Rationale

Awareness raising and mental health/suicide prevention training

Positive psychology

Early identification and management of mental health problems

Social prescribing/community referral

Awareness raising and mental health/suicide prevention training
There is some evidence to suggest that population level interventions using mass media campaigns and social marketing can be effective.[1] Informed by reviews of effectiveness evidence, NICE public health guidance 06 Behaviour change at population, community and individual levels sets out a set of generic principles and recommended actions to guide the planning and delivery and evaluation of public health activities to change health related behaviour at the individual, community or population level. The NHS Health Scotland Commentary on this guidance supported these actions points subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[2] A recent report for the Foresight Mental Wellbeing project proposed a social marketing approach to communicating five key evidence-informed messages about mental wellbeing, however, this work has not been evaluated.[3]

The Scottish Government has promoted suicide awareness raising and prevention training through a series of programmes for front line staff and the general public: Applied Suicide Intervention Skills Training (ASIST), SAFEtalk and Skills-based Training On Risk Management (STORM). Whilst there is no highly processed evidence of the effectiveness of these approaches, evaluations suggest that they are effective in changing knowledge, attitudes and helping behaviour and reduction in stigma.[6] An impact evaluation of the effects of suicide awareness raising and prevention training on successful practice and, indirectly, people at risk of suicide will report in 2010.

The Scottish Government has promoted mental health awareness and prevention training through Scotland’s Mental Health First Aid training programme. Whilst there is no highly processed evidence of the effectiveness of this programme, evaluations suggest that they are effective in changing knowledge, attitudes and helping behaviour towards people with mental health problems, although they have not been evaluated in terms of the effect on those who are recipients of the first aid. [4, 5]

Positive psychology
There is no highly processed evidence about the effectiveness of positive psychology and mindfulness interventions, however, there is emerging evidence that these types of interventions have potentially valuable mental health benefits for both patient and non-patient samples both in terms of, for example, reducing psychological distress, negative mood and stress levels and improving quality of life, and aspects of mental wellbeing. Positive psychology interventions appear to produce more sustainable outcomes when delivered at an individual rather than group level and for relatively long periods of time. Some studies have demonstrated successful outcomes using online delivery of interventions.[7, 8]

Early identification and management of mental health problems
The recent partial update of the NICE clinical guidelines for depression (which has no formal status in Scotland) recognises that sub-threshold depressive symptoms can be distressing and disabling if persistent and recommended offering advice on sleep hygiene if needed, active monitoring and specified low-intensity psychosocial interventions (individual guided self-help based on cognitive behavioural therapy, computerised cognitive behavioural therapy and a structured group physical activity programme) [9].

SIGN 114 Non-pharmacological management of depression in adults has recommendations on guided self-help based on cognitive behavioural therapy, computerised cognitive-behavioural therapy and structured exercise but does not extend there use to people with sub threshold depressive symptoms.[10]

There is review-level evidence from the UK that counselling in primary care for people presenting with broad psychosocial and psychological problems is associated with modest improvements in psychological symptoms in the short-term (1 – 6 months) compared with usual GP care, however there is conflicting evidence about outcomes in the longer term.[11]

Social prescribing/community referral
Social prescribing/community referral aims to strengthen the provision of, and access to non-medical sources of support within the community, thus providing social solutions to mental health problems.[12, 13] There is no highly processed evidence about the effectiveness of social prescribing, however, there is some emerging evidence, from small scale projects such as arts on prescriptions, exercise referral and referring to learning advisors, that social prescribing can have a positive impact in terms of enhancing self-esteem, reducing low mood, increasing opportunities for social contact, increasing self-efficacy, increasing transferable skills and increasing greater confidence. The evidence base for social prescribing is, however, limited by wide variations in how the term is used and understood and considerable inconsistency in indicators used to measure success. The small size of pilot trials, lack of independent evaluation and poor methodology, notably in the design of qualitative research, all make it difficult to draw robust conclusions about the mental health impact of social prescribing, particularly in comparison with usual GP care or in terms of cost effectiveness.

Source

1. NICE (2007). NICE public health guidance 06: Behaviour change at population, community and individual levels. NICE: London.

2. NHS Health Scotland (2007). Health Scotland Commentary on NICE Public Health Guidance: Behaviour change at population, community and individual levels. NHS Health Scotland: Edinburgh.

3. Aked J, Marks N, Cordon C & Thompson S (2008). Five ways to mental wellbeing: A report presented to the Foresight Project on communicating the evidence base for improving people’s mental wellbeing. National Economics Foundation: London.

4. Kitchener B & Jorm A (2006). Mental health first aid training: review of evaluation studies Australian and New Zealand Journal of Psychology, 40: 6-8.

5. Stevenson, R and Elvy N, Hexagon Research and Consulting (2007). Evaluation of Scotland’s Mental Health First Aid, NHS Health Scotland: Edinburgh.

6. Griesbach D, Russell P, Dolev R & Lardner C (2008). The use and impact of Applied Suicide Intervention Skills Training (ASIST) in Scotland: a literature review and evaluation. Scottish Government: Edinburgh.

7. Schneider A and Huppert F (2009). Review of the Mental and Physical Health Benefits of Positive Psychology Interventions Overview and References (unpublished).

8. Schneider A and Huppert F (2009). Review of the Mental and Physical Health Benefits of Mindfulness-Based Interventions (unpublished).

9. NICE (2009). NICE clinical guideline 90 Depression: the treatment and management of depression in adults (partial update of NICE clinical guideline 23). NICE: London.

10. SIGN (2010). SIGN 114: Non-pharmacological management of depression in adults: A national clinical guidelines. SIGN: Edinburgh.

11. Taylor L, Taske N, Swann C & Waller S (2006). Public health interventions to promote positive mental health and prevent mental health disorders among adults: Evidence briefing. NICE: London.

12. Freidli L et al. (2007). Developing social prescribing and community referrals for mental health in Scotland. Scottish Development Centre for Mental Health: Edinburgh

13. Foresight Mental Capital and Wellbeing Project (2008). Final Report. The Government Office for Science, London.