window to return
Issue 7, April
Urban regeneration and mental health
Peter Huxley and Anne Rogers
The link between social disadvantage and mental health is well established.
A number of small studies suggest that mental health problems can be reduced
by interventions targeted at those who have experienced job loss, unemployment
and teenage pregnancy in the context of poverty. There is also some indication
that the mental health of the population can be enhanced by improvements
to housing and the local area. However, there has been little systematic
research into the impact of large-scale changes in people's socio-economic
circumstances on their mental health.
Contemporary urban regeneration initiatives provide both an opportunity
and a need for such research. Our study focuses on the regeneration programme
in Wythenshawe, a disadvantaged area in Manchester, and is investigating
the impact of changes in socio-economic circumstances on mental health
by comparing the local population with a control area (also in Manchester)
where no such initiative exists.
We have conducted a baseline postal survey of 2600 people (1300 in the
index and control areas) in which we have collected information about
mental health status, quality of life, personal circumstances and consulting
behaviour. A second survey, to be conducted almost two years after the
first, will enable us to assess the nature and extent of change in these
items. A sub-group of 200 people has been selected for interview to enable
us to explore in greater detail mental health status, quality of life,
and perceptions of the community. A second interview with this sample
will take place one year later. In addition, further data will be obtained
from 20 in-depth qualitative interviews with a sub-group of these respondents,
chosen because of their particular experiences of the Single Regeneration
Budget (SRB) changes.
Here, we report on findings from the baseline surveys. The measures of
mental health we used included the General Health Questionnaire (GHQ-12),
together with measures of vulnerability and life events, quality of life
(QoL) and community experience derived from work by Sorensen and Leighton.(1,2)
As anticipated, the index and control areas both scored highly on disadvantage,
both as measured by standard deprivation indicators and by a range of
personal factors which increase vulnerability to mental illness (like
living apart from parents before 16 and not working for two years). However,
there was a higher proportion of residents in poorer socio-economic circumstances
in the index group, with low QoL and with a longstanding illness.
Residents were asked to say how they felt about living in the area, expressed
as the strength of their desire to stay or to move away. In the interviewed
sample, the question was expressed as the degree of satisfaction with
the area and this method produced identical results. This makes it possible
to compare our results with those of national surveys where dissatisfaction
with the area is assessed.
High levels of dissatisfaction were reported in both areas. Dissatisfaction
with area was double the national average (22% compared to 11%) and was
highest in the index area (29%). (These high levels of dissatisfaction
are similar to those reported in an East London study(3)). Only a minority
of residents in the index area was happy to stay: 11% very strongly wanted
to move, and 18% preferred to move, 31% had mixed feelings about the area
and 40% were happy to stay.
Mental health, quality of life and community experiences
Higher SES was associated with better QoL and better mental health, with
higher scores reported by employer/managers and homeowners. People with
better QoL and better health also reported fewer longstanding illnesses
and fewer risk and vulnerability factors.
Our measure of community experience, the Community Experience Scale (CES),
consists of 11 items tapping such dimensions of community life as local
employment prospects, co-operation, safety and community identity, leisure
facilities and local leadership (Table 1). Factor analysis suggested that
residents saw both negative and positive aspects to living in Wythenshawe.
Negative aspects included low levels of co-operation ('no-one wants to
join in projects that start here'), poor job prospects, a perception of
area decline and fears about safety. The quality of leadership, solidarity,
neighbourliness and a sense of belonging/community emerge as the positive
features of living in Wythenshawe.
Our analysis also highlighted the way in which the items of community
experience that related to children focused on the safety and crime factors.
The association between children and safety also emerged in the interview
survey, which showed that the major concern of people on the estate was
the need for safe play areas for children. It will be interesting to see
whether the CES is sufficiently sensitive to identify shifts in community
perceptions following the regeneration programme.
Finally, we examined the relationship between mental health, quality of
life and the CES factors. Higher overall quality of life ratings were
associated with a greater sense of belonging, less isolation, better leadership,
more leisure opportunities, more neighbourliness/security and the absence
of the perception that the area is in decline. Higher symptom scores for
mental health problems were associated with less neighbourliness/security,
fewer leisure opportunities and the feeling that the area is in decline.
These associations are only cross-sectional at this stage, and are therefore
of less value than our longitudinal data currently being collected. Nevertheless,
the association between the total symptom score and all the factor scores
remains when depression is controlled.
Table 1: Experience of the community in Wythenshawe: factor analysis results
(-) negative aspects
(+) positive aspects
The government's strategy for tackling urban poverty and health inequalities
emphasises area-based initiatives, both through the Single Regeneration
Budget and through such initiatives as Health Action Zones (see article
by Fiona Johnstone, Health Variations Programme Newsletter, Issue 7, pp.10-11),
Sure Start and the New Deal for Communities. These programmes provide
researchers with 'natural experiments' through which to map the effect
of area interventions on the well being of local communities.
While our baseline surveys are only the first stage of our project, they
give an insight into community experience and mental health needs. The
follow-up surveys will enable us to establish the leverage of the urban
regeneration initiative on the community-level factors which influence
mental health and quality of life in disadvantaged areas.
Peter Huxley is Professor of Psychiatric Social Work at the Institute
of Psychiatry and Anne Rogers is Professor of the Sociology of Health
Care in the School of Primary Care, University of Manchester.
1. Sorensen, T., Kleiner, R., Boe, N., Moum, T. and Sandanger, I. (2000)
'Sociocultural integration and disintegration: the local-community approach
to mental health' North-East Series in Community Psychiatry, Oslo
: Nordkyst Psykiatri.
2. Leighton, A. H. (1963) The Character of Danger, New York : Basic
3. Mumford, K. (2001) Talking to Families in East London, London
: Centre for the Analysis of Social Exclusion.