Poverty, pathology and pills: moral narratives and the medicalisation of distress

Lead Research Organisation: University of Exeter
Department Name: University of Exeter Medical School

Abstract

The provision of effective treatment and support for mental distress is a stated aim of the Department of Health and civil society organisations e.g. Mind. Yet despite a stated need to tackle health inequalities, current strategies e.g. Closing the Gap: Priorities for Essential Change in Mental Health (DoH 2014), frame mental distress as a psychological problem that lies within the individual concerned. This not only suggests that distress can be 'corrected' through medical treatment, but also masks the factors that often underlie the root causes of suffering e.g. poor living conditions, unemployment. At the same time, policies in place to restrict welfare support, and popular media e.g. Benefits Street, draw on moralising narratives that promote the idea that people are responsible for their own actions and circumstances. This research aims to explore how these moralising narratives impact on the ways that people in low-income communities perceive and respond to mental distress caused by material deprivation and social disadvantage, and to examine the impacts of this on their wellbeing. This will be achieved through in-depth research in two low-income communities in the South West, which seeks to understand: i) the way that moral narratives are defined and used or resisted in people's everyday lives in relation to mental distress; ii) the influence of moral narratives on people's decisions to seek medical support for distress; iii) how moral narratives manifest within GP consultations and influence treatment decisions and patient wellbeing; and iv) which responses to mental distress have the potential to effectively support vulnerable populations, and to inform ethical debates on the medicalisation of distress in a way that benefits patients, and assists practitioners and policy makers seeking to support low-income communities.

This 30 month programme of research consists of two linked stages:
1) 96 people from 2 targeted low-income areas will participate in focus groups to explore how moral narratives are defined and used/resisted in people's daily lives. Groups will be divided by gender and age to identify any differences across groups. Information collected in Stage 1 will provide informed contextualisation for data collection and analysis in Stage 2.

2) Secondary analysis of 60 video-recorded consultations will enable insight into the contexts in which GPs and low-income patients discuss mental distress. In-depth analysis of 30 consultations will identify how GP-patient interaction influences decision-making to prescribe/accept or withhold/reject treatment. Further insights will be gained through interviews with 10 GPs in the study sites and repeat interviews with 40 people from low-income communities who have attended a GP consultation for mental distress. The first interview will focus on the person's experiences of distress and the role of moral narratives in i) their decision to seek medical consultation, and ii) their responses to the treatment or intervention prescribed/accepted or withheld/rejected. The second interview will enable participants to reflect on their experiences of mental distress within the wider context of daily pressures e.g. poor living conditions, their decision to seek medical support, and the outcome of the GP consultation.

The research programme is intended to have strong and distinctive impacts for user groups by informing policy and practice regarding the development of effective, meaningful and non-stigmatising responses to mental distress in low-income communities. This will be achieved by advancing understanding of i) people's use/resistance of moral narratives of responsibility (why? when? how? where? with who?); ii) the relationship between moral narratives and the medicalisation of distress; iii) the ethical implications of prescribing antidepressants for distress induced by poverty/deprivation; iv) identification of GP-patient interactions that enable positive wellbeing.

