Social Psychiatry and Psychiatric Epidemiology

, Volume 43, Issue 5, pp 364–372

More than jobs and houses: mental health, quality of life and the perceptions of locality in an area undergoing urban regeneration

Authors

    • National Primary Care Research and Development CentreUniversity of Manchester
  • Peter Huxley
    • School of Human Sciences, Dept. of Applied Social SciencesUniversity of Swansea
  • Sherrill Evans
    • School of Human Sciences, Dept. of Applied Social SciencesUniversity of Swansea
  • Claire Gately
    • National Primary Care Research and Development CentreUniversity of Manchester
ORIGINAL PAPER

DOI: 10.1007/s00127-008-0316-2

Cite this article as:
Rogers, A., Huxley, P., Evans, S. et al. Soc Psychiat Epidemiol (2008) 43: 364. doi:10.1007/s00127-008-0316-2

Abstract

Background

Urban regeneration initiatives are considered to be one means of making a contribution to improving people’s quality of life and mental health. This paper considers the relationship between lay perceptions of locality adversity, mental health and social capital in an area undergoing urban regeneration.

Methods

Using qualitative methods as part of a larger multi-method study, perceptions of material, and non-material aspects of the locality and the way in which people vulnerable to mental health problems coped with living in adversity were identified as being more highly valued than intended or actual changes to structural elements such as the provision of housing or employment.

Results

Themes derived from narrative accounts included concerns about the absence of social control in the locality, the reputation of the area, a lack of faith in local agencies to make changes considered important to local residents, a reliance on personal coping strategies to manage adversity and perceived threats to mental health which reinforced a sense of social isolation. We suggest these elements are implicated in restricting opportunities and enhancing feelings of ‘entrapment’ contributing to low levels of local collective efficacy. The gap between social capital capacity at an individual level and links with collective community resources may in part have accounted for the absence of improvements in mental health during the early life of the urban regeneration initiative.

Implications/conclusions

In order to enhance quality of life or mental health, agencies involved in urban initiatives need as a basic minimum to promote security, increase leisure opportunities, and improve the image of the locality.

Key words

urban regenerationmental healthquality of lifeUKsocial housing

1 Introduction

A range of evidence points to the potential of urban regeneration initiatives to make a contribution to improving quality of life and mental health. Within social and psychiatric epidemiology both structural1 and psychosocial aspects2 of neighbourhood living have previously been considered risks to mental health [14, 18] and data linking geographical location and properties of neighbourhood have suggested a link between social conditions and mental health status (e.g. [5, 17, 31]). Recent research suggests that people living in ‘socially disorganised’ urban areas are more likely than others living elsewhere to experience psychological distress because of exposure to the impact of uncontrollable life events, psycho-social insults and the negative impact of unemployment, family disruption, violence and crime and lack of supportive relationships [26]. Stansfeld et al. [27] have previously suggested a hierarchical framework in which the influence of environmental deprivation is integrated with more immediate contribution of adverse personal experiences. In order to understand the relationship between those aspects and mental health attempts have been made to extend a focus beyond the compositional and contextual effects of localities in order to view neighbourhood living as a set of ‘relational resources’ providing a sense of identity and aspirations linked to ontological security, mastery, self-esteem and overall life satisfaction [15, 19]. Neighbourhood resources may increase individual vulnerability to stress by reducing the effectiveness of individual resources such as a personal sense of control [4] and in terms of individual responses to adversity, there is some evidence to suggest that beliefs about personal control mediate the relationship between environmental stressor and depressive symptoms [2].

Aspects of social capital in urban environments are also thought to mediate individual and community level resources in a way, which is likely to impact on mental health [10]. The combined resources of individuals (e.g. trust, norms, social networks) [21, 22] and their integration into collective activity (e.g. sporting, religious, educational, cultural and artistic events and routines) have been linked with changes in rates of emotionally related behaviour across different neighbourhoods [25]. Psychological well-being has been associated with social support networks which enhance individuals self-esteem and self-efficacy in areas with low social capital where these features of local life are sparse or absent [13]. However, there is a need to describe more precisely the linkages between social membership, social connectedness and psychological well-being [29]. The purpose here is to begin to explore the way in which individual resources, and responses to mental health vulnerability and broader collective or structural aspects of the environment might be related. In particular our intention is to focus on people’s subjective perceptions of structural change and possible connections between the social environment and ways of dealing with adversity in an area undergoing change and the way in which this may be connected to the presence of social capital resources relevant to mental health.

