Mental health inclusion realist synthesis: How, why, for whom, and under what circumstances do what interventions improve inclusion in mental health services for marginalised groups?

People belonging to socially excluded, minoritised, groups have bigger challenges accessing mental health services, and worse mental health outcomes.  The NHS National Framework for Health Inclusion 2023 creates an onus to address these inequalities.  The Framework states that health inequalities across these groups are caused by common shared experiences.  This suggests that there may be a common set of mechanisms that could address health inequalities across these diverse groups.  It is unknown how, why, for whom and under what circumstances such mechanisms might work.  We will conduct a realist synthesis to fill this knowledge gap.    

Aims  

Aim: to understand which interventions will improve inclusion in mental health services for minoritised groups which are socially excluded, and how, why, for whom, and under what circumstances these interventions work.  

Objectives:  

1. To conduct a realist synthesis of interventions to tackle mental health exclusion for minoritised groups who are socially excluded to produce an actionable programme theory  
2. To produce recommendations that support tailoring, implementing, and evaluating approaches to tackling mental health exclusion for minoritised groups which are socially excluded  

Review questions:  

1. How, why, for whom and under what circumstances can social exclusion be addressed to improve inclusion in mental health services for groups at risk of health exclusion?  
2. How, why, for whom, and under what circumstances can common experiences that lead to causes of health inequalities (discrimination and stigma, violence and experience of trauma, poverty, invisibility in the health data set) be addressed to improve inclusion in mental health services for minoritised groups which are socially excluded?  
3. How, why, for whom, and under what circumstances can causes of health inequalities (insecure and inadequate housing, very poor access to healthcare services due to service design, poor experiences of public services, poorer health than people in other socially disadvantaged groups) be addressed to improve inclusion in mental health services for minoritised groups which are socially excluded?  
4. To what extent can over-arching programme theory be applied across different minoritised groups?  
5. To what extent does this programme theor(ies) align with the NHS Framework Principles for Action on Inclusion Health?

Activity   

We have undertaken pilot searches to inform our methodological design.  Using NHS policy and results from pilot searches we have created an initial programme theory suggesting how mental health inclusion interventions might work, and highlighting knowledge gaps regarding why, for whom, and under what circumstances these might work.  We are in the process of finalising our approach to stakeholder engagement, so that we can work with practitioners and people belonging to groups that experience mental health exclusion to best effect during the review process.    

Outputs  

Expected outputs:  

• Realist synthesis protocol paper  

• Realist synthesis, including programme theory of how to improve mental health inclusion for socially excluded marginalised groups  

Next steps  

Having created an initial programme theory, we are currently refining the protocol paper for submission.    

We are also in the process of recruiting experts by training and experience to our stakeholder group.  If you are interested in joining our stakeholder group, please contact charley.hobson-merrett@plymouth.ac.uk.