and promotion work. Without it, the costs of mental health problems by 2026 are expected to rise to unaffordable levels. Providing preventative psychological interventions, at a universal level, may be a cost and time effective way of creating more resilient communities who are less likely to develop mental health difficulties. General practice settings, located within communities, appear to be a logical place for this. Therefore, the aims of this work are two-fold. First, to assess the current state of the literature in terms of community psychological interventions in primary care. Second, to evaluate the impact of community psychological interventions delivered by a new psychological workforce in primary care.

Approach

Two-part mixed methods approach. PART 1: a systematic review (following PRISMA guidelines) exploring existing research into psychological interventions in Primary care which aim to build community resiliency. Academic articles and grey literature are reviewed. PART 2: A service evaluation was conducted into community-based interventions delivered by a new psychological workforce in primary care (Trainee Associate Psychological Practitioners, or TAPPs). The number of people and types of communities reached are summarised. Psychometric measures of anxiety, depression, wellbeing and resiliency, as well as qualitative feedback from TAPPs and the community, are used to assess the efficacy of these interventions.

Findings

In progress. PART 1: 1939 academic articles were identified and 10 were included in the final review after title, abstract and full text screening. 8 articles were identified from the grey literature, with 4 included in the final review after screening. The articles have been categorised under four main focus areas: early prevention for community resiliency, specific community populations, resiliency programs, and specific services. Data extraction is currently underway. PART 2: Data was collected from 14 TAPPs. They engaged in a range of community-based work, such as delivering workshops to local schools, charities and organisations and running community groups. Over 9 months, TAPPs reached 1237 people in the community. Preliminary results from the community groups show significant reductions in depression and increases in resiliency and wellbeing. Staff, patients and the public responded positively to the community interventions. TAPPs reported some difficulty in engaging with the community, in part due to Covid-19 and being a new workforce.

Consequences

Preliminary findings from the systematic review and TAPP service evaluation are positive and suggest that community interventions are effective. Providing psychological practitioners in primary care with time away from 1:1 work with patients, to deliver community-level interventions, may provide an effective and universal preventative approach to addressing mental health needs in the NHS. The findings also highlight the need for more robust research into efficacy in this area.