Researching the implementation of community mental health promotion programs

Understanding the process of program implementation plays a critical role in advancing research, practice and policy in mental health promotion. This paper focuses on the implementation of community mental health promotion and considers the challenges presented in implementing and evaluating complex, multifaceted interventions carried out in the context of dynamic community settings. The Rural Mental Health Project1–3 is presented as a case study to illustrate the practical and research challenges encountered in implementing and evaluating a community mental health promotion initiative. This case study highlights the factors that contributed to the successful implementation and evaluation of a community‐based intervention for rural communities on the border region in the Republic and Northern Ireland. Among the factors identified are: a partnership model of working; local co‐ordinating structures and consultation mechanisms; use of a structured planning model to guide program planning and implementation; mobilisation of cross‐community and inter‐agency support; and a comprehensive logic evaluation framework to assess the input, process, impact and outcomes of the project as it unfolded.     

Sustaining an intervention for physical health promotion in community mental health services: A multisite case study

There is a growing body of literature on sustainability, but its definition and the factors that affect it are not well understood. This paper focuses on the sustainment of health promotion interventions in community mental health organisations, where the institutional context has been found to play an important role. Normalisation Process Theory (NPT) was used to characterise the extent of sustainment of health promotion interventions and to identify important factors that influence it. The study builds on a previously reported qualitative multiple case design focusing on four Danish community mental health organisations. We aimed to include cases (provider organisations) with varied political‐administrative contexts that were expected to impact sustainment. Data included 27 semistructured interviews with managers and frontline staff. The analysis adopted a thematic approach combining within‐case and cross‐case analysis. One important factor contributing to sustainment was the high degree of coherence generated during and after implementation. Perceptions of meaningfulness and formal tools for external accountability such as municipal activity plans also stimulated the cognitive participation of management and staff in sustaining the intervention. On the practical level of collective action, working with health promotion in a continuous way was particularly supported by two formal tools: internal health policies and municipal activity plans. Sustainment was further aided by reflexive monitoring based on ongoing informal assessments, supplemented by information required for status reports to the municipality on individual users and information from the annual individual user health checks. Future studies should adapt NPT to a broader range of cases to assess more thoroughly its contribution to the literature on sustainment. Future interventions need to pay closer attention to securing continuous and active local management support as well as to political‐administrative contexts as potential external drivers of sustainment.     

Looking backwards: A personal look at community mental health

This paper is a personal review of the forces affecting community mental health over the past 50 years from a psychiatrist who played a significant role in the movement.     

Reduced list costings: Examination of an informed short cut in mental health research

The demands for cost information in health services are many and various but the supply of such information is less than might be expected and is compounded by the expense of undertaking costs research. This paper examines a short cut to mental health research which, if certain rules and conventions are obeyed, can still produce valid costs data. By distilling evidence from previous research a reduced list of services is identified which accounts for the greater part of the total costs of care packages. By concentrating on these key services, 94 per cent of the total costs of care were predicted for discharged long-stay patients and no less than 91 per cent for people supported by community psychiatric nurses. The results suggest that this reduced list method can work well where the aim is to obtain broad orders of magnitude for the costs of care. By reducing the resources required for research, the approach could expand the current costs information base and move towards meeting the pressing practice demands for costs data.     

Using cocreated visually informed community mental health education in low‐ and middle‐income countries: A case study of youth substance misuse in Assam,India

IntroductionOur aim is to evaluate the visually informed community mental health education materials cocreated in our research on youth substance misuse in Assam, India, and to reflect on what we might learn for similar initiatives in low‐ and middle‐income countries.MethodsMaterials consist of: (i) images participants brought to the interview; (ii) 30 posters cocreated by participants to convey key messages from their interview; (iii) six short films on the implications of addiction, and (iv) an animation of our Pathways to Recovery model. We also created a community education package that incorporated these materials. We analyse feedback from three groups of events and a social media campaign, which drew variably across our materials and engaged a range of audiences.ResultsOutcomes indicate the cocreation process and focus on the visual was successful in promoting young people''s voice, increasing awareness and has potential for stigma reduction. Our educational package was deemed useful in increasing awareness and has potential for prevention and treatment.ConclusionsOur case study offers insights into community mental health education in low‐ and middle‐income countries, confirming the importance of cocreation, the usefulness of visual materials and the potential of social media campaigns while acknowledging the importance of local context in health messaging, particularly for stigmatized topics.Patient or Public ContributionService users were involved in the cocreation of the materials evaluated in this study and contributed as presenters in one of the events reported. Members of the public took part in events in which the materials were shared and provided us with the feedback analysed in this article.     

