In a recent study published in BMC Public Health, researchers adopted a realist evaluation approach to identify how co-location in community settings, such as libraries, faith institutions, and community centers, affects public mental health outcomes, the contexts in which it operates, and people for whom it works best using data from six sites across England.

Study: How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation. Image Credit: Monkey Business Images/Shutterstock.com

There are several reasons for inequitable access to community-based co-location for people at risk of poor mental health. First and foremost are the stigma associated with mental health support within medical services and distrust in healthcare professionals due to their discriminatory behavior.

They may also arise from a lack of cultural sensitivity in service providers and a lack of financial resources with service users to travel to services.

Accordingly, prior research emphasized delivering public mental health interventions in a familiar and non-stigmatizing space to enhance the impact of co-location, a term used to denote the delivery of several different services in the same physical space.

In England United Kingdom (UK), expanding co-locating services across the health, social, and community sectors reduced the negative impact of fragmented services; more importantly, it improved care coordination for individuals with complex psychosocial needs.

However, evidence is limited concerning best practices and the effect of co-location delivery models.

In the present study, researchers endeavored to fill the knowledge gaps on how community co-located services reach those most in need and reduce mental health inequalities rampant across the country.

They conducted in-depth interviews, group discussions, and two online multi-stakeholder workshops, a kind of evidence review collection, among service providers, including paid staff members and volunteers, service users, funders, commissioners, policymakers, and members of the public, and developed three preliminary theories for public mental health services within community spaces.

The participant group was diverse based on ethnicity, gender, disability, age, and use of co-located services.

Further, they collected data from sites in Northwest London, South London, Northwest England, Northeast England, Northamptonshire, and Newcastle upon Tyne between March 2021 and February 2022.

These six sites varied in geographies, target users, modes, and operational platforms and helped produce many cases to inform this study's theory.

The researchers used a comparative case study design with qualitative methods to examine different theories.

For realist analysis, they conducted data collection and analysis simultaneously, including audio recordings of interviews, workshops, and focus groups transcribed and coded into context-mechanism-outcome (CMO) configurations.

The use of Maxwell's strategies for data analysis elucidated how contextual factors trigger causal mechanisms, leading to different outcomes for different sites and unraveling the complexity and effectiveness of co-located services.

Based on the results, finally, they revisited and refined or rejected initial program theory hypotheses.

The study findings furnish comprehensive evidence of how co-locating services in the community provide holistic and customized support for individuals with multiple and complex psychosocial needs compared to statutory services.

In addition, it showed how they facilitate a less bureaucratic service delivery culture, which is also more tailored and responsive to local community needs.

Additionally, users of co-located services in the community had more autonomy in service access. However, there were certain conflicts of interest between users of different services at the same site, which, in turn, discouraged some people from using a service and strained their relationships with the staff and volunteers of those services.

Regarding how community-based co-located services reduced mental health inequalities, the results suggested they did so by removing hidden obstacles to service access. They addressed risk factors, such as debt advice, employment, and housing support, to name a few.

Further, the proximity of service sites and their users reduced the time and effort required to access them, especially among service users with complex needs. The warmth and empathy of the service providers reduced uncertainty about a service's suitability. 

Furthermore, community co-located organizations promoted more trusting relationships with communities, thus alleviating fear and stigma among those accessing the services, giving them a reputation of being confidential and nonjudgmental. 

However, the authors acknowledged that the service providers were not immune from experiencing compassion fatigue, which prompted them to distance themselves (emotionally) and protect their own mental health.

To conclude, policymakers should let community-based co-located services expand without constraining the ways they work.

Additionally, they should optimize service access by removing psychological barriers and enhancing trust. It could be especially beneficial for groups disengaged from traditional healthcare settings.