2 Methods

2.1 A multi-method research design

A major urban regeneration programme in a disadvantaged area in South Manchester (the index area) provided an opportunity to investigate the impact of changes in socio-economic and locality circumstances on the mental health of different groups and individuals and to compare this to a control area where no such initiative existed. The aims of the overall study were to further the understanding of: the role played by urban regeneration in altering the degree and distribution of socio-economic variations in mental health; the impact of socio-economic and locality changes on peoples’ mental health vulnerability and subjective well-being. A multi-level multi method longitudinal study approach was used with a 22-month follow-up in a Single Regeneration Budget area, and matched control area in South Manchester. A total of 1,344 subjects responded to a postal questionnaire survey. The main outcome measures were GHQ12 (mental health) status, MANSA (life satisfaction), and GP use. Mental health outcome in the index and control areas showed no improvement over time and restricted opportunities, a variable closely related to mental health, were not removed by the urban regeneration initiative. The results of this study were published in an earlier paper in this journal [12].

2.2 The linked qualitative study

The large longitudinal survey in which we collected information about mental health status, quality of life, personal circumstances and consulting behaviour was followed by a more focused interview survey of 200 people carried out at two time points which explored in greater detail, mental health and quality of life perceptions and experience of living in, and changes to, the community3. From this sample of 200 people a further smaller purposive sample (n = 20) were chosen for in-depth qualitative interviews on the bases of significant changes to CIS scores between the first and second stage interviews (between T1 and T2). The qualitative interviews were designed to obtain further details about the subjective views of the locality, effects of the urban regeneration programme, psychosocial well-being and perceptions of mental health were ascertained from a sub-group of the main sample.

As Huberman and Miles [11, p 434] point out qualitative studies can identify causal relationships through exploring ‘the local processes underlying a temporal series of events and states’. In this regard the qualitative study sought to link subjective understanding of the influences of neighbourhood character on individuals as a means of understanding the full personal and social picture relevant to mental health. Narrative accounts of people’s subjective evaluations in which lay respondents make regular allusions to biographical, social and cultural factors in explaining health status and behaviour are the capacity to provide complementary insights to those produced from more traditional epidemiological and psychological perspectives and measures [23]. Our evaluation examined how individuals and communities ‘feel’ and participate in areas undergoing community regeneration and explored how structural community elements of change as part of the regeneration are perceived and experienced. This was to enable us to focus on events and aspects of the environment relevant to perceived changes in psychological well-being. The qualitative study was aimed at exploring the influences that might be implicated in change in mental health status from the individual perspective. In particular we explored people’s subjective meaning and experience of mental health in relationship to a sense of place, social and community networks and changes occurring within the locality. The qualitative interviews explored the following areas:
  • Personal history of living in the locality and perceptions of major problems and their causes in the locality

  • Awareness of and attitude toward involvement in the regeneration initiative and other policy changes

  • Lay epidemiology, knowledge and conceptions of the main causes of mental health problems and determinants of mental health (an examination of the peoples’ perceptions of the relationship between employment and mental health and other local environmental determinants of mental health)

  • Assessment of personal vulnerability to mental health problems and stressors

  • Perceived ways of maintaining mental health and available lay and professional strategies for averting mental health problems arising

  • Perceived sources of social support

  • Contact with primary, secondary and voluntary organisations.

The interviews were taped, fully transcribed and analysed thematically.

3 Results

The interpretation of the dynamic between the subjective perceptions of locality change (e.g. in terms of employment and involvement of external agencies) and the possible links to personal resilience at an individual level are summarised in Fig. 1. This interpretation of the relationships are derived from thematic analysis of respondents statements about aspects of perceived locality change on the one hand and accounts of their psychological well-being and coping strategies on the other.
https://static-content.springer.com/image/art%3A10.1007%2Fs00127-008-0316-2/MediaObjects/127_2008_316_Fig1_HTML.gif
Fig. 1

Interpretation of the dynamic between perceptions of locality change and personal vulnerability

