Public mental health affects us all – this new tool pulls together all the connected components in one visual framework.
Laura E. Fischer & Bobbie Galvin
Public mental health is the art and science of promoting mental health and wellbeing, and preventing mental health issues. It recognises that the psychological, physical, social, cultural, political, and economic environments all influence people’s mental health, from the start to the end of their lives.
It is known that many factors are connected to public mental health, but these were not drawn together into one comprehensive framework…until now!
A bit of context
As part of the NIHR School for Public Health Research’s Public Mental Health Programme, a research team – led by UCL and the University of Cambridge, along with associates and collaborators from the McPin Foundation – set out to create a conceptual framework of public mental health by bringing together expertise from academics, practitioners, researchers with lived experience of mental health issues, and members of the general public.
To identify which factors influence public mental health, the team reviewed and summarised relevant research, conducted an online survey, facilitated workshops and consultations, and eventually arrived at a final list of 55 determinants.
Two members of the research team, Laura and Mylene, are also designers. Naturally, they agreed to take on the task of visualising these determinants. A third designer, Bobbie, also joined the team.
Laura, Mylene, and Bobbie worked closely with the research team and with advisors who brought additional perspectives drawn from practitioner and/or lived experiences. After months of designing, illustrating, building, reviewing, user testing, and editing, the conceptual framework for public mental health is now live!
In this blog, we (Laura and Bobbie) share a little bit of the behind-the-scenes process of making the framework.
Mapping out the framework
We had a list of determinants but lists only take you so far: what we needed was a map of the ecosystem of public mental health.
First, we had to get the lay of the land. At what levels in the landscape do these 55 factors exist? What paths connect them? What’s important to know about each factor on the map? Who will use this map? How will they navigate it? Where are they trying to get to?
By answering these questions, we charted what we wanted from this map. In other words, we clarified the objectives of the conceptual framework and identified its core components.
We established that the aims of the framework are to map out the factors affecting mental health across all stages of a person’s life and provide information that is relevant to academics, practitioners, and members of the public.
Defining the characteristics of the framework
To do this, we defined the main characteristics of the framework as follows:
The framework was founded on research and constructed through design: for these to be meaningful, they had to be informed by lived experiences of mental health. We believe that we cannot capture how peoples’ mental health is affected by different factors without making these lived experiences integral to both the research process and the design process.
For the framework to be useful, it has to not only provide an overview of all the determinants of public mental health but also offer some key information on each determinant: its definition, whether it is a risk and/or a protective factor for mental health and why, significant literature and interventions on the topic, helpful resources, and lived experiences.
While there isn’t sufficient research to be able to conclusively outline how factors are related, we know that these don’t exist in isolation and their impact on mental health is linked. Therefore, we felt it was important to illustrate these factors as belonging to one interconnected system.
Visualising 55 determinants of public mental health in a meaningful way is complex and we chose to respect this complexity by not using simplistic categories. For example, we feel strongly that we cannot classify mental health in a binary of good and bad and we cannot equate mental health to an absence or presence of specific determinants: mental health is much more complex and lived experiences much more nuanced.
Public mental health is about everyone (yes, you too!). This framework was an opportunity to create a research output that is different from traditional academic papers, which are often only read by academics. The framework is relevant to researchers, public health practitioners, and anyone interested in mental health, therefore we aimed to make it accessible to all these audiences by carefully considering the content, language, and imagery, and by making it available online for free.
Visualising the framework
We had a list of determinants, a list of characteristics, and clear aims. The next step was to translate these into design and bring the framework to life. To do this, we added another four characteristics that guided our design and brought form to the framework:
Our design concept was inspired by the research process. It had begun with the question ‘What underpins public mental health?’ and, in answering this, different layers had emerged: people’s mental health is impacted by factors at structural level, community level, family level, and individual level, and each factor unveils its own cluster of risks and/or protective features and its own place in constellations of factors that are unique to each person’s experiences of mental health.
Echoing this, we created the framework in layers; starting from the wider ecosystem and ‘peeling back’ the layers until we arrive at the detail of distinct determinants. Users can choose which layers they peel back and navigate between any number of determinants based on their interests, so each journey through the framework is unique.
In the first layer (pictured above), we wanted to create an environment which could hold all the levels, give an overview of public mental health in England, and provide a starting point for users to navigate the framework.
From here, the user can select which level to explore, zooming in on a part of the environment (individual in red, family in blue, community in orange, structural in purple) and revealing the groups of determinants that belong to that level. Users can then select a group and a determinant of interest. With each layer peeled, another is revealed until the core is reached.
We were very interested in this sense of exploration and discovery. Not only is it conveyed in how the framework is built, it was also very much part of our design process: with each layer we were creating, we would find ourselves stepping into a new environment.
At every stage we would build on what we learnt in the previous space as well as opening ourselves up to new material to inform our work.
It was immediately clear to us that the existing iconography was not good enough.
Stereotypical imagery such as White men in suits to represent employment or an apple and a measuring tape to represent physical health were out of the question. These visuals do not represent the rich diversity of our population and perpetuate discrimination and inequality.
We believe it is critical that a framework about the population reflects the population. Therefore, we created all the illustrations from scratch and, while the breadth and depth of our diverse country cannot fully be captured, we put every effort into including as many different people, identities, and experiences as we could.
As noted above, we wanted to ensure that our design process was informed by lived experience. Individuals both internal and external to the public mental health programme were involved in the development of the framework, working with us or reviewing our work at different points.
We also drew directly from our own lived experiences to create some of our illustrations. This is particularly evident in the ‘Trauma & Adversity’ illustration (below) which is an honest reflection of our experiences of trauma.
We captured this complex and challenging aspect of mental health by conveying not the traumatic events themselves but the impact these have on the individual as trauma is not what happened but the meaning and consequences of what happened.
Our Conceptual Framework for Public Mental Health is now available for exploration and we invite you to make your own way through it.
More on public mental health
At McPin we have a new study on inequalities and mental health recruiting in the London Boroughs of Harrow and Lambeth.
You can also read about our work with UCL and other partners delivering Public Mental Health projects and explore the dedicated website, including 70 entries describing Covid life using poetry, art and music.