INtersectional Network Of community and stakeholder Voices, And research to Tackle (in)Equities (INNOVATE) in mental health and well-being
Lead Research Organisation:
University of Essex
Department Name: Health and Social Care
Abstract
The new England-wide Integrated Care Systems (ICS) create the momentum for reducing health inequalities in outcomes, experience, and access, while simultaneously supporting broader social and economic development. "Place-based partnerships" are recognised as key to driving this change, with several reports putting forward key functions and principles of partnership building and emphasising local action to develop community and asset-based approaches to health improvements. Local action to harness community members' resources and capabilities is central to this. Yet, the best ways to operationalize 'place-based partnerships' and reach those experiencing multiple disadvantages and exclusions to ensure 'Health for ALL' remains under-developed.
Who remains at the margins of health and social care planning?
What factors shape their exclusion and isolation and how these interact to inform states of mental ill-health and wellbeing?
How can we bring the voices and lived experiences of multiply disadvantaged groups to inform health and social care planning and resource distribution?
These questions are at the heart of INNOVATE, a consortium that brings together leading researchers from the University of Essex, the mid and South Essex ICS Board, key knowledge users, statutory services, third sector organisations and community members to drive a new transformative agenda for mental health and suicide prevention in Essex, a priority challenge for the mid-South Essex region marked by stark inequalities and deprivation.
We note that prominent understandings of health inequalities in the UK rest primarily on area-based deprivation or socio-economic inequalities. Other aspects of social disadvantage (gender, disability, ethnicity/race), and their interactions, are missed. This limits our understanding of how different aspects of one's social location or disadvantages interact with each other, and the processes that shape these (i.e. causes of causes), and the states of ill-health these produced. Intersectionality has emerged as a promising approach to better understand and more effectively respond to health inequities. However, despite its growing popularity among public policy and third sector actors, the best ways to incorporate intersectionality in studying and planning distribution of assets/ resources, in a collaborative way with affected communities, remains underdeveloped.
INNOVATE will produce new ways to consider health inequalities challenges, drawing on leading edge intersectional analysis, and offer grounded insights, practical tools and innovative approaches to build capabilities, and foster resilient systems and healthy communities. We will combine intersectionality with social-materiality perspective to develop a participatory research and action agenda in the policy field of mental health and suicide prevention, an area that bridges healthcare and social care, and requires effective integration of the two.
This will be achieved through 4 inter-related work-streams and a range of innovative participatory activities via Challenge labs, Creative research Community, Asset mapping and Advocacy forum. Collectively, the outputs from this ambitious yet achievable programme of work will support the continued efforts and respond to calls to find the best ways to accurately conceptualize and tackle health inequalities and to incorporate an intersectional perspective in operationalising a 'place-based approach'. Interdisciplinary and community engagement proposed by this research will promote a scientifically rigorous approach based on intersectionality to understand the diverse mental health needs of people and the intersecting nature of their social determinants informing the 'Integrated Care Strategy' of Mid-South Essex, but have relevance for whole of Essex, and wider applicability in ICSs across England.
Who remains at the margins of health and social care planning?
What factors shape their exclusion and isolation and how these interact to inform states of mental ill-health and wellbeing?
How can we bring the voices and lived experiences of multiply disadvantaged groups to inform health and social care planning and resource distribution?
These questions are at the heart of INNOVATE, a consortium that brings together leading researchers from the University of Essex, the mid and South Essex ICS Board, key knowledge users, statutory services, third sector organisations and community members to drive a new transformative agenda for mental health and suicide prevention in Essex, a priority challenge for the mid-South Essex region marked by stark inequalities and deprivation.
We note that prominent understandings of health inequalities in the UK rest primarily on area-based deprivation or socio-economic inequalities. Other aspects of social disadvantage (gender, disability, ethnicity/race), and their interactions, are missed. This limits our understanding of how different aspects of one's social location or disadvantages interact with each other, and the processes that shape these (i.e. causes of causes), and the states of ill-health these produced. Intersectionality has emerged as a promising approach to better understand and more effectively respond to health inequities. However, despite its growing popularity among public policy and third sector actors, the best ways to incorporate intersectionality in studying and planning distribution of assets/ resources, in a collaborative way with affected communities, remains underdeveloped.
