ENRICHED
There is substantial evidence that those with a psychotic disorder, compared with the general population, are much more socially disadvantaged and isolated across multiple domains such as education, employment, housing, income and debt, social resources and networks, and are more likely to live in impoverished neighbourhoods. For example, in South London and Maudsley NHS Foundation Trust, people with severe mental disorders experience high levels of unemployment (84.9%; Chilman et al., 2024) and isolation (Morgan et al., 2008). Needs across these domains are often mutually impacting; for example, a lack of material resources prevents participation in community activities, and this can increase social isolation. This can create a vicious cycle of worsening outcomes and social exclusion where social adversities exacerbate mental distress (e.g. Jenkins et al., 2008) and poor mental health, which in turn further increases social exclusion and so on. Although social disadvantages are evident at first presentation to services, they typically worsen over time, with evidence of negative impacts on clinical (symptom) course and outcome.
In the UK, these social disadvantages are even more pronounced among those from minoritised ethnic communities, especially those of Black Caribbean and Black African ethnicity (Chilman et al., 2024; Morgan et al., 2008). In addition, there is substantial evidence that those with a psychotic disorder are substantially more likely, compared with the general population, to have been exposed, over the life course, to multiple instances of violence, trauma, discrimination, and other significant life events (Hardy et al., 2024; Trotta et al., 2015; Varese et al., 2012). We know that these social adversities and the social processes which underpin them are causally implicated in whether someone experiences psychosis in the first place. As highlighted by intersectional perspectives on mental health, service users may also experience multiple intersecting identities associated with interacting forms of social exclusion (Cho et al., 2013; Crenshaw, 1989; Rhead et al., 2022).
In short, those with a psychotic disorder are multiply disadvantaged and isolated and often have chaotic and traumatic histories, with exposure to many linked adversities. These histories, circumstances, and experiences directly impact mental health and are associated with poorer outcomes and reduced effectiveness of therapeutic interventions. Therefore, it is imperative for services to address the social and economic needs of people with psychosis to improve outcomes.
Aims
Workstream One: Evidence Synthesis
Aim 1: To review the current literature to identify and synthesise all interventions aiming to improve the social and/or economic circumstances of people with a mental health problem, including Common Mental Disorders (CMD) and Severe Mental Illness (SMI) (Barnett et al., 2022; Killaspy et al., 2022).
As part of this core aim, we address three sub-aims; (i) to map the populations and geographies involved in social interventions research; (ii) to assess whether the effectiveness of these interventions varies for different sociodemographic and socioeconomic groups, and (iii) to review and assess the effectiveness of social and/or economic interventions that have been adapted or designed for people from marginalised groups. In addition to these aims, we separately synthesised research focused on people with psychosis.
Workstream Two: Scoping the local context
Aim 2: To quantify the distribution of psychoses within South London, focusing on the identification of psychosis ‘hot-spots’ or ‘cold-spots’ and possible associations between psychosis prevalence and neighbourhood-level characteristics and indices of deprivation via the use of deidentified electronic health records.
Aim 3: To examine the extent to which social needs are currently being assessed and addressed by services across SLaM, what related services are provided, by whom, and how, using a survey of service providers across SLaM.
Workstream 3: Workshops and community partnerships – what should be done?
Aim 4: To explore the experiences and perspectives of people who have either used or delivered mental health services to determine how we can improve upon the support available for social needs.
As part of this core aim, we addressed two sub-aims: a) explore the experiences of people with lived experience of severe mental illness (including people who use services within SLaM and families/carers) regarding the existing receipt of social interventions and how this can be improved upon and b) explore the perspectives of health and social care providers, commissioners, third sector groups, and people with lived experience of mental health problems (both common mental disorders [CMD] and severe mental illness [SMI]) to create a Theory of Change regarding how social needs can be better met by SLaM services.
Aim 5: To explore current examples of excellent practice within SLaM in the field of social inclusion by creating a set of “Service Spotlights” as well as a systematic overview of the barriers and facilitators to implementation of social inclusion service, co-produced with Lambeth Vocational Services.
Methods
We used a combination of different research methodologies to address these aims, including systematic literature reviews (Aim 1); geographic mapping of psychosis ‘hotspots’ in the South London and Maudsley catchment, using deidentified electronic health records (Aim 2); service evaluation audits in South London and Maudsley (Aim 3); participatory workshops held by community partners, Black Thrive Lambeth (Aim 4); and the participatory theory of change methodology (Aim 4).
Principal Investigators
Professor of Social Epidemiology
Professor of Social & Psychiatric Epidemiology
Investigators
Postdoctoral Research Associate
Post-doctoral Research Associate
Postdoctoral Research Associate
Funding
Amount: £270,331
Period: January 2023 - March 2025