Planned Impact

The project is designed to include key stakeholder's perspectives from the outset and to maximize opportunities for co-production of impact and knowledge exchange through engagement with low-income communities, healthcare professionals, policy makers and civil society organisations (see also Pathways to Impact):
Low-income communities: incorporating patient's perspectives to improve healthcare provision is a core priority of the UK government. Involvement of low-income residents on the project Advisory Board will ensure engagement and impact with low-income communities from the outset. An Introductory workshop in the study sites will enable local communities to negotiate ways of working and participating in the research that will increase the applicability and utility of the study. A Knowledge Co-Production workshop in each site once data is collected will enable communities to discuss findings and i) agree methods of dissemination to other low-income communities e.g. via national C2 network, ii) agree key findings and priorities to inform guidelines on good practice for health practitioners, iii) guide the focus and aims of, and share experiences and ideas at, a high-impact two-day Research-Policy Briefing Seminar in London alongside presentations by experts in the fields of social inequalities, mental health, and community wellbeing e.g. What Works Centre for Wellbeing, Joseph Rowntree Foundation, McPin Foundation.
Health professionals: identification of GP practice (relating to mental distress) that enhances patient wellbeing will be developed into guidelines on good practice for health professionals working in low-income communities. Health professionals will draw on their experiences to refine the guidelines at a Regional Practitioner workshop, and agree a dissemination strategy that maximizes their utility for the health sector. Participation in the workshop by local authorities charged with health provision e.g. Teignbridge DC & Plymouth CC, will ensure findings feed in to local health plans e.g. Devon Joint Health and Wellbeing Strategy. Networks developed during the project will lead to oral presentations at practitioner-focused events and regional clinical commissioning groups. Impact will be evidenced through changes to working practice amongst GPs that enhance wellbeing in low-income communities.
Civil society groups: valuable relationships will be built through networks of the project Advisory Board (AB) whose members represent key user groups and stakeholders (see Pathways to Impact for confirmed membership). AB members will provide ongoing feedback on the research to their organisations/communities, and develop networking opportunities with other potential user groups e.g. Mental Health Foundation, Young Foundation, Turning Point. User groups will be encouraged to contribute discussion and case studies to the project website, and will promote the research and its findings on their websites. Involvement in the Research-Policy Briefing Seminar will enable academic and user group networking and collaboration, and identify how research findings can be practically and effectively implemented to support low-income communities.
Policy: Joining up understandings of mental distress with the broader social and structural context in which they are experienced will provide key policy makers (with whom links will be fostered via the AB) e.g. Dept. of Health, Dept. for Communities & Local Government, Dept. for Work & Pensions, as well as the cross sector Mental Health Taskforce and public bodies e.g. Social Mobility & Child Poverty Commission, Fairness Commissions, with an evidence base to inform implementation of key strategies e.g. No Health Without Mental Health Implementation Framework (Centre for Mental Health et al. 2012). Internationally, findings will inform the WHO Europe Health 2020 policy to reduce health inequalities via Thomas's (PI) work with WHO on cultural determinants of health (see Pathways to Impact).
 
Title Community co-created film 
Description A film about lay experiences of distress directed and produced by community members in the study sites 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact The film highlighted mental stress experienced in the study sites and helped community members openly discuss having issues of stress and anxiety. This linked more people in to local peer support groups and also led to a further community member being recruited onto the project Advisory Board. This film has been used at a Advisory Board meeting where it generated considerable discussion amongst members from third sector, commissioning and practitioner backgrounds around biomedical and social models of mental health. It will also be used as the basis for health practitioner training on experience of distress within low-income communities. 
URL https://youtu.be/o30xL7HrK8g
 
Title GP training film clips 
Description A series of film clips on the experiences of low-income patients attending GP consultations for mental health issues 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact The film clips were developed by community members on the project advisory board. They have been used as training materials at two workshops for health professionals (one group of medical students, one group of established GPs and health professionals); at a conference workshop for health professionals; and at the project conference in London. Feedback from, and evaluations of, these events have identified the film clips as having powerful impacts on the ways that health professionals understand the experiences of low-income patients. Health professionals have stated in evaluations that this will influence their clinical practice, in particular, through making them less judgemental and more understanding of the anxieties people may have attending a consultation for mental health, and in thinking through how best to provide more personalised and potentially non-medical forms of support. The film clips will also be used as part of the GP training we will be developing with the Royal College of GPs over the coming year. 
 
Description The role of narratives of responsibility in the medicalization of distress:
Three types of narrative were identified as impacting on mental health and wellbeing in low-income communities: a 'neoliberal narrative', which leads to feelings of guilt and helplessness; a 'shame narrative', which leads to fear of judgement and avoidance of help seeking; and a 'medicalization narrative', where distress is considered a pathological issue requiring medical intervention. These narratives were pervasive in people's everyday lives, impacting adversely on behaviour and identity, and reducing people's trust and willingness to seek support. These narratives and the current system of welfare rules feed into a paradoxical situation where people feel blamed and unable to seek care, yet where drivers exist to push people into care that is inappropriate and often disempowering, and where GPs feel they have few options available to them that do not exacerbate the over-medicalisation of poverty-related stress.

