Addressing marginalisation and inequalities in access, experiences and outcomes of mental health care
All research projects under this theme.
Projects
HARP Doctoral Fellowship 2025 - Brad Begley
Unaccompanied Asylum-Seeking Children (UASC) are a clinically vulnerable population at greater risk of mental health difficulties than their peers. With global political and environmental insecurity on the rise, so too are the numbers of UASC. This poses a challenge for health services globally as they aim to support UASC when they settle in their destination country. Typically, UASC experience higher levels of PTSD, anxiety and depression symptoms than their peers (Kien et al., 2019). Research on interventions for the treatment of mental health difficulties with UASC populations is sparse and there is a need for evidence of what works best in order to provide timely support and minimise the long-term negative consequences of migration on wellbeing.
Solution Focused Brief Therapy (SFT) is a brief psychological intervention with roots in social constructionism and focuses on helping clients envision difference in their lives. It has been adapted for many populations, mental health challenges and settings such as for children living with cancer, for children with suicidal ideation and for adults with substance misuse. SFT has also been researched for PTSD, as an alternative to more problem focused interventions such as EMDR and Trauma-focused CBT. Due to its adaptability and its focus on difference, SFT should be considered as an intervention for UASC. This has not yet been explored and this PhD fellowship therefore aims to explore in-depth the suitability, acceptability and feasibility of SFT with UASC in the United Kingdom. Through a single armed feasibility study, SFT will be offered to UASC, and the outcomes on their mental health analysed.
HARP Doctoral Fellowship 2025 - Umar Chaudhry
City St George’s Lead: Dr Jacqueline Sin
Funder: Wellcome Trust, £450,638.10
Duration: October 2025 to September 2028
Alongside a focus on public / population health and health inequalities, my current research interests are on diabetes complications, especially in South Asian and Black ethnic populations. During my PhD, I will use qualitative and quantitative methods to study diabetes complication risks among these groups who are at high risk. I will explore patient and clinician perceptions, and co-design a communication guide, working closely with South Asian and Black ethnic communities, in addition to stakeholders, to ensure the research is impactful and findings are widely disseminated.
Building recovery and resilience in severe mental illness: Leveraging the role of social determinants in illness trajectories and interventions
City St George’s Lead: Professor Rose McCabe
Funder: MRC Medical Research Council, £25,129.76
Duration: April 2024 to March 2029
Severe Mental Illnesses (SMIs) are defined as those conditions with the most severe symptoms and functional impairment. These conditions, together affect just under 10% of the population, and carry significant impacts on education, employment, relationships, health, and quality of life. They also incur direct and indirect economic costs. These human and economic costs can be minimised through prevention. This involves identifying the root causes of SMIs and targeting these in early interventions. But because many of these conditions involve lifelong, recurrent episodes, a complementary approach is to identify factors that shape and maintain the course and outcomes of SMIs and target these through treatments. Indeed, across SMIs, illness trajectories can be highly variable. Between-individuals, some show adaptive trajectories: symptom reduction and/or minimising the impact of their symptoms on daily functioning and resuming responsibility and control over their own lives. In comparison, others show poorer trajectories, struggling to hold down employment, relationships, have co-morbid health conditions, and report poor life satisfaction. Still, many others show considerable within-individual mixed patterns: fluctuating courses of symptoms, interference, and life satisfaction.
This hub will focus on identifying the factors which contribute to illness trajectories. SMIs arise from and are maintained by a complex interplay of biological, psychological, and social factors. Yet most frontline treatments for SMIs target biological and psychological factors. In this hub, we aim specifically to generate new knowledge on the role of social determinants in shaping illness trajectories. We aim to identify social determinants that carry positive or protective effects and formatively explore how these can be leveraged in community-based resource-oriented social interventions to boost recovery and resilience in those with poorer trajectories and in those with mixed trajectories. While we are interested in within-condition heterogeneity in illness course and outcomes, we are also interested in between-disorder heterogeneity and similarities. Therefore, we focus on 3 SMIs – schizophrenia, bipolar disorder, and severe forms of major depression – these conditions share common symptoms (e.g. psychotic, affective and cognitive disturbances), are thought to be driven by similar aetiological influences, yet XX. Studying them together will identify transdiagnostic factors for universal treatment protocols but also differences that explain unique symptom profiles at the disorder level, as well as within disorders.
