Mental Health Promotion and Prevention of Mental Ill Health

To design and deliver social prescribing, two key resources offer blueprints: the NHS Standard Model (as part of the Universal Personalised Care Model) [19] and the World Health Organization toolkit on implementing social prescribing [20]. However, both lack details on the theoretical underpinning of social prescribing in terms of how it impacts behaviours and subsequent health outcomes, which is reflected in the evidence base for social prescribing interventions [9–11, 15–17, 21]. The lack of clear guidance on the selection and use of a theory to inform the development of intervention components (active ingredients) targeting specific behaviours and behavioural outcomes prevents clear conclusions about the impact of interventions to be made, and replicability is hindered [22, 23].

The lack of underpinning theory has led to issues with reliable communication of what social prescribing is and what support can be offered to people to manage their mental health [9, 24]. Previous reviews have reported a lack of stakeholder involvement, including social prescribing service providers (SPSPs) and service users, in the development of localised social prescribing, which detrimentally affects outcomes [11, 21]. The lack of stakeholder involvement has been associated with reduced engagement in services due to issues with connectedness with community resources, in turn leading to poor service user experience and outcomes [11, 21]. Therefore, this research aimed to identify the barriers and facilitators experienced by SPSPs when designing and delivering social prescribing services to support adult mental health.

Scoping Review of Social Determinants of Health…

Communicating the SDOH through conceptual models.

The model, or conceptual framework, approach moves beyond a list of SDOH to show (often visually) how various elements interconnect and are experienced at different levels (e.g., societal, community, family, individual) to produce different outcomes (e.g., opportunities, health outcomes, distribution of opportunities). Most models share the idea that health represents a web of social influences.[103] Well-known examples of SDOH models, presented in chronological order, include Evans and Stoddart’s (1990) framework, which shows how individual and social factors interact outside of the health care system,[22] Whitehead and Dahlgren’s (1991) ‘rainbow model’ which shows concentric half-circles of influential social factors,[104] and more recently, Solar and Irwin’s (2007) conceptual model produced for the WHO that shows the multiple directions through which structural and intermediary determinants impact health and health equity.[16] Lesser known examples include Fox and Meier’s (2009) right to development SDOH model [21] and the model for Métis SDOH that shows interrelationships specific to this population (e.g., self-determination, land, colonization).[66] While numerous other models exist, they have been documented elsewhere [e.g., [20, 89, 93, 103, 105–106]] and will not be reviewed here. A comprehensive and illustrative guide to various models of the SDOH, including those outside the scope of this review, is provided in MacDowell’s webpage created for medical students at the University of Ottawa in Canada.[107]

The model approach also brings potential challenges and benefits to communicating the SDOH. They are particularly beneficial in that they depict the influence of social, economic, and political factors at multiple levels. Some models even identify areas where action on the SDOH can be taken.[15, 108] Others serve to illustrate pathways, which are helpful to individuals in understanding the ‘how’ behind the SDOH. One of the challenges is that they may oversimplify (and thus misrepresent) or overcomplicate (and thus overwhelm) the SDOH. To the extent that models and lists do not resonate with members of the public, for any reason, they may not instill a sense of need or urgency to act (e.g., contact their elected representative on SDOH-related matters), to the detriment of public engagement in public policy decision-making.

Public Mental Health Implementation, Royal College of Psychiatrists (UK) (2022)

Report of the Global Conference on Primary Health Care: From Alma-Ata Towards Universal Coverand and the Sustainable Development Goals (2018