Mental Health and Wellbeing in Our Places: some recent

evidence and a policy provocation.

Rhiannon CorcoranAcademic Director

+Heath & Wellbeing LeadHeseltine Institute, UoL

@rhiannoncor @livuniheseltine @clahrc_nwc @WhatWorksWB @prosocialplace

Liverpool City Region Health Summit 12.10.16

Data Sources & Coverage

North West Mental Wellbeing Survey: highlights 2009 & 2012

CLAHRC NWC: Household Health Survey 2016 –preliminary mental health and wellbeing analyses for the neighbourhood

Community Wellbeing: some findings from the What Works Centre for Wellbeing evidence programme

Prosocial Place: Some theory qualitative evidence and a policy provocation

The Urbanicity Effect 1938 - Wirth: Depression higher in urban compared to rural settings.

1939 - Faris & Dunham: “Mental disorders in urban areas”: Schizophrenia was much more common in deprived inner city Chicago than its affluent suburbs.

2001 Pedersen & Mortensen: A dose-response relationship between time spent in urban environments in childhood and risk.

2003/ 2009 - Evans and Ellaway et al: The relationship is associated with perceived quality of place.

2004 - Sundquist et al: Sweden - 4.4 million adults. Those living in the most densely populated areas had 68–77% more risk of developing psychosis and 12 –20% higher risk of developing depression than the reference group.

2010 - Peen, Schoevers, Beeckman & Dekker: Meta-analysis of urban-rural differences of mood and anxiety disorder.

2012 - Vassos et al: Meta-analysis of urbanicity in schizophrenia.

Urban vs RuralHow we feel about our neighbourhoods?

Understanding Society Survey

Urbanicity Effect - NWNorth West Mental Wellbeing Survey 2009 (& 2012): Compared to the other North West areas surveyed, people in Liverpool had lower general levels of MH&W across the lifespan.

In particular Liverpool residents felt: Reduced sense of belonging to their community. Less participation in organizations. Feeling unable to ask others for help. Feeling unsafe outside their home. Relative isolation.

Comparative WellbeingBy Area NWMWS - 2009

WarringtonHalton & St.Helens

Central LancashireNorth West

WirralSefton

Knowsley

Liverpool

Place-related Changes

Reported in NWMWS from 2009 -2012 Neighbourhood belonging reduced significantly, with 12.7%

fewer respondents saying they felt ‘very strongly’ that they belong to their immediate neighbourhood.

The number of respondents who are meeting the physical activity standard has reduced from 30.4% in 2009 to 27.1% in 2012/13.

The number of people reporting that they talk to neighbours on most days has fallen by 35.2%. Approximately 1 in 20 of those surveyed never talk to their neighbours.

Subjective Wellbeing National data on subjective wellbeing: ONS

*

*

*

*

Household Health Survey CLAHRC NWC - 2015

Most deprived neighbourhoods (n=2006)

Deprived neighbourhoods(n=1498)

Least deprivedneighbourhoods(n=809)

Depression 1.60 (0.70) 1.52 (0.65) 1.33 (0.42)

Anxiety 1.58 (0.77) 1.48 (0.71) 1.33 (0.48)

Paranoia 2.03 (0.91) 1.97 (0.87) 1.70 (0.72)

Wellbeing 3.61 (0.84) 3.71 (0.78) 3.92 (0.67)

All are statistically significant differences: most deprived > deprived > least deprived

Depression by WardsNeighbourhood MeanGREYFRIARS 1.2356WILPSHIRE 1.3172CHILDWALL 1.3193HELSBY 1.3267BLUNDELLSANDS 1.3496NORBRECK 1.3539BEARDWOOD with LAMMACK 1.3601SWANSIDE 1.3991DEEPDALE 1.4077WORSLEY 1.4367HALTON CASTLE 1.4462CAMBRIDGE 1.463CHURCH 1.4659VICTORIA 1.4722MILL HILL 1.4835VIVARY BRIDGE 1.488MOORCLOSE 1.5011WINSFORD OVER and VERDIN 1.5261OLD SWAN 1.5377DUKE'S 1.5838FAZAKERLEY 1.5858DITTON 1.5904SUDELL 1.5959ST GEORGE'S 1.6039ELLESMERE PORT 1.611MOSS BAY 1.6181WENSLEY FOLD 1.667STOCKBRIDGE 1.7149CLAREMONT 1.7355PAGE MOSS 1.7439

