Maximising the health impacts of free advice services in the UK: A mixed methods systematic review

Community-based interventions on the social determinants of mental health in the UK: an umbrella review

Purpose

There is growing evidence that several social determinants influence mental health outcomes, but whether or not community-based prevention strategies are effective in intervening on these social determinants to improve mental health is unclear. We synthesised the state of knowledge on this topic in the UK context, by conducting an umbrella review of the relevant systematic review literature.

Methodology

We searched five electronic databases for systematic reviews of community-based interventions that addressed any social determinant of mental health (SDOMH) in the UK, provided that mental health outcomes were measured. We reported the results according to PRISMA guidelines and synthesised narratively.

Findings

Our search yielded 1,101 citations, of which 10 systematic reviews met inclusion criteria. These reviews included 285 original studies, of which 147 ( 51.6%) were from the UK. Two reviews focussed on children and young people, with the remainder based on working-age adult populations. We identified five categories of SDMOH, where financial insecurity and welfare advice interventions were addressed by the largest number of reviews (N=4), followed by reviews of interventions around social isolation and support (N=3), and housing regeneration initiatives (N=2). Results across all social determinants and mental health outcomes were highly heterogenous, but evidence most consistently supported the effectiveness of interventions addressing financial and welfare support on mental health outcomes.

Originality

Our review highlights the paucity of high quality, causal evidence from the UK and beyond on the effectiveness of interventions on the social determinants of mental health; severe methodological heterogeneity hampers progress to identify scalable interventions to improve population mental health.

Money Matters: Time for Prevention and Early Intervention to Address Family Economic Circumstances

Child poverty is associated with poorer physical and mental health, negative educational outcomes and adverse long-term social and psychological consequences, all of which impact on service demand and expenditure. Until now, however, prevention and early intervention practice has tended to focus on enhancing inter-parental relationships and parenting skills (e.g., via relationship skills education, home visiting, parenting programs, family therapy) or child language, social-emotional and life skills (e.g., early childhood education, school-based programs, youth mentoring). Programs often target low-income neighborhoods or families but rarely address poverty directly. While there is substantial evidence for the effectiveness of such interventions in improving child outcomes, null results are not uncommon and even positive effects are often small, short-term, and difficult to replicate. One avenue to enhance intervention effectiveness is to improve families' economic circumstances. There are several arguments for this refocusing. It is arguably unethical to focus on individual risk without acknowledging or seeking to address (where relevant) families' social and economic contexts, while the stigma and material constraints associated with poverty can make it harder for families to engage with psychosocial support. There is also evidence that increasing household income improves child outcomes. Although national policies to alleviate poverty are important, it is increasingly recognized that practice-based initiatives have a role to play (e.g., income maximization, devolved budgets, money management support). However, knowledge about their implementation and effectiveness is relatively thin. For instance, there is some evidence that co-located welfare rights advice in healthcare settings can improve recipients' financial circumstances and health, but it is mixed and of limited quality. Moreover, there is little rigorous research on whether and how such services affect mediators (parent-child interactions, parenting capacity) and/or child physical and psychosocial outcomes directly. We call for prevention and early intervention programs to attend more to families' economic circumstances, and for experimental studies to test their implementation, reach and effectiveness.