Derek Underwood was struggling with depression and suffering side-effects from antidepressants when he decided to try a course on happiness run by his local adult education service. The retired engineer from Surbiton had been “in a downward spiral”. As a result of the medication, he was experiencing tremors in his hands, and he was relying on sleeping tablets to deal with insomnia.

The programme, titled “Practical ideas for happier living”, changed his life. “I found it very difficult to write down three positive things every day at the start of the course,” he recalls. “By the end of the course, I was often putting down six positive things a day.”

Underwood says that the mindfulness aspect of the course “had a great effect on me”. Indeed, it was so effective that he has been off antidepressants and sleeping pills for the past 18 months.

Underwood is one of thousands of people whose symptoms of depression or anxiety have improved after taking part in the biggest-ever study in Britain exploring the impact that community learning can have on mental health.

Transformative potential

These findings have the potential to transform the status of community learning and spark an explosion in prescribed education. They also point to the benefits of closer links between health and education, as well as raising questions about the barriers preventing more joined-up working between the two services.

The £20 million “community learning mental health research project”, conducted between 2015 and 2017, was launched by Sir Vince Cable when he was business secretary for the coalition government. Cable, now leader of the Liberal Democrats, had a personal interest in the subject: his mother had been hospitalised with postnatal depression, and adult education supported her recovery.

The research project aimed to identify the potential for adult and community learning courses to help people manage and recover from mild-to-moderate mental health problems, ranging from insomnia to anxiety and depression. Last month, the government released the findings of the second phase of the research programme. More than 10,000 individuals took part (see box, opposite).

Overall, not only did the average wellbeing of learners rise after doing a course - from significantly below average to around the average mark - but 76 per cent of respondents perceived some improvement in their overall mental health.

Positives cited by many learners include developing a support network through meeting other people on the course and gaining confidence by learning new skills. And, out of the 3,633 people who started their course having had clinically significant symptoms of anxiety and/or depression, in 52 per cent of cases, these had disappeared by the end of the programme.

For comparison, this is a higher proportion than the 49 per cent of people on the NHS “Improving access to psychological therapies” programme who make such a recovery. Not only that, but the completion rate of the former (76 per cent) was far higher than the latter (59 per cent). This shows that community learning can outperform certain NHS services when judged on the same basis.

Although all groups of learners experienced an overall benefit, adult courses explicitly centred on mental health and wellbeing were the most effective in improving mental health outcomes, according to the evaluation report by Ipsos MORI and the Centre for Mental Health.

Interviews were also carried out with 58 learners to complement the quantitative data gathered by the project. They revealed that learners found the courses had positive effects on their mental health by allowing them to focus on something else, making time for them to do something enjoyable and giving them something to look forward to.

The report says that support is needed to enable such courses to continue, and calls for “joint commissioning where feasible” between different services, as well as “joined-up awareness-raising to ensure that people who need support understand the different options available to them”.

It adds: “Health practitioners and [Jobcentre Plus] advisers could signpost people to learning provision. This may help reduce demand for NHS mental health services … and provide a more acceptable form of support for people who do not want a medical intervention or are less likely to access medical treatment for mental health problems.”

Other recommendations include having learning providers ensure that “adequate support is in place for staff delivering courses focused on managing mild-to-moderate mental health problems.”

The report states: “Consideration should be given to whether links to social-prescribing initiatives would help the offer to reach those who may benefit from it, but may not seek out learning opportunities proactively.”

‘Embedding awareness’

As the man who commissioned the pilot, Cable believes the findings show that education has a key part to play in individuals’ wellbeing, long after their course has finished. “Embedding an understanding and awareness of mental ill health throughout the education system can play a vital role in improving prevention and early intervention,” he says.

Education is also important to tackling the stigma that remains around mental health, Cable adds, arguing that there need to be “clear mental healthcare pathways between education providers and local mental health services”.

June Hayes, a tutor at Redbridge Institute, an adult education provider in East London, taught meditation and mindfulness as part of the research project. “What I do is to give [participants] the tools so that they can do it themselves,” she says, adding that the stress and pace of modern life exerts a pressure to perform that can take its toll on people. Many of her learners had been in work, but had succumbed to the pressure of their jobs, while others “had retired and couldn’t slow down - they couldn’t get off that treadmill”.

Another teacher who saw the “significant positive impact” of the pilot first-hand is Chris Truckle, who teaches health and wellbeing, and employability at Blackburn with Darwen Council’s adult learning service. Many individuals who took part “have progressed into work, volunteering, further learning, or established peer-led groups to provide ongoing support to each other as a result of the courses”, he says.

The testimonies of those involved in the pilot appear to back up the data, further demonstrating its impressive impact. Accordingly, you might have expected the government to make a big fuss about the report. Yet, there was no press conference or launch event. Instead, the research report was quietly placed on the government website last month, containing the following disclaimer: “This research was commissioned under the 2010 to 2015 Conservative and Liberal Democrat coalition government. As a result, the content may not reflect current government policy”.

So has the research been kicked into the long grass, tainted by its association with a previous political administration?

Community learning is conspicuous by its absence from the government’s recently launched loneliness strategy, despite a link being made between isolation and mental health. And while funding for community learning has remained stable in recent years, there has been a real-terms cut of £88 million in the value of the annual community learning grant, which has stood at £210 million since 2005-06.

Social prescriptions

Although social prescribing is gaining momentum, the Department of Health and Social Care’s health and wellbeing fund has yet to mention community learning as a possible route. Of the grants awarded to date, none include adult education courses as a potential option for treatment.

Why is this? Put simply, community learning and adult mental health are not priorities for the Department for Education, claims Catina Barrett, who was the lead civil servant on the research project. “There is currently one person [in the DfE] who has one day a week for community learning; that’s it,” she says.

