Priority Area Overview – Mental health and Wellbeing
This report has been prepared to support the Review of Health Improvement Programmes. A series of priority areas have been identified for the review derived from policy and strategy documents. The Review has a number of identified outputs, one of which is a high level summary of each priority area which highlights, based on current evidence of effectiveness, which interventions have the greatest potential to improve health in each priority area.
Methodology
The Review is being conducted within a limited timeframe, as a result an extensive review of the literature across all of the priority areas and initiatives is not feasible. The review team has adopted the following approach:
- Evidence from systematic reviews or reviews of reviews
- Guidelines derived from an assessment of the available evidence
- Reviews from sources which have a clearly defined methodology and quality assurance process that is nationally or internationally recognised.
The Library and knowledge management service of Public Health Wales has undertaken an initial search of the following sources using agreed search terms:
- NICE Guidelines
- Cochrane Database of Systematic Reviews (Cochrane Reviews Only)
- Campbell Collaboration Reviews
- EPPI Centre Reviews
- The Community Guide Recommendations (included as robust methodology and majority of recommendations applicable to UK)
Where limited material was identified, or specific information gaps, or where the reviews or recommendations are more than 5 years old, a further search has been undertaken of DARE and Health Evidence Canada for reviews conducted within the last five years, which are rated as moderate to good quality.
Reviews have been screened for inclusion based on agreed criteria e.g. health promotion interventions, interventions which involve clinical preventative services were excluded and those which focus on primary or secondary prevention.
Key information has been extracted and summarised in the evidence table attached. An assessment has been made about the strength and direction of the evidence from the review based on the grading system developed and attached as Appendix 1. A subjective assessment has also been made by the reviewer of the extent of adoption or implementation of the intervention in Wales. The grading of the evidence and the implementation assessment were reviewed by the team for consistency.
There are a number of limitations to this approach which it is important to consider when interpreting this report:
- this is not an extensive review of the evidence in each area, a large amount of material will not have been considered
- the sources used mean that the interventions used are more likely to reflect established or well-tested approaches and less likely to reflect innovative technologies and approaches
- the assessment of implementation is subjective and based on the knowledge of the review team
- the evidence gradings are designed to give an indication of the strength of the evidence and enable current understanding of the efficacy of different interventions to be compared, the quality of the studies included within the reviews is drawn from the assessment by the reviewers
Version 1 / 1 / November 2012
Public Health Wales Observatory / Health Improvement Review - Evidence Sub Group
Priority Area / Mental health and Wellbeing
Study Details / Outcome measures / Main findings / Results / Current Implementation Wales / Evidence Grading
NICE, 2008
Occupational therapy and physical activity interventions
National Institute for Health and Clinical Excellence
Mental Health and Wellbeing
Older People / Summary:
- Older people should be offered regular group and or individual sessions to encourage them to carry out daily routines.
- Also tailored community-based physical activity programmes including moderate activities should be offered.
- Older people and their carers should be advised to carry out 30 minutes of safe exercise.
- Promote regular participation in local walking schemes as a way of improving mental wellbeing.
- Involve occupational therapists in the design of training offered to practitioners.
NICE, 2008
Promoting social and emotional wellbeing in primary education
National Institute for Health and Clinical Excellence
Mental Health and Wellbeing
School Children / Summary:
- All primary schools should adopt a comprehensive, ‘Whole School’ approach.
- Provide a comprehensive programme involving curriculum, training to teachers, support to parents/carers and integrated activities
- Teachers and practitioners should be trained to identify and assess early signs of anxiety and behavioural problems
? / A.This intervention is based on evidence of effectiveness and is recommended for use in the UK
NICE, 2009
Promoting social and emotional wellbeing in secondary education
Mental Health and Wellbeing
National Institute for Health and Clinical Excellence
Children and young adults /
- All secondary schools should adopt an organisation-wide approach.
- Teachers and other staff should ensure that social and emotional wellbeing features within improvement plans, policies, systems and activities.
- A curriculum that promotes positive behaviours and successful relationship should be provided to young people.
?