The accounts of people interviewed suggested that a range of factors commensurate with well-proven aetiological and triggering factors accounted for both deterioration and improvement in mental status in respondents between Time 1 and Time 2 (T1 and T2, see Table 1). These related to major life and familial events including those related to health, employment and divorce. In dealing with mental health distress, people mainly referred to a reliance on personal resources, support from significant others or help-seeking from primary care. The latter was clearly identified as a formal agency attributed with providing counselling, advice and treatment in relation to emotional problems. Our focus in the quantitative study was on the factors, which may be linked to the formation of mental distress in a locality. Correspondingly in the qualitative analysis attitudes and perceptions of the structural influences previously associated with risks to mental health and the variable of restricted opportunities were the most important to illuminate. In the multi-variate analysis ‘restricted opportunities’ had the strongest association with mental health. (This variable referred to residents’ frustrated attempts to make desired improvements in all life domains.) This finding corresponds with other studies showing that blocked or absent personal goals are associated with poor mental health outcomes.
Table 1

Respondents who were identified for in-depth interview (n = 20)

Sex

Age (years)

+/− Mental health score

Self-defined reasons for change in mental health status

Female

56

+5

Frustration with ‘problem’ neighbours

Female

44

+8

Increased anti-social behaviour by local youths—feels a constant target

Male

61

−14

Sought help from GP and was prescribed anti-depressants

Male

45

−2

Unemployment

Female

41

−11

Learnt to live with the situation she was in and became more involved in the area

Female

36

−11

Sought help from GP

Male

22

+2

Believes that area impacts on mental health but tries to remain positive

Female

25

−1

MH remained the same

Male

52

−15

Improvement with family problems

Male

49

+20

Deterioration in chronic illness

Female

48

+11

Family problems

Male

26

−16

Gained regular employment/improvement in financial situation

Female

51

+9

Loneliness

Female

50

+22

Less motivation to go out and do things—unhopeful for the future

Male

60

−5

Improvements in physical health

Female

54

+3

Life remains unchanged

Female

27

−12

Returning to college

Female

28

+1

Improvements at work

Female

38

−7

The possibility of achieving goals set/seeing a future

Male

42

−14

Coming to terms with physical illness

The experience of living in the locality and using local resources could enhance or ameliorate feelings of psychological distress. It was clear from people’s accounts that the most important direct locality factor was anti-social behaviour such as harassment /vandalism and the type of employment available (i.e. low-paid temporary employment) and newly created employment opportunities being made available to local people. In this respect locality factors were implicated as mediating influences by increasing a sense of increasing personal vulnerability or resilience to an existing mental health state.

Like I said I feel like it is becoming a war zone. These kids and what they are doing and these druggies are all nasty people, they are ruining what could be a nice area. They should be dealt with, you know… It would be quite happy and everyone could get on with their little lives and there would be probably less stress and anger and rage and all this sort of thing… I need these yobbos to leave me alone and I will be alright.

ID 2224 44-year-old single female, in full employment

In addition to these direct references to the connection between external influences and mental health state the qualitative data provided a more elaborate picture of the way in which people conceptualised each of the key structural changes and their relative importance to peoples’ everyday lives.

4 Perceptions of locality change

4.1 Changes to the infrastructure of the locality

The quantitative data analysis showed an association between higher mental health symptom scores and ‘less neighbourliness/security’, fewer leisure opportunities and a reported sense that their area is in decline [12]. The importance ascribed to this was expanded upon in the narrative accounts with suggestions that changes made under the rubric of the regeneration initiative in the locality were viewed as being superficial or having a relatively neutral, ambivalent or marginal impact on present and future aspirations of people living in the locality. This was clearly seen in relation to responses to housing improvements, which constituted a key feature of the local regeneration initiative. Whilst the quantitative survey of people in the index area found a majority reporting changes to their homes, accounts given suggested mixed feelings about the experienced and perceived benefits of ‘housing improvements’:

I don’t think they {those responsible for housing improvement} have done anything like extraordinary. The work they had done … is basically what they had the grants for, like your windows and your kitchen is supposed to be getting done and them in…

ID 8410 43-year-old divorced male, unable to work due to a disability

On the outskirts of the Willow Park Estate, its done up to all look nice and that but as soon as (you) go straight into the heart of the estate itself, its just like a dump, it’s like a bombs hit it… I mean it’s just like appearances, if someone was driving through going to the airport, they might think oh right it’s a bit done up round here but if they turn left into the estate they’d be like blimey…

ID 6124 24-year-old single male, in full employment

There’s so much private housing being done round here now. Now we’re supposed to aspire to that. But we don’t it just winds us up because if they can afford to do that why can’t they afford to do it with everybody. Why aren’t we all given the right to live in places like that…?