How welfare reforms and austerity impact on mental health:
The complexity of welfare reform was widely reported as a key source of stress. To avoid the shame and stigma of poverty, people feel pressure to 'legitimise' poverty-related distress to their families, friends and key services e.g. job centres. The medicalization of distress is greatly exacerbated by the need to medically legitimise welfare claims, encouraging people to seek medical help, and invest in narratives around the 'normalcy' and 'need' to see and act on themselves as in need of treatment. People felt a need to be seen as 'taking control' of their lives - either through avoiding support services, or through adhering to expert advice - or risk being seen as irresponsible and undeserving.

How mental health treatments are used in low-income communities:
People face difficulties accessing mental health support, and when they do, it is often inappropriate to their needs. Use of Conversational Analysis alongside narrative methods identified widespread dissatisfaction with the medical model for mental health amongst GPs and low-income patients. GPs face considerable pressures (reiterated through medical education and NICE guidelines) to 'fix' patients through mental health diagnosis and treatment. Antidepressants have low effect rates and can be harmful, yet are commonly used long-term in low-income communities. IAPT (talking therapy) is rarely considered helpful by people experiencing poverty-related distress and self-referral is a significant barrier to uptake. Lack of GP endorsement for antidepressants and IAPT is common, and has negative implications for patient wellbeing and for GP stress and burnout.

How can people experiencing poverty-related distress be better supported?
GPs need to be better supported to adopt a role that recognises the bio-psycho-social and is aware of non-medical forms of support. Responsibility for poverty-related distress needs diluting away from GPs to other sectors, as well as to communities themselves. Recognition of a 'third way' between blaming neoliberalism and absolving people from all responsibility for their lives is required. Whilst not condoning the current situation of poverty and austerity in any way, there is a need to recognise that people can overcome adversity through action that does not resort to unnecessary over-medicalisation.
Exploitation Route We are working with Health Education England and the Royal College of GPs to refine and accredit the GP training materials. They will then be put to use as training for GPs working in low-income communities across the UK. The training materials may also be used in postgraduate and undergraduate medical education. Research findings also have the potential to inform mental health commissioning relating to the provision of more personalised IAPT (talking therapies).

Key findings on dissatisfaction with, and low endorsement of, existing mental health treatments may be used to inform new styles of primary care consultation that focus on a more holistic and supportive bio-psycho-social approach, reduce over-medicalisation, and work more effectively with community-based assets.

The project has demonstrated the value of combining narrative and conversational analysis to elicit in-depth understanding of the ways that social interactions impact on lived experience of mental wellbeing. Key areas that might be taken forward within academic research relate to missed opportunities for action within GP consultations, and in-depth understanding on how treatments are prescribed and taken up.

Findings also demonstrate the value of co-creating research with communities and project stakeholders, and may help inform researchers keen to undertake engaged research.
Sectors Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice

URL http://destressproject.org.uk
 
Description The research process and findings from the DeStress (Poverty, Pathology and Pills) project have been used and achieved impact beyond academia in the following ways: Sustained engagement with project stakeholders has maximised opportunities for the co-production of impact and knowledge exchange across low-income communities, healthcare professionals, policy makers and civil society organisations. Participation on the project Advisory Board has enabled a wide collaborative network to develop across the fields of health equity and community wellbeing, mental health support, policy and applied healthcare. Requests to attend project Advisory Board meetings have also been made by representatives from Public Health England and mental health commissioning, as well as from a former lead on health inequalities at the Department of Health. Networking has also been supported through the project website http://destressproject.org.uk, which has promoted project information, events, blogs, podcasts and resident-led film to over 4000 individual users, and via social media, with over 220 twitter followers. The involvement of low-income residents (experts by experience) on the Advisory Board has been crucial in guiding the project to understand and address the concerns of this population group, and in enabling the engagement of other low-income communities through the C2 Connecting Communities (http://www.c2connectingcommunities.co.uk) national network. This has involved a series of resident-initiated community exchange visits in which experiences of supporting mental wellbeing have been shared; resident involvement in the C2 national learning event; and the involvement of residents from other low-income communities in the UK as speakers at the DeStress project conference. The project has also had impact for mental health policy. Presentations on findings made to health care commissioners have influenced discussions on IAPT provisioning in the south-west, with initial steps now being made towards more personalised support for people experiencing poverty-related distress. Findings have also fed into discussions on the need for better provisioning for community mental health teams in the most deprived areas of Plymouth. Earlier findings from the project have also been used to feed into the redesign of early help support for families facing statutory intervention in Plymouth, with Plymouth City Council now committed to involving vulnerable families in the co-creation and commissioning of services. Findings from the project have been used to develop training materials for primary health care professionals working with people experiencing poverty-related distress. These materials include film clips developed by residents involved in the study. The materials were presented at two Regional Health Practitioner workshops, one targeted at medical trainees, one at established health professionals. They were also presented to health professionals and policy makers at the DeStress conference held at the Wellcome Collection, London. Feedback has been extremely positive, with health professionals identifying a number of areas in which they have acquired new knowledge that they feel will lead to a change in clinical practice e.g. being less judgemental of low-income patients; questioning diagnosis and prescribing for poverty-related distress; seeking non-medical forms of support personalised towards patients. We are currently working with the Royal College of GPs (with support from Health Education England) to refine and accredit online training materials, ensuring that they will be available and promoted to GPs across the UK. Impact has also been achieved via the project's two-day research-policy conference held at the Wellcome Collection, London in January 2019. This event attracted considerable interest, with over 120 people signing up (plus waiting list), and 94 attendees. Attendees comprised policy makers, health professionals, civil society and academics. Speakers included Helen Stokes-Lampard (Chair, RCGP), Paul Farmer (CEO, Mind), Gregor Henderson (Mental Health Lead, Public Health England) and Kate Cornford (Mental Health Policy Lead, OECD). Feedback on the event has been extremely positive, with formal requests for more information on the project from Public Health England, OECD and the McPin Foundation. Evaluations of the event also identified a range of ways that the project findings and conference discussion had influenced thinking and practice. In particular, areas that influenced thinking and practice related to the project's approach to community engagement and co-creation; the use of antidepressants for poverty related distress; and the ways that health professionals could revise clinical practice to provide more supportive and personalised care to patients in a way that did not over-medicalise poverty-related distress. Presentations from the event are available on the project website in slide and film format, ensuring that the event will have impact beyond the lifespan of the project funding.
First Year Of Impact 2017
Sector Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice
Impact Types Cultural,Societal,Policy & public services

 
Description Contributing to re-design of mental health services in Plymouth
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description Informing working practice of Mind
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact The findings of the DeStress project have led Plymouth and District Mind to support their clients to 'Find the Words' they need to speak with their GP about their mental health. This is supported by a printed resource that they can take with them to their GP. Current feedback to Mind has shown that this resource is helpful in ensuring that the consultation meets the needs of the patient. Plymouth and District Mind also delivers services from GP surgeries in some of the most deprived areas of Plymouth, where they report that they have been able to embed learning from the project into practice.
 