Find out more here: City researchers part of £3.5m mental health research hub
Evaluation of Culturally Appropriate Advocacy Pilots
City St George’s Lead: Anthony Salla
Funder: NIHR / DHSC Department of Health and Social Care, £348,770.23
Duration: December 2023 to June 2025
Independent Mental Health Advocacy (IMHA) is a type of statutory advocacy. Its aim is to give people who are detained in hospital under the Mental Health Act (MHA) a voice, and to protect and promote their rights. For example, a patient detained under MHA section on a ward could be supported to request leave to visit home for a period; or in their request to be discharged from the section and then be treated in the community.
More people from Black, Asian and minority ethnic populations are detained in mental healthcare than we should expect. Research also shows they have poorer access to services, worse outcomes in relation to care and treatment, and a more disadvantageous experience, too often involving racial discrimination.
It is important that IMHA works for everyone. IMHA has been identified as a measure to reduce poor experiences people have in mental healthcare. However, research shows Black ethnic groups in particular do not always experience advocacy positively. Therefore, the UK government is commissioning research to test if culturally appropriate advocacy (CAA) can make improvements and potentially improve outcomes in care and treatment. CAA means that a patient or client would have the racial and/or cultural perspectives, or factors pertaining to their experiences of (racial/ cultural) discrimination and its impact on him/her taken into consideration in the support offered.
Find out more here: Culturally Appropriate Advocacy Evaluation: Mental Health Act Reform - Health Research Authority
Inclusive and holistic health for all (in East London)
City St George’s Lead: Dr Jacqueline Sin
Funder: City St George’s, University of London, £5,986
Duration: August 2023 to July 2024
Participatory Research Fund bid 2023-2024
This project aimed to expand our participatory research network involving local residents and grassroot collaborators in East London, to co-produce sustainable strategies to optimize EDI in participatory health research.
This project used the Community-based Participatory Research (CPBR) method to embed the cultural context and beliefs of the community co-researchers and stakeholders (specifically the Insights - Bromley by Bow Centre and independent consultant on decolonizing health research) into our holistic health research agenda.
Our project outputs were pragmatic and practical gains in building capacity – both horizontally by engaging with a larger number of individuals (micro) and vertically through building and strengthening partnership working with communities and the wider systems/society (macro). As a collective, we ran two research engagement events in the community and held multiple public consultation sessions to collect views on shaping health research project outlines and setting research priorities.
Health Inequalities Masterclass programme 2022 – 2024
City St George’s Lead: Professor Angela Harden
Funder: GLA Greater London Authority, £66,306.51
Duration: March 2022 to January 2024
Building a Well Communities Research Consortium to address health disparities through Integrated Care Systems
City St George’s Lead: Professor Angela Harden
Funder: AHRC Arts & Humanities Research Council, £205,240.85
Duration: November 2022 to October 2023
Actions on the social determinants of health are needed to tackle disparities including a focus on upstream interventions to improve population health. Interest in community-centred and asset-based approaches such as community development and, the more individual and patient focused social prescribing, has been growing - especially since the COVID-19 pandemic.
We aim to build an interdisciplinary and cross-sectoral Well Communities Research Consortium working collaboratively and inclusively to research and develop ways to scale-up, spread and embed community and asset-based approaches within new Integrated Care Systems (ICSs) within and outside of London.
The ambition for our Consortium is grounded in evidence which demonstrates that community assets such as strong community networks and groups, arts and cultural activities, parks and green spaces are associated with a wide range of health and social benefits. However, we also know that engagement in arts and cultural activities is inequitable and that given the health and wellbeing benefits - there is a need to promote equality of access to community assets such as arts and cultural activities in order to address health disparities.
This Research Consortium will explore how local health and care systems can better interface with, develop and mobilise community assets to improve health and reduce health disparities in two contrasting geographical contexts.
Find out more here: Building a Well Communities Research Consortium to address health disparities
Taiwan-UK Sex, Gender and Sexuality Health Network: making connections, establishing commonality, forwarding research
City St George’s Lead: Professor Sally McManus
Team: Ford Colin Hickson (London School of Hygiene and Tropical Medicine, CI), Cheuk Yin Li (Co-I), Isaac Yen-Hao Chu (Co-I), Nai-Ying Ko (Co-I),
Funder: Economic and Social Research Council, £24,965
Duration: August 2021 to January 2023
With the support of an ESRC-MOST UK-Taiwan Networking Grant, this project will establish the Taiwan-UK Minority Health Network and strengthen future collaboration. The project is led by LSHTM with the aim of developing a sustainable network of researchers in Taiwan and the UK. It involves co-developing a battery of alternative measures of sex, gender and sexuality that will facilitate cross-cultural queer health research, as well as improve measurement of these human qualities in health care services in both countries.
Find out more here: UKRI project page: Taiwan-UK Sex, Gender and Sexuality Health Network: making connections, establishing commonality, forwarding research