How are social and economic needs assessed and addressed in mental health services? A service evaluation of the largest mental health trust in the UK

There is an urgent need for services to address the social and economic adversities which contribute to the aetiology and outcomes of mental health problems. However, the implementation of interventions to do so is inconsistent, and entrenched cycles of poor mental health and social exclusion persist. We conducted a service evaluation survey of 28 staff working across community and inpatient teams, enhanced by a series of in-depth case studies, in the largest NHS mental health trust in the UK to explore how social and economic needs are currently assessed and addressed. We found that assessment for social and economic needs varied across different domains; for example, family relationships were more consistently assessed than domains such as education and income. A range of support is available and provided by a patchwork of teams, including Community Mental Health Teams, other NHS teams, Local Authority staff, and many third sector organisations. However, what support is available is severely restricted and respondents highlighted a lack of adequate support in every domain we considered – employment, education and training, social participation and connectedness, family relationships, community support, social security, debt, income, housing, and trauma and victimisation, as well as additional domains including healthy eating, sex and relationships, and activities of daily living. Nevertheless, our case studies illustrate examples of approaches to addressing social and economic needs to improve outcomes for people with mental health problems.