Public health in community settings: An introduction
Public health in community settings: An introduction

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Public health in community settings: An introduction

2.2 Working together: prioritising needs, and agreeing and progressing solutions

Once the community worker has brought the group together, their first task will be to define its purpose, clarify and prioritise its goals, set realistic targets for action, and agree the mechanisms for monitoring and reviewing the outcomes. In the light of this, they will also need to review the group’s membership in terms of the skills mix and training needs, particularly if they see the group as working towards a long-term future. This stage will form the basis for developing a framework for action which will include a timescale and timetable for meeting the agreed objectives, and a common agreement and shared understanding of the members’ roles and responsibilities within this. It will also start the process of establishing effective team building and developing partnership ways of working, as well as providing opportunities for flagging up potential areas of conflict when particular dilemmas and contradictions may emerge for group members.

Central to this process will be the issue of the group achieving its objectives while building and developing the organisational structure to enable this. A prime example would be the emphasis on delivering concrete measurable outcomes as a measure of achievement.

Although important, quantifiable measures of concrete outcomes do not acknowledge the importance of the building of organisational structures and the empowerment of individuals and communities which this entails. It can, therefore, be difficult to translate the rhetoric (about community development and community action) into the concrete reality of achieving action and change. Thus, the community’s action plan should include the development of an organisational structure to meet its particular needs and what it sees as its terms of reference. This may be done informally, agreeing the processes of recruitment/membership, decision making, communication and accountability, or more formal arrangements may be made which, as a first step, include a written constitution with agreed policies and procedures. However, the community group may also wish to seek limited company status and/or charitable status. Although this provides the group with a legal framework and also other opportunities for fundraising and income generation, it also brings additional levels of responsibility and accountability.

The process can be quite lengthy and time-consuming, demanding high levels of commitment, particularly if the group also needs to raise funds in order to support its activities. Indeed, at this point, the original purpose of the group can become subsumed under these demands, and members may become disenchanted and disillusioned as they struggle with their other various competing commitments outside the group. The community worker’s skills in supporting these processes will be crucial, in terms of maintaining the impetus of the group and the commitment of its members. There is a need for perseverance, a good deal of realism and a sense of humour. The community worker will also need the ability to collect and provide information, give administrative and organisational support, and enable the group to network and liaise with other organisations so that the relevant expertise, advice and support can either be brought into or made available to the group. They may also need to resolve areas of conflict, which may be internal or external to the group.

Activity 3 Community development in action: interventions to improve mental health

Timing: 1 hour

Listen to the audio below in which Pat Gilmartin, an occupational therapist with BASA, talks about community development. Take notes as you go and then answer the following questions:

  • Pick out three practical examples of the use of a community development approach
  • How does this fit with the Standing Conference on Community Development Statement (SCCD) in Box 1?
  • Would you expect these principles to be any different when promoting mental health?
Download this audio clip.Audio player: Fitting into the community
Skip transcript: Fitting into the community

Transcript: Fitting into the community

Pat Gilmartin: Occupational therapist, Clackmannanshire General Hospital
To me, one of the values of community development work is really meeting the needs from the bottom upwards and what I mean by that is this idea where the project is being driven by the need of service users and members who have experience of mental ill health.
There’s lots of different partnerships within the project between the allied health professions and the members of the project, but what the allied health professions recognise is that for the project to be sustainable and for the project to work then the members have to be in the driving seat and for them to learn and to develop their roles, so to me that’s what’s really quite unique about it.
We use a lot of the local community halls for a lot of our group work, so it’s not based within a hospital so it is very much seen as a community-based kind of project.
One of the other elements is that we’re very much engaged with other organisations within the community, so one of the ideas that’s come forward there is that BASA as a project would be able to develop a range of health walks for tourists coming to the area, so to me that again demonstrates that ability where the project fits very nicely into the community.
End transcript: Fitting into the community
Fitting into the community
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Download this audio clip.Audio player: Harnessing the strengths of volunteers
Skip transcript: Harnessing the strengths of volunteers

Transcript: Harnessing the strengths of volunteers

Pat Gilmartin: Occupational therapist, Clackmannanshire General Hospital
To me volunteering is a tremendous activity. It’s very reciprocal in the way that people can put something back into the community and to society. One of the elements for BASA is that we’ve identified that people can come through the project, so people can become volunteers within the project through choice, whether they want to provide that time.
What we’ve also recognised is that there’s also other people in the community who maybe want to spend a little bit of time in the project as well. These people have not been part of the services so they are very much seen as volunteers coming from the mainstream.
Recently we have managed to get a local lady who’s provided a volunteering role for us, and her name is Janice and she’s been a tremendous asset. It demonstrates that the community can come to us. It’s not like we have to come to the community all the time.
And one thing about the project is about dealing with the myths about mental illness and the stigma and all that and I think we can’t be seen as an isolated project. We need to be very much part of the community in order to do that, and I think volunteering provides that inlet for that to happen.
End transcript: Harnessing the strengths of volunteers
Harnessing the strengths of volunteers
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Box 1 A statement on community development

Community development is about building active and sustainable communities based on social justice and mutual respect.

It is about changing power structures to remove the barriers that prevent people from participating in the issues that affect their lives.

Community workers support individuals, groups and organisations in this process on the basis of the following values and commitments.

Values

Social justice – enabling people to claim their human rights, meet their needs and have greater control over the decision-making processes which affect their lives.

Participation – facilitating democratic involvement by people in the issues which affect their lives, based on full citizenship, autonomy, and shared power, skills, knowledge and experience.

Equality – challenging the attitudes of individuals, and the practices of institutions and society, which discriminate against and marginalise people.

Learning – recognising the skills, knowledge and expertise that people contribute and develop by taking action to tackle social, economic, political and environmental problems.

Co-operation – working together to identify and implement action, based on mutual respect of diverse cultures and contributions.

Commitments

Challenging discrimination and oppressive practices within organisations, institutions and communities.

Developing practice and policy that protects the environment.

Encouraging networking and connections between communities and organisations.

Ensuring access and choice for all groups and individuals within society.

Influencing policy and programmes from the perspective of communities.

Prioritising the issues of concern to people experiencing poverty and social exclusion.

Promoting social change that is long-term and sustainable.

Reversing inequality and the imbalance of power relationships in society.

Supporting community-led collective action.

(SCCD, 2001, p. 5)

Answer

Building capacity for mental health which embraces a community development approach should be no different from any other form of capacity building. While the style may differ, the principles should always remain the same. These principles are about engagement, participation and empowerment.

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