Barrett, now an educational consultant, adds: “There is no lifelong learning or adult learning strategy from the DfE.” Community learning has relied on “winning hearts” in the past, “but civil servants won’t encourage ministers to do anything without there being robust evidence”. The research report is that evidence, she insists - all that remains is for the government to act on it.

Ruth Spellman is chief executive of the Workers’ Educational Association, one of the 52 adult learning providers that took part in the research project. She says the findings are backed up by her organisation’s own survey of 4,000 students for its annual impact report. This found that 82 per cent of students with mental health issues reported improvements in their condition after taking a course. “This provides further evidence of the role that community learning can have in tackling mental health,” she adds.

When it comes to health and education, there is a virtuous circle, according to Barrett. “If people have better health, then they can take up the educational opportunities, which in turn give them a better quality of life.” However, she warns that significant barriers remain when it comes to trying to bring health and education closer together, not least the differing organisational priorities and a “flavour of the month” policymaking culture.

Catalyst for change

Despite the apparent apathy within the DfE, the project has left a significant legacy, and some providers have continued to run the courses after the end of the pilot.

Kingston Adult Education, for instance, is offering short courses to aid mental health with the help of funding it has secured from the local public health body. Redbridge Institute, too, is running some of the programmes that showed the most benefit during the project, such as meditation; it has embedded these in its core provision, and has built in health and wellbeing as a priority of equal worth to English and maths.

But for many other providers, sustaining the courses - and the training and support for those who deliver them - remains a formidable challenge. Added to this is the uncertainty over how community learning will be funded next year when control of the adult education budget will be devolved to London and combined regions in England.

In theory, at least, the DfE says it is a supporter of the role of community learning in improving mental health. Helping those with mental health issues to boost their confidence and skills is a government priority, according to apprenticeships and skills minister Anne Milton - herself a former nurse.

“We have long known that community learning courses can have a positive impact on people’s lives,” she says. “These courses are helping more than half a million people to gain skills and improve their self-esteem. The courses can change people’s lives and the lives of the families around them.”

In the longer term, Andy Bell, deputy chief executive of the Centre for Mental Health, is optimistic that the research project will prove to be a catalyst for change: “We hope that this project will stimulate much more development in adult and community learning to reach out to people with mental health difficulties and offer courses in mental health routinely.”

As for Underwood, he says: “I can’t praise the effectiveness of the course too highly. It changed my attitude to life with the result that I have a much more positive outlook and enthusiasm.”

Jonathan Owen is a freelance journalist

What the research involved

The second phase of the community learning mental health pilot took place between September 2016 and August 2017. The initiative involved 10,100 individuals (7,091 of whom went on to take a course) and more than 50 adult learning providers, including FE colleges and local authority adult education services.

For the learners who took part, improving their mood and mental health were the main motivations. They attended short part-time courses of 15 hours in total, and were assessed at several points before, during and afterwards, on the same measures used by the NHS in determining mental health. This took place through self-assessment multiple-choice questionnaires that recorded symptoms of depression and anxiety.

Participants were given up to three hours of one-to-one information, advice and guidance sessions to support them; they were also offered the opportunity to take part in one-off top-up sessions after their course had finished. The learners were divided into three groups. In groups A and B, all participants had mild-to-moderate mental health problems. Those in group A went on courses to manage symptoms of mental health problems, while those in group B took courses focused on traditional community learning topics, such as yoga, arts, crafts and creative writing.

Group C also involved general community learning courses - the only difference being that the participants were a mix of learners with and without mental health problems.

Uniting health and education: what the experts say

Joni Cunningham, principal of Redbridge Institute, believes the project’s impact has been seismic for the adult education sector.

“The most important thing is that we’ve got hard evidence for the first time about the impact that learning can have on health and wellbeing, and that we’ve got the evidence that, for many people, it can improve their mental health,” she says.

What needs to happen now is for other government departments to act on the findings and for community learning to play “a part in recovery programmes in terms of social prescription”, she adds.

Sue Pember, director of policy and external relations at adult education body Holex, also believes that the findings present a clear message to the government. “This report demonstrates what teachers and providers have always known: that this should be another alternative to the more formal type of treatment,” she says.

The Royal College of General Practitioners acknowledges that conventional medicine does not work for all patients. Its chair, Professor Helen Stokes-Lampard, says: “Not everyone will benefit from traditional medical care for their healthcare problems, and we know that encouraging patients to take up new hobbies or skills instead of, or alongside, more conventional approaches can have a significant positive impact on their health - particularly their mental wellbeing.”

Back in the world of education, the Association of Colleges is in agreement, according to senior policy manager Liz Maudsley.

“We believe that it is crucial for health and education to work closely together and share resources to support people with mental health difficulties,” she says. “For some people, the opportunity to move away from a medical model of mental health and have the chance to be seen primarily as a learner can be very therapeutic.”

One learner’s story

Maria Bunker, from Watford, participated in a sculpture course run by the Hertfordshire Adult and Family Learning Service.

“I’d had depression in the past and had reached a point where I was getting very down,” she says. “I was reaching 50 and didn’t know who I was any more, I didn’t have any social life.”

Bunker found out about the course from an advert on Facebook. “I was very, very anxious and nearly didn’t go through the door,” she admits. “But I did, and they were absolutely lovely and I met some wonderful people there.

“It’s given me a lot more confidence; I wouldn’t have spoken to you a year ago.

“Community learning should be more widespread, more readily available and accessible to people everywhere - it does make a difference.

“I have a life now. I had my children, I had my granddaughter, but my life was around them. Now I have a life for me.”