Promotion

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direct impact through health and social service changes and community located projects.
These projects could be specifically labelled as being connected to mental health,
or to other health topics such as exercise with mental health consequences or general
community development. Most operated on a small scale and evaluations were modest
although positive mental health outcomes were reported, especially from some projects
working with ethnic minority groups and women with young children (Tilford
et al. 2002).
Raeburn (2001) has reported on a number of community-based projects which
have included mental health outcomes. Superhealth (Abbott and Raeburn 1989) was
designed to meet health promotion goals identified through community needs assessment
and focused on coping style, social support and social and health skills. People
met in small groups, participated in a range of activities including discussions, practical
exercises and group support. Facilitators were community members who had already
participated in the programme. The programme was evaluated through a quasiexperimental
design study where two forms of the intervention, one informational and
the other behavioural, were compared with a control population. Both interventions
showed changes but these were greater in the behavioural form. This was a low cost
programme which could easily be disseminated widely.
Housing, architecture, space and design
Systematic reviews of mental health promotion have included few, if any studies,
reporting on studies evaluating these issues in relation to mental health. Goodchild
(1998) makes the point that housing measures have undoubted potential as a health
intervention but they must be treated as a single aspect of coordinated programmes
and policies that upgrade the quality of life of people living in poverty. A recent systematic
review suggests, on the basis of seven studies, that housing interventions may
improve mental health, perceptions of safety and social participation (Thomson et al.
2001). The authors suggest that methodological difficulties (poor housing co-existing
with other problems of deprivation) and political obstacles may be some of the reasons
for the lack of evaluation studies on health and housing. A further controlled trial
in the UK showed that housing improvements can reduce anxiety, depression and
self-reported mental problems (Thomson et al. 2003).
Homelessness
Although the needs of homeless people have been investigated in great detail, there is
very little evidence available as to what mental health promotion interventions actually
work. There is some evidence that behavioural interventions for mental health
problems and associated drug and alcohol problems may be effective. It has also been
suggested that peer involvement would increase the effectiveness of interventions, but
there is little actual evidence available to show this (WHO Regional Office for Europe’s
Health Evidence Network (HEN) 2005). An American review outlines the characteristics
of successful outreach programmes with homeless people as applying a non-threatening
approach; providing flexible services; having regular contact; responding quickly to
personal needs; taking sufficient time to develop motivation among the homeless
(Dickey 2000). A comparison of the uptake of outreach services in London and
New York found that the variables specified by the theory of planned behaviour