ID 9837 55-year-old widowed female, unable to work due to a disability

A similar set of ambivalent comments were made about the provision of employment and leisure opportunities.

We’ve got the airport, which is lucky but I mean the jobs at airport are only seasonal, they’re only temporary, they’re only for six months. And then if you get kept on, another thing it only seems to be people out of the area that get kept on.

ID 13513 28-year-old single male, in full employment

Like the theatre at the Forum, that was a fabulous theatre but half the population of Wythenshawe didn’t even know it was there and the other half … it’s people from out of the area who drive in, watch that and then drive out for something to eat.

ID 9837 55-year-old widowed female, unable to work due to a disability

You go over to the Forum and the library and that but that’s about all that you’ve got … it’s not the gym it’s leisure facilities you need like a picture house.

ID 12995 29-year-old divorced female, unable to work due to a disability

They’ve got the Forum for swimming and recreation but they could with, all the clubs are down Manchester, you know … they should have a club up here. And some of the local pubs you can’t really go in to.

ID 12622 61-year-old married male, unable to work due to a disability

One structural element of change that was viewed in a more favourable light was the proposed alteration to transport arrangements. These were seemingly linked to the perception that this would ‘connect’ up the area with other desirable resources, which were viewed as making a positive contribution to peoples’ quality of life (shopping, nightlife, the countryside) that lay beyond the immediate area.

They are supposed to be putting the Metrolink down here as well so it’s going to be like the transport infrastructure for the Wythenshawe in two or three years time will be really good.

ID 6174 24-year-old single male, in full employment

4.2 Perceived impact of locality reputation on opportunities

The impact of non-material or structural aspects of the environment were stressed more than changes proposed to the infrastructure of the area. This was particularly the case when respondents discussed the meaning and impact of the reputation of the area [16]. The respondents who lived in the Wythenshawe area considered that the relative standing of their area had improved in recent years.

… the place is lovely and green. In other places all you can see is houses. Everything is lovely and green. There’s plenty of green belts, you’ve got Wythenshawe Park, you’ve got a few parks … there’s trees everywhere. You go to other areas like Rusholme and you never see a tree… It’s just that I think that is more freedom up here, you can take the dogs out in the park. Everything seems brighter. I think it is going to take off here in the next couple of years with the Metro and the third runway.

ID 12622 61-year-old married male, unable to work due to a disability

However, the marginal improvement to the area’s status which was apparent to local residents did not extend to the way in which outsiders were seen to make and act upon negative judgements about the locality as intimated by these respondents:

You’re from Wythenshawe; you’re looked down on. And if you the other side … if you say you lived in Stockport or Heald Green or Gatley then you get different respect definitely.

ID 8952 31-year-old married female, in full employment

And then when you mention Wythenshawe they go Wythenshawe you can’t walk through at night, you can’t do this, you can’t do that, you know leave your car unlocked.

ID 13986 40-year-old divorced female, unemployed

A flawed sense of self was at times tied up with the ascribed reputation of the area which was viewed as having implications at an individual level for personal and social opportunities:

I think, just by being in Wythenshawe you’re not 100%. You’re living in an area of need so you must need. They don’t realise the skills that are in this area.

ID 9837 55-year-old widowed female, unable to work due to a disability

When I went for a job they said where do you live and I said Benchhill: you could forget the job. Oh yes. You could forget the job, you had no chance of getting it, as soon as you mentioned Benchhill that was because like I said it had a very bad name and it’s still got it now.

ID 13388 56-year-old divorced male, unemployed

I sent off an application from and where it had on your address and your postcode, it had M22, they’d be like that bin … Just because of the area you live in you get tarred with the same brush of the other people that live there.

ID 6174 24-year-old single male, in full employment

These last two comments illustrate the prominence of themes relating to social control more generally in the locality—‘Nuisance families’, gangs, bored youths, drugs, vandalism of and taking over public areas, car noise and offences and threatening behaviour. Most people regarded these things to have got worse over the period of the study.

Its anti-social behaviour more than anything I think it’s increased. I really do think it’s increased … there’s a hell of a lot of anti-social behaviour with kids. I mean I had a twelve-year-old expose himself to me and nobody could understand that I was upset about it…

ID 1329 59-year-old divorced female, unable to work due to a disability

That’s another thing there’s so many heroin addicts in Wythenshawe it’s just like methadone. They are getting more methadone dosage than they were on heroin. You can see it outside the chemist sometimes as well, the dealers selling the methadone to the kids who were swapping it with the addicts, a bottle of methadone for heroin. And the kids having it on the streets.

