Minded to change coverRealeased today, our latest report has uncovered a concerning trend in the misuse of the health trainer service in the UK, with professionals reporting being used as a ‘dumping ground’ for clients with severe mental health problems, including severe depression, schizophrenia and suicidal thoughts, which they are unequipped to deal with.

Read the full report.

The health trainer service, introduced in 2004, provides personalised face-to-face support to the most deprived in society to help them maintain healthier lifestyles, with the aim of reducing avoidable illness and tackling health inequalities. A previous RSPH report has already found that health trainers are operating far beyond their original remit, helping clients with everything from financial issues to mental health problems.

However, the report out today finds people with complex mental health problems are being inappropriately referred to health trainers as a default last option by other services – partly due to a lack of adequate alternative mental health provision in their local areas.


We are calling for:

  • More training in mental wellbeing for health trainers to help them cope with clients with low level mental health issues such as social isolation, anxiety and stress, and;
  • Greater understanding among other professionals of the health trainer role in order to prevent inappropriate referrals of individuals with more complex conditions.

RSPH’s report also clearly demonstrates the link between mental wellbeing and physical health. Data analysed via the Data Collection and Reporting System (DCRS) from health trainers across the UK shows clients who score low on mental wellbeing measures before intervention are held back from achieving the same general health scores as those who begin the process in better mental health.

Those who start the process with poor mental health are also more likely to fail to achieve the goals of their personal health plans regarding things like diet, weight and physical activity. Those who achieve their goals start with an average WHO-5 mental wellbeing score of 45.44, compared with only 39.26 among those who do not go on to achieve their physical health goals.

Shirley Cramer CBE, RSPH Chief Executive, said: “Health trainers have been shown to be hugely effective at improving the health and wellbeing of some of the most deprived and vulnerable in our society. The substantial improvements they achieve, even in cases where clients have initially low mental wellbeing, is testament to their hard work and professionalism.

“However, health trainers cannot pick up the tab for a lack of mental health provision elsewhere – they should not be used as a ‘dumping ground’ by other professionals when there is nowhere else for people with severe mental health problems to go. While more understanding of their role is needed to prevent these inappropriate referrals, health trainers can also benefit from greater training to support clients with lower level mental health issues.

“As shown by this report, mental health and physical health are inextricably linked. We cannot ignore this link in the health trainer setting if we are to work towards much-talked about parity of esteem between mental and physical health.”

David Hopkinson, DCRS National Service Lead, added: “Due to the fact that they’re purposely targeting more challenging, deprived, community clients, the capability, flexibility and resilience of the health trainer intervention to achieve success continues to astound us. Their results have long been demonstrating positive physical impact upon the majority of individuals across a wide range of health attributes – not forgetting the knock-on benefits for their immediate family. As is so clearly demonstrated by this latest independent RSPH analysis, these services also offer profound inter-related emotional health and wellbeing measure successes.

“I would like to congratulate the health trainer services on behalf of the DCRS team. It’s an honour to continue to play our small part in helping to support the demonstration of that ongoing success.”


About the report

Minded to change: the link between mental wellbeing and healthier lifestyles, is published by the Royal Society for Public Health (RSPH) today (6 November 2015). The research for the report incorporated both quantitative analysis using data collected by the Data Collection and Recording System (DCRS), and qualitative research in the form of semi-structured interviews with health trainers and service leads.

The DCRS data was collected over a three year period from July 2012 to July 2015. 31 interviews were conducted throughout August and September 2015, 14 with service leads and 17 with health trainers. For more information on which health trainer services took part, please see the full report.