What works in rapid response public health projects?

Abstract

This Current Issues piece describes how short-term funding in response to public health emergencies can be put to best use. This is a current issue as many public health agencies are having to respond to these types of funding calls as a consequence of the rising COVID-related health inequalities. We describe how one local authority in the UK commissioned established organisations to address areas of need indicated by community groups. The resulting projects directed support towards people who were likely to experience mental ill-health using an advocacy-based approach. We describe the outcomes for people who used the services as well as giving some ‘top tips’ for ensuring such short-term funding is successful for the people who most benefit.

Keywords:

• Mental health interventions
• public health funding
• young people
• COVID-19

Introduction

The coronavirus (COVID-19) pandemic disproportionately impacted disabled people, increasing discrimination, isolation, and poverty as a result of inadequate state responses to the crisis (Cobley 2022; Kuper et al. 2020). The various lockdowns resulted in longer-term mental health implications for disabled people in particular (Kumar and Nayar 2021; Procknow 2022; Macdonald and Wilde (in press); Shakespeare et al. 2022; Theis et al. 2021). In the wake of the pandemic, various funding bodies prioritised projects addressing mental health and wellbeing as a way to ameliorate these rising health inequalities.

The pandemic has therefore changed the way public health research projects are funded and carried out. Research institutions have been forced to restructure their use of funding in public health-related projects to tackle the wider and longer-term effects of COVID-19 (Spagnolo et al. 2020). However, ethical questions arise from this (ibid), such as: Who decides what research areas are most important? How are these decisions made? And what are the implications for the future? This article uses the example of the Public Health England funded programme ‘Prevention and Promotion for Better Mental Health’ in one local authority in England to describe what works well in short-term funded rapid response projects.

The Better Mental Health fund

This fund was set up to address mental health difficulties arising from the COVID-19 pandemic. The Office for Health Improvement and Disparities (OHID) was responsible for its administration. The funding aimed to prevent mental ill-health whilst promoting good mental wellbeing amongst the most deprived communities in England as part of the government’s Levelling Up agenda, and was designed to reduce mental health inequalities by targeting at risk groups to maximise impact, equity and reach.

Blackburn with Darwen Local Authority is the 9^th most deprived in England (out of 317), with comparatively poorer health outcomes and life expectancy than the England average. The region has a younger than average age profile, with a significantly higher number of young people experiencing mental health conditions than the national average. The mental health of children and young people in the North of England was deteriorating prior to COVID-19, but there was significant deterioration during the pandemic (Pickett & Taylor-Robinson, 2021). The Borough was hit hard during COVID-19, experiencing localised peaks in cases, and becoming a designated ‘hotspot’ during 2021. Following the pandemic, health outcomes have become poorer and inequalities have been exacerbated (Munford et al. 2022).

The Better Mental Health short-term funding allowed the Council Public Health Team to design a combination of projects to address various risks to mental ill-health, as follows:

• Project 1: Embedding a Whole Suicide Prevention Approach – this project commissioned established provider Papyrus to link with schools to design and implement suicide prevention policies, including delivering secondary school assembly sessions focused on hope. Papyrus also provided various accredited training courses for practitioners working with young people.

• Project 2: Community Wellbeing Champions – this project responded to an articulated need that came from the local Youth Forum. A cohort of young people, many from minority groups, were trained in mental health peer support methods by established providers Re-Align Futures. The Wellbeing Champions carried out various activities throughout the year including attending outreach events and co-creating innovative online and physical resources.

• Project 3: Healthy Mind Safe Home – this project partnered Shelter Blackburn with Lancashire Mind to work together to support people with debt and housing issues, who are more at risk of mental ill-health. One-to-one wellbeing and advice sessions were provided to people who needed support using an advocacy approach, and bespoke training sessions were offered to users of various services on the themes of debt advice, welfare guidance and housing support.

For the programme as a whole, the engagement was significant, reaching around 2000 beneficiaries. A significant number of these were people from minoritized groups − 21% identified as disabled, 31% were from minority ethnic groups, 30% described themselves as having existing mental health conditions, and 54% were from the most deprived areas of the region. The short/medium term impacts of the programme were numerous and multifaceted. Project 3 demonstrated significant increases in quantitative wellbeing (WEMWBS) scores (statistically significant at p < 0.05), whilst the other projects demonstrated positive qualitative impact for beneficiaries and the wider community.

Steps for success

Blackburn with Darwen’s Mental Wellbeing and Inequalities Definition recognises that mental wellbeing is something that is relevant to everyone and that a person can experience high or low wellbeing, with or without the presence of mental health conditions. The Council states that their services should be of an equal high standard for all residents.