Description Written submission for the Visit by the United Nations Special Rapporteur on extreme poverty and human rights to the United Kingdom
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description ESRC IAA Co-creating early support for families with complex needs
Amount £15,535 (GBP)
Organisation ESRC Impact Acceleration Account Cambridge 
Sector Academic/University
Country United Kingdom
Start 04/2018 
End 03/2019
 
Description Engaged Research Exploratory Award
Amount £2,930 (GBP)
Organisation University of Exeter 
Sector Academic/University
Country United Kingdom
Start 01/2018 
End 07/2018
 
Description Engaged Research Exploratory Award
Amount £2,910 (GBP)
Organisation University of Exeter 
Sector Academic/University
Country United Kingdom
Start 01/2019 
End 06/2019
 
Description Engaged Research Exploratory Award
Amount £4,385 (GBP)
Organisation University of Exeter 
Sector Academic/University
Country United Kingdom
Start 05/2017 
End 07/2017
 
Description Health Education England
Amount £10,495 (GBP)
Organisation Health Education England 
Sector Public
Country Unknown
Start 04/2018 
End 12/2020
 
Description MRC TRACES FUND
Amount £24,955 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 02/2019
 
Title DeStress database 
Description This dataset comprises transcripts from 16 focus groups (participation n=97); 80 semi-structured interviews with patients; 10 semi structured interviews with GPs. The database is currently being formatted for submission to UKDS by end of April 2019. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact Use of database to analyse project findings for presentations and papers. 
 
Description Collaboration with National Institute for Mental Health, Czech Republic 
Organisation The National Institute of Mental Health
PI Contribution The methodology and narrative approach used in Destress has been of interest to partners at NIHM and WHO Europe who are looking to understand how cultural factors influence mental health and mental health reform.
Collaborator Contribution NIMH worked with the DeStress PI and WHO Europe to run a collaborate workshop on the cultural aspects of mental health reform in Central and Eastern Europe.
Impact A two day workshop on the cultural aspects of mental health reform in Central and Eastern Europe was held by the collaborators in Klecany, Czech Republic. This was a multi-disciplinaly collaboration involving: psychiatrists; psychologists; social scientists; historians; economists and focused on the value of using narrative, participatory and qualitative approaches to understanding lived experiences of mental health and mental health related policy making. The discussions from the workshop have been published as a WHO report (2018) in English and Russian. As a result of this work, the PI is also working with workshop participants from Belarus and Ukraine to develop further work on using narrative approaches to understand lived experience.
Start Year 2017
 
Description Health Education England training 
Organisation Health Education England
Department Health Education England Thames Valley
Country United Kingdom 
Sector Public 
PI Contribution We have been funded by Health Education England to produce training materials for GPs. This has included the delivery of two workshops for GPs and health professionals across the south west.
Collaborator Contribution Health Education England have funded the development of training materials. They also funded a ST3 medical student to work with us to develop these materials for half a day a week for a year.
Impact Training workshop for approximately 25 medical students from in and around Plymouth. Training workshop for approximately 30 GPs and health professionals from across the South West. Both workshops were run jointly by the research team and community members and both included film clips made by community members on our project advisory board. Both workshops received excellent feedback and have led to discussion on incorporating the materials into the medical curriculum. We are also working with the Royal College of GPs to accredit the training materials. The collaboration is multidisciplinary, involving the following disciples/sub disciplines: medicine; psychology; anthropology; youth and community work; public health and also involves members of the public co-creating training materials.
Start Year 2018
 
Description 3rd Resistance Day at Loughborough University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Resistance Day is a biannual, one-day meeting which focuses on the theme of interactional resistance. A data extract from the DeStress Project on this theme was presented at the 3rd of these meetings, with attendees (comprising academics who specialise in conversation analysis and related methodologies) invited to comment on how the interaction played out. Outcomes included additional insights into existing analytic points, as well as suggestions of new analytic points that could be pursued.
Year(s) Of Engagement Activity 2018
 
Description C2 learning event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Involvement in a C2 Connecting Communities event with low-income residents from across the UK. This helped to raise awareness of the Destress project, providing opportunities for low-income residents to share experiences of poverty-related distress and responses to this, and to attract community 'experts by experience' to speak at the DeStress project conference.
Year(s) Of Engagement Activity 2018
 
Description Co-production of newsletter with study site communities 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Co-development and production of community newsletters (x2) with residents in the project study sites. The second newsletter focuses on peer support, with residents identifying organisations in their locality that provide support for poverty-related distress. This information has been requested by health professionals working in Plymouth so that they can refer patients to community based support.
Year(s) Of Engagement Activity 2017,2018
URL http://destressproject.org.uk/newsletter/
 