Improving maternal health through social accountability: A case study from Orissa,India

Abstract

As maternal health specialists accelerate efforts towards Millennium Development Goal Five, attention is focusing on how to best improve service accountability to target communities as a strategy for more effective policy implementation. We present a case study of efforts to improve accountability in Orissa, India, focusing on the role of local women, intermediary groups, health providers and elected politicians. We highlight three drivers of success: (1) the generation of demand for rights and better services, (2) the leverage of intermediaries to legitimise the demands of poor and marginalised women and (3) the sensitisation of leaders and health providers to women's needs. We use the concepts of critical consciousness, social capital and ‘receptive social spaces’ to outline a social–psychological account of the pathways between accountability and service effectiveness.     

The research dance: university and community research collaborations at Yarrabah, North Queensland, Australia

This article reflects upon collaborative research relationships between indigenous communities and universities in social health and empowerment programmes. This article is focused on Family Well Being programme and Indigenous Men's Support Groups conducted over the last decade at Yarrabah in northern Queensland. These programmes have incorporated a process whereby the community has set research agendas, local researchers have been employed, and university researchers have facilitated the development of appropriate programmes, the capacity of the community to manage these, and programme evaluation. This article draws upon reflective data derived from intensive group workshops and semistructured, in-depth interviews with both community and university-based researchers conducted in late 2006 and early 2007. These workshops and interviews describe, often in the words of participants, the experiences, challenges and strategies for research collaborations. This article recommends positive strategies for successful partnerships and outlines some challenges faced by both community and university researchers in programmes. The findings of the interviews and workshops are thematically discussed in relation to international literature on collaborative research.     

Psychiatric rehabilitation and community care: resettlement from a North Wales Hospital

The Health Services Research Unit, University College of North Wales, Bangor is evaluating the care provision and outcomes for a cohort of 63 long-stay psychiatric patients from the North Wales Hospital, Denbigh. Hospital closure is being phased in up to 1995 with reprovision of mental health services in the community. The paper reports on the care process in two specially designed community living schemes and assesses the outcomes for 34 patients from the cohort 12 months after discharge from hospital. The results show some positive outcomes with the majority resettled in well-resourced care settings. Levels of client dependency show significant improvement in these schemes, with increases in social activity, community skills and speech skills. The majority of clients have reacted well to changes in care provision and report a number of improvements in their quality of life. It is concluded that long-stay hospital clients need continuing high levels of support if care in community settings is to be successful.     

Unknown makes unloved—A case study on improving integrated health and social care in the Netherlands using a participatory approach

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co‐created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.     

Honouring the role of community in community health work with Cambodian Americans

Despite surviving extreme forms of violence, torture and other traumas during the Khmer Rouge genocide and forced migration, Cambodian Americans experience devastating health inequities and barriers to health access in the United States (U.S.). From the perspective of Cambodian American community health workers (CHWs), we explored three aims in this community‐based participatory research (CBPR), qualitative study: Cambodian Americans’ understanding of health, community health work strategies that improve health access of Cambodian Americans, and action steps that improve health access for Cambodian Americans. From 2014 to 2016, our two‐phased study spanned seven U.S. states, which included a focus group (n = 5) and 16 semistructured interviews. Participants identified an indigenous concept of health, and micro‐level (e.g. service navigation, peer education) and mezzo‐level interventions (e.g. community building, coalition work) to improve health access. Finally, Khmer Health Advocates, a community‐based health advocacy organisation, served as a vital study partner in this CBPR study.     

The impact of a community‐based music intervention on the health and well‐being of young people: A realist evaluation

In recent years, music‐based interventions have been utilised as a tool for improving public health, reducing inequalities and promoting well‐being of young people. Although some researchers have begun to draw links between music‐related interventions and positive health outcomes, there is little understanding as to how such effects are produced. Realist evaluations—understanding what works, for whom and under what circumstances—are a particularly apt means by which we can open this ‘black box’. In this paper, we use a realist evaluation to assess a community‐based music initiative designed and implemented to support the well‐being of disadvantaged young people in Scotland. In order to gain perspectives on the range of contextual characteristics, mechanisms and outcomes, we collected quantitative and qualitative data in the form of pre‐ and post‐questionnaires, as well as conducting interviews with beneficiaries and stakeholders. Our findings show that the intervention achieved a positive impact on the self‐confidence, well‐being and engagement of disadvantaged young people. This impact was achieved via an approach personally tailored to the individual needs of the young people; and an organisational environment characterised by trust, whereby young people felt safe to express themselves.