The PMH Consortium, part of UKRI’s Population Health Improvement UK (PHI UK), was established to create a nationwide research network aimed at improving health and reducing inequalities across the UK through population-based approaches.
Our research priorities focus on addressing societal conditions and determinants of inequity[1] which contribute to mental health inequalities — particularly for children and young people (CYP), suicide and self-harm prevention, and multiple long-term conditions. The impact[2] we have is fundamental to how we work in a unified and integrated way as a consortium.
In the pursuit of equity in population mental health, it's not just about who’s at the table—but who’s missing, and why. The emerging insights below highlight the urgent need to address systemic gaps that continue to marginalise disadvantaged individuals and communities across sectors such as healthcare, education, and data systems.
Traumascapes, a survivor-led organisation dedicated to changing the ecosystem of trauma and creating new horizons for survivors through art and science, and part of the ‘Partners in policy, practice and lived experience’ platform (platform 1) are collaborating with the ‘Narrowing inequalities’ platform (platform 3), to lead a photovoice participatory action research project.
The photovoice project seeks to focus on and amplify the experiences of a specific underserved community absent from mainstream population mental health discourse. Findings will be written up collectively through a workshop with artist researchers and curated as part of an exhibition to amplify less-often-heard voices and engage the broader public.
Inspired by the Equity, Equality, Diversity and Inclusion (EEDI) approach and survey by leads in platform 3 (Narrowing inequalities), one-to-one conversations with consortium colleagues provided insights into challenges of inclusivity in research.
These dialogues showed the current research landscape across challenge areas and platforms, and ways to consider and action embedding principles of inclusivity in our work. Fundamentally for the photovoice project, these conversations helped to uncover whose voices are missing, and why.
These initial conversations and Equity, Equality, Diversity and Inclusion survey responses highlighted the emerging learnings:
Food for thought - who gets to speak?
Even when we try to include diverse voices in research, we often only hear from people who fit certain ideas of what “mental wellness” looks like, or who may be able to work within academic institutions. This can create a small, elite group, even within communities that are already marginalised (Okoroji et al., 2023).
This raises an important question: Are we really hearing from the people who are most left out? Sometimes, even those who speak up for change still need approval from people in power, which limits how much change can happen with inherently unequal power dynamics.
We must consider how people are marginalised systematically through structures that reaffirm inequities and inequalities through the process of social exclusion/inclusion. For example, academic spaces are not widely accessible to the general population and are a privileged environment.
To increase inclusivity, the consortium will start ‘Check & Challenge’ sessions in October 2025. These sessions will give teams a chance to talk about their work and ask:
- How do we create a space to reflect on what efforts are directly and indirectly excluding vulnerable individuals and communities, through careful consideration of protected characteristics?
- Are we leaving anyone out, especially people who are vulnerable or often ignored?
These sessions will help teams reflect, take responsibility, and make sure their work includes people from all backgrounds, especially those with protected characteristics.
Children and young people (CYP) face unique barriers
Children and young people are a key focus for the consortium in challenge area 1. Conversations indicated many young people’s voices are missing from research and decision-making. They often face unfair treatment, especially those from lower socioeconomic backgrounds or racially minoritised communities. These challenges can affect their mental health:
- Children and young people who are not in regular school or who get counselling at school often aren’t asked about their experiences.
- Some families choose not to take part in research because they’ve faced racism or unfair treatment before. This means that what we understand from large survey datasets is missing important narratives.
- Young people who are neurodiverse or from racially minoritised groups may experience systemic barriers, which can contribute to difficult experiences in school. This shows how important it is to make research and policies more inclusive.
Why intersectionality matters
Intersectionality means considering how different aspects of a person’s identity, such as how they are racialised, their gender, disability, age and how much money they have, can affect how they are treated in society (Bowleg, 2012). These social aspects can overlap to make life easier or harder for someone.
Some people can experience unfair treatment because of sexism, racism, classism, ableism, heteronormativity, and ageism. These unfair systems can make it harder for people to live healthy lives, find jobs or feel in control of their future.
If we don’t look at how different aspects of a person’s identity interconnect, research can miss important details. We stand the risk of generalising experiences and ignoring the needs of people who face the most unfair treatment and are systemically placed at the furthest margins of society.
To really understand people’s lives, we need to think about how history, culture, and the systems around them, like racism, the effects of colonialism, and socioeconomic inequalities that have been around for a long time, shape their health and their lives. Jones (2000) outlines three levels of racism: institutionalised, personally mediated, and internalised, using an allegory to show how these types of racism can impact people’s health.
Education and training: who benefits?
Currently, we don’t have enough information about who is taking part in mental health training programs (platform 4 education and training). This means we don’t know which communities are being left out, including those who may be facing digital exclusion.