INNOVATE will produce new ways to consider health inequalities challenges, drawing on leading edge intersectional analysis, and offer grounded insights, practical tools and innovative approaches to build capabilities, and foster resilient systems and healthy communities. We will combine intersectionality with social-materiality perspective to develop a participatory research and action agenda in the policy field of mental health and suicide prevention, an area that bridges healthcare and social care, and requires effective integration of the two.
This will be achieved through 4 inter-related work-streams and a range of innovative participatory activities via Challenge labs, Creative research Community, Asset mapping and Advocacy forum. Collectively, the outputs from this ambitious yet achievable programme of work will support the continued efforts and respond to calls to find the best ways to accurately conceptualize and tackle health inequalities and to incorporate an intersectional perspective in operationalising a 'place-based approach'. Interdisciplinary and community engagement proposed by this research will promote a scientifically rigorous approach based on intersectionality to understand the diverse mental health needs of people and the intersecting nature of their social determinants informing the 'Integrated Care Strategy' of Mid-South Essex, but have relevance for whole of Essex, and wider applicability in ICSs across England.
Publications
Arthur M
(2023)
Community participation and stakeholder engagement in determining health service coverage: A systematic review and framework synthesis to assess effectiveness
in Journal of Global Health
Kapilashrami A
(2023)
Enhancing Priority-Setting Decision-Making Process Through Use of Intersectionality for Public Participation.
in International journal of health policy and management
Kokkinidis G.
(2023)
INNOVATE Challenge Lab Report
Lax A.
(2023)
Testimonies of lived experiences: An interactive map
Vedadhir A
(2023)
Constructing Equitable Health Resilience: A Call for a Systems Approach to Intersectionality
in International Journal of Health Policy and Management
Vedadhir, A.,
(2025)
Health System Resilience Understanding Complex Adaptive Systems
| Title | Legislative Theatre - BRIGHT ORANGE TRAINERS AND BLUE LORAZEPEM PILLS |
| Description | • Purpose This research output, a thought-provoking community play titled Bright Orange Trainers, was developed to open meaningful dialogue around mental health, challenge prevailing stigmas, and create a safe and inclusive environment for discussion and reflection. By placing service-users' lived experiences at the forefront, the play aimed to bridge gaps in understanding between mental health service users, healthcare practitioners, policymakers, and the broader community. It was deeply rooted in testimony narratives, seeking to authentically articulate the complexities surrounding mental health experiences and treatment. • • Description of who it involved The play actively engaged diverse stakeholders, including mental health service-users as performers, local charity representatives, healthcare professionals, policy influencers, and the wider community audience. Developed through a series of creative workshops and reflective dialogue sessions, it provided a unique intersection between academia, arts practitioners, community advocates, and healthcare professionals. Participants experienced direct and indirect benefits, with service-users gaining skills and confidence, practitioners gaining deeper insights into lived experiences, and community members benefiting from increased awareness and sensitivity regarding mental health experiences. The inclusive and collaborative nature of this project established a model for future participatory research and creative community interventions. |
| Type Of Art | Performance (Music, Dance, Drama, etc) |
| Year Produced | 2024 |
| Impact | Influence on practice, policy or communities The play notably impacted practice and community attitudes toward mental health. Performed entirely by mental health service-users associated with a community mental health charity, it empowered participants by validating and amplifying their voices, fostering self-confidence, resilience, and enhanced wellbeing. For practitioners, policy-makers, and local communities, the production served as an influential catalyst, encouraging reflection on current mental health service provision, raising awareness of barriers faced by service-users, and inspiring critical conversations around inclusivity and systemic improvements. As a result, the performance positively influenced local policy discussions, informed community-led advocacy initiatives, and contributed significantly to shaping more compassionate, responsive mental health support frameworks. |
| Title | Lived experiences Testimonial Map |
| Description | This Testimony Map was one of the multiple collaborative outcomes emerging out of a series of Community Art Workshops. It captured: - Life Journeys captured the important events in participants lives, and the journeys they have made both physically and emotionally. The Life Journeys became intricate and revealing maps, richly textured and as brilliantly unique as their makers. Painful and celebratory in turns, they are a testament to human resilience and the importance of community. - Life Testimonies are curated extracts from enlightening conversations where we learn about each other through deep listening. These Life Testimonies are the chance to encounter other people in their own words, playing back their stories so that we meet the complete human being. Insightful, illuminating, and wise, these are narratives of survival and courage. |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2023 |
