Support outside formal services accounts for a substantial part of what actually helps people, and it is systematically undervalued in health policy.
Peer support
Support from people with lived experience of the same difficulty.
Which provides something clinical relationships cannot — the credibility of having been through it.
Evidence is mixed in quality and generally favourable, with effects on hope, self-management and engagement with services.
Formal peer support worker roles have been established in mental health services in several countries.
Mutual aid
Groups where members support each other without professional facilitation.
Which exist for a very wide range of conditions and circumstances.
Evidence varies by group and by condition, and the twelve-step model has been studied most extensively with generally favourable findings in recent reviews.
Social prescribing
Clinicians referring patients to community activities rather than or alongside medical treatment.
Which has expanded substantially in several health systems.
Evaluation has been mixed, with implementation quality varying and outcome measurement inconsistent.
The underlying reasoning — that many presentations to primary care reflect social rather than medical problems — is well supported.
What the activities are
Physical activity groups, arts and creative activities, gardening, volunteering, befriending, and practical support with debt, housing and benefits.
Which addresses problems that medication and therapy do not, and several of these have their own evidence bases.
Loneliness
Associated with health outcomes at magnitudes comparable to established physical risk factors.
Which makes addressing it a health intervention rather than a social nicety.
Interventions providing opportunity for contact show modest effects, and those addressing the thinking patterns associated with loneliness have performed somewhat better in reviews.
The infrastructure
Community activity depends on venues, on volunteers and on small amounts of funding.
Which is precisely what has contracted under public spending pressure in several countries.
Library, community centre and leisure facility closures remove the infrastructure that community activity requires.
The limits
Community support does not treat conditions requiring treatment.
Which means it should sit alongside clinical care rather than substituting for it, and the risk of it being used as a substitute under funding pressure is real.
Referral into community activity from a service with no capacity to treat is a documented pattern.
Finding it
Local directories, doctors' surgeries, libraries and council websites list what exists locally.
Link workers attached to primary care in some systems exist specifically to help people navigate this.
Anyone in crisis should use crisis services rather than community provision, which is not equipped for it.
Volunteering as intervention
Providing support rather than receiving it shows associations with wellbeing in research.
Which may reflect selection and is consistent enough across studies to be interesting.
The proposed mechanisms are role, structure, social contact and a sense of contribution.
It is one of the few workplace and community interventions with reasonably consistent positive findings.
Green and blue space
Access to parks, woodland and water is associated with mental health outcomes in population studies.
Which persists after adjustment for the obvious confounders in several large analyses.
Structured programmes using outdoor settings have been trialled with reasonable results, and access is unequally distributed.
Practical support
Debt advice, housing advice and benefits advice address the causes of distress rather than its symptoms.
Which is why they belong in a discussion of mental health support rather than being treated as a separate matter.
Free services exist in most countries and are consistently underused relative to need.
Groups and quality
Peer groups vary in how they are run, and a poorly facilitated group can be unhelpful.
Which is worth knowing before concluding that peer support does not suit you.
Groups with clear ground rules, some facilitation and a defined focus generally work better than open-ended ones.
Digital communities
Online peer support reaches people who cannot attend in person and carries specific risks.
Which includes exposure to harmful content and to inaccurate information, and moderated communities perform better on both.
Checking whether a community is moderated and what its rules are is a sensible precaution.
Transport
Getting to a community activity is a barrier that is frequently overlooked in provision design.
Which affects older people, disabled people and those in rural areas particularly.
Community transport schemes exist in many areas and are poorly publicised relative to their usefulness.
Sustainability of provision
Much community activity depends on short-term grant funding.
Which produces a cycle where useful groups start, build attendance and close when funding ends.
The people who came to rely on them lose the support, and the pattern repeats with a new initiative elsewhere.
Referral quality
Signposting someone to a service that has closed or has no capacity is worse than saying nothing.
Which happens where directories are not maintained.
Checking that a service is running before recommending it is a small step that matters more than it sounds.
Starting small
Attending once with no commitment is how most people begin.
Which is how groups expect people to arrive, and asking to observe first is generally accepted.