With a population of over a million people, Birmingham is the largest local authority in England. It is a highly ethnically diverse city, with over half of the population being from racialised communities and one out of four people being of South Asian heritage.
Many areas in Birmingham are amongst the most deprived in the country, with 40% of Birmingham’s population living in the most deprived decile areas in England. The impact of Covid-19 has not been equal across the population of Birmingham and it has disproportionately affected people living in the more deprived communities, and people from Pakistani, Indian and Bangladeshi, Black African and Black Caribbean communities.
For a full description of local needs and assets: Birmingham Joint Strategic Needs Assessment (JSNA)
Identifying the focus for the Better Mental Health Fund
Mental health was identified as a major theme for Covid recovery, and the projects that were initially proposed addressed previously identified need. For example, Birmingham undertook a detailed Covid-19 Impact Survey in 2021 to understand the local impact of the pandemic and lockdown measures on health and wellbeing, isolation, social cohesion and behaviours.
The key themes highlighted how communities of identity felt their relationship with their community had deteriorated during lockdown, and this was most marked for ethnic minority communities, followed by LGBT communities. Rates of self-reported anxiety and feeling lonelier were also highest for people from racialised communities. It was also evident that domestic abuse had increased.
The projects that were prioritised built on established work programmes and had the potential to have a legacy beyond the Better Mental Health Fund. The pre-existing Birmingham Mentally Healthy City Forum which brings together a wide range of providers from across the city was critical in this process. The existing relationships with providers enabled projects to be established quickly within the timescale of the Fund.
In addition, Birmingham was able to draw on existing work to address inequalities for specific communities. A key example of this is the joint work with Lewisham Borough Council on the health inequalities experienced by African and Caribbean communities.
The unifying theme across these projects is engaging with communities that are experiencing the greatest disadvantage, and which have been particularly affected by the pandemic. The overarching approach is to provide easier access to information and connection to peers, communities and organisations that can provide tailored support and address social isolation.
How was the Better Mental Health Fund used?
The additional investment from the Better Mental Health Fund was welcomed by local stakeholders and used to extend the scope of existing projects. The Fund supported a range of projects, most of which were delivered by the voluntary sector, operating across the life course and targeted at populations facing greater inequalities, both in terms of their social conditions and access to support that can properly meet their needs. There were eleven projects, which provided:
- Targeted bereavement support for communities that are less engaged, provided by Cruse, Birmingham, and peer bereavement support for the Muslim population provided by The Delicate Mind.
- Community Mental Health First Aid (MHFA), provided by organisations that support refugees, LGBT people, people with disabilities, Asian communities, Polish people and other European expatriates.
- Counselling for people identifying as LGBT and awareness training for frontline staff, provided by Birmingham LGBT.
- Workshops to tackle stigma, create dialogue and connect communities, targeted at the Muslim community, provided by The Delicate Mind.
- A course for women who have undergone trauma and ‘Feeling Safe’ for those needing respite from domestic violence, provided by Anawim, Birmingham’s Centre for Women.
- Mental health and wellbeing courses for people with mild to moderate mental health problems and increasing capacity for the helpline, both provided by Birmingham Mind.
- Wise Steps, a suicide prevention programme targeting Black African, Caribbean South Asian, Eastern European and Chinese people, provided by Common Unity.
- New Start East: a whole school approach to mental health, including staff training.
- Peer support for young people up to 25, provided by Birmingham Women’s and Children’s NHS Trust.
- Psychologically Informed Environments (PIE) Peer Support Programme for young people with complex needs, including experiences of homelessness and substance abuse, also provided by Birmingham Women’s and Children’s NHS Trust.
Suicide Prevention Training: Common Unity
Common Unity works with communities that are traditionally seen as ‘hard to reach’ to offer preventative approaches. They were commissioned to provide ’Wise Steps’, a suicide prevention training programme which targeted specific communities. In developing the project, there was consultation with various communities, for example with Polish and Eastern European people, who are over-represented in suicide data. Different communities were then allocated funding to provide suicide prevention training for front-line workers from these communities. Underspend was used to adapt the training for people with a learning disability.
You can find out more about this work here.
Culturally appropriate bereavement support: The Delicate Mind
The Delicate Mind was started in 2018 to support the Muslim population by a young man following the death by suicide of his brother. It aims to address the structural problems faced by the Muslim community, notably poverty and racism.
A small amount of funding enabled the organisation to fund staff to extend their reach and to create a culturally appropriate bereavement service. The Delicate Mind provided two services, a men’s group and a women’s group, as well as raising awareness of mental health in the Muslim community in Birmingham. The service was collecting feedback data at the time of our evaluation and felt that the services were positively received. The organisation is also involved in national work to develop approaches to mental health grounded in non-Western beliefs.
Impacts on local people
The programme estimated that it would reach 24,737 beneficiaries and finally recorded 24, 438.
There was strong engagement with people living in areas that are in the top 30% most deprived in England – which account for almost 70% of the Birmingham population and 93% of all beneficiaries. The programme benefited a high number of people living in the greatest deprivation, in areas in the top 10% of most deprived in England, which account for 42.7% of the Birmingham population and made up 78% of the beneficiaries overall. Engaging residents from the poorest areas was a challenge for several sites, but projects in Birmingham were successful.
Pakistani communities make up 15.4% of the population in Birmingham yet the proportion of beneficiaries from those communities was 52.9%, demonstrating the effectiveness of the targeted elements of the programme.
The Being Well project, delivered by Mind, showed clear improvements in wellbeing because of its interventions. 101 participants were assessed using SWEMWBS. They recorded an impressive increase of 12.7 points overall, from the average baseline score of 39.9, to the post intervention score of 52.6. This indicates a clear improvement in wellbeing and a positive impact of the project.
What have we learnt?
The Better Mental Health Fund was used to target specific populations experiencing the greatest inequalities. It is evident that a relatively modest investment can be used to build social and community capital for relatively small grassroots organisations and can help them leverage in additional funding.
The approach taken by Birmingham recognises the role played by smaller grassroots organisations in promoting better mental health and addressing inequalities in the access and uptake of preventative approaches. It offers insight into how universal approaches can be adapted to meet the needs of different groups.
Projects can be set up quickly if there are existing positive relationships with potential providers and a forum to bring these providers together to focus on promoting better mental health and addressing inequalities. It also requires a different approach to usual, lengthy contracting processes.
Open and honest conversations with providers and citizens can lead to interventions that are appropriate and relevant to all populations. For example, when considering the mental health impact of Covid on disabled people, it became apparent that needs had initially been overlooked.
Sustaining the work is challenging. Birmingham Council is actively exploring options for funding and identifying how to support providers in other ways, for example through promotion and profile raising, and enabling collaboration. Some of the initiatives, notably those aimed at building awareness and community capacity will have a legacy. For example, Cruse ran online bereavement workshops on loss and almost 70 young people attended. They also trained an additional 12 bereavement volunteers, some in the most deprived areas of Birmingham.
Local evaluation
Birmingham’s local evaluation will focus on issues relating to implementation, impact, and sustainability and legacy. It will include analysis and interpretation of quantitative and qualitative data and will report in December 2022.