| Impact | The process of conducting these arts workshops was one of discovery and humility, meeting people who had overcome some profound challenges to be in spaces where they were investing in their recovery and making connections. Though encounters with mental health history occasionally made participants emotional, the sessions were also filled with laughter, celebration and communal support. The workshop participants were brimming with creativity and expressive abilities, and retold their own stories with precision, perception, and panache. Excerpt from the Impact case: Blending the transformative power of art and personal storytelling from poetry to photovoice participants immersed themselves in mapping their journeys and crafting Life Testimonies that revealed resilience, courage, and shared humanity. This creative process allowed them to delve into the complexities of mental health, fostering acceptance, understanding, and connection. Together, they shared their often-overlooked struggles within a supportive community, where resilience and creativity naturally flourished. A third sector partner expressed about a workshop participant: "He began speaking without worrying about his English and started expressing his thoughts freely. His willingness to give feedback about the sessions surprised other participants and highlighted his newfound confidence" "M's transformation is a true success of the project, highlighting how it helped him self-assess and improve overall". The workshops were filled with moments of laughter, tears, and shared vulnerability creating a safe, supportive space where individuals could reflect on their mental health experiences. |
| URL | https://innovate4mh.org/testimonies-map/ |
| Description | Whilst the project is still active and research and knowledge exchange activities are underway, we summarise some preliminary findings corresponding to our objectives and workstreams. These emerge from a combination of i) intersectional analysis of existing datasets (data from Understanding Society: The UK Household Longitudinal Study (UKHLS), ii) stakeholder engagement through challenge labs and policy dialogue, iii) experiential insights gained through our community workshops that involved creative arts, theatre and participatory research methods tools (asset mapping). More specifically, our findings suggest that: • There is paucity of data and statistical evidence to fully grasp mental health inequities and populations most at risk, and the interaction of conditions and environments that produce these inequities. Analysis of existing datasets is shaped by compartmentalised thinking about the healthcare needs of deprived populations identified on the basis of single axis of vulnerability (mainly socio-economic status/ deprivation). • Deeply engrained, systems-wide manifestations of organizational compartmentalisation have traditionally underpinned the design of mental health services in the UK care system. Stakeholders - Mental Health care planners, providers - highlighted how such approaches fail to reach those most in need, and effectively tackle those intersectional needs that place them at most disadvantage. Future opportunities for service redesign are likely to come from a mix of ongoing practices and learning that can be developed within and among various public, voluntary and community organisations that were previously separate; and by engaging communities left behind, in participatory and priority setting processes utilising an intersectionality lens. • The absence of more holistic intersectional approaches is exemplified in care provision where stakeholders report practitioners' focus on one dimension of care provision that may mean neglecting another. RQ -Who remains at the margins of health and social care planning? RQ - What factors shape their exclusion and isolation and how these interact to inform states of mental ill-health and wellbeing? • There are systemic issues that determine mental health of populations; and the poor burden of mental ill health is not equally distributed. Stakeholders identified a greater risk and burden of mental ill health (isolation, depression, risk of suicides) among young people living in remote areas, refugee and asylum seekers (esp. those with transient and temporary accommodations), sexual minorities, homeless and people living in coastal regions. The pathways through which these 'excess' burdens are produced need more explanation (and evidence). This is current focus of our secondary data analysis. • Intersectional disadvantages/ vulnerabilities (e.g. unemployment and insecure/ poor housing, accessibility to services, remoteness of location and poor transport networks) impact the odds of mental health. Different dimensions of neighbourhood deprivation intersect with distinctly vulnerable populations to create unique mental health profiles. For example, areas with high barriers to housing and services adversely impact people with physical disabilities and poor-quality neighbourhood housing intersects with migrants (and ethnic minority groups) with minority sexual orientation to lower mental health. • Whilst innovative ways (e.g. use of