The short-term funding allowed the Council to use this aspiration to guide their programme – the principles that the projects followed were:

• People/community centred: planning originated from consultation with community groups, and collaboration continued throughout

• Using a whole system approach: bringing agencies together in partnership for creativity and innovation

• Building on existing resources: using embedded infrastructure to tackle inequalities outside of traditional support systems

• Applying learning from the pandemic to address evidence of widening inequality, and mental health risk due to isolation and loneliness

• Aiming for Equity: with a significant number of beneficiaries from minority groups and/or residing in the most deprived areas

What did beneficiaries say about the programme?

The project evaluation uncovered many positive testimonials, such as:

Whole School Suicide Prevention Approach: ‘I think the training needs to happen in as many educational settings and as many authorities as possible in order for it to have an impact upon preventing suicide in children and young people. We are the frontline workers so need to feel confident and competent in asking about suicide and responding appropriately. I believe that a lot of work is still needed to be done, in understanding and destroying the stigma and barriers that can prevent school staff from broaching such subjects as suicide.’ (School staff member)

Community Wellbeing Champions: ‘It’s really important that I have developed my skills of listening and communicating. And in terms of day-to-day use, people have approached me and asked for support in just general conversation. The skills I’ve learned from the Wellbeing Champions have helped me quite a lot, because they allow me to identify what the issues are, what that young person or person may need support with, and to direct them to resources and educational material’ (Community Wellbeing Champion)

Healthy Mind Safe Home: ‘I’ve been homeless since 2015. I’d lost faith in the world. [Team worker] has helped me sort my life out, he’s helped me get somewhere to live, and put me through to someone that’s helped me for a few months just to keep the gas and electric on. Got some free help to fix the house up. I’m just getting one bit at a time sorted at the moment. You know, I’m doing 14 hours a week work now! He’s been able to get me financial support in a time of crisis helping me apply for benefits I didn’t know I was entitled to… I now have a leg to stand on and capability of making decisions for myself.’ (Healthy Mind Safe Home Beneficiary talking about the support they received)

Key learning and challenges

These are the ‘top tips’ gleaned from the key learning points over the entire programme:

• COVID-19 has impacted minoritized communities significantly. Councils should harness the unique knowledge of organisations that have close links to their community and know the areas of highest need.

• Wellbeing intervention projects benefit from utilising established infrastructure, in particular non-statutory organisations working together to provide multidimensional support.

• Public health-related projects require consultation with the target group as a key part of planning and implementation. This programme shows that responding to articulated need within the community can bring about better engagement from beneficiaries.

• Genuine co-production and collaboration throughout projects reduces hierarchy, involves communities in partnerships and increases success.

• Peer support interventions with trusted leadership can have far-reaching impact on the peer workers and their wider network.

• Bespoke interventions can improve the situations of even the ‘hardest to reach’ people, demonstrating transformation in the lives of people who have previously not engaged with services. When providing one-to-one support, an advocate approach works best. Referring vulnerable people to other services is more effective if a team member supports them through the whole process rather than signposting.

• There are many benefits of bringing third sector organisations together to work collaboratively, such as:

• the launch of new partnerships and reduced feelings of competition

• reduced duplication of effort

• shared understanding of customer needs (social and geographical)

• greater trust between these services and local authorities/other partners.

• Establishing links with some organisations such as schools requires significant time due to yearly calendar planning and staffing.

• There can be enduring benefits from short-term projects such as these, but sustainable funding is needed to fully realise them. Organisations working with councils need the capacity to plan longer-term, to maintain and build on project gains. Further, longer-term contracts can facilitate collaboration by reducing staff turnover and the burden of tendering and competition.

Conclusion

The effects of COVID-19 and various lockdowns have put minoritized groups at greater intersectional risk of financial instability, isolation, and mental ill-health. This rapid response programme demonstrates how primary, secondary, and tertiary interventions can reach these groups to have an impact on mental wellbeing. The Public Health team at Blackburn with Darwen Council used the Better Mental Health rapid response funding to work closely with community groups, designing a range of projects that addressed urgent issues highlighted in the COVID-19 literature and by the groups themselves. The projects provided support to marginalised people and consequently their wider networks. Despite the various challenges, many due to the after-effects of the pandemic, the projects demonstrated enduring and transformative impact. New supportive connections and creative ways of working together were generated, and co-production and collaboration featured throughout. This was advanced by the enthusiasm of team members, and their flexibility in responding to emerging areas of need.

The work has been so impactful because of the supportive connections between provider organisations, and the creative ways of working together they generated. However, there were many challenges related to the short timescales, such as recruiting skilled workers quickly, and planning events and meetings with organisations who book their calendars in advance. Although this programme has demonstrated positive outcomes, it is important that short-term funding schemes are backed up by longer term funding, to allow public health and third sector collaborations to advance post-pandemic (see also Fish et al. 2022). To ensure that disabled people are included in the decision-making, policymakers, research funders, and service providers should collaborate closely with disability organisations in order to ensure that disabled people are not left behind in the recovery process (Cobley, 2022; Mladenov & Brennan, 2021).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The Office of Health Improvement and Disparities (OHID) and Lancaster University Applied Research Collaboration.