Priority Area Mental health and Wellbeing Details Outcome measures Main findings Results Current Implementation Wales Evidence Grading NICE, 2008 Occupational therapy and physical activity interventions National Institute for Health and Clinical Excellence Mental Health and Wellbeing People Summary: Older people should be offered regular group and or individual sessions to encourage them to carry out daily routines. Also tailored community-based physical activity programmes including moderate activities should be offered. Older people and their carers should be advised to carry out 30 minutes of safe exercise. Promote regular participation in local walking schemes as a way of improving mental wellbeing. The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details Some elements are implemented widely such as Occupational Therapy sessions, walking groups and schemes such as Exercise on Referral. Less clear whether information on services is widely available and the involvement of OTs in designing training for professionals. A. This intervention is based on evidence of effectiveness and is recommended for use in the UK
Involve occupational therapists in the design of training offered to practitioners. NICE, 2008 Promoting social and emotional wellbeing in primary education National Institute for Health and Clinical Excellence Mental Health and Wellbeing School Children Summary: All primary schools should a comprehensive, ‘Whole School’ approach. Provide a comprehensive programme involving curriculum, training to teachers, support to parents/carers and integrated activities Teachers and practitioners should be trained to identify and assess early signs of anxiety and behavioural problems The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details Healthy Schools approach covers some areas ? A. This intervention is based on evidence of effectiveness and is recommended for use in the UK NICE, 2009 Promoting social and emotional wellbeing in All secondary schools should adopt an organisation-wide approach. Teachers and other staff should ensure The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details Healthy Schools ? Some outreach work done by A. This intervention is based on evidence of effectiveness and is
secondary education Mental Health and Wellbeing National Institute for Health and Clinical Excellence Children and young adults that social and emotional wellbeing features within improvement plans, policies, systems and activities. A curriculum that promotes positive behaviours and successful relationship should be provided to young people. Samaritans in secondary schools around wellbeing recommended for use in the UK NICE, 2009 Promoting mental wellbeing at work National Institute for Health and Clinical Excellence Mental Health and Wellbeing Working age adults Summary: An organisation-wide approach should be adopted to integrate promotion of mental wellbeing into all policies and practices those related to employment working conditions. Employee’s mental wellbeing should be assessed and monitored using a survey or reviewing absentee’s rate. This will identify risks in work and improvements can The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details Mental Health First Aid scheme encourages those who have been trained to work with their employers around policies. Investors in people also covers some aspects of health and wellbeing at work. A. This intervention is based on evidence of effectiveness and is recommended for use in the UK
be made in the working conditions. Employees should have flexible working conditions to balance their work and personal life. The line manager’s role should be strengthened to promote employees mental wellbeing through supportive leadership and management practices. NICE, 2010 Looked-after children and young people National Institute for Health and Clinical Excellence Mental Health and Wellbeing Summary: There should be strong leadership and strategic partnership to addresses health and educational inequalities of looked-after children and young people Commission mental health services of looked-after children to enhance their quality of life through addressing The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details A recent Wales Audit Office report on the educational attainment of looked after children indicated that whilst some progress had been made, there was still unacceptable variation, a lack of clearly defined outcomes and many children still not achieving their full potential A. This intervention is based on evidence of effectiveness and is recommended for use in the UK
Children and young adults their physical and emotional health needs. There should be robust audit and inspection of local authorities There should be adequate range of suitable placements Swann C, 2010 Health systems and health-related behaviour change National Institute for Health and Clinical Excellence Mental Health and Wellbeing Working Age Adults To develop an evidence-based conceptual model of health systems. The important role of policy and national programmes, and marketing, the environment and planning in health stewardship and behaviour change The role of finance and sustainable resources in health promoting systems How improvements in service design and delivery, such as tailoring and targeting interventions, building partnerships and networks, and using appropriate modes of delivery, This report presents the findings from rapid research projects. It is based on learning gleaned from different types of evidence considered during development of public health guidance by the National Institute for Health and Clinical Excellence (NICE). The research comprised a: • review of NICE evidence reviews • literature review • review of stakeholder responses to NICE public health guidance consultation Key findings used to develop the model were: The importance of a stable political context The political climate is ever shifting at present and the economic climate is challenging, thus current systems do not reflect many of the areas this guidance indicates are essential A. This intervention is based on evidence of effectiveness and is recommended for use in the UK
0.21 (95% CI -0.17 to 0.59) and 0.57 (95% CI 0.11 to 1.04), respectively. Twelve trials compared exercise as part of a comprehensive programme with no intervention. Only four provided data sufficient to calculate overall effects, and the results indicate a moderate short-term difference in in favour of the intervention [SMD 0.51 (95% CI 0.15 to 0.88)]. Gilbody S et al, Screening and case finding instruments for depression Cochrane Database of Systematic Reviews Mental health and Wellbeing Working Age Adults and Older People To determine the clinical and cost effectiveness of screening and case finding instruments in: 1) improving the recognition of depression; 2) improving the management of depression, and 3) improving the outcome of depression. There is substantial evidence that routinely administered case finding/screening questionnaires for depression have minimal impact on the detection, management or outcome of depression by clinicians. Practice guidelines and recommendations to adopt this strategy, in isolation, in order to improve the quality of healthcare should be resisted. The longer benefits and costs of routine screening/case finding for depression have not been Twelve studies (including 5693 patients) met our inclusion criteria. Synthesis of data gave the following results: (1) the recognition of depression: according to case note entries of depression, screening/case finding instruments had borderline impact on the overall recognition of depression by clinicians (relative risk 1.38; 95% confidence interval 1.04 to 1.83). However, substantial heterogeneity was found for this outcome. Screening and feedback, irrespective of baseline score of depression Case finding for depression not routinely carried out. G. There is some evidence suggesting that this intervention is ineffective but it is not conclusive.
Cochrane Database of Systematic Review Mental Health and Wellbeing population studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, methodological flaws in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these flaws are addressed in future studies (for example by providing greater detail on the implementation of programs, using more robust designs, with integrated process evaluations and measurement of health outcomes) it could provide a better understanding of what might work and why. When updating this review, we will analyse any partnership or process evaluations of our included showed health benefit; four showed modest improvement in one or more of the outcomes measured, but no clear overall health gain; and one study showed no evidence of health gain. Two studies were related to lifestyle improvements of which one failed to show health gains for the intervention population, while the other showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies were related to chronic disease management and all three failed to demonstrate health gains.
measures such as resilience, hardiness, and empowerment. Adverse outcomes will include any physical or psychological adverse outcome recorded in the included studies. Pratt BM & Woolfenden S, 2002 Interventions for preventing eating disorders Cochrane Database of Systematic Reviews Mental Health and Wellbeing Children and young adults To determine if eating disorder prevention programs for children and adolescents are effective in: 1) promoting healthy eating attitudes and behaviours; 2) promoting protective psychological factors; 3) promoting satisfactory The one significant pooled effect in the current review does not for any firm conclusions to be made about the impact of prevention programs for eating disorders in children and adolescents, although none of the pooled comparisons indicated evidence of harm. The meta-analysis is in the process of being revised to account for the impact of cluster randomised trials. Combined data from two eating disorder prevention programs based on a media literacy and advocacy approach indicate a reduction in the internalisation or acceptance of societal ideals relating to appearance at a 3- to 6-month follow-up [SMD -0.51 to -0.05, 95% CI]. There is insufficient evidence to support the effect of five programs designed to address eating attitudes and behaviours and other adolescent issues in the general community or those classified as being at high risk for eating disorder and insufficient evidence to U G. There is some evidence suggesting that this intervention is ineffective but it is not conclusive. (Authors are continuing to analyse data to account for cluster RCT effects)
physical health; 4) having a long-term, sustainable, and positive impact on mental and physical health; and, 5) ensuring safety in relation to possible harmful consequences on mental or physical health. support the effect of two programs designed to improve self-esteem. Data from two didactic eating disorder awareness programs could not be pooled for analysis. There is not sufficient evidence to suggest that harm resulted from any of the prevention programs included in the review. Van-Oostrom, SH et al, 2009 Workplace interventions Cochrane Database of Systematic Reviews Mental Health and Wellbeing Working Age Adults The objectives of this review were to: 1)determine the effectiveness of workplace interventions in preventing long-term work disability among workers, when compared to usual care or As a result of the few available studies, no convincing conclusions can be formulated the effectiveness of workplace interventions on work-related outcomes and health outcomes regardless of the type of work disability. The pooled data for the musculoskeletal disorders subgroup indicated that workplace interventions are effective in the reduction of sickness We included six randomized controlled trials (749 workers): on low back pain, one on upper-extremity disorders, one on musculoskeletal disorders, and one on adjustment disorders. Five studies were as having low risk of bias for the sickness absence outcome. The results of this review show that is moderate-quality evidence to support the use of workplace interventions to reduce U G There is some evidence suggesting that this intervention is ineffective but it is not conclusive
clinical interventions; 2) determine whether there are differences between the effectiveness of workplace interventions for musculoskeletal disorders, mental health problems, and health conditions. absence, but they are not effective in improving health outcomes. The evidence from the subgroup analysis on musculoskeletal disorders was rated as moderate-quality evidence. Unfortunately, conclusions cannot be drawn on the effectiveness of these interventions for mental health problems and other health conditions due to a lack of studies. sickness absence among workers with musculoskeletal disorders when compared to usual care. However, workplace interventions were not effective to improve health outcomes among workers with musculoskeletal disorders. The lack of studies made it impossible to investigate the effectiveness of workplace interventions among workers with mental health problems and other health conditions. A comparison of a workplace intervention with a clinical intervention, in one study only, yielded similar results for sickness absence and symptoms for workers with mental health problems. Barlow J & Parsons J, 2005 Group-based parenting programme (parents of children under the age of 3 years) 1) To establish whether parenting programmes are effective in improving the emotional and behavioural adjustment of The findings of this review provide some support for the use of group-based parenting programmes to improve the emotional and behavioural adjustment of children under the age of 3 years. There is, however, insufficient evidence to reach any firm conclusions Five studies were included in the review, and there were sufficient data from five studies to combine the results in a meta-analysis. Meta-analyses were conducted for both parent-reports and independent assessments of children's behaviour. The result for parent reports shows a Component of the Flying Start scheme E. There is good evidence to suggest that this intervention has a sound theoretical basis or that work in this area is likely to
Campbell Review Mental health and Wellbeing Working Age Adults children less than three years of age 2) To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems regarding the role that such programmes might play in the primary prevention of such problems. Furthermore, there are limited data available concerning the long-term effectiveness of these programmes, and the results from the two studies for which data were available produced borderline insignificant findings. Further research is required. nonsignificant result favouring the intervention group (ES CI -0.55 to 0.02). The result for independent observations of children's behaviour shows a significant result favouring the intervention group (ES -0.54, CI -0.84 to -0.23). A of the limited follow-up data available shows a small non-significant result favouring the intervention group (ES CI -0.56 to 0.09). have an impact but this has not been demonstrated in trials (this would apply particularly to pilot or novel interventions) Shepherd J et al, 2002 Barriers and facilitators of the health of young people EPPI Mental Health and Wellbeing Children and Young Adults The aims of three reviews summarised in this report were: 1)To undertake a systematic mapping of research undertaken on the barriers to, and facilitators of , good mental health, physical activity and healthy eating amongst Summary: There should be separate interventions, where required for young men and young women according to the specific needs. should be careful implementation of mental health interventions: framing suicide prevention initiatives in terms of avoiding stress and anxiety; This report will be useful to all audiences such as policy specialists, practitioners, researchers, people, their families and friends National Suicide strategy that is implemented at a level in different ways to address local issues. The new Welsh Mental Health Measure addresses some of the service provision issues contained here. C. There is some evidence supporting the use of this intervention but it not conclusive.
young people , especially those from socially excluded groups. 2)To select a sub-set of studies to review 3) To synthesise what is from these studies about mental health, physical activity and healthy eating barriers and facilitators amongst young people. 3) To identify gaps in existing research evidence complementing information provision with skill development using behavioural techniques to prevent depression; and ensuring that content of interventions fits with the language and context relevant to young people. School-based initiatives should be integrated within multi-component interventions involving home and family, community youth groups, health services, local authorities and other agencies. Unclear what school based multi-component interventions are being implemented The Community Guide Recommendations The Community is a product of the Community Preventative Task Force in the US. The Community Preventive Services Task Force was established by the U.S. Department of Health and Human Services (DHHS) in 1996 to