art-related activities) are emerging as popular and promising approaches to engage communities, and provide a more situationally informed view of how mental health services are experienced, there are critical challenges to engage most disadvantaged groups at the intersections of multiple dimensions of precarity in a sustained and meaningful manner. • More time and methodological innovation are necessary in reaching these groups and engaging them in a process that helps identify needs as well as solutions. In this content, we have developed an intersectionality informed guidance for engaging communities and stakeholders in priority setting and intervention design, and are engaging in wider consultations for its uptake. • Great scepticism on the suitability of existing green and blue spaces in helping to address mental health burdens and improve wellbeing of those who are at the intersections of multiple disadvantages and precarious living (esp. care givers, people with disabilities, precariat housing and living). RQ - How can we bring the voices and lived experiences of multiply disadvantaged groups to inform health and social care planning and resource distribution? Our findings suggest that there is a strong appetite among all key stakeholders for: • Developing integrative community-based approaches to mental health care that would be based upon: i) integration of existing practices and knowledge; ii) processes of co-designing and implementation of community-based approaches that would encourage greater participation and control over mental health care services by the community. • The need to invest in collective discussions that could underpin a new culture of health and social care. • Reorient the system of user involvement/incorporating voices around more meaningful forms of engagement with service users. • Use of new technologies to develop an intersectionality-informed asset map that would not only document existing assets in the region, ensure its sustainability and regular updating, community ownership while also offering opportunities for greater collaboration across all stakeholders. |
| Exploitation Route | Other research networks, statutory organisations and TSOs can utilise: 1. Intersectional analysis of local/ regional data on mental health to identify those populations carrying disproportionate burden. 2. Our intersectionality informed guidance to engage disadvantaged groups in further consultation and its application to co-design effective services and intervention; 3. Use our participative methodology and Legislative theatre to involve wider audience and disadvantaged groups in priority setting and developing solutions. 4. Follow-on funding will help pilot the guidance to define community-led integrated interventions and assets that are being scoped through this work. |
| Sectors | Communities and Social Services/Policy Digital/Communication/Information Technologies (including Software) Healthcare Culture Heritage Museums and Collections Other |
| URL | https://innovate4mh.org |
| Description | The project has resulted in multiple impacts of third sector practice, engagement techniques We are still finalising some outputs including analysis of secondary data on mental health and healthcare inequalities utilising intersectionality lens. However, given the scope of proposed work in INNOVATE, and the aim to establish a multi-stakeholder and multi-disciplinary consortium that brings together a diverse range of subject and experiential experts and stakeholders from Essex to examine inequities in mental health, the project is yielding critical insights and collaborations for realising impact. We have successfully: 1. Established a network involving NHS Integrated Care Boards, local authorities, community organizations, academic and community researchers, service providers, and people experiencing multiple disadvantages, who have come together to share insights, evidence and assets linked to mental health in the region. We have an active website focused on 'innovating for mental health' that is subscribed by all our partners. https://innovate4mh.org/about-us/ 2. Developed consensus on the need for applying intersectionality in analysing data/ evidence to identify most vulnerable/ at risk and are beginning to undertake such analysis collectively. 3. Co-develop new guidance for applying an intersectional approach in engaging communities in tackling health disparities in mental health and well-being. The draft guidance was reviewed by partners and through a collaborative work revised in line with stakeholders' needs int he community. 4. Demonstrated the value of arts and theatre based approach in tackling mental health challenges - the project has adopted a distinctive approach of legislative theatre to activate the stories collected from a series of interviews with mental health service users, family members and mental health workers. Legislative Theatre elicited active participation from the audience to respond to the stories presented with the aim to act out potential solutions. The success of using this approach together with policy dialogue is evidenced in additional requests received from consortium members (TSOs and local authorities) to replicate and adopt this approach for priority setting. There is also consensus achieved on the need for co-designing integrative community-based approaches to mental health care that that would encourage greater participation and control over mental health care