GREYFRIARS

HELSBY

BEARDWOOD with LAMMACK

WORSLEY

CHURCH

VIVARY BRIDGE

OLD SWAN

DITTON

ELLESMERE PORT

STOCKBRIDGE

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Anxiety by Wards

Neighbourhood MeanGREYFRIARS 1.2657

BLUNDELLSANDS 1.2814CHILDWALL 1.2983NORBRECK 1.3029DEEPDALE 1.3124WILPSHIRE 1.3314SWANSIDE 1.3649HELSBY 1.37HALTON CASTLE 1.3869BEARDWOOD with LAMMACK 1.415VICTORIA 1.422WORSLEY 1.4242VIVARY BRIDGE 1.442OLD SWAN 1.4546CAMBRIDGE 1.4615MILL HILL 1.4736CHURCH 1.4915SUDELL 1.4925FAZAKERLEY 1.5086DITTON 1.5121MOORCLOSE 1.5154WINSFORD OVER and VERDIN 1.5293DUKE'S 1.5537ST GEORGE'S 1.5708WENSLEY FOLD 1.599ELLESMERE PORT 1.6686CLAREMONT 1.6888MOSS BAY 1.6951PAGE MOSS 1.7582STOCKBRIDGE 1.7733

GREYFRIARSCHILDWALL

DEEPDALESWANSIDE

HALTON CASTLEVICTORIA

VIVARY BRIDGECAMBRIDGE

CHURCHFAZAKERLEY

MOORCLOSEDUKE'S

WENSLEY FOLDCLAREMONTPAGE MOSS

0 0.5 1 1.5 2 2.5 3 3.5 4

Paranoia by Wards

Neighbourhood MeanGREYFRIARS 1.41BLUNDELLSANDS 1.5111WILPSHIRE 1.5475NORBRECK 1.662HELSBY 1.7175BEARDWOOD with LAMMACK 1.7733FAZAKERLEY 1.7946VIVARY BRIDGE 1.8242SUDELL 1.8538CHURCH 1.8541DEEPDALE 1.8864CHILDWALL 1.8902MILL HILL 1.9099MOSS BAY 1.9234STOCKBRIDGE 1.9421WORSLEY 1.9612DITTON 1.9745WENSLEY FOLD 1.9884WINSFORD OVER and VERDIN 2.024MOORCLOSE 2.0405SWANSIDE 2.0455OLD SWAN 2.0543DUKE'S 2.069ELLESMERE PORT 2.0761CAMBRIDGE 2.0795PAGE MOSS 2.1357HALTON CASTLE 2.1476ST GEORGE'S 2.1544VICTORIA 2.1592CLAREMONT 2.239

GREYFRIARS

NORBRECK

FAZAKERLEY

CHURCH

MILL HILL

WORSLEY

WINSFORD OVER and VERDIN

OLD SWAN

CAMBRIDGE

ST GEORGE'S

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Wellbeing by Wards

BLUNDELLSANDS

WILPSHIRE

DEEPDALE

WINSFORD OVER and VERDIN

BEARDWOOD with LAMMACK

CAMBRIDGE

DITTON

FAZAKERLEY

OLD SWAN

ELLESMERE PORT

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Neighbourhood MeanBLUNDELLSANDS 4.0586NORBRECK 4.0574GREYFRIARS 4.0571WILPSHIRE 3.9355MILL HILL 3.8521SWANSIDE 3.8478DEEPDALE 3.8442CHILDWALL 3.8388HELSBY 3.8152WINSFORD OVER and VERDIN 3.8151MOORCLOSE 3.798HALTON CASTLE 3.7715BEARDWOOD with LAMMACK 3.7683VIVARY BRIDGE 3.7534ST GEORGE'S 3.7275CAMBRIDGE 3.7048CHURCH 3.7016WORSLEY 3.6856DITTON 3.6756VICTORIA 3.6683WENSLEY FOLD 3.6313FAZAKERLEY 3.6242STOCKBRIDGE 3.5748DUKE'S 3.5688OLD SWAN 3.5658SUDELL 3.5599PAGE MOSS 3.5463ELLESMERE PORT 3.545CLAREMONT 3.5087MOSS BAY 3.4691

Place Variables

Which place variables are related to MH&W?

Sense of belonging

Use of open space

Level of reported incivilities

Level of community trust

depression YES NO YES MARGINALanxiety YES NO YES NOparanoia NO NO YES NOwellbeing YES YES YES NO

Reported level of incivilities - the visible cues to impoverishment, threat and poor place stewardship

Place Related Distress The ‘psychology’ of place-related distress

The amount we anticipate threat is related to: sense of belonging to neighbourhood, and level of reported neighbourhood incivilities.

The amount we ruminate is related to: sense of belonging to neighbourhood, lack of community trust, and level of reported neighbourhood incivilities

The extent to which we feel hopeless is related to: lack of use of open space, and lack of community trust.

Lived Experience Places of Paradoxical Pride & Shame – an Ambivalent Attachment to Place?Hayden (2013): “…place comes to define people and how they, in turn, define their community as in need of defence and not easily understandable to strangers.”