ID 6174 24-year-old single male, in full employment

4.3 Perceived attitudes of agencies charged with bringing about change

The perception of ineffectual agencies compounded the perceived problems that cosmetic rather than substantive changes had or were likely to occur. Accounts about housing were replete with caveats about the gap between expectations and what local agencies could actually deliver in terms of housing and employment opportunities. Additionally agencies were viewed as perpetuating the problem by failing to deal with matters effectively and for policies that brought problems to the area (e.g. attributions about providing housing for ‘nuisance’ families who disrupted everyday life and posed a threat to personal safety).

I think the police are no good, I’ll be honest the police don’t seem too good at all … you phone them up it takes them two or three hours to come…

ID 9980 51-year-old married female, not in paid work due to caring for the home

You know unless they do something permanent, just laying trees there is not going to work. And that’s what I would like, if I could see something, which was definite improvement like stopping them there [joy riders], it’s there definitely so they couldn’t get past then I would get involved more.

ID 13388 56-year-old divorced male, unemployed

I really am hoping that it’s going to make a change and bring back the community because I think they’re trying but they (housing agency) have not really got it off on the right foot yet, they’ve got to find the way round it…

ID 1329 59-year-old divorced female, unable to work due to a disability

Others considered the powerlessness of external agencies in the face of the need to change the people who lived in the locality:

If you’re going to regenerate the area, then you’ve got to regenerate people’s minds, ‘cos it’s just going to go the same way, its just going to go down hill, no matter how much money you pump into it.

ID 6174 24-year-old single male, in full employment

4.4 The impact at an individual level: restricted opportunities and entrapment

Whereas opportunities for employment were seen to be restricted because of the reputation perceived by outsiders, the lack of social control within the vicinity was seen to restrict opportunities for personal improvement, movement and safety. Quotes from these two middle-aged women describe curtailment of individual efforts to improve living arrangements and thwarted personal goal setting. The first refers to a response to vandalism and petty theft from her garden by young people and in the second account, benefits accrued from seeking and obtaining work are under threat:

It annoys you. It annoys you. You think you try and make places look nice and you’ve got to come home to this. You know when you come home from wherever you’ve been and you come home to that. It’s like all the stuff out of the garden that went. You don’t feel as though you want to put any more into it. You want to buy things and you think ‘why should I spend that’, when it’s, you know, you’re working hard for it and you go out and that’s gone and this has gone.

ID 1047 57-year-old married female, in full employment

With the new job I’ve got, in six months time I will be entitled to a brand new car, all expenses paid except for petrol and I am frightened to take it. How can I live with it? They said ‘well don’t worry it is all insured and taxed and that’, but I said ‘but what if every five minutes I am claiming for the car? Will it get taken off me? What’s going to happen?’ So I’m frightened. I keep saying ‘no’. I don’t think I will have the car. So I’m losing out, that’s part of my salary. So I’m losing that now because I’m too scared to have a car on my drive.

ID 2224 44-year-old single female, in full employment

Restricted opportunities which led to feelings of entrapment arose both from actual restrictions to physical mobility and ready access to leisure opportunities, for example from a lack of transport:

I used to go out every Wednesday with my sister in law and cousin, you know when the football has been on, which it has been over the last, it’s finished over now. We just don’t go out now ‘cause taxis don’t turn up for you, even the taxis now are not coming out…

ID 1047 57-year-old married female, in full employment

We used to go to St Mary’s regular me and Mary so when we come out everything is pre-booked for half eleven to come home, the minibus is gone which they shouldn’t do because they’re not insured once someone else gets in and we are often left there. It’s a long walk in the snow and the rain so we had to stop from going out there.

ID 12622 61-year-old married male, unable to work due to a disability

Restrictions on taking up everyday social and personal opportunities were also related to a sense of fear generated by others.

I think it is an intimidating thing for the older people who have to go round to the shops at the nighttime. It is frightening. A lot of them won’t even go round. It is because you have about 20 youngsters/teenagers hanging round and it’s quite intimidating, even for myself. If I knew I was going to have a drink at night time I would make sure I be there before 7 o’clock and have got my drink and I’m at home. I wouldn’t like to attempt to go round there at 9 o’clock gone. No.

