Creating Space for Mental Wellbeing: Identifying and Applying Salutogenic Concepts From a Body of Work Representing Two Health Interventions

There is increasing recognition that clinical approaches to health which focus on symptoms and treatment are often ineffective when applied to those experiencing mental health challenges. The Recovery Movement in psychiatry, along with a proliferation of asset-based approaches to health promotion, illustrate a growing appetite for health and other public services to recognise and tackle the social determinants of poor mental health. These interventions have their roots in salutogenesis, a philosophy of health which moves away from treating deficits and gives primacy to the strengths and resources available to individuals and their communities. This thesis revisits the empirical findings from five studies focussed on two different community health interventions with the aim of identifying how salutogenic concepts may be operating within the interventions to promote mental wellbeing. Using a meta-ethnographic approach, I construct a line-of-argument synthesis which reveals how salutogenic concepts such as identity and connectedness; empowerment; hope and meaning, are already present within the interventions, and are promoted by the creation of healthy spaces and positive relationships. I then explore how this knowledge, along with the future collaboration of health professionals, local councils and community organisations, could be used to inform the more explicit salutogenic development of public services in order to more effectively facilitate the promotion of mental wellbeing

The frontline of social prescribing – how do we ensure Link Workers can work safely and effectively within primary care?

Objective To identify the training, skills and experience social prescribing Link Workers, working with patients presenting with long term conditions, need to carry out their role safely and effectively with in primary care services. Method Qualitative data were collected from Link Workers as part of the evaluation of three social prescribing schemes. Interviews and focus groups were audio-recorded and transcribed. Results Link Workers describe the complexity of the work and the need to define the boundaries of their role within existing services. Previous life and work experience were invaluable and empathy was seen as a key skill. A variety of training was valued with counselling skills felt to be most critical. Clinical supervision and support were felt to be essential to conduct the work safely. Discussion Social prescribing is a significant theme within UK health policy and internationally and schemes in primary care services are common. Patient accounts consistently suggest that the Link Worker is key to the success of the pathway. Link Workers can facilitate positive behaviour change, however they must be recruited, trained and supported with a clear understanding of the demands of this complex role

The frontline of social prescribing – how do we ensure Link Workers can work safely and effectively within primary care?

Objective To identify the training, skills and experience social prescribing Link Workers, working with patients presenting with long term conditions, need to carry out their role safely and effectively with in primary care services. Method Qualitative data were collected from Link Workers as part of the evaluation of three social prescribing schemes. Interviews and focus groups were audio-recorded and transcribed. Results Link Workers describe the complexity of the work and the need to define the boundaries of their role within existing services. Previous life and work experience were invaluable and empathy was seen as a key skill. A variety of training was valued with counselling skills felt to be most critical. Clinical supervision and support were felt to be essential to conduct the work safely. Discussion Social prescribing is a significant theme within UK health policy and internationally and schemes in primary care services are common. Patient accounts consistently suggest that the Link Worker is key to the success of the pathway. Link Workers can facilitate positive behaviour change, however they must be recruited, trained and supported with a clear understanding of the demands of this complex role

Well London: results of a community engagement approach to improving health among adolescents from areas of deprivation in London

This article reports findings among adolescents of the impact of Well London, a program of wellbeing interventions delivered across 20 deprived neighbourhoods of London using a community engagement model. Twelve hundred and fifty-four adolescents were surveyed from matched intervention and control areas. There was no significant intervention effect on the main outcome measures: unhealthy eating, physical activity, and mental health. Factors influencing the results may include the possibility that the communities defined by the cluster randomized controlled trial (CRCT) were not an accurate reflection of the adolescent’s natural community, and interactions within the school environment in particular could have led to a dilution of effect

A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically