A COLLABORATIVE APPROACH TO COMMUNITY MENTAL WELLBEING Scoping review – August 2018

About the CRRMH The Centre for Rural and Remote Mental Health (CRRMH) is based in Orange NSW and is a major rural initiative of the University of Newcastle and the NSW Ministry of Health. Our staff are located across rural and remote NSW. The Centre is committed to improving mental health and wellbeing in rural and remote communities. We focus on the following key areas:

• the promotion of good mental health and the prevention of mental illness; • developing the mental health system to better meet the needs of people living in rural and

remote regions; and • understanding and responding to rural suicide.

As the Australian Collaborating Centre for the Integrated Foundation for integrated Care, we promote patient-centred rather than provider-focused care that integrates mental and physical health concerns. As part of the University of Newcastle, all of our activities are underpinned by research evidence and evaluated to ensure appropriateness and effectiveness.

Centre for Rural and Remote Mental Health T: +61 2 6363 8444 E: crrmh@newcastle.edu.au

Suggested citation

Powell N, Dalton HE, Perkins D (2018). A collaborative approach to community mental wellbeing – a scoping review. Centre for Rural and Remote Mental Health, University of Newcastle.

Prepared by

Nicholas Powell, Dr Hazel Dalton and Prof David Perkins

Acknowledgements

Prepared with funding support from the Mental Health Commission of New South Wales as part of a broader project on community wellbeing collaboratives which also encompasses the evaluation of such initiatives in rural NSW. We thank Dr Scott Fitzpatrick for critical review and feedback.

All material in this report is provided under a Creative Commons Attribution 3.0 Australia licence (www.creativecommons.org/licenses). For the avoidance of doubt, this means this licence only applies to material as set out in this document.

The details of the relevant licence conditions are available on the Creative Commons website as is the full legal code for the CC BY 3.0 AU licence (www.creativecommons.org/licenses).

A collaborative approach to community wellbeing – a scoping review – August 2018 1

Contents

Executive Summary ....................................................................................................................... 2 1 Introduction ............................................................................................................................. 6 2 Methods ................................................................................................................................... 8

Purpose ................................................................................................................................ 10 3 Findings ................................................................................................................................. 10

Enablers ................................................................................................................................ 10 Planning and community engagement ............................................................................ 10

Organisation, purpose and scope ................................................................................... 11 Communication ................................................................................................................ 12 Activities ........................................................................................................................... 12 Reflection and evaluation ................................................................................................ 14

Case Study: Well London ................................................................................................ 15 Barriers ................................................................................................................................. 16

Unsuitable for the community .......................................................................................... 16 Lack of infrastructure ....................................................................................................... 17

Poor communication ........................................................................................................ 17 4 Discussion ............................................................................................................................. 19

Similarities to public health initiatives .............................................................................. 19 Consideration for mental health initiatives ...................................................................... 21

Other health and wellbeing programs ............................................................................. 22 Evaluation ........................................................................................................................ 23 A ‘well’ community ........................................................................................................... 25

Conclusion ............................................................................................................................ 26

5 References............................................................................................................................. 27 6 Appendices............................................................................................................................ 33

A collaborative approach to community wellbeing – a scoping review – August 2018 2

Executive Summary

The idea of thriving communities is central to governmental policy at local, state and national levels. Yet a community cannot thrive if the local citizens suffer from poor mental health. Therefore, good mental health and wellbeing should be central to any community development plan. Community wellbeing features in the action plans of many local governments both nationally and internationally, however guidance around best practices for mental health initiatives is often not standardised or easily accessible to local policymakers. This review describes evidence from the literature about community wellbeing initiatives and community empowerment.

Community wellbeing is a multifaceted phenomenon. Moreover, what a ‘well’ community looks like will differ greatly according to context. This makes addressing community wellbeing an issue that is too complex for a single organisation or centralised government to address on a meaningful scale. Local, tailored and collaborative measures, therefore, may be the ideal solution to improve wellbeing in community settings. This ‘bottom-up’ approach to community development can assist with engagement and is more likely to contribute toward empowerment than a ‘top-down’ approach. The most appropriate role of national bodies, therefore, is to enable and facilitate initiatives driven by local organisations and individuals rather than the implementation of paternalistic programs.

A coalition of enthusiastic local stakeholders is often the driving force behind community initiatives. This often takes the form of a steering committee which is tasked with managing the design, implementation and evaluation of the initiative. A steering committee can enable parties from across the community to contribute to the direction of the initiative and allows interagency collaboration in terms of resources. The steering committee can be the forum to use feedback from the community to develop and refine a vision and plan for the initiative. In the literature, these plans usually involve mentally healthy activities, social engagement, education and increased access to services. Initiatives were most successful when they responded directly to the community’s wishes. Sometimes, stakeholders and committee members may work in the community as or through champions, volunteers and mentors. It is important that the people in these roles have the networks, skills and position to facilitate change in their community

There is a large body of research available to policymakers and community members about community engagement, community empowerment and program implementation. There is a large body of research on social capital cohesion, collective impact and capacity building. There is a growing literature on what it means to be mentally healthy. This report presents the findings of a scoping review of the literature that draws these three fields together in order to provide guidance and recommendations for communities who seek to cooperatively improve wellbeing.

A collaborative approach to community wellbeing – a scoping review – August 2018 3

A collaborative approach to community wellbeing – a scoping review – August 2018 4

A Guide to Collaborative Action for Community Wellbeing: Summary of evidence

Wellbeing is a broad concept which encompasses components of good health including physical, social, mental, spiritual and environmental. We searched the literature for common elements in community-led initiatives that influence mental wellbeing. We found that these initiatives often included activities which affected all aspects of wellbeing.

Here we describe elements of community wellbeing collaboratives (CWC) found in the literature. However, as no two communities are identical, each initiative should be shaped to the local context. This is a guide, not a recipe for improving community wellbeing.

CWC initiatives are often developed to address a particular contributor to community wellbeing such as social capital, social participation and isolation, community pride, youth engagement and parental support. Initiatives need to be based on a good understanding of the community driven by objective data. The literature suggests that community engagement, ownership and empowerment are more likely if the community identifies the area for improvement itself1. A local process of co-design that creates opportunities for community members to contribute to the design and planning of initiatives can help to embed environmental, organisational and behavioural changes in their community.

Action: Establish purpose & rationale

• Consider the views of a broad range of community members. If there is significant interest in action from the community, then gather information from objective data sources, meetings, interviews and forums to develop a shared definition of community problems and establish what the citizens want to change in their community2-

4.

• Identify and map local needs, assets and strengths5. A strengths-based approach tends to be more constructive if the community is to progress the initiative6.

• Steering groups are a way to formalise a plan of action based on the feedback from the community. This group of dedicated individuals should be representative of the wider community and may include community members, local businesses, health workers, NGOs, or local representatives of government2,7.

Result: Shared vision

Action: Plan with partners

• The steering group should meet regularly, maintain effective communication and develop trust with their community through democratic decision making and collaboration on short-term goals7,8.

• Creating collaborative relationships, collective accountability and including a range of stakeholders is important to achieve the desired goals, share resources and increase sustainable efforts and partner satisfaction9. A bridge between the steering committee and local policy-makers will assist in the implementation of plans4.

• A framework for governance, roles and responsibilities should be developed so that each partner is clear on their role, the overall goal of the initiative and accountability mechanisms10,11. An iterative, evidence-informed logic model helps create the compelling case for community wellbeing and frame the priorities, actors, actions and evaluation measures for the initiative12.

• Collaboration between partners on grant applications can assist in obtaining funding resources13.

• Community collaborators should be aware that it take time to realise change. Progress may appear to be slow and funding limited at the beginning of an initiative14. Try not to let this be a barrier to progress.

Result: Collective understanding

A collaborative approach to community wellbeing – a scoping review – August 2018 5

Action: Implement & engage

• This aim of this action is to foster collaborative action. This may rely on team building, communication, training, leadership and identifying barriers to involvement for the community. Overall, action should be designed to address the area for improvement within each specific community. A toolkit of practical action from other initiatives can be found below (Appendix 2). Some ways to implement action are to:

• Engage volunteers, champions and mentors to help work in the community. Those with a lived experience can be especially valuable15.

• Educate community members about mental health. This will help to decrease stigma and also help people identify specific actions that may improve their mental health16.

• Work with established groups in the community to organise mentally healthy activities that foster a sense of purpose and pleasure for participants14,17.

• Develop ‘safe spaces’ for the community to go to and talk, and perhaps learn about options for mental health care18.

Result: Collaborative action

Action: Embed & evaluate

• Regularly reinforce the narrative. This can be done by sharing and celebrating achievements and milestones which demonstrate the progress of the initiative with the community and help to keep the steering committee and volunteers engaged and motivated19.

• Regularly seek community feedback on the activities and achievements of the initiative2,20.

• Measure and evaluate the progress of the initiative towards its goals. Adapt the initiative based on the evaluations1.

• Communicate with wellbeing initiatives in other communities for broader support and develop learning opportunities to share knowledge and experience21.

• Try to make mental health and wellbeing part of ‘business as usual’ for community groups and organisations. Assess if the key messages of the initiative are embedded in the culture of the community22.

Result: Sustainability

Regularly review and adapt as needed (to align with goals and respond to community feedback on what is needed no

This series of actions, or a selection of them, should help communities create a robust initiative that can improve mental wellbeing locally. A very successful initiative may, in time, build community resilience and empower the citizens to maintain their wellbeing without input from a central leadership group.

A collaborative approach to community wellbeing – a scoping review – August 2018

1 Introduction

Poor mental health is prevalent in and detrimental to all communities. Approximately 1 in 5 people

experience symptoms of mental illness every year23. These symptoms decrease an individual’s

quality of life and, with a lower quality of life, individuals are less likely to contribute positively to

the social and economic aspects of their community24. Mental ill health costs the Australian economy at least $60 billion annually due to absenteeism, presenteeism, unemployment and

treatment25-28. Due to the costs associated with poor mental health, it is imperative that all levels

of government enable systems that can help lessen the burden of poor mental health. As with most

diseases, it is cheaper, faster and more effective to prevent mental illness than it is to engage in

complex treatment.

Positive mental health is not merely the absence of mental illness29. A high satisfaction with life

across a number of different domains – work, relationships, culture and community – is necessary

to be mentally healthy30. Life satisfaction and health can be divided into different spheres of

wellbeing, which include psychological, social, emotional, spiritual and physical wellbeing31. These

spheres are interdependent, therefore, mentally healthy individuals will maintain each of these

facets of wellbeing. Fundamentally, a mentally healthy individual lives in a state where they are

able to adapt and respond to changes in their environment to maintain all the aspects of their

wellbeing (Figure 1). By extension, one aspect of a mentally healthy community is resilience. Community resilience is attendant upon the balance between and quality of three spheres of

capital: social, environmental and economic (Figure 2)32,33.

Poor mental health is caused by biological, environmental and social interactions34. Specifically,

factors such as isolation, alienation, disempowerment, unemployment, homelessness, stress and

trauma have been identified as precipitating factors of mental illness35-37. The social determinants

of health interact to create a feedback loop between socioeconomic disadvantage, stresses and

mental health38. Therefore, any initiative to improve mental health at the population level must also

work to lessen the negative social determinants of health. This makes community wellbeing a

problem that is too large and complex for a single organisation to address. For this reason, a community wellbeing initiative may be more likely to succeed if it is driven by collaboration between

individuals and organisations within the community. A collaborative initiative can establish

connections between organisations that approach a problem from a different perspective, which

may give the group the ability to innovate in a novel and concerted manner39. Some goals of these

initiatives will require extensive support from government through policy change and funding, while

others can be developed by local support and ownership40.

The aim of this paper is to find the common factors of successful community initiatives that aim to

increase the wellbeing of the populace, which are described in the literature.

A collaborative approach to community wellbeing – a scoping review – August 2018 7

Figure 1: Pillars for positive health which shows the aspects of health that could be considered in a comprehensive model of wellbeing. Reproduced from Institute for Positive Health (2017).

Figure 2: Spheres of capital for resilient communities. Figure adapted from Wilson (2010) and reproduced from Hazell et al. (2017).

A collaborative approach to community wellbeing – a scoping review – August 2018 8

2 Methods

Initial literature searches were conducted in Google Scholar to identify highly cited relevant

papers. Themes from these papers and expert input informed the development of search terms

for a scoping review. The SPIDER tool was used to frame the search terms (Outlined in

Table 1). SPIDER was developed as a search strategy for qualitative systematic and scoping

literature reviews, as such, it returns more specific, narrower searches than tools such as

PICO41,42. As most wellbeing initiatives are assessed qualitatively, it was determined that SPIDER

would be well suited to this review. The search terms were entered into the following databases: CINAHL, Cochrane Library, Web of Science and Embase and Medline (both via Ovid). English

journal articles from 2007 to 2017 were included. The refinement of the search is outlined in Figure

3. Reference lists were reviewed for relevant papers and an additional nine studies were included

for analysis. Additionally, grey literature searches were performed in Google Scholar, Black Dog

Institute, the state and federal Mental Health Commissions in Australia, The World Health

Organisation and the World Bank. In total 38 documented were fully analysed for this review.

The inclusion and exclusion criteria are listed in Table 2.

Table 1: SPIDER search term strategy for scoping review

Sample Communit* AND (program OR initiative OR collab* OR partner* OR framework OR model OR campaign)

Phenomenon of Interest

AND ("mental health" or wellbeing OR well-being OR resilience OR suicide OR depression OR anxiety) AND engag* OR empower* OR "collective impact" OR "cooperative behavio*" OR "stakeholder governance" OR “stakeholder leadership” OR "community network" OR "intervention mapping" OR "community education" OR “community development” OR “capacity building” OR “social capital cohesion” OR “mentally healthy activities” OR “social determinants of health”

Design & Evaluation

AND interview OR survey OR “thematic analysis” OR “case study” OR “cohort study” OR “focus group*” OR questionnaire OR observ* OR “implementation process” OR “implementation analy*” OR “process evaluat*” OR "program logic"

Research Type AND qualitative OR quantitative OR "mixed method"

A collaborative approach to community wellbeing – a scoping review – August 2018 9

Table 2: Inclusion and exclusion criteria for scoping review

Included Excluded Type of Evidence

• Reviews (systematic, scoping or literature) • Process evaluations • Outcomes Evaluations • Conference abstracts • Government & Organisational Websites

• Commentaries

Setting • Community settings • Initiatives which were only relevant to schools, prisons, aged-care homes or full-time care facilities.

Initiative • Designed with some level of community ownership

• Designed with a focus on mental health or wellbeing

• Initiatives not focussed on mental health or wellbeing

• Initiatives that cannot be replicated in developed countries

• Top-down initiatives that do not require community ownership

Records identified through database searching

(n = 1274)

Scre

enin

g In

clud

ed

Elig

ibilit

y Id

entif

icat

ion Additional records identified through

other sources (n = 120)

Records after duplicates removed and titles screened (n = 361)

Records excluded (n = 287)

Full-text articles excluded, with reasons

(n = 36)

Studies included in scoping review (n = 38)

Records screened by abstract (n = 361)

Full-text articles assessed for eligibility (n = 74)

Figure 3: PRISMA flow diagram of the study selection process

A collaborative approach to community wellbeing – a scoping review – August 2018 10

Purpose

This review will bring together literature from several fields. This includes community development,

engagement and empowerment, program implementation, social capital cohesion, collective

impact, capacity building, collaborative working and mental health and wellbeing. This work will inform a model for community wellbeing collaboratives. This model will both help guide

implementation for new initiatives and refine existing collaborations. This research will assist all

levels of government and community coalitions in deciding how to address community wellbeing.

3 Findings

The key goal of this literature review was to identify the active ingredients of community initiatives

which enable them to benefit the wellbeing of the community. Mostly, these facets can be divided

into enablers and barriers, although often identified barriers were simply the absence of the

enabler. For that reason, the section on enablers is more comprehensive than the section on

barriers. Overall, there was a lack of specific detail about setting up initiatives and more research

is needed in this area. This might also be part of a bias in the literature against initiatives which

are not well suited to academic analysis. Most of these papers investigated targeted initiatives

which addressed a problem of a certain demographic in a community. These initiatives were designed to increase mental health through social participation, resilience building, organised

social capital building and purpose in life.

Enablers

Planning and community engagement

Many studies identified a significant early planning stage in their wellbeing initiative. Usually,

wellbeing initiatives were formed in response to a problem and the more strongly the target demographic felt about the problem, the more impetus there was to drive the initiative forward. The

will and ability of the community can be examined via a needs assessment and an assets

evaluation5. This information should be directly gathered from the community in the form of

interviews, focus groups, surveys, forums and workshops2,3,8,13,22,43. Generally, the use of a

strengths-based approach helps to motivate and empower a community more than a deficits based

A collaborative approach to community wellbeing – a scoping review – August 2018 11

approach. At this stage, counsel from outside experts can help frame and guide the community

will, but it is important that the initiative remains in the control of the community10,22. The consistent

message in the literature is that community involvement will lead to community ownership which

will lead to greater support for the initiative, which would increase the likelihood of community

empowerment19. The preparation period can be long, with little progress to show, but coordinators

should not be disheartened by this10,14.

Organisation, purpose and scope

No single plan will be suitable for all communities so consultation and research will be needed to

identify the community-specific issues to customise the project for citizens11. After the views of the

community have been considered, a leadership team should be formed, and regular meetings should be scheduled4,5. This team is often comprised of the most passionate members from the

community consultation4, but care should be taken to ensure it is representative of the community

and that it has appropriate networks to reach target demographics13,21,44. Early meetings of the

leadership team can be used to identify organisations that could bring valuable resources to the

initiative45. Many studies identified this as a key time to develop partnerships and build trust

between organisations through the development of a clear framework which outlined the vision,

goals and purpose of the initiative8. This can facilitate an understanding of the roles of each partner

to build trust and to maintain progress of the initiative10,11,46. To enable this, it is important for each

member of the leadership team to understand the other organisations involved. This helps to

organise resources and decide which organisations should lead various aspects of the

program4,46,47. Studies reported that training and workshops led by management experts could aid

the leadership team in collaborative operation and management4,5.

Once a clear plan has been developed by the leadership team, it is beneficial to reach out to local

government and policymakers, especially if they are not represented on the leadership team4,18.

Local government can help spread the message of the initiative and provide resources which may

also be sourced from local corporations, goodwill organisations or charities. If funding is secured,

members of the leadership team can be employed to organise activities and administer the

initiative which will strengthen its presence in the community18. One study had separate working

and steering groups that successfully performed different roles in the functioning of the initiatives 3. Several initiatives engaged community champions to be frontline workers and role-models who

also acted as a bridge between hard to reach members of the community and health services3,14,15.

Champions were more effective if they were local, enthusiastic and charismatic, with well-

developed social skills and an empathetic nature14,15,18,20,48. It is important to support the leadership team and champions with training, support networks and supervision4,8,11,15,19,49.

A collaborative approach to community wellbeing – a scoping review – August 2018 12

Depending on the scope of the wellbeing collaborative, it can be beneficial to train gatekeepers to

detect the early signs of poor mental health7,50. Health workers and other interested parties should

be encouraged to move into empowering and nurturing activities, such as leadership and voluntary

social roles18. Any local mental health teams should be strongly involved in the initiative18.

Communication

Many studies noted that effective communication between all partners of the initiative is important

for achieving project outcomes as no single organisation can independently address a complex

problem like mental wellbeing4,47. Supportive collaboration can be promoted through team building

activities which help limit power differentials and encourage non-competitive sharing between

partners4,46. It is important for the relationships to be sustainable, which can be fostered through

shared plans and purpose46. One study described an asset mapping task for collaborators, where

they were assessed on their collaboration, communication and output after several weeks5.

Supportive collaboration will help maintain the initiative through highs and lows.

The initiative must also maintain contact with the community, especially those who are

vulnerable11,18,22. Vulnerable groups are often difficult to reach, but culturally appropriate

communication of information can help make the initiative more accessible and appealing3. It is

beneficial for initiatives to engage with existing social networks such as schools, sports teams and

faith-based organisations to reach into the community14,17,21. Each of these institutions can connect

to the broader community through friends and family and help involve a large portion of the

population. For the community to become empowered, the message and activities of the initiative

need to become ingrained in the everyday culture, interactions and activities of the citizens. An

empowered community will continue to benefit from the lessons of the initiative after funding and

administration cease. For example, once the messages of a mental health initiative are ingrained

in the everyday behaviour of an individual, they may continue to volunteer or socialise, as they are

aware of the personal benefits22. Communication with the community may be in the form of social and traditional media, pop-up hubs or educational resource distribution. A number of studies

developed a toolkit that can guide the development of mental health initiatives11,50,51. Champions

are a valuable resource for communication and can help educate and guide people into the health

system if that is required15.

Activities

Plentiful, appropriate and rewarding activities are the hallmark of successful wellbeing initiatives48.

Numerous studies reported that poor mental health, unemployment and low life satisfaction were

A collaborative approach to community wellbeing – a scoping review – August 2018 13

more prevalent in communities that lacked safe places and activities to occupy every

demographic2,45. This was particularly evident for young adults and rural communities2,18,48. Certain

activities gave individuals and groups purpose and identity, while also providing a vehicle for social

interaction49,52.

Activities which involve social participation or collective purpose can foster a sense of community

and cultural pride, which promotes social cohesion and capacity19,49,53,54. Engagement with

services (both emergency and health) in activities can create trust and make them more accessible

to citizens21.

Appropriate activities can provide opportunities for creative, enjoyable and inspiring interactions

which creates a positive cycle where people want to give back to the community, to increase

wellbeing19,52,53. Activities can link people with shared interests, which gives a common ground for

socialisation and promotes continued engagement and, ultimately, to participants socialising beyond organised activities52,55,56. Champions are ideally placed to organise and gain support for

these activities18. Even simple measures such as organised transport to planned activities can help

involve those who are often detached from community activities18. One initiative developed a

system of reciprocal support, which encouraged participants to give their time to others, as they

knew they would receive support when they required it57. Several initiatives mentioned the benefits

of mentors, particularly those with lived experience, for showing participants how people who live

with mental illness can be empowered13,45,54,55. These relationships can be transformative for both

the mentor and the mentee53,57.

It is also beneficial to partner the activities of other health initiatives with mental wellbeing initiatives54. Positive mental health is associated with physical activity, healthy nutrition and

responsible use of drugs and alcohol58-60. Each of these health issues has been the focus of a

multitude of community initiatives20,54,56,61. These initiatives will benefit general health and often

increase social interaction, both of which benefit mental wellbeing. On the whole, activities should

be specifically developed to address issues identified by the community needs assessment17.

The development of safe spaces is also valuable for mental health initiatives52,54. Examples of safe

spaces include: a shed for men to share problems, a dedicated building for sharing stories about

everyday experiences or a building for new parents to get support, counselling and create art18,52,53.

Confidential peer support groups can help citizens gain perspective and receive empathy based on shared experiences18,54,55. These groups may meet informally to share and may invite speakers

to increase the group’s knowledge and awareness16. These support groups are well placed to help

destigmatise poor mental health through various mental health education and promotion

activities16. One strength of community initiatives, therefore, is that they can provide facilities and

services that are distinct from those provided by the health system18.

A collaborative approach to community wellbeing – a scoping review – August 2018 14

Reflection and evaluation

Once the initiative is established, it is beneficial to begin to assess and subsequently refine the

initiative to better meet the goals and align with the vision22. The majority of the studies in this

review conducted interviews with participants and facilitators to gain a qualitative understanding of

the function and success of the initiative. The most comprehensive evaluation was in the studies

on Well London that used a combination of interviews and quantitative tools, including the Warwick

Edinburgh Mental Wellbeing Scale, to measure changes in wellbeing, social factors and healthy

behaviours during the initiative62.

When the initiatives were well established, it was also beneficial to reach out to other initiatives to

create a broader support network, which can be valuable vehicles for accountability and shared

purpose21. The shared sense of purpose between initiatives may help stakeholders to celebrate

the small achievements of each initiative, which can help maintain the motivation and enthusiasm

of the leadership group19.

A collaborative approach to community wellbeing – a scoping review – August 2018 15

Case Study: Well London

Well London is focussed on actions at the neighbourhood level. It provides a framework for

community to improve health and wellbeing through capacity and strength building. The framework

was developed by a group of strategic and local partners. Local partners trialled the framework in

small areas and their experiences informed further iterations of the framework. Well London

launched in 2014 in one community and had expanded to 11 communities in 2015.

The program used community engagement principles to improve physical activity, nutrition and

mental health in some of London’s most disadvantaged communities. While the same framework

was used for each community, the activities were designed specifically through a process of co-

production. The project was well funded and so could involve physical changes to the neighbourhoods, to enable citizens to participate in physically and mentally healthy activities. The

project was formally evaluated in 2012 through a series of surveys, and there is an opportunity for

further evaluation later in the project.

A collaborative approach to community wellbeing – a scoping review – August 2018 16

Barriers

Unsuitable for the community

One of the main criticisms of community initiatives is that they are not designed to meet the needs

of the community2. Community members often report that they do not engage with the initiative

because they feel they will not get anything worthwhile out of it. They believe the projects are

designed to adhere to a defined academic process or to meet outcomes of government

departments, which makes the initiative provider driven rather than a response to the needs of the

community2,8. There is also the perception that there are no new ways to deliver services, and that

each initiative is going to suffer from the same problems as the previous initiative, and so some

communities exhibit apathy based on ‘initiative overload’2. From this stems a distrust of academics and services and a sense of disenfranchisement4,20,50. To increase engagement, services should

show the community that they are invested in the local area, this will develop overtime if the

services are consistently visible, responsive and contributory in terms of resources and time. No

single initiative will be suitable for all communities, so any model should include measures to allow

for adaptation44,45.

Mental health is intrinsically linked to exercise, nutrition, sleep and employment, and each of these

facets of life can be targeted by various, proven initiatives. Mental health initiatives, therefore,

should partner with and learn from these other initiatives. Without messages targeted at these

other aspects of health and wellbeing, some participants felt that community wellbeing initiatives were not holistic49. For example, Act-Belong-Commit encourages individuals to participate in

different groups within the community, which, taken together, may benefit many aspects of

health22. Further, some participants reported that without the possibility of employment or training

they could not justify participation, as unemployment was a pressing concern49. A role of

community wellbeing initiatives could be to advocate to and partner with local council and

government for changes in the social conditions in the community.

Similarly, some participants felt that there were too many initiatives that had to compete for time,

energy and investment from the community43. This shows that there is a lack of coordination

between various social and environmental initiatives to respond to the needs of the community in a concerted manner. In addition to competition between initiatives, participants also mentioned

other time pressures, such as work and family commitments14. For this reason, initiatives that were

too demanding were often less successful. In fact, if an initiative is too demanding for volunteers,

champions and other advocates, it may be deleterious to the mental wellbeing of that individual43.

A collaborative approach to community wellbeing – a scoping review – August 2018 17

Lack of infrastructure

A lack of infrastructure around an initiative was often identified as a barrier to implementation and

engagement. Insufficient planning and preparation in the early stages of an initiative can result in

a poorly defined initiative with little local support. Partners should develop an agreement and terms

of reference that clearly explains the roles and responsibilities of each partner and their contribution

to the goals of the initiative10,21. Competing priorities may act as a barrier to engagement and,

therefore, the roles of each partner should be both practical and reasonable47. These agreements

should also help partners deliver a clear and consistent message to the community46. Partnerships

also need administrative and procedural guidance and support, which may be provided by

government, a leadership group or outside counsel10,43,47. Indeed, a lack of support from levels of

government was a barrier to the development of initiatives8. A lack of local leadership in the form

of a steering group or community champions acted as a barrier to community engagement and

ownership20. However, as mentioned above, if the leadership group is not representative of, and active in, the community, it may not overcome community resistance or recognise the needs of the

community. For example, one study found that a group who acted on behalf of a community without

broad support contributed to the lack of community engagement with, and trust in, the initiative,

which decreased its effectiveness2. This may be mitigated by ensuring that a wide range of

community members are involved in each step of the initiative.

The stakeholders of the initiative are often the driving force behind its success. However, if

circumstances change for these stakeholders the initiative is often adversely affected. Changes in

partner organisations can impact the agreements and resources of the initiative and lead to

changes in personnel which creates problems around continuity of messages and actions4,8,16,43,53. Similarly, dispersal and transience of the local population, especially of medical professionals and

in rural areas, can make it difficult to engage with the community and sustain partnerships within

the collaborative20. In some cases, a clear memorandum of understanding may create the

accountability for partners to commit to the initiative. However, organisational cultures and

professional attitudes can create a rigid, overly bureaucratic initiative which may engender

resistance in the community and other, perhaps unequal, partners4,16,46.

Poor communication

Insufficient communication was a shortcoming of several initiatives11. Communication between all

groups involved in the initiative is essential to the functionality and sustainability of the program.

Individual egos and unmanaged power differentials can detract from the communication of the

collaborative which will limit resource sharing, organisation and goodwill46. A lack of

communication between partners, policymakers and volunteers can also detract from the continuity

A collaborative approach to community wellbeing – a scoping review – August 2018 18

of the initiative10. Further, in response to an identified problem in the community, some

organisations will tend to focus on their organisational response, rather than interagency

communication and collaboration to pool resources and limit duplication11.

Infrequent communication to the community can decrease visibility and relevance of an initiative,

and fail to draw individuals into the initiative. For some initiatives, it was especially difficult to

communicate with all groups within a community8. Other sectors, such as first responders and

cultural organisations, were found to be difficult to engage due to other priorities11. A diversity in

means of communication may help to connect with hard-to-reach demographics/groups. Effective

communication may also overcome community resistance and apathy, which act as a barrier to

engagement.

There were also cultural barriers to the success of initiatives. In many communities, particularly

rural communities, there is a culture of self-reliance, which along with stigma, may decrease community uptake of an initiative, particularly in rural areas14,18. Several studies found that it was

particularly difficult to reach certain socially marginalised groups14. Some communities are

resistant to community wellbeing initiatives as the factors mentioned above reinforce the idea that

nothing can change, which potentiates a fear of raising expectations, only for ultimate

disappointment2.

A collaborative approach to community wellbeing – a scoping review – August 2018 19

4 Discussion

Similarities to public health initiatives

While there is extensive literature on community engagement and on mental health care, there is

comparatively little about community initiatives that aim to increase population mental health

through community engagement, ownership and empowerment. However, the literature on

community engagement with broader health initiatives can still inform the development of

community wellbeing initiatives as there is an apparent partial overlap between the findings from

this review and reviews of community participation43,63-69. Initiatives that promote exercise,

nutrition, education and environmental care involve social interactions as a side-effect which is

beneficial for the population’s mental and social wellbeing, without being the primary goal of these

initiatives43,64. However, an initiative that aims to improve mental health could be implemented

through these activities, as such, there are valuable lessons to be learned from these initiatives.

There is a wealth of literature on community implementation theory, empowerment and

engagement, which could be drawn from in the development of a comprehensive model for

community wellbeing (reviewed in Popay et al. (2007), Nutbeam et al. (2010), & Laverack (2006)). For example, Laverack (2006) identified nine empowerment domains: participation, community-

based organisations, local leadership, resource mobilisation, asking ‘why’, assessment of

problems, links with other people and organisations, the role of outside agents and programme

management 71. These domains aim to develop interpersonal trust through common ground

support and enable citizens to build capacity to address the needs of the community through

resource mobilisation. Broadly, these outcomes are the goals of many of the initiatives identified

in this review, and so these domains cover similar themes to the model presented.

There are also noticeable similarities between the enablers discovered in this review and in a

review of general health collaborative functioning. Roussos and Fawcett (2000) describe seven interdependent factors to consider in initiatives targeting changes in population-level health

outcomes which have been supported by other studies 72. These are: 1) having a clear vision and

mission, 2) action planning for community and systems change, 3) developing and supporting

leadership, 4) documentation and ongoing feedback on progress, 5) technical assistance and

support, 6) strong financial resources for the work, and 7) making outcomes matter40. These factors

align with the enablers from this review which pertain to the function of the leadership group such

as developing a vision, planning extensively, supporting leadership with training and external

advice and evaluating progress towards goals, and show that there is well developed literature to

prompt collaborative formation. However, no studies identified in this review emphasised

documentation as a key enabler of wellbeing initiatives, but rather highlight community consultation

and feedback as a key enabler for systems change and engagement.

A collaborative approach to community wellbeing – a scoping review – August 2018 20

As a more practical guide for communities, the National Institute for Health and Care Excellence

(UK) has developed a set of guidelines and principles of good practice for community engagement

(overviewed in Figure 4)73. The PARiHS (Promoting Action on Research Implementation in Health

Services) framework could also be used by communities to guide implementation of evidence-

based actions that are beneficial for mental wellbeing. PARiHS proposes that the implementation

of evidence into practice is dependent on evidence, context and facilitation. PARiHS has also been

used as an evaluation tool once the initiative has been established74. Each of these resources emphasises the importance of adaptation to context, which was also a prominent theme in the

review of wellbeing initiatives, and so an understanding of context is important to maintain (see

appendix 4 for diagrams from other studies on collaboration in public health).

Figure 4: NICE guidelines for community engagement. Reproduced from NICE (2017).

A collaborative approach to community wellbeing – a scoping review – August 2018 21

This review identified many different actors and actions in community initiatives, especially for

mental health as it is, in itself, a complex issue which requires a coordinated approach39,75. The

community and mental health settings can, therefore, be viewed as a complex system, and so we

can draw lessons from complexity theory2,76. Braithwaite et al. (2018) state that “A complex system

has a set of interdependent components, defined not just by their interrelations but by the

permeable and shifting boundaries between them. The components (people, technology, artefacts,

equipment) are combined haphazardly and in unexpected ways, aggregating to be more than the

sum of their parts, and are characterized by eddying, recurring patterns of behaviour” pg 3,

Braithwaite et al. (2018). This reinforces the theme from the literature that a wellbeing plan or

initiative should be adaptable to the dynamic context of the community, and so, by extension, that

the ‘pipeline’ view of implementation as a series of linear steps is a flawed way to approach

community wellbeing76. For this reason, we have not presented a linear model for community

wellbeing, but an iterative guide.

Consideration for mental health initiatives While there are similarities between mental health and wellbeing and other health initiatives, there

are some important features that need to be considered for mental health. For example, the

literature still identifies stigma and sociocultural attitudes as barriers to mental health initiatives and

mental health care14,77,78. Mental health training was incorporated in several of the initiatives

included in this review and can decrease the stigma of mental illness, increase help-seeking, and

promote ways to maintain personal mental wellbeing7,15,44,61,79-82. As such, an increase in general

mental health literacy should be a goal of a comprehensive wellbeing initiative. This information

may help communities and medical practitioners identify and respond to the early symptoms of a

deterioration in mental health. Beyond family and friends, frontline workers (police, teachers and

nurses), community volunteers and champions and general practitioners may be the first point of

contact for people who need or seek mental health advice83-85. As such, they should be involved

in community mental health initiatives and receive the training, resources and support to aid

people. In addition to general advice about mental health, these individuals are well placed to refer

help-seekers on to relevant services. These are features of suicide prevention programs, which may be useful to incorporate into broader wellbeing initiatives 86. That said, the goals and actions

of the initiative should always reflect the motivation behind the creation of the initiative.

In many public health initiatives, social connectedness is often a secondary benefit to health

promotion and activities, whereas in community wellbeing initiatives it can be viewed as one of the

primary goals. The studies in this review consistently identified increased social activity as one of

the main benefits of the initiatives across different communities and groups, such as Connecting

Communities, the Ngala Nanga Mai pARenT Group Program, Men’s Sheds and Coping Through

A collaborative approach to community wellbeing – a scoping review – August 2018 22

Football2,52,53,56. Participants often identified the hubs and activities of these initiatives as safe

places to identify common ground and share stories about mental health and wellbeing. Discussion

of mental health problems can help decrease the stigma that surrounds mental illness and may

promote help-seeking behaviour. Increased education about mental health reveals to participants

that mental health problems are common and can trouble anybody. It also shows that avenues to

care and recovery exist and are successful. For role modelling purposes, the involvement of those

with a lived experience can be very beneficial to participants54.

It’s very difficult to set up events that have a direct impact on the mental health of a whole

community, as, between individuals, there is variance in perceptions of mental wellbeing and ways

individuals maintain it (see, for example, the range of activities promoted under Act-Belong-

Commit)22,87,88. Often, when compared to other public health initiatives, wellbeing initiatives require

a broader range of activities which can make them difficult to organise, fund and monitor. Perhaps

due to this, the majority of the articles included in this review targeted only a specific subset of the

population (e.g. Indigenous youth, families or school children) where the activities could be tailored

to a similar demographic who may respond positively to similar actions. A whole-of-community

wellbeing collaboration would need to develop wellbeing plans, programs and activities that can reach all facets of the community. For example, Well London aimed to increase social cohesion

through activities that were relevant and appeal to most citizens. Broadly these were healthy

eating, physical exercise and social connectedness20,61. Well London provides some resources

and a community-engagement centred framework to help develop local solutions to wellbeing (See

appendix 2). The pitfall of this broad-scale approach is that participation was dependent on

personal agency, and perhaps those who needed the programs most did not access them.

Other health and wellbeing programs There are numerous large-scale projects to develop frameworks for community engagement,

program implementation, service collaboration and health promotion. While these initiatives do not

necessarily involve community ownership, they still provide valuable frameworks for certain

aspects of community wellbeing. Even though the literature suggests bottom-up initiatives create

greater engagement, it is still important to receive input from external experts. These frameworks

may form part of this input.

The DataPrev Project was a collaborative effort in the European Union to create a database of

evidence-based mental health interventions for parents, schools, workplaces, communities and

elderly people89,90. The DataPrev reviews found that early childhood establishes the foundation for mental health90. As none of the community initiatives in this review targeted parenting and young

children, this may be an area that is under-represented in wellbeing initiatives. However, it may be

difficult to design parenting initiatives in a bottom-up, community-driven manner. Another

A collaborative approach to community wellbeing – a scoping review – August 2018 23

European project, ROAMER, consulted with mental health experts on the direction of mental health

research and promotion91. ROAMER recommended 20 priorities for mental health research, many

of which cover aspects that are relevant to community wellbeing such as building on

interdisciplinary perspectives to address the complexity of mental health (see appendix 3 for the

full list of recommendations). This suggests that there is still a large amount of research into

community wellbeing needed.

Early detection of mental health issues is just as important for mental health as physical health92,93.

Community gatekeepers can assist with detection if they are appropriately trained7. This may be

particularly important in rural communities, where access to specialist care may be limited. For

GPs and other health workers, a similar system to Project Echo could connect specialist knowledge

in centralised research facilities to rural practitioners to help detect and manage mental illness94.

For teachers, champions, volunteers, law enforcement and other frontline workers, mental health

training is available from programs and organisations such as RAMHP, GoodSpace, headspace,

beyondblue, Mental Health First Aid and the Black Dog Institute. This training of services will help

spread the responsibility for mental health across the community, address stigma and make the

community as a whole better able to respond to changes in mental health states.

Evaluation

The broader literature into the evaluation of community initiatives may also help guide the formation

and assessment of community wellbeing collaboratives. It is important to embed evaluation in

community initiatives from the outset so that progress may be tracked and that the findings from

the evaluation will help inform subsequent planning. Thorough evaluation of initiatives will also

help contribute to the evidence base for what makes community initiatives successful. There are

many tools that have been developed to gauge effectiveness for community initiatives, which may

be a valuable starting point for community groups to build their evaluative framework. For example,

the Prevention Institute (California) has developed a tool to assess collaborative effectiveness (LINK), VicHealth has developed a checklist for the creation of collaborations for health promotion

(LINK) and the Collaboration Primer has developed questions to assess whether the health

promotion project met its goals (LINK). These tools deal with the effectiveness of collaborations,

but there is also difficulty in the measurement of wellbeing itself. As wellbeing is a broad, adaptable

and contextual term, the tools to measure wellbeing invariably target different facets of social and

emotional health and wellbeing (see Linton et al. (2016) for a review of tools). The self-assessment

tool on the Act Belong Commit website may be a useful tool for communities to begin to identify

areas for improvement for individuals87. It may be beneficial for collaboratives to combine these

tools, or others, to create a comprehensive impact assessment tool, tailored to their community

which contains a mix of objective and subjective measures and recognises collective impact

A collaborative approach to community wellbeing – a scoping review – August 2018 24

(Figure 5)95-97. Despite all these tools, researchers realise that quantitative measures alone cannot

fully assess wellbeing initiatives98. For this reason, most studies in this review used qualitative or

mixed method analysis. This may also be because community behavioural studies, such as

wellbeing, are not well-suited to the randomised controlled trials which are predominant in other

fields of health research.

Community proxy measures for mental health provide an objective way for collaboratives to assess

the impact of wellbeing initiatives. Economic measures have traditionally been used to report on

macro- and meso-level wellbeing, however, these do not fully explain the trends in mental

health99,100. In the last two decades, social capital has been considered as a measure for

community social wellbeing, and it was recognised as an important driver of other measures of community function, including economics and health101-104. More comprehensive metrics have

been developed which include the social determinants of health, yet these often operate on a broad

scale and are not useful for communities (eg. OECD). In terms of local assessments, volunteer

rates seem to be a good gauge of wellbeing in a community46,105-107. Participation rates in sports

The five conditions of collective impact

1. A common agenda All participants have a shared vision for change including a common

understanding of the problem and a joint solution through agreed actions. 2. Continuous communication

Open communication is needed to build trust, reaffirm mutual objectives and

maintain collective motivation. 3. Backbone support

Backbone organisational support provides overall strategic direction, facilitates

dialogue between partners, manages data collection and analysis, handles

communication, coordinates community outreach and mobilises funds. 4. Mutually reinforcing activities

Actions should complement each other and respond to an overarching plan of

action. This requires that the actions of all stakeholders are coordinated. 5. Shared measurement

Shared measurement can keep efforts aligned and create an accountability

mechanism for stakeholders. Results can inform new iterations of the overarching

plan of the initiative.

Figure 5: The five conditions of collective impact. Adapted and summarised from Kania & Kramer (2011), Hanleybrown et al. (2012) and the Australian Institute of Family Studies (2017).

A collaborative approach to community wellbeing – a scoping review – August 2018 25

clubs, art groups and social committees could also provide objective measures for social wellbeing

and should be considered as a community develops an impact assessment.

A ‘well’ community

To establish a vision and measure progress towards it, a community needs to discuss what would

make their community well. The idea behind wellbeing initiatives is that they are primarily a positive

way to view health, that is, to distance itself from the deficit based models of health. The literature

suggests that mental health could be drastically improved by addressing the social determinants

of health108,109. This is a daunting task for a community group, as social and political factors

influence the social determinants, and thus are difficult to address by local action, particularly in

the short term. However, the literature on capacity building and social capital suggest that life

satisfaction can be improved through practical action47,110-112. Through the use of a capabilities

approach, local collaboratives could begin to raise the social capital of the local citizens which can,

over time, improve the conditions within a community and improve the social determinants of

health. As there seems to be a feedback loop between the social determinants and mental health,

an improvement in either should improve life satisfaction and wellbeing on an individual scale.

What a local collaborative could directly promote is social cohesion, which is often linked to

individual wellbeing. Many of the studies in this review mentioned organised group activities as

promoting social interactions, at least on the micro-scale. This social cohesion seemed to promote

pride in community20, hope53,113, confidence in support57 and positive social behaviour2, which in

turn generated a sense of belonging, purpose, control and personal agency20,48,49,52,56,61,114. These

benefits are all features that are frequently touted as traits of the mentally healthy115,116.

Numerous communities aspire to create a well community as evidenced by the prevalence of

localised wellbeing plans (e.g. Mildura, Margaret River, Monash, Maroondah, Moonee, Ayrshire &

Arran, Saskatchewan and Dufferin County). However, there is an apparent lack of documentation

relating to the implementation and evaluation of these programs, as very few are referenced in the

academic literature. While the rigidity of the academic process can be perceived as a barrier to the

initiative4,43,50, it can also ensure that rigour is applied to the initiative, so that a) the community can

refine its initiative based on the evaluation and that b) other communities can learn from the

success of the initiative. For these reasons and others, partnerships between universities and

communities can benefit both parties4.

