Evidence base for prevention

What works to promote good mental wellbeing and prevent poor mental health?

Tackling mental ill health remains a difficult challenge which, in order to be effectively addressed, requires an approach that takes account of the whole person and their social context – looking at both needs and strengths. Wider aspects, such as belonging, identity, social connection, and purpose are crucial. Social and structural factors such as the distribution of education and employment, the built and online environment, and social norms and practices all impact on our health. There is a strong economic case for interventions to prevent mental illness and promote good mental health and wellbeing.

Given the importance of the wider determinants of mental wellbeing as set out above, a briefing from the Centre for Mental Health set out ten evidence-based actions that government could take to tackle health disparities:

  1. Reduce poverty and financial inequity
  2. Tackle racism
  3. Ensure people have good homes to live in
  4. Boost early years mental health support
  5. Implement a ‘whole school approach’ to mental health
  6. Fund the hubs
  7. Improve working conditions
  8. Tackle climate change and its impact on communities
  9. Close the gap for people with a mental illness
  10. Adopt minimum pricing on alcohol

The Centre for Mental Health has identified actions local authorities can take to improve mental health in their communities and summarises research on how mental health services can best support the social needs of people living with mental health difficulties.

There is also strong evidence showing effective ways to improve specific wider determinants of mental health. A recent comprehensive review identifies seven recommendations for action for mental health professionals, policy makers and researchers to improve population mental health and reduce inequities in mental health problems by prioritizing intervention on social determinants:

1. Make social justice central to all public mental health interventions. Mental health problems are inequitably distributed between and within populations, principally arising from systemic structural inequalities. Making social justice core to all public mental health interventions and policies would reduce these inequities.
2. Invest in interventions that pay off in multiple domains. Few social determinants solely affect mental health. Investing in interventions that target key social determinants will improve physical, mental and social outcomes for individuals and communities. Intervention programs should routinely measure mental health alongside these other outcomes.
3. Invest in interventions that target critical windows of the life course to interrupt intergenerational transmission of mental health inequalities. Providing good-quality and accessible parental and familial support early in life can interrupt the intergenerational transmission of mental health inequalities within families or communities.
4. Prioritize interventions that focus on poverty alleviation. Any comprehensive public health approach to reduce the burden of poor mental health must include efforts to reduce poverty. Poverty is inextricably linked to most social determinants of mental health, and could be considered a root cause.
5. Strengthen causal inference in research on social determinants of mental health and primary prevention. Most research on social determinants of mental health is observational, often subject to selection and confounding bias. Stronger causal inference methods are needed, as well as larger, interdisciplinary observational and experimental studies in representative and adequately powered samples to accelerate progress of knowledge and develop effective primary interventions.
6. Establish inclusive longitudinal population mental health monitoring. Many countries struggle to accurately estimate psychiatric morbidity in their populations, which inhibits both clinical and public mental health provision. Samples are often unrepresentative. Reliable, inclusive and precise longitudinal monitoring of population mental health is the essential basis for effective prevention.
7. Ensure parity between primary, secondary and tertiary prevention in mental health. Investing sufficiently in primary prevention to stop the onset of mental disorders prevents suffering, improves quality of life and societal outcomes, and reduces demand for secondary and tertiary prevention.

Source: Kirkbride, J.B., Anglin, D.M., Colman, I., Dykxhoorn, J., Jones, P.B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T. and Griffiths, S.L. (2024), The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry, 23: 58-90. https://doi.org/10.1002/wps.21160

Poverty and Financial Insecurity

Debt advice services can help protect mental health and have a positive return on investment. One study found that the benefits of these services in terms of debt-related depression, health and legal systems and society as a whole lead to a return on investment of £2.60 for every £1 spent, over a period of five years.

A systematic scoping review (2023) looking at actions on reducing socioeconomic inequalities in health found positive effects for some interventions for targeted populations but a lack of clear conclusions on the differential impact of interventions policies or programmes targeting wider social determinants.

Housing, Homelessness and Environmental Justice 

  • Housing interventions can improve mental health and wellbeing. For example, tackling fuel poverty has been shown to improve social relationships and the mental health of teenagers and adults (25).
  • The ‘Everybody In’ initiative in the early stages of the COVID-19 pandemic showed that ending homelessness is an achievable policy goal. Healthcare access could be improved for people experiencing homelessness through improved staff education, and the development of more flexible healthcare systems, which are better able to provide holistic care to patients with complex needs.
  • Access to green space is consistently linked to greater wellbeing and improved mental health, as well as acting as a buffer for the effects of psychological distress (52). Green space has positive impacts on emotional and behavioural difficulties in young people (53). Moving to an area with more green space produces long-term improvements to mental health (54); though the relationship between green space and mental health may be moderated by factors such as the safety of local parks (55).

Employment and Working Conditions 

‘Job club’ interventions for unemployed people to cope with job loss and assist them into new employment, can support people at risk of depression or experiencing depression. Job clubs provide skills training usually in groups to improve job seeking and build self-esteem and problem-solving skills.

Community Wellbeing

Interventions that improve have been shown to improve the wellbeing of children and young people include:

  • Social support is a strong predictor of wellbeing (126). Interpersonal skills training and emotional regulation have shown consistently positive effects on mental health outcomes in teenagers (127); whilst there is mixed evidence for peer support schemes aimed at young people (128).
  • Community engagement (such as empowering communities and peer-delivered interventions) has been shown to improve self-efficacy and health outcomes across all ages (129). 8 actions have been identified for community engagement to be successful, including acknowledging and addressing power imbalances between citizens and professionals and creating a safe environment for citizens to give input into services (130).
  • Physical activity has been shown to improve self-esteem in children, and well as reducing depression and anxiety (131). Physical activity can be promoted through infrastructure investments (such as access to parks and improving neighbourhood walkability) and group-based activities (such as youth groups) (125).
  • Mindfulness-based interventions haven shown to improve mindfulness, and reduce depression and anxiety, in children and young people (132).
  • Community-based creative activities have been shown to have positively impact on young people’s self-esteem and self-confidence (133).