Description Collaborative workshops with low-income families and service providers to influence the formation of Plymouth's Chlid Poverty Strategy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Building on relationships developed with local parents through the DeStress project and with the Children's Centre (run by Barnardo's) we ran a series of workshops bringing together low income parents, local service providers and Plymouth city council policy makers and commissioners to discuss the implementation of the city-wide Child Poverty Action Plan. As a result parents views and opinions were taking into account and the plan was reviewed, and PCC are committed to ensuring parents' voices are heard in future service plan developments. Also as a direct result of feedback from parents in the workshops Barnardo's have introduced two new parent drop-in sessions in two local areas to increase accessibility to their support services (Coffee and Craft session at Four Woods Children's Centre and Community Café at The Barn).
Year(s) Of Engagement Activity 2017
 
Description Community exchange visit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact Following the initial 2 meetings of the DeStress Advisory board, community members from the two study sites community members expressed a wish to get to know each other and to learn and exchange ideas around peer support groups. Three community members of the Advisory group from Plymouth and a Housing Officer from DCH, travelled to Teignmouth in September 2017 to meet various groups at the local Teignmouth hub - the Pow Wow café, (approximately 25 people in total). The Teignmouth community hosted this visit to meet key community leaders and the members of 2 peer support groups, Crafters of the Round Table (operating from the café, they have created an informal drop in that anyone can join that is a very popular peer support group for mental health). They also met with the Advisory members from Teignmouth - the Helping Hand Low Moods group to hear from the wider members how they started the group and their ingredients for success. The outcome of the day was that the Low Moods Group offered to come to Plymouth and to support the community in setting up their on version of a community support group, sharing all the experiences gained on their journey (detailed further in DeStress community newsletter).

This follow up support happened in November with six members of the Helping Hands groups offering support and mentorship to the gathering of eight people who had self selected to try and create their own support group
Year(s) Of Engagement Activity 2017
 
Description Creation of community networks 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact The DeStress project team was introduced the Creative Minds Art Group in Plymouth via an Advisory Group member. In collecting stories for the newsletter to highlight effective peer support groups in the local areas the project attended the group to introduce the project and to ask if they would like to talk about their group for an article. The group agreed and in meeting them and understanding their plans to reach a wider audience, have connected them to Townstal Community Partnership group to share funding ideas for their group that could reach out to, and support more people with mental health issues.
Year(s) Of Engagement Activity 2017
 
Description DeStress Project Twitter account 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Twitter account was set up to disseminate materials both from and relevant to the DeStress Project and its aims, and to network with other individuals working in related areas. It currently has 226 followers. It was of particular use during the January 2019 DeStress Conference, where it was used to live tweet presentations and discussions. These tweets received a lot of engagement (likes and retweets) from both conference attendees and individuals following the conference on Twitter. Attendees also sent praise, both for the conference and the project as a whole, to the account.
Year(s) Of Engagement Activity 2017,2018,2019
URL http://twitter.com/destressexeter
 
Description Developing an ideal primary care mental health system for areas of deprivation 
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 A workshop on 'Developing an ideal primary care mental health system for areas of deprivation' at the Universal Health for All conference, held in Malta, Dec. 2018. The workshop was run by project Co-I, Richard Byng (a GP) in collaboration with one of the residents who sits on the project advisory board. It sparked questions and discussion and the audience reported that they would consider changes in working practice with patients from low-income communities experiencing mental health related issues.
Year(s) Of Engagement Activity 2018
URL https://uhmhcongress2018.net/assets/files/CongressBook.pdf
 
Description Discourse Bee seminars at University of Exeter Medical School 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Discourse Bee is a series of fortnightly meetings focusing on the analysis of interactional data. Data extracts from the DeStress Project were presented at two of these meetings, with attendees invited to comment on how the interaction played out. Outcomes included additional insights into existing analytic points, as well as suggestions for new analytic points that could be pursued.
Year(s) Of Engagement Activity 2018
 