services by the community. One of our TSO partner further collaborated with Prof Annecy Lax to develop a new script of Legislative theatre - titled "Bright Orange Trainers and Blue Lorazepem Pills". To this end, our vision for the next stage is to amplify the learnings on tackling health inequalities, the power of participatory methods, and integrated care design for mental healthcare. These findings are now informing training and capacity strengthening in other regions including Manchester as well as internationally. We anticipate using the guidance to co-design integrated services that would integrate social determinants and assets within mental healthcare provision. This model foregrounds community empowerment and collaboration and will be crucial in consolidating and building on existing community initiatives and improving access to community assets. |
| First Year Of Impact | 2023 |
| Sector | Communities and Social Services/Policy,Healthcare |
| Impact Types | Societal Policy & public services |
| Description | Board Member Clacton Towns |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Contribution to new or improved professional practice |
| Description | Future funding for our practice partner- Third sector organisation |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The funding success was driven by Trustlink's uptakte of the powerful legislative theatre that we incorporated into the project, and engaged 40+ key stakeholders from across the Essex Care system. An excerpt from our impact evaluation of the project- One of INNOVATE's successes was highlighted when participation in the legislative theatre led other consortium partners to adopt this strategy for more effective planning, co-production and creating community solutions. Trustlinks, a consortium partner, used legislative theatre as a transformative tool to bring the voices of service users to the forefront in their annual Wellbeing Recovery Conference in Rochford. Reimagined through the lived experiences of community members and service providers, the performance was brought to life by local actors, giving a powerful voice to those often unheard. Before an audience of over 100 stakeholders including service providers, mental health organizations, policymakers, and service managers-the performances powerfully illustrated diverse mental health challenges, experiences accessing and providing mental health services, as well as the hopes and dreams of people coping with mental health challenges. This helped to highlight inequities and the critical need for personalized mental health services. These performances did not just move hearts; they opened doors to new funding opportunities and fostered deeper engagement with both service users and planners. ""We just got a nice grant to do further engagement in Castle Point and Rochford, and that was a direct result of the conference. The lady who encouraged us to do the bid and agreed the funding came to our conference, and she said she was in tears through it because of the powerful stories of the people that spoke." Reflecting on the power of legislative theatre, a Trustlinks representative shared: "I do think things like that conference Innovate held in April was really powerful in that it did really amplify the voices of the people and the individual voices, and I haven't been to many things that do that very effectively. We do have a lot of meetings, where they talk about, you know, processes, and planning and strategy and budgets and all this stuff. But there's not a lot of the real voices of real people and really I think, that legislative theatre did that really powerfully". |
| Description | Training provision for Manchester Integrated Care Board |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | Intersectional Network for Integrated Mental Healthcare |
| Organisation | MQ Mental Health Research |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Establishing collaboration in proposal development stage, seeking funding for the deliverables, regular meetings to plan activities and outputs. |
| Collaborator Contribution | Supported the evidence workstream and contributed to the Challenge Lab and Theory of Change |
| Impact | ALL outputs (Challenge Lab and Asset analysis) created in workstream 1 and 2 were jointly produced. |
| Start Year | 2022 |
| Description | Being Creative for Health Improvements - Participatory Methodologies in HS Research, design and evaluation - Capacity Building Workshop at the 8th Global Symposium on Health Systems Research |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | We ran a half-day workshop on arts-based creative methodologies that can be utilised for health systems research, design and evaluation. Event Overview The workshop was a capacity-building session focused on creative participatory methods in health systems research, design, and evaluation. It introduced dynamic, arts-based techniques to enhance community engagement, co-creation, and reflexive praxis among stakeholders and researchers. We utilised specific examples of arts-based rich picture methods and legislative theatre as promising examples. Using Photovoice, Theatre, Rich Pictures, and Quiz Methods, participants explored inclusion and exclusion in health systems, grassroots activism, and the gap between policy and practice. The session featured case studies from India, Bangladesh, Benin, and the UK (based on Innovate), demonstrating the real-world application of creative