Without this data, it’s hard to know if the training is working or how to enhance it. To address this, we need to make training more inclusive and easier to access. We also need to be clear about who it’s for, so it reaches the people who need it most.
Multiple long-term conditions: overlapping needs, overlooked voices
In conversations with colleagues working on multiple long-term conditions research (challenge area 3), they highlighted that people who have received diagnoses of severe mental illness face stark health disparities:
- Without proper care, people who have received diagnoses of severe mental illness may live 15 to 25 years less than the general population.
- Mental and physical health care are often not integrated, which makes it harder for people to get the full support they need.
- LGBTQI+ people who have received diagnoses of severe mental illness often face additional stigma and social exclusion.
Mental health is deeply affected by unfair systems, like racism, ableism, and homophobia. These systems must be challenged and changed if we want to improve mental health for everyone.
The silences in data
Big surveys and linked data can help us learn more about upstream determinants of mental health. But even with these opportunities, we can still miss important voices and narratives.
Who’s being left out?
- People from mixed or “other” ethnic backgrounds, gender minorities, sexual minorities and across religious groups often don’t fit into the standard identity boxes used in research, although they may experience disadvantage and systemic violence. The process of how ethnicity and other demographic factors are categorised can uphold systems of exclusion.
- Some communities, like Gypsy, Roma, and Traveller groups, and other racially minoritised groups are missing from linked data across health, education, social care, and justice systems. This can happen because of missing or incorrect data, and/or because some groups are more likely to opt out from research.
Why this matters
Mental health is shaped by historical and social conditions. For example, in racially minoritised communities, differences in experiences through generations, including experiences of migration and being born in the UK, can give us important insights, but these are often overlooked. Yet they hold critical insights into evolving needs and living experiences.
Missing data on protected characteristics can create blind spots in our understanding. This can lead to unfair policies and services. A recent study by Lam et al. (2025) shows how the way we collect and label data, such as using standard ethnic categories without context, can hide the real issues. These choices affect:
- Who gets access to care
- Who is represented in research
- How public health programs are designed
What needs to change
To make mental health research and care fairer, we could:
- Use an intersectional approach.
- Include more lived experiences and cultural knowledge
- Question the systems and categories we use in research
This shift is not just academic - it’s about creating a society where everyone’s experiences are seen, heard, and valued.
So what? What next?
To build truly inclusive societies, we must go beyond surface-level representation. This means:
- Actively seeking out and amplifying marginalised voices. Platform 3 (narrowing inequalities) is thinking not only of whose voices are missing, but how to strengthen these missing voices.
- Thinking about our own role in research. Embedding reflexivity as standard research practice and considering our positionality in how we approach research.
- Improving how we collect and use data. We need to make sure data reflects the real, complex lives of people from underserved communities. Using an intersectional lens helps us see how multiple overlapping and interacting factors across various social categories contribute to health inequalities.
- Challenging unfair systems. We must name, face and break down the systems of oppression, such as sexism, racism, classism, ableism, heteronormativity, and ageism, that exist in our institutions and the way knowledge is created.
Equity, equality, diversity, and inclusion are not optional—they are foundational to achieving fairer mental health outcomes for all.
References
Bowleg, L. (2012). The Problem with the Phrase Women and Minorities: Intersectionality—an Important Theoretical Framework for Public Health. American Journal of Public Health, 102(7), 1267–1273. https://doi.org/10.2105/AJPH.2012.300750
Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener’s tale. American Journal of Public Health, 90(8), 1212-1215.
Lam, J., Aldridge, R., Blackburn, R., & Harron, K. (2023). How is ethnicity reported, described, and analysed in health research in the UK? BMC Public Health. https://doi.org/10.1186/s12889-023-16947-3
Okoroji, C., Mackay, T., Robotham, D., Beckford, D., & Pinfold, V. (2023). Epistemic injustice and mental health research: A pragmatic approach to working with lived experience expertise. Frontiers in Psychiatry, 14, 1114725. https://doi.org/10.3389/fpsyt.2023.1114725
Acknowledgements
Many thanks to leads in platform 3 (Narrowing inequalities) for sharing the equity, equality, diversity, and inclusion survey results — Dr Rebecca Rhead, Professor Stephani Hatch and Dr Jacqui Dyer.
We’d like to thank our colleagues for their time and rich insights: Dr Natasha Chilman, Dr Sam Davies, Professor Jay Das-Munshi, Dr Niamh Doherty, Dr Annie Jeffery, Dr Dionne Laporte, Professor Gerry Leavey, Dr Kate Lewis, Dr Sarah Steeg, Patrick Wong and Natasha Cutler.
Footnotes
[1] Professor Camara Jones, Anti-Racism and Health: Levels of Health Intervention.
[2] Professor Camara Jones, Anti-Racism and Health: Levels of Health Intervention.