King's College London

Mental ill-health does not occur in isolation from socio-economic disadvantage. Poverty, insecure housing, debt, unemployment, trauma and loneliness all drive poor mental health, while mental illness itself can make these challenges harder to overcome. Many people are therefore trapped in cycles where social adversity both causes and worsens mental distress.

A two-year research programme funded by the Maudsley Charity at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and ESRC Centre for Society and Mental Health at King’s College London, published across five studies, has reviewed national and international evidence on what works to support people with mental health conditions – particularly those from marginalised communities.

The first phase of the ENRICHED programme concluded Friday with the publication of a new study in the International Journal of Mental Health Systems, which proposes a practical framework for embedding social and economic support into mainstream mental health care.

The findings from this phase of the programme call for a shift in how mental health care is delivered, placing housing, employment and social connection at the heart of recovery.

Professor Craig Morgan, Co-Director of ESRC Centre for Society and Mental Health, Professor of Social Epidemiology at King’s College London and Principal Investigator of the research, said: “When a service user is discharged into inadequate or unsafe housing and mounting rent arrears, they can quickly become trapped in a cycle of social and economic exclusion, deteriorating mental health, and readmission. Our findings show that mental health services need to more systematically and routinely address the real-world social and economic challenges service users face.”

 
Gaps in current NHS provision

High caseloads held by care coordinators means that service users receive limited support from services with social and economic inclusion and many needs go unmet. Currently, the only social intervention mandated in services for people with severe mental illness is Individual Placement and Support (IPS), which helps people into work. While valuable, IPS cannot meet other fundamental needs like housing, financial security or social connection, particularly for those most in need of support who may not have the capacity to work.

The researchers working on ENRICHED surveyed NHS staff at the South London and Maudsley NHS Foundation Trust – the UK’s largest mental health trust – to understand how social and economic needs are addressed in practice. Their findings, available as a pre-print on medRxiv, revealed that while staff widely recognise the importance of factors such as housing, employment, debt, education, trauma and relationships in supporting recovery, services lack the resources to provide this support consistently.

Despite these constraints, the researchers identified pioneering initiatives already making a difference, such as the Peer Support Service and Family and Friends Support Service for people with psychosis, the Community Welfare Team in Southwark, and culturally tailored advocacy programmes such as those delivered by Black Thrive.

Further research, published in BJPsych Bulletin, highlights the value of a person-centred, socially inclusive approach. Lambeth Vocational Services at the South London and Maudsley NHS Foundation Trust already offer one such model, providing user-led programmes that help people achieve their vocational goals and find employment, for example through ‘Clean and Care’, a commercial carpet cleaning service which directly employs service users.

Dr Anna Greenburgh, Research Associate in the Centre for Society and Mental Health at King’s College London, said: “The work taking place in Lambeth Vocational Services has been transformative for service users, helping people not only find employment but also rebuilding confidence, purpose, and connection. This concept of prioritising social inclusion through holistic, person-centred approaches, and offering a wider range of support across a continuum of need, can be applied by any service across the country.”

 
What interventions work and who benefits?

Although interventions to improve social and economic services for people living with mental illness have been developed, research is unclear about who they are effective for. The researchers explored the effectiveness of these interventions in two systematic reviews.

The most recent review, published in Psychological Medicine, examined 78 interventions across 16 (mostly high-income) countries that were specifically designed to improve the social and economic circumstances of people with mental health difficulties from marginalised or minoritised communities.

These included Housing First programmes which aim to get people experiencing homelessness, or at risk of homelessness, into stable accommodation, culturally adapted services for ethnic minority communities, financial advisory services, and tailored perinatal support for mothers. Interventions also addressed the needs of older adults, caregivers, people with an offending history, and women experiencing intimate partner violence.

Despite their diversity, all demonstrated feasibility or positive outcomes in at least one area, such as housing stability, employment, reduced isolation or improved access to services. The findings offer a selection of promising approaches that could be adopted or adapted by UK services, and underscores the need for investment in social interventions as part of mainstream mental health care.

The other review, published in Social Psychiatry & Psychiatric Epidemiology, analysed 266 studies across 34 countries. It revealed major gaps in the reporting of participant characteristics such as ethnicity, gender and socioeconomic status. As a result, it remains unclear who truly benefits from many interventions, although there was some indication that social interventions may be less effective for people in lower socioeconomic groups.

Dr Helen Baldwin, Postdoctoral Research Associate in the Centre for Society and Mental Health at King’s College London, said: “Because most studies fail to report participants’ background characteristics, we still know far too little about who actually benefits from social and economic interventions for people with mental health difficulties. Future research must do better in representing marginalised groups if we are to understand what works, and for whom.”

 
A roadmap for change

The final publication from the programme, outlines a practical framework to improve social and economic support in UK mental health services.

Developed with input from people with lived experience, health and social care professionals and families, the model calls for:

• Routine assessment of social and economic needs in all mental health services.
• Building collaborative networks and community groups.
• Securing long-term funding for social and economic interventions – including peer programmes.
• Simplifying referral pathways between NHS and community organisations.
• Embedding awareness of cultural diversity and inequalities in care planning.

Professor Jayati Das-Munshi, Professor of Social & Psychiatric Epidemiology at King’s College London and Co-Investigator of the research, said: “This is about rethinking what recovery really means. It’s not just about reducing symptoms, it’s about helping people live full, connected and meaningful lives.”

The ENRICHED programme highlights the urgent need for joined-up services that integrate mental health care with housing, employment support, welfare access and social connection. With appropriate investment and policy reform, the new model could help tackle inequalities and improve long-term outcomes for people living with mental illness.

The research programme was supported by Maudsley Charity and the ESRC Centre for Society and Mental Health at King’s College London.

 

For more information, please contact nina.m.bryant@kcl.ac.uk or michele.harris-tafri@kcl.ac.uk.