Description Discourse and Rhetoric Group Meeting at Loughborough University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact The aim of this meeting was to present data from the project for a group of academics who specialise in conversation analysis and related methodologies. Outcomes included additional insights into existing analytic points, as well as the suggestion of new analytic points that could be pursued.
Year(s) Of Engagement Activity 2018
URL http://www.lboro.ac.uk/departments/socialsciences/research/darg/
 
Description Discourse and Rhetoric Group meeting at Loughborough University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact The aim of this meeting was to present data from the project for a group of academics who specialise in conversation analysis and related methodologies. Outcomes included additional insights into existing analytic points, as well as the suggestion of new analytic points that could be pursued.
Year(s) Of Engagement Activity 2017
URL http://www.lboro.ac.uk/departments/socialsciences/research/darg/
 
Description Exeter Collaboration for Academic Primary Care (APEx) seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact This was a presentation given as part of the Exeter Collaboration for Academic Primary Care (APEx) seminar series. The goals were to explain the research, solicit feedback on data, and to recruit interview participants.
Year(s) Of Engagement Activity 2017
URL http://medicine.exeter.ac.uk/media/universityofexeter/medicalschool/research/healthservicesresearch/...
 
Description GP training workshops 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We ran two workshops for GPs and health professionals from across the South West. One workshop was targeted at GP trainees; one workshop was targeted at more established health professionals. The workshops focused on how GPs and health professionals can more effectively respond to patients from low-income backgrounds experiencing poverty related distress and were co-delivered by the research team and residents from low-income backgrounds who are involved in the project advisory board. The workshops also provided an opportunity to trial our training materials and receive feedback on how we can most effectively disseminate these materials to GPs and health professionals across the UK.

Evaluations from the workshops were extremely positive, with health professionals reporting that they would implement the learning from the workshop into their clinical practice. The main areas where the workshop added to knowledge related to ways that health professionals could better communicate and inter-relate with patients; give patients hope; work with patients in a non-judgemental way; the challenges facing patients self-referring to talking therapy; how GPs could respond to poverty-related distress with over-medicalising; and better understanding of the low efficiency of antidepressant medications.

The main ways that health professionals reported that they would change their practice was to prescribe fewer antidepressants; to support rather than seek to 'fix' patients with drugs; to elicit hope in their patients; to not make assumptions about their patients; to consider non-medical treatments for poverty-related distress.

Health professionals were also keen to receive information put together by residents on our Advisory Board on the availability of local support organisations. GPs reported that they planned to use this information to refer patients to appropriate support.
Year(s) Of Engagement Activity 2018
URL http://destressproject.org.uk/upcoming-events/
 
Description Interview for BBC Radio Devon 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact Live interview on the BBC Radio Devon Janet Kipling afternoon programme discussing the topic of Stress. Interview covered the purpose of the research project and how stress impacts on low-income communities, resulting in discussion in the following phone-in debate.
Year(s) Of Engagement Activity 2017
URL http://www.bbc.co.uk/programmes/p039zh4c
 
Description Interview for ITN Productions 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Interview with ITN Productions for their broadcast of the New NHS Alliance Summit 2017 which led to requests for further information on the project, and follow-up meetings with third sector and health practitioners.
Year(s) Of Engagement Activity 2017
URL https://itnproductions.wistia.com/medias/jgqsh0wl1m
 
Description Meetings with CoLab director and other staff to talk about DeStress findings and outputs, and future research 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Colab Exeter is an integrated wellbeing and innovation hub that works in collaboration with agencies across sectors to strengthen local services and achieve positive whole community outcomes around homelessness, addiction, (re)offending, and health inequality. Held several meetings with practitioners from different organisations interested in the research findings and attended the open day, building new relationships for engagement in future research.
Year(s) Of Engagement Activity 2018
 
Description Participation in Childrens centres Advisory Board 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Invited to participate in Barnardo's Childrens centres Advisory Board, to talk about the engagement work we had done with parents and families locally and to contribute to discussions about local strategies which may impact on families.
Year(s) Of Engagement Activity 2018
 