Stafford et al. (2008): Strong attachment to a deprived neighbourhood increases the risk of depression.

Participant: “...because I feel ashamed being associated with part of that area when deep down people would come to the area and say ‘oh my god look, looks rough round here’. But the people are lovely. I’m not ashamed to be associated… I’m ashamed of people that have got no shame in themselves and they just throw litter. Maybe I’ve used the wrong word of saying I feel ashamed because I’m not ashamed of coming from where I’ve come from because I’ve come from there all me life, and it’s better for me because I’m not a posh nob or I don’t try and be what I’m not.”

Lived Experience When Your Place Makes you Discount Your Future

Life History Theory shows how the qualities of an environment directly determine our life strategies and our wellbeing, emphasising the importance of our places.

Where resources are perceived to be stable, reliable and predictable, people plan their futures, develop the capacity to adapt to inevitable life stresses, cooperate with other future -oriented people, to determine their positive futures.

Where resources are perceived to be unstable, unreliable and unpredictable thrill-seeking and non-cooperative impulsive, self-centered choices are more adaptive and so become the norm.

Wellbeing in Place – People’s Views

“What makes a good place?” 66 views aired

I - Community Spirit; Good People & Neighbourliness

II - Nature & Open Space III - A Clean Living Environment

“Where do you go to feel better?”

51 views expressed

I - Nature & Open Space II - Family & Friends III - Private Activities Diversions

Wellbeing in Place – People’s Views

“Where’s Your Dismaland?”29 Views Aired

I - Aspects/Features Of City Living

II - Matters Of Governance/ Politics III - Being Alone

Wellbeing in Place - People’s Views

People & Power in Place 315 professionals/practitioners working on wellbeing were asked ‘ what is meant by the term community wellbeing?’

...is what emerges from physical surroundings that enable people to flourish.

...is the total sum of wellbeing of all the individuals who live in a community.

…is about nobody being excluded from the community they live in, and ensuring that everyone can lead a good life.

...means people’s feelings of trust in, belonging to and safety in their community.

…means people feeling able to take action to improve things in, and influence decisions about, their community.

…is about strong networks of relationships and support between people in a community, both in close relationships and friendships, and between neighbours and acquaintances.

0% 10% 20% 30% 40% 50% 60% 70%

Community Wellbeing

Encouraging community wellbeing by reclaiming the public realm

“Spread & growth of 'Playing Out' activities. This is where streets are closed to traffic for short periods of time, but

opened-up to children and adults to play, talk, interact and socialise. This has the potential to increase exercise for

children, reduce isolation and loneliness, allow neighbours to get to know one-another, builds trust, understanding,

increases safety in that people look out for one-another and much more.”

Community Wellbeing

Encouraging community wellbeing by reclaiming the public realm

“A once run down, crime ridden area has been given a new sense of pride for the individuals to live in due to one street

deciding to come together to do little things i.e. plant flowers and shrubs and discourage their children throwing litter

around etc. It has made a huge difference over time and led to people appearing to smile more.”

Changing Places Changing places changes futures.

South et al. (2016) Community wellbeing evidence programme.

Well-Design – a policy provocation

Can the ‘Five Ways to Wellbeing’ deliver place-making principles?

Corcoran, R. and Marshall, G. (2016) Planning for Wellbeing. Urban Design and Mental Healthhttp://www.urbandesignmentalhealth.com/journal1-planning4wellbeing.html

Well-designGet ConnectedWell-Design should prioritise and facilitate legible connections to and between potential hubs and gathering places, and remove the barriers to everyday interactions. Be ActiveWell-design should promote active movement to and between potential hubs and gathering places to facilitate the pursuit of everyday physical activity.

Take NoticeWell-design should promote people’s conscious awareness of place, of each other and our relationships.

Well-designKeep LearningWell-design should embrace ‘co-production’ to enable individuals to learn about and so develop an allocentric response to and sense of place.

GiveWell-design should include flexible places and environments that prioritise, accommodate and give explicit consent to cooperative community activity.

Well-design should encourage, facilitate and enable people to volunteer their time as a form of ‘stewardship’ in the pursuit of good places to live.

AcknowledgementsPeople

IMH and PH theme in CLAHRC NWC: Katie Bristow, Ben Barr, Jason McIntyre

Community Wellbeing consortium – especially NEF team, Andy Pennington, Jane South and Anne-Marie Bagnall

Prosocial Place team – Graham Marshall, Rosie Mansfield, Mo Thomas

Funding

NHS- National Institute for Health Research

Economic and Social Research Council

University of Liverpool Knowledge Exchange scheme

Liverpool Institute for Health Inequalities Research –Liverpool CCG