ID 8410 43-year-old divorced male, unable to work due to a disability

I like to potter in the garden and things, and you know, if you’ve got gangs and that you feel a bit intimidated going out there.

ID 930 38-year-old married female, in full employment

The extent to which people felt personally vulnerable or resilient to these threats and therefore the potential to restrict opportunities varied. Women respondents seemed more threatened than men and newcomers more than established residents. There seemed less of an impact too if the individuals causing trouble were personally known. Familiarity meant being able to normalise matters and perhaps enabled the cognitive minimisation of external threats:

I’ve gone to bed with my door wide open and gone to sleep because I know the people here. I mean if I’d just moved in and did that probably the kids would have burgled me, probably the kids who are in there would burgle me.

ID 13513 28-year-old single male, in full employment

I mean they come and knock and say we’re having a party, we’re going to have music and everything, is it going to, it not going to bother me, it doesn’t bother me in the slightest.

ID 1472 47-year-old divorced male, unable to work due to a disability

However, others reported distress, fear and disruption to everyday lives. Additionally, feelings of entrapment may have been reinforced by strategies of avoidance and voluntary social isolation which people deployed to deal with threats. Peoples’ accounts pointed to a preference for dealing with matters in isolation from others outside of immediate family and significant others. Respondents seldom reported visiting one another and people commented on a palpable decline in a sense of community.

If we were going out and there was a crowd of lads stood at the gate next door. I wouldn’t go out because that would mean my house was empty and I wouldn’t trust (them) not to come and break in, it’s as simple as that I would wait for them to leave and then shoot off out…

ID 13089 52-year-old married male, unable to work due to a disability

Like there was a problem with dogs and everybody was out shouting about these dogs keep attacking people … and I went over and says I’m willing to go and report it, if somebody else will say they’ll report because it’s no use just me doing it. And it turned out I was the only one who went. It just depends. It’s not really got the community spirit…

ID 1329 59-year-old divorced female, unable to work due to a disability

And people see things here but they don’t see it, you know what I mean? I am the one who is always reporting. I know they are spying out of their windows and they play dumb, I know.

ID 2224 44-year-old single female, in full employment

I tried to get a petition up but they are just not interested, oh they won’t do any good. They’ve put up with it for so long with nothing being done.

ID 12300 55-year-old divorced male, unable to work due to a disability

I mean you might not, apart from saying good morning or hello or something like that, during the winter months you might not see you neighbours from one month to the next.

ID 1972 47-year-old divorced male, unable to work due to a disability

The reluctance of residents to engage in collective activities and a lack of faith in agencies to bring about substantive changes which mattered to individuals may have acted to increase a sense of having to deal with things at an individual level and fitted into a pre-existing culture of self-reliance and keeping ‘oneself to oneself’.

5 Discussion

There has been growing interest in the relationship between the impact of neighbourhood environment on mental health and in the interplay between agency and structure in understanding how locality effects can influence mental health. The analysis of qualitative data reported here formed part of a larger study designed to explore the relationship between socio-economic policy interventions (in this case an urban regeneration initiative and its impact on mental health [14, 12]). Within the field of mental health qualitative methods are increasingly being used as a means of illuminating aspects that remain hidden or are latent in quantitative methods [30, 24] and here the qualitative investigation aimed to illuminate more about the perceptions of the socio-economic and structural changes in the locality environment alongside respondents personal strategies which they described as being against potential threats to mental health.

A key theoretical pre-supposition underlying the main quantitative study was that locality socio-economic circumstances such as poverty, which exacerbate the personal consequences of adverse events are mediated through the perceptions of individuals which act as the last filter on the pathway to poor mental health. In the quantitative multi-variate analysis restricted opportunities were found to have the strongest association with improvements in mental health scores [12]. Restricted opportunities refer to residents’ frustrated attempts to make desired improvements in all life domains and from the qualitative interviews a corresponding notion of ‘entrapment’ emerged which implicated perceptions of changes (or lack of them) introduced in the locality undergoing regeneration together with the way in which people attempted to deal with limitations and threats to mental health. The personal strategies people adopted to protect emotional well-being and relationships to others suggested one aspect of the way in which low levels of social capital in an area are maintained. The material changes to the infrastructure were not highly valued and were considered to be seen as cosmetic rather than substantive. Moreover, in terms of making improvements to peoples’ quality of life the need to bring about actual material change was viewed as less important than needing to improve matters related to ‘a sense of place’ [6] and in particular the reputation of the locality and threats to personal safety. The way in which these aspects were experienced in everyday life were clearly related to feelings of entrapment and the inability to escape from negative situations—factors which have been found to be central to the formation of depression [1]. Agencies charged with bringing about change in these areas (e.g. police and housing authorities) were thought to be ineffective in managing these non-material aspects of the environment and as such were perceived as failing to address the concerns which were of key importance to people’s sense of well-being and providing a decent place to live in.

