'The Impact of Adult and Community Learning Programmes on Mental Health and Wellbeing' first appeared in Mental Health Today in July 2011. To subscribe to the magazine click here.
Frontline mental health, social care or medical practitioners working with adults with low-level depression or anxiety.
- Adult and community learning programmes can have a significant positive impact on the mental health and wellbeing of people with mild to moderate mental health problems for more than 12 months
- These sorts of learning programmes can work well for increasing the wellbeing of people who do not want to access traditional mental health services
- Adult and community learning should link mental health care with education, employment services and work placements
- Such learning programmes could be delivered by via partnerships between adult education providers and primary care trusts.
Adult and community learning programmes can have significant and long-lasting effects on the mental health and wellbeing of people with mild to moderate mental health problems and should be protected from funding cuts.
Education professionals have long recognised the potential benefits of adult and community learning on improving mental health and wellbeing. It has the potential to widen social networks,improve employment prospects and boost self-esteem. It may also improve physical health and reduce the risks for developing depression.
However, mental health problems can make it difficult for some adults to attend such courses, and they may have been excluded from adult education. This type of learning can be delivered through a 'social prescription' model.
Social prescribing aims to link people with sources of support in their communities, where they can engage in positive activities and develop skills that promote self-management. Adult andcommunity learning programmes are usually delivered in a flexible and informal environment, often in informal community settings. It can take place as either a structured or unstructured activity. In some areas, GPs have been known to refer people to courses such as exercise programmes, arts classes or workshops.
These types of non-medical interventions may be useful for people who choose not to access statutory mental health services due to the perceived stigma of entering them. Such adult and community learning programmes, designed to support people with mild to moderate mental health problems, could be delivered via partnerships between adult education providers and primary care trusts (PCTs) - and the new local GP commissioning consortia that seem set to replace them.
Furthermore, the government's recently-published mental health strategy, 'No health without mental health' has recognised the role of adult and community learning in improving mental health. It emphasises the duty of the Department for Business, Innovation and Skills (BIS) in providing adult and community learning to support mental health and wellbeing. Indeed, the government has appeared supportive of adult learning programmes.
In 2010, John Hayes MP, Minister of State for Further Education, Skills and Lifelong Learning, stated that: "Adult learning is not a luxury; it is an essential component of our education system." Nevertheless, funding levels for adult and community learning services are uncertain. BIS funding in recent years has been maintained at £210 million per year, which represents a decrease when adjusted for inflation. This should also be viewed in the context of the 28% cut in Whitehall funding for local authorities over the next four years, and the £15-20 billion savings being requested of the NHS by 2014. Both of these reductions may result in cuts to adult and community learning services.
This report outlines an independent evaluation of an adult and community learning programme for people with mild to moderate symptoms of depression and anxiety, as available through a model of social prescription. The Changing Minds Centre, part of Northampton Teaching Primary Care Trust, and Northamptonshire County Council Adult Learning Service developed Learn 2b; a three-year programme of adult and community learning courses that aimed to offer non-medical treatments for mental health problems.The programme was funded by the Skills Funding Agency, an agency ofBIS.
An adult and community learning programme
Programme courses were structured around three themes:
- Wellbeing - eg. cognitive behavioural therapy, stressmanagement, confidence building
- Creative expression - eg. creative writing, painting, drawing
- Healthy living - eg. Tai Chi, complementary therapies.
Courses were taught by accredited adult learning tutors and wereeligible for statutory quality control procedures, such as Ofstedinspection.
The Mental Health Foundation evaluated the programme using amixture of quantitative and qualitative methods. Longitudinal datawas also collected on the impact of the adult and communitylearning programme on the symptoms of depression and anxiety.Qualitative data was also collected through individual interviewswith people who had participated in the courses. Thelongitudinal aspect of the study involved collecting data fromparticipants at four points: upon starting their first course, uponfinishing their first course, six and 12 months later. Lastly,telephone interviews were done with a small sample of coursetutors. A full report of the programme and evaluation method isavailable in 'Learning for Life: Adult learning, mental health andwellbeing', available from the Mental HealthFoundation.
Results and discussion
Participants' perceptions of the programme were positive. A hugemajority (94%) claimed that they would recommend it toothers.
People who attended courses enjoyed the fact that they wereengaging in a regular group activity. Courses appeared to promotesocial relationships, teach self-management strategies to managemental health, raise self-esteem and empower people to take controlof their recovery.
Participants showed better wellbeing and less severe symptoms ofdepression and anxiety after finishing their courses, and there wasevidence to suggest that these effects may be maintained for atleast 12 months after finishing it.
The social prescription model also had some success, since thelargest proportion of people who took part in the programme firstheard about it through their GP (33%). Results indicated that theprogramme was reaching the appropriate clients; almost everyoneattended a course reported needing some support with a mentalhealth issue.
The majority had some specific ideas about what they would liketo get out of their course. Specific improvements afterattending the course included feeling happier, more relaxed, moreable to deal with stress, more able to tackle problems, andincreased self-confidence. One male course attendee said: "The mainthing about this course is you feel you are not alone with certainbehaviours or thoughts, which has given me strength."