Some outreach work done by Samaritans in secondary schools around wellbeing / A.This intervention is based on evidence of effectiveness and is recommended for use in the UK
NICE, 2009
Promoting mental wellbeing at work
National Institute for Health and Clinical Excellence
Mental Health and Wellbeing
Working age adults / Summary:
- An organisation-wide approach should be adopted to integrate promotion of mental wellbeing into all policies and practices those related to employment working conditions.
- Employee’s mental wellbeing should be assessed and monitored using a survey or reviewing absentee’s rate. This will identify risks in work and improvements can be made in the working conditions.
- Employees should have flexible working conditions to balance their work and personal life.
- The line manager’s role should be strengthened to promote employees mental wellbeing through supportive leadership and management practices.
Investors in people also covers some aspects of health and wellbeing at work. / A.This intervention is based on evidence of effectiveness and is recommended for use in the UK
NICE, 2010
Looked-after children and young people
National Institute for Health and Clinical Excellence
Mental Health and Wellbeing
Children and young adults / Summary:
- There should be strong leadership and strategic partnership to addresses health and educational inequalities of looked-after children and young people
- Commission mental health services of looked-after children to enhance their quality of life through addressing their physical and emotional health needs.
- There should be robust audit and inspection of local authorities
- There should be adequate range of suitable placements
Swann C, 2010
Health systems and health-related behaviour change
National Institute for Health and Clinical Excellence
Mental Health and Wellbeing
Working Age Adults / To develop an evidence-based conceptual model of health-promoting health systems. /
- The important role of policy and national programmes, media and marketing, the environment and planning in health stewardship and behaviourchange
- The role of finance and sustainable resources in health promoting systems
- How improvements in service design and delivery, such as tailoring and targeting interventions, building partnerships and networks, and using appropriate modes of delivery, can contribute to behaviour change and health promoting systems
The research comprised a:
• review of NICE evidence reviews
• literature review
• review of stakeholder responses to NICE public health guidance consultation
Key findings used to develop the model were:
- The importance of a stable political context
- Legislation as a tool for behaviour change
- The role of health systems in promoting equity
- The importance of involving stakeholders in the development of health systems and the wider community – and of partnerships between health systems and the wider health network.
- The impact of “flatter” organisational structures on ease of information flow and management within a health system
- Factors that influence managers and their allocation of resources
- The impact of partnership and collaboration on health outcomes
- Changing professional behaviour within a health system
- Clear leadership and chains of accountability
- Investment in training and development
- Use of information and intelligence for service development – learning systems
- Partnerships and the concept of ‘connectedness’
Ekeland E et al, 2004
Exercise to improve self-esteem
Mental health and Wellbeing
Children and young adults / To determine if exercise alone or exercise as part of a comprehensive intervention can improve self-esteem among children and young people. / The results indicate that exercise has positive short-term effects on self-esteem in children and young people. Since there are no known negative effects of exercise and many positive effects on physical health, exercise may be an important measure in improving children's self-esteem. These conclusions are based on several small low-quality trials. / Twenty-three trials with a total of 1821 children and young people were included. Generally, the trials were small, and only one was assessed to have a low risk of bias. Thirteen trials compared exercise alone with no intervention. Eight were included in the meta-analysis, and overall the results were heterogeneous. One study with a low risk of bias showed a standardised mean difference (SMD) of 1.33 (95% CI 0.43 to 2.23), while the SMD's for the three studies with a moderate risk of bias and the four studies with a high risk of bias was 0.21 (95% CI -0.17 to 0.59) and 0.57 (95% CI 0.11 to 1.04), respectively. Twelve trials compared exercise as part of a comprehensive programme with no intervention. Only four provided data sufficient to calculate overall effects, and the results indicate a moderate short-term difference in self-esteem in favour of the intervention [SMD 0.51 (95% CI 0.15 to 0.88)]. / Sport Wales are promoting basic sporting skills in schools and have grants and support available / D. The evidence is inconsistent and it is not possible to draw a conclusion but there is some evidence of effect
Gilbody S et al,
Screening and case finding instruments for depression
Cochrane Database of Systematic Reviews
Mental health and Wellbeing