At a personal level coping with an adverse environment was characterised by avoidance and containment strategies (which from the narrative analysis were the most frequently identified principal means of dealing with external threats) that involved a retreat into ones’ own living space and sharing matters with close family members where there was a chance of maintaining a sense of mastery and control. Although ‘avoidant’ coping has been associated with adaptive functioning in relation to depression at higher levels of stress it has been positively associated with depression at low levels of stress [8]. It is likely that enforced social isolation served to enhance rather than militate against entrapment and that the perceived ineffectiveness of change agents and the ambient norms in the locality reinforced this. Respondents reported a reliance on ‘strong’ ties with significant others and a street culture emphasising an ethos of individuality and privacy as the best way of protecting oneself from external threats.

The connectedness between different elements of the relationship between individuals and wider influences within a locality (depicted in Fig. 1) suggests the presence of a vicious circle in which low levels of social capital at a community level are maintained through the interplay with individual means of managing threats to psychological well-being. At the individual level cognitive forms of social capital such as trust and norms of reciprocity, which ideally, one might have been expected to have been present in relation to people’s perceptions about community agencies were not apparent or abundant. This suggests that the conditions for engaging local residents by local partnership organisations associated with the urban regeneration initiative had not seemingly been established. An instance of the latter was clearly demonstrated when the research team outnumbered local residents at one of the regeneration open meetings about the health component of the SRB programme. Given the failure to engender a sense of faith in the ability of key locality agencies to make changes to key areas of peoples’ everyday lives individualised strategies were by comparison experienced as more reliable and efficient. It is likely that in the absence of ‘linking’ social capital between individual and community levels [27] existing pattern of relationships runs the risk of reinforcing feelings of entrapment and acting to further restrict already restricted opportunities both of which are associated with poor mental health and quality of life [14, 12]. Accounts from individuals suggested little motivation for people to engage with initiatives at a collective level or to work with external agencies in contributing to change in the locality.

Breaking this vicious circle appears to be a major challenge for regeneration initiatives. It is likely to require the promotion of an environment likely to enhance levels of positive mental health, lower a sense of entrapment and temper a trend on the over-reliance of individualised responses to environmental problems. Agencies involved in urban initiatives need to develop practices which promote a sense of security, increase leisure opportunities, and where necessary improve the image of the locality. It seems what was needed to improve engagement and participation might have been aspects of the environment seen as causing major restrictions (e.g. using initiative money to build and patrol a number of secure play areas, addressing the safety at night travel problem, the provision of cheap or free transport back from the centre of town). Additionally, the involvement of agencies seen to help with individual distress such as primary care might be able to act as catalysts to promote the ‘strength of weak ties’ [9] between individuals and other community agencies. Restoring faith in agencies might in turn lead to the re-building of the social capital resources needed to bring about sustainable change.

Footnotes
1

Traditional ‘structural’ approaches to mental health inequalities such as the community studies of the impact of the environment on mental health conducted in the 1950s and 1960s (e.g. [10, 15]) suggested links between social conditions and disadvantage (e.g. unemployment, poverty and racism) and psychiatric morbidity. Recent research into the prevalence of mental disorder amongst women and impact of employment, unemployment and standard of living point to the importance of macro-structural variables and environmental causes in determining mental health [20, 24, 28, 31].

 
2

Psycho-socially orientated perspectives are concerned with changes in and experience of life events, the social world of individuals and the way in which social environmental demands generate psychological stress [3, 18].

 
3

The main measures used in the study are measures of mental health—the General Health Questionnaire (GHQ-12) (Goldberg 1978) [7] and the Clinical Interview Schedule - Research version (CIS-R) (Lewis et al. 1992) [30].

 

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© Steinkopff Verlag Darmstadt 2008