The majority of people who attended the course said that theyexperienced the benefits six months later. Some felt that adult andcommunity learning had a more lasting impact on their wellbeingthan other forms of support they had accessed in the past. Some hadlearnt new skills that they were still using to help improve theirwellbeing. Others found that what they learnt had helped themunderstand their feelings.
Many spoke about the benefits of meeting new people, whichhelped them to feel less isolated. People also liked the factthat the courses were held within non-clinical settings. They mayhave found that dealing with mental health problems in this kind ofsetting helped to reduce the stigma associated with mental healthproblems: "It's acceptable to say that you are going to college;it's taking it out of that medical field and into education. Itmakes all the difference; it changes people's attitudes aboutmental illness." (Female, course attendee)
However, some tutors expressed concern about following upstudents after the course had ended. Some felt that follow-upoptions were limited to other courses within the programme, or totheir own private classes. This emphasises the need for tutors tomanage expectations. But some attendees were still in contactwith others from their course; exchanging contact information withothers, taking part in coffee mornings, getting involved inactivities outside of the sessions.
Friendships developed during the courses potentially provided anongoing support network. "I mean I think there is one of my groupsthat is still meeting on a weekly basis on their own privately toget together because they have made friends through the group."(Course tutor)
Adult and community learning can be a useful part of a carepathway for people with mild to moderate depression and anxiety.Such programmes have the potential to provide a simple, low cost,non-stigmatising way of helping people to recover. Likewise, peoplewho have not previously sought treatment for mental health problemsmay wish to access such programmes. People who have soughttreatment elsewhere may find them useful as a supplementary sourceof support.
Nevertheless, encouraging transition from adult and communitylearning into mainstream education and employment may provechallenging. In this programme, few participants were engaged intraining and learning activities outside of the courses provided.For this reason, adult and community learning programmes shouldconnect to mainstream adult education providers.
Adult education programmes have also shown low rates of gainingemployment, and people with mental health problems may faceadditional difficulty and discrimination in the labour market. Forthis reason, such programmes should also link with local employmentagencies and with organisations that provide work placements. The proportion of referrals from GPs to the course programme wasencouraging. The success of the programme highlights the relevanceof adult and community learning to PCTs.
If GP consortia assume responsibility for mental health servicecommissioning (as proposed to occur by April 2013), organisationsrunning successful adult and community learning mental healthprogrammes may wish to bid for their contracts. This reportoutlines an evaluation which in itself has limitations. Firstly, itwas difficult to obtain complete assessments for participantsthroughout the evaluation. Secondly, it was a non-randomisedstudy without a control group; it will not provide clinicalevidence to influence organisations such as the National Institutefor Health and Clinical Excellence (NICE).
Further research could address two main areas. First, a seriesof randomised controlled trials could establish the success ofadult and community learning programmes in improving mental healthand wellbeing. Secondly, research must be done to investigateaccess routes to adult and community learning programmes,particularly regarding GPs' referral practices. This is important,since GPs will be key stakeholders for commissioning services infuture.
- Adult and community learning programmes can providenon-stigmatising environments to help people manage mild tomoderate mental health problems. Healthcare commissioners should,in co-operation with local authorities, consider the benefits ofsuch programmes
- Course programme curricula should include strategies forfollowing up adult learners after courses finish. This may includedeveloping communities of interest or setting goals for educationand employment beyond the programme itself
- Adult and community learning can be seen within the context ofwellbeing. Programmes should link mental health care, education,employment services and work placements
- Future research should focus on access routes to such courses,exploring the opinions of potential referrers. This would maximisethe potential of these programmes in the present economicclimate.
Aldridge F & Lavender P (2000) The Impact of Learning onHealth. Leicester: NIACE.
Chevalier A & Feinstein, L (2006) Sheepskin or Prozac: Thecausal effect of education on mental health. London: Centre for theEconomics of Education.
Department of Health (2011) No Health without Mental Health: Across-Government mental health outcomes strategy for people of allages. London: DH.
Further Education Funding Council (FEFC) (1996) InclusiveLearning: Report of the Committee on Students with LearningDifficulties and/or Disabilities. ('The Tomlinson report') London:HMSO.
Scottish Development Centre for Mental Health (2007) DevelopingSocial Prescribing and Community Referrals for Mental Health inScotland. Edinburgh:
Scottish Government. HM Treasury (2010) Spending Review 2010.London: Crown Copyright.
NHS Confederation (2009) Dealing with the Downturn: The NHS'sgreatest ever leadership challenge. London: NHS.
Mental Health Foundation (2011) Learning for Life: Adultlearning, mental health and wellbeing. London: Mental HealthFoundation.
Tett L, Hall S, Maclachlan K, Thorpe G, Edwards V & GarsideL (2006) Evaluation of the Scottish Adult Literacy and Numeracy(ALN) Strategy - Final Report. The Scottish Executive.