Despite previous work focussed on the social determinants of psychoses and other severe mental health conditions' onset, course and outcomes, key questions remain. There has been limited research on the impacts of social and environmental conditions, and few studies have focussed specifically on the experiences of racially minoritised groups.
The UK census is conducted every ten years and collects detailed information on social indicators like migration status, housing, education and employment. Our project links data from the Census with clinical records from one of Europe’s largest secondary mental health providers, South London & Maudsley Trust (SLaM Trust). SLaM provides mental health care to an ethnically diverse, urbanised location in South East London, with a catchment area of 1.3 million people.
This data linkage is unique because it provides details on social and economic conditions which are often not included, missing or captured inadequately in standard electronic health record systems. Through advanced statistical methods and informatics, we will analyse the data to better understand relationships between mental health, employment, ethnicity and overlapping forms of disadvantage. Our research questions will inform current service, treatment and policy concerns relating to the severe mental illnesses.
In Phase 1, we completed ethics applications and established a linkage of Census 2011 records to electronic health records of service users from South London & Maudsley Trust (though the NIHR Maudsley BRC Clinical Record Interactive Search (CRIS) system). This has led to a linked cohort of more than 20,000 people with severe mental health conditions such as schizophrenia, bipolar affective disorders, and major depression. Each case was matched to 5 population controls, who did not have these conditions. The linkage will enable us to examine the social determinants of onset, course, and outcomes (admissions, worklessness and mortality) in people living with severe mental health conditions. We also developed a network of individuals from universities, commissioners, policymakers and third sector organisations to increase the reach and impact of our work.
Phase 2 is dedicated to data analysis using advanced statistical methods. We will engage community members and partners around the methods of analysis and accessibility of research processes. Our findings will be shared in collaboration with our partners, through email, social media, meetings, and conferences.