A collaborative approach to community wellbeing – a scoping review – August 2018 26

Conclusion No single initiative will suit all communities. Therefore, a standard framework or model for

community wellbeing collaboratives may be too rigid to be effectively implemented in any individual

community. This review was designed to discover key elements that contribute to the success of

community led mental health and wellbeing initiatives. We have created a guide based on these

findings which shows similarity to broader health initiatives and collaborations, but contains

considerations which are related specifically to mental health. Broadly, awareness building seems

to be an important element to mental health initiatives as it can improve community capacity to respond to mental health issues and self-care, and reduce stigma, which may promote help-

seeking behaviour.

A collaborative approach to community wellbeing – a scoping review – August 2018 27

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6 Appendices

Appendix 1:

Toolkit of mentally healthy activities from initiatives included in this review • The University of Alabama hosted workshops that assisted citizens apply for grants that

focussed on public health. Over time, institutions contributed to a body of resources to which funded the grants13.

• Men’s Sheds give men a shed or community building to enable them to do handiwork and create projects of shared interest52.

• Shift over time from short, one-off activities (Elders Bush Camps) to longer, more intensive activities and events (festivals and a series of linked activities, such as sport, art or music)19

• Some of the activities that Well London117 enabled: o ‘Active minds’ - a weekly session where people could socialise and play board

games. o ‘Dirty Fingers’ - where locals could meet and socialise while gardening. o ‘The White City Co-op - local volunteers and school students sold healthy produce

to locals. o The ‘Healthier Options’ award - restaurants could apply for this award which

labelled their menus with the healthiest options so that patrons could make an informed choice. The local food providers received training from a nutritionist as part of this.

o Creative wellbeing for all - a programme of events was developed with activities such as sewing, yoga, a film festival, a football tournament and summer activities for all age groups.

o Cranford Ceramics Project - professional artists helped participants express their feelings about wellbeing in the form of pottery.

o Physical Activities for Women - which addressed the cultural factors which prevent women from participating in physical activity

o Camden ‘Handbuilt’ Art Project - casts of hands were taken from all different demographics which were combined into a sculpture to represent the building of community

• A nightclub in a disadvantaged community in Cornwall, UK, offered to host a choreography workshop for local young people. The event was well attended and eventually a local supermarket provided fruit and vegetables for participants. In time, this group performed at a Christmas concert2. They also created skateboard ramps and bike jumps for local kids, based on feedback from a community workshop, however, ownership and maintenance issues meant that they were removed and the problem returned.

• ‘Big Noise’ gave students in some of Scotland’s deprived neighbourhoods an instrument to learn and care for48.

• The ‘Ngala Nanga Mai pARenT Group Program’ ran art sessions twice a week for new and expecting mothers. Through this mothers listened to health talks, participated in cultural events and exhibited artwork. It also acted as a pathway into further education53.

• In Manchester, UK, community focus groups were held at different venues in the community to talk about the activities that were happening and ask what activities the community wanted3.

• WHO Health Promoting Schools created secure bike racks to promote active transport to school or increase the provision of healthy foods with a catering service118.

• Community exchange in Allentown, Pennsylvania, developed a credit exchange system of voluntary support. Participants could help others and accrue time credit which they could call in when they needed help113.

• In New York, a group of mental health service consumers started a consumer-run mental health centre, where individuals can support each other with recovery and wellbeing. It has developed into a multiservice centre which helps people with employment, housing and

A collaborative approach to community wellbeing – a scoping review – August 2018 34

advocacy. Members lived and holidayed together and check-up on each other if they did not attend57.

• In South London, community and wellbeing champions were trained and employed to go to African and African Caribbean faith-based organisations to speak about mental health14.

• In a community in Missouri a group of hospital administrators, business managers, school administrators and local government officials teamed up with some university partners to create a wellbeing plan for their community4.

• In North East London a local football club teamed up with health services to facilitate football coaching and games with socially isolated adults56.

• Indigenous men’s groups in Australia run weekly health education sessions, counselling, social activities and support traditional culture by making instruments and artwork54.

• A group of community members in rural South Australia partnered with the local community mental health team to create group sessions in an old shearing shed. These sessions were flexible, safe and supportive and careful facilitation built the capacity of participants18.

• Community health champions in Yorkshire and Humber organised health walks, worked in community gardens, set up social clubs, delivered health awareness seminars and informed people about options for care15.

• Act-Belong-Commit is a health promotion campaign that aids people to find and participate in activities that are beneficial for their mental wellbeing22,88,119,120. The Act-Belong-Commit website has resources and examples for both individuals and organisations. The A-B-C self-assessment tool is a valuable starting point for assessing individual involvement in mentally healthy behaviour. This tool could also be a valuable starting point for community collaboratives as it may highlight what opportunities citizens have to engage in certain activities within the A-B-C framework.

A collaborative approach to community wellbeing – a scoping review – August 2018 35

Appendix 2:

ROAMER recommendations for mental health research.

A collaborative approach to community wellbeing – a scoping review – August 2018 36

Appendix 3:

Other representations of collaborative formation and function.

This figure for collective action for applied health research arranges formation and function in a

context-mechanism-outcome framework. It depicts that collective action initiatives work best by

following an iterative process which recognises that context and mechanism can change but are

generally dependent upon resources, governance, connectivity, motivation and facilitation. Figure

reproduced from Rycroft-Malone et al. 2015.

A collaborative approach to community wellbeing – a scoping review – August 2018 37

Braithwaite et al. (2018) drew lessons from complexity science to inform their strategies for

facilitating program implementation. This figure represents the feedback loops within and the

interconnected and iterative nature of community health initiatives. These four strategies could be

useful in forming the backbone of a localised plan for mental health and wellbeing, as they

emphasise that the infrastructure surrounding the initiative, such as administration, consultation

and resources are integral to function. Figure reproduced Braithwaite et al. 2018.

A collaborative approach to community wellbeing – a scoping review – August 2018 38

Based on an evaluation of the SAM Our Way Project Blignault et al. (2016) gave seven

recommendations to the Australian Red Cross for future program development. These

recommendations align with the goals of community wellbeing collaboratives, and are a simple

way to guide the plan of the initiative. Figure reproduced from Blignault et al. 2016.

A collaborative approach to community wellbeing – a scoping review – August 2018 39

The University of Arizona’s Southwest Center for Community Health Promotion developed eight

questions which are designed to guide communities build collaborative groups. These questions

are based on network analysis and could assist community wellbeing collaboratives in becoming

effective and sustainable through reflection. Figure reproduced from Provan et al. 2005.

Centre for Rural and Remote Mental Health T: +61 2 6363 8444 E: crrmh@newcastle.edu.au PO Box 8043 Orange East NSW 2800