Working Age Adults and Older People / To determine the clinical and cost effectiveness of screening and case finding instruments in: 1) improving the recognition of depression; 2) improving the management of depression, and 3) improving the outcome of depression. / There is substantial evidence that routinely administered case finding/screening questionnaires for depression have minimal impact on the detection, management or outcome of depression by clinicians. Practice guidelines and recommendations to adopt this strategy, in isolation, in order to improve the quality of healthcare should be resisted. The longer term benefits and costs of routine screening/case finding for depression have not been evaluated. A two stage procedure for screening/case finding may be effective, but this needs to be evaluated in a large scale cluster randomised trial, with a prospective economic evaluation. / Twelve studies (including 5693 patients) met our inclusion criteria. Synthesis of these data gave the following results:
(1) the recognition of depression: according to case note entries of depression, screening/case finding instruments had borderline impact on the overall recognition of depression by clinicians (relative risk 1.38; 95% confidence interval 1.04 to 1.83). However, substantial heterogeneity was found for this outcome. Screening and feedback, irrespective of baseline score of depression has no impact on the detection of depression (relative risk 1.00; 95% confidence interval 0.89 to 1.13). In contrast, three small positive studies using a two stage selective procedure, whereby patients were screened and only patients scoring above a certain threshold were entered into the trial, did suggest that this approach might be effective (relative risk 2.66; 95% confidence interval 1.78 to 3.96). Separate pooling according to this variable reduced the overall level of heterogeneity. Publication bias was also found for this outcome.
(2) the management of depression: according to case note entries for active interventions and prescription data, a selected subsample of all studies reported this outcome and found that there was there was an overall trend to showing a borderline higher intervention rate amongst those who received feedback of screening/case finding instruments (relative risk 1.35; 95% confidence interval 0.98 to 1.85), although substantial heterogeneity between studies existed for this outcome. This result was dependent upon the presence of one highly positive study.
(3) the outcome of depression: few studies reported the impact of case finding/screening instruments on the actual outcome of depression, and no statistical pooling was possible. However, three out of four studies reported no clinical effect (p<0.05) at either six months or twelve months.
No studies examined the cost effectiveness of screening/case finding as a strategy. / Case finding for depression not routinely carried out. / G. There is some evidence suggesting that this intervention is ineffective but it is not conclusive.
Hayes S et al, 2011
Collaboration between local health and local government agencies
Cochrane Database of Systematic Review
Mental Health and Wellbeing
Whole population / To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes. / Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that interagency collaboration, compared to standard services, leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, methodological flaws in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these flaws are addressed in future studies (for example by providing greater detail on the implementation of programs, using more robust designs, with integrated process evaluations and measurement of health outcomes) it could provide a better understanding of what might work and why.
When updating this review, we will analyse any partnership or process evaluations of our included studies to try to identify markers of success in local collaborative partnerships that could inform policy developments in the future. / Eleven studies were identified, presenting information on a total of 26,686 participants. Owing to the heterogeneity between studies a narrative synthesis was undertaken. The included studies covered a range of topics. Six studies examined mental health initiatives, of which one study showed health benefit; four showed modest improvement in one or more of the outcomes measured, but no clear overall health gain; and one study showed no evidence of health gain. Two studies were related to lifestyle improvements of which one failed to show health gains for the intervention population, while the other showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies were related to chronic disease management and all three failed to demonstrate health gains. / Collaborative arrangement are in place for the provision of mental health services / G. There is some evidence suggesting that this intervention is ineffective but it is not conclusive
Mirza I Pit SW, 2006
Exercise for positive mental health outcomes (Protocol)
Cochrane Database of Systematic Reviews
Mental health and Wellbeing
Working Age Adults / Major outcomes will include self esteem, emotional aspects of well being (affect balance, happiness, life satisfaction), cognitive aspects (coping, optimism, hopefulness), quality of life and non
specific psychological distress (such as that measured by GHQ, SRQ, HAD and SF 36).
Secondary outcomes will include measures such as resilience, hardiness, and empowerment. Adverse outcomes will include any physical or psychological adverse outcome recorded in the included studies. / N/A / Research has not been carried out yet this is a research protocol