Description Presentation at New NHS Alliance Summit 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Plenary session presentation delivered to an audience of approx. 200 health professionals, policy makers, third sector organisations and patient groups which sparked questions and discussion around the role of antidepressant prescribing within low-income communities. The presentation also received significant interest on social media.
Year(s) Of Engagement Activity 2017
URL http://www.nhsalliance.org
 
Description Presentation at South West Hospices Community Engagement Network meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Gave a presentation at the first meeting of the Hospices South West Community Engagement Network, using the DeStress project findings as an example of health inequalities to spark discussion about inequalities in access to end of life care. Established contact with practitioners in hospices involved in community engagement who are interested in being involved in future research as part of my fellowship post.
Year(s) Of Engagement Activity 2019
 
Description Presentation at a workshop for mental health practitioners and commissioners across the south west 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presented on the findings of the project at a meeting for mental health practitioners and commissioners which sparked questions and discussion around models of mental health treatment in Plymouth and Torbay CCGs. The meeting led to a series of recommendations on reforming the model of provision for IAPT.
Year(s) Of Engagement Activity 2018
 
Description Presentation at an Engaged Research workshop for community partners 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Gave presentation at a workshop focussing on Engaged Research attended by community partners including Exeter City Council, Exeter City Futures and various third sector organisations. Resulted in discussion of the mutual benefits of partnership between researchers and the local community and networking with key practitioners and organisations interested in involvement and dissemination of our findings.
Year(s) Of Engagement Activity 2017
 
Description Project stand at South West Academic Health Science Network social prescribing event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We ran a project stand at the South West Academic Health Science Network social prescribing event, which sparked discussion and follow up work with policy makers and third sector organisations.
Year(s) Of Engagement Activity 2017
 
Description Project website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Engagement focused project website, detailing project aims and approach, findings, events, blogs, film clips, twitter feed. Since February 2018, the project has had almost 400,000 hits, with over 7000 visits and 4158 individual users ('unique visitors').
Year(s) Of Engagement Activity 2018,2019
URL http://destressproject.org.uk
 
Description Running DeStress conference 
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 Ninety four people attended the DeStress project research, policy and practice conference that we held in London on 15th-16th January 2019. The audience comprised health practitioners, policy makers, third sector organisations, and academics from across the UK, as well as participants from Europe. The event attracted a range of high profile speakers including Paul Farmer, CEO, Mind; Gregor Henderson, Mental Health Policy Lead, Public Health England; Jessica Allen, Institute of Health Equity; Vanessa Pinfold, CEO, McPin Foundation; Lynne Freidli, Centre for Welfare Reform, and Kate Cornford, Mental Health Lead, OECD. Speakers also included representatives from community groups and residents with lived experience of poverty-related distress.

Evaluations and feedback from the event has been extremely positive and has led to a number of potential follow-on collaborations. The main messages that people reported taking from the event were: understanding of the link between austerity and mental health; the importance of community co-creation and empowerment; the potential for new approaches in clinical practice that shift away from 'fixing' patients via medications to more personalised and non-medical approaches.

The parts of the event that people found most useful were: findings from the DeStress project, in particular it's approach to project co-creation with local communities and the training materials for GPs that we have developed; insights into lived experience from the community/resident speakers; the potential of conversation analysis to provide insights into clinical interactions; ways of reconceptualising responses to poverty-related distress; local initiatives from practitioners and communities.

Aspects of their work that people felt they would change as a result of the event included: engaging people with lived experience in the co-creation of practice and policy initiatives; greater awareness of social determinants and early life trauma; disseminating DeStress project findings through their networks.

The event was filmed and is available on our project website destressproject.org.uk ensuring that the information generated is available to an unlimited audience. The event also attracted a significant level of attention on twitter where presentations were discussed and the event received high levels of praise.
Year(s) Of Engagement Activity 2019
URL http://destressproject.org.uk