A prevention revolution

On May 10, speaking at the launch of Mental Health Awareness Week, Jenny Edwards, the Chief Executive of the Mental Health Foundation, called for a national prevention strategy. “We need,”she stated, “to tackle the causes that increase the risk of mental ill health and to equip people with practical tools that help prevent stress, anxiety and depression, and build resilience. We need a prevention revolution.”

Is this a role that housing, and in particular, housing associations, could play?

Social housing already plays a role in secondary prevention, providing care and support for millions of people across England who have been diagnosed with mental ill health. Over the last five years, specialists within the sector have highlighted other potential roles housing could play in working with the health sector, from making better use of its existing estate in a more commercial and creative way to promoting early intervention services, to promote recovery for young people with diagnosed mental ill health.

What, though, about primary prevention? How can social housing play a role in creating supportive environments, and empowering people and communities, so that they don’t suffer from mental ill health?

It’s estimated that over 4 million social housing tenants are affected by mental ill health each year. And it’s known that poor housing can cause mental ill health, just as poor mental health can make it difficult for people to maintain their homes.

What, though, about other potential triggers?

How will, for example, the impact of further benefit cuts result in more anxiety caused by people having to choose between paying rent or buying food?

How will the growth in public scare mongering about outsiders, and those who are different, result in more hate crime incidents against LGBT* and BAME social housing tenants?

Can social housing organisations play a role in these cases, in preventing mental ill health?

Some housing providers are working with tenants around community resilience and wellbeing. Most providers have tenancy sustainment teams to help those with financial issues so they can stay in their homes. But by that stage it is probably too late. Housing associations should really be looking further upstream. They could, for example, be sharing the invaluable experience of those working in their tenancy sustainment teams with their repairs contractors.

Tower Hamlet Homes have taken one step towards this in their development of an internal mental health first aid network. Its aim is to raise staff awareness of mental health issues among residents, and how they can signpost them to services. But couldn’t providers go beyond this?

Take one example: repairs. More often than not, for many tenants, the repairs experience – from reporting the problem, to waiting for the repair to be completed – will result in stress, anxiety and feelings of helplessness. Some providers are reviewing their repairs processes using lean principles, asking the question, how should we design this service for the benefit of the customer, so that it’s less stressful and more satisfying for them. Should they all be taking this approach, rather than relying on processes, and business systems, that are inappropriate, inefficient and ineffective?

The next five years are going to be tough for many social housing tenants. Thousands will be financially poorer because of benefit cuts. Many may face a climate of fear, over their employment, their housing or because of their ethnicity, gender or sexuality. Others will suffer because of cuts to support services. Anxiety and depression are likely to increase.

Housing associations cannot, and should not try, to fix everything. They do, though, need to focus on what they actually do now, but do it far better. Only then will they have a lasting, positive impact on the mental wellbeing of their customers.


Primary prevention is defined as being actions or initiatives taken to reduce the incidence of mental ill health within any given population, either through universal measures that reduce lifestyle risks and their causes, or by targeting high-risk groups.

Secondary prevention is defined as being actions that seek to lower the rate of established cases of mental ill health within any given population, through early detection and treatment of diagnosed conditions.