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When treatment is not enough: evidence and implementation in mental health promotion

Published

4 Mar 2020

Dr Aleisha Clarke and Prof Margaret Barry (NUI Galway) survey the promising new evidence on mental health promotion and the key components of high-quality implementation.

Mental health is intrinsic to good health, wellbeing and quality of life. In the UK and internationally, there has been an increasing recognition of the importance of mental health to overall health.

Confronting the mental health challenge

The direct and indirect consequences of mental ill-health lead to significant health, social and economic burdens. The estimated global cost attributable to mental, neurological and substance use disorders in 2010 was £1.9 trillion, and this figure is projected to double by 2030.

Looking at prevalence in children and young people in particular, results from a dataset of over 28,000 adolescents (aged 11–14 years) in England revealed that two in five young people are scoring above thresholds for emotional problems, conduct problems or hyperactivity.[1] These figures highlight the scale of the problem and the need for a new approach to mental health.

Treatment approaches alone are not sufficient to address the growing global burden of mental disorders and to bring about improvement in mental health and wellbeing at a population level. There is a growing need and appetite for an approach that focuses on keeping children, young people and adults mentally healthy. Mental health promotion has a critical role to play in meeting this challenge. Together with Prof Rachel Jenkins and Prof Inge Petersen, we have recently been involved in co-authoring a revised edition of the international text Implementing Mental Health Promotion (Springer). This textbook illustrates how to practically implement mental health promotion and what is needed to ensure that evidence-based strategies can work successfully in everyday settings.

Updating the evidence on mental health promotion

Since the publication of the first edition of the text in 2007, there is now even more compelling evidence that there are effective and feasible interventions for promoting mental health. These can enhance protective factors for good mental health, reduce risk factors for mental disorders, and lead to lasting positive effects on a range of health, social and economic outcomes.

In this latest edition, we draw on systematic reviews which show that strategies that integrate mental health promotion within routine prenatal and postnatal care services, including home visiting and parenting programmes, lead to improved child development and parenting skills, reduced behavioural problems and improved maternal health and social functioning.[2] Universal and targeted parenting and family strengthening interventions have been shown to promote child emotional and behavioural adjustment, particularly in young children.[3] There is a strong case for investing in such programmes: they have been shown to be cost-effective and to benefit those children and families who are most in need.

The government’s green paper on children and young people’s mental health underscores the role of schools in supporting children’s mental health and wellbeing. There is recent, compelling evidence here too. Universal social and emotional learning (SEL) interventions implemented in schools have been shown to benefit children’s social and emotional functioning and academic achievement.[4] Targeted interventions which enhance coping skills, resilience and emotional regulation for children and young people at higher risk have been shown to be effective in promoting mental health and preventing the onset of mental health problems such as anxiety, depression and suicide.[5] There is also promising evidence that out-of-school youth development programmes can improve the mental health and wellbeing of young people, and lead to positive academic and social outcomes, including for those who are disadvantaged and socially excluded.[6] As these strategies can make a significant difference to the life chances and outcomes of children and young people, there is a strong case for their delivery as a core part of what is being offered in school and youth service settings.

Using this evidence

Translating evidence into real-world practice requires more than selecting an evidence-based programme. It also requires a focus on developing capacity in local contexts that will support high-quality implementation.

In the text, case studies from leading researchers and practitioners in the field show that while the intervention is generally thought of as the major change agent, the ‘implementation system’ makes an important contribution to intervention outcomes as well, as it provides the means and the context for the intervention. These case studies highlight the importance of variables related to the characteristics of the:

  • the implementer – including their knowledge, skills and motivation
  • the implementing organisation – such as structure, ethos and resources
  • intervention activities – including the quality and availability of training
  • intervention participants – including factors relating to identifying, recruiting, engaging and retaining the target population
  • the specific context – such as environment, local policies, agencies and collaborations.

Significant work has been carried out to advance our understanding of high-quality implementation in the context of evidence-based programmes. The text reviews a number of implementation frameworks which describe the core phases of implementation and the specific steps practitioners can take to facilitate high-quality planning, implementation and evaluation of interventions.

This revised edition should be of interest to a broad range of readers, including practitioners, policymakers and researchers working in mental health, health promotion and public health. Interventions featured in the book include home visiting family support programmes, parenting programmes, preschool interventions, universal and targeted mental health promotion interventions in schools, digital mental health interventions, community-based interventions, primary health care interventions, and mental health promotion interventions delivered as part of early intervention services. The text is written from a ‘how to’ perspective, combining current research and evidence with practical advice to support the planning and implementation of interventions in real-life settings.

Mental health promotion has a critical role to play in advancing health, wellbeing and quality of life for people living across a range of economic and social-cultural contexts. By shedding light on the range of effective interventions being implemented internationally, across high-, middle- and low-income countries, the text provides an essential roadmap to mental health promotion.


Notes

1: Deighton, J., Lereya, S. T., Casey, P., Patalay, P., Humphrey, N., & Wolpert, M. (2019). Prevalence of mental health problems in schools: poverty and other risk factors among 28 000 adolescents in England. The British Journal of Psychiatry215(3), 565–567.

2: Barlow, J., Smailagic, N., Ferriter, M., Bennett, C., & Jones, H. (2010). Group‐based parent‐training programmes for improving emotional and behavioural adjustment in children from birth to three years old. Cochrane Database of Systematic Reviews, (3).   /   Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., ... & MacMillan, H. (2017). Early Childhood Development Interventions Review Group, for the Lancet Early Childhood Development Series Steering Committee. Nurturing care: promoting early childhood development. Lancet389(10064), 91–102.

3: Stewart-Brown, S. L., & Schrader-Mcmillan, A. (2011). Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project. Health Promotion International26(suppl_1), i10–i28.

4: Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta‐analysis of school‐based universal interventions. Child development82(1), 405–432.   /   Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting positive youth development through school‐based social and emotional learning interventions: A meta‐analysis of follow‐up effects. Child development88(4), 1156–1171.

5: Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical psychology review51, 30–47.   /   Brunwasser, S. M., & Garber, J. (2016). Programs for the prevention of youth depression: Evaluation of efficacy, effectiveness, and readiness for dissemination. Journal of Clinical Child & Adolescent Psychology45(6), 763–783.

6: Barry, M. M., Clarke, A. M., Morreale, S. E., & Field, C. A. (2018). A review of the evidence on the effects of community-based programs on young people’s social and emotional skills development. Adolescent Research Review3(1), 13–27.   /   Durlak, J. A., Weissberg, R. P., & Pachan, M. (2010). A meta‐analysis of after‐school programs that seek to promote personal and social skills in children and adolescents. American journal of community psychology45(3-4), 294–309.

About the author

Dr Aleisha Clarke

Aleisha is head of what works, child mental health & wellbeing, at EIF.