methods in diverse settings. Event Participation A total of 82 researchers attended this half-day participatory workshop, with 61 actively engaging in exercises such as Photovoice, Forum Theatre, Rich Pictures, Fishbowl Experience, World Café, and Quiz Methodology. Event Impact The workshop highlighted the power of participatory, arts-based approaches in breaking disciplinary silos, amplifying marginalized voices, and fostering reflexivity in health systems research. Key outcomes included: • Empowering participants to integrate visual and performance-based methods into their research. • Challenging traditional knowledge hierarchies by emphasizing Southern voices and non-academic perspectives. • Strengthening cross-disciplinary collaboration across economics, sociology, public health, and development studies. • Evaluating the HSR conference itself through participatory tools, providing real-time feedback on inclusivity, accessibility, and representation. Capacities built by this session This session built practical research capacities by: • Equipping researchers with hands-on skills to implement community-driven, participatory research approaches. • Demystifying creative methodologies, making them more accessible to health systems researchers. • Developing strategies for reflexive engagement, ensuring that policy decisions align with lived experiences. • Training participants in critical evaluation methods through Photovoice and Quiz Methods, allowing them to assess large-scale events like HSR 2024. • Immersive experiences of world café, quizzing and fishbowl to integrate interaction in capacity-building forums, making this a bidirectional exchange of information We further utilised the photovoice method to train early career researchers in evaluating the conference. The activity was very well received. This participatory workshop demonstrated the transformative potential of arts-based methods in health systems research. By fostering reflexivity, amplifying hidden voices, and creating actionable insights, the session contributed to a more inclusive, practical, and policy-relevant research environment. Looking ahead, these insights will guide future community-driven, participatory research approaches at HSR 2026 and beyond. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.linkedin.com/posts/c4ghier_hsr2024-nagasaki-healthsystems-activity-7261584805278969856-S... |
| Description | Challenge Lab: Engaging stakeholders in interrogating Integrated Mental Health |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Third sector organisations |
| Results and Impact | Twenty three participants attended the event, bringing together a diverse group of stakeholders (researchers, service providers, charities, local authority representatives, community groups and community representatives) to collaboratively identify data gaps of service use and/or burden of mental health, map existing assets, reflect on challenges and barriers to mental health services and explore ways to create meaningful collaborations and a supportive ecosystem to tackle mental health inequities. Consensus was achieved on the need to establish a network focused on applying intersectionality to examine most at risk populations, and co-producing asset maps and examining lived experiences of mental health with these groups. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://innovate4mh.org/challenge-lab-report/ |
| Description | Community art workshops and testimonies |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | A series of community arts workshops conducted with individuals who are coping with mental health conditions was a celebration of creativity and healing. Through the transformative power of art, including creative writing, poetry, drawing and crafting participants (from communities) embarked on sessions of self-expression and self-discovery. Working with local charities and mental health support organisations, these workshops provided nurturing spaces where people could share their unique experiences and connect with one another on a deeply empathetic level. The process allowed them to explore the intricate tapestry of their mental health conditions, fostering a sense of understanding, acceptance, and unity. As a result, the workshops not only gave voice to the often-silenced struggles of individuals but also created a vibrant, supportive community where resilience, courage, and shared creativity flourished. This fusion of art and mental health was a testament to the profound encounters that can occur when people come together to celebrate their inner strength, resilience and humanity. Output - Visual testimonial map that included: 1. Life Journeys captured the important events in participants lives, and the journeys they have made both physically and emotionally. The Life Journeys became intricate and revealing maps, richly textured and as brilliantly unique as their makers. Painful and celebratory in turns, they are a testament to human resilience and the importance of community. 2. Life Testimonies are curated extracts from enlightening conversations where we learn about each other through deep listening. These Life Testimonies are the chance to encounter other people in their own words, playing back their stories so that we meet the complete human being. Insightful, illuminating, and wise, these are narratives of survival and courage. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://innovate4mh.org/testimonies-map/ |