A mixed-methods study of mental and physical health inequalities in people who have experienced social exclusion
‘Social exclusion’ describes the process whereby certain groups are excluded frommainstream society. People who have experienced homelessness, sex work or prison may be exemplars of this; recent work indicates that these groups are at a higher risk of adverse mental and physical health outcomes and excess mortality, compounded by barriers in accessing services.The prevalence of severe mental illness is elevated in these groups, however interactions with mental health are unclear. In many cases adversities indicative of social exclusion cluster or overlap in individuals, yet the nature of these intersections, and specific factors over the life-course leading to social exclusion, are poorly understood.This mixed methods study will provide systematic assessments of physical and mental health inequalities in the above groups, enriched by the perspectives of people with lived experience of social exclusion.
The project aims are to:
• Assess the prevalence of mental and physical health problems for socially excluded groups, and associations with mortality.
• Understand how mental/physical health comorbidities and service use interact with social exclusion.
The quantitative part of the study will use information from the Adult Psychiatric Morbidity Surveys (APMS) from 2007 and 2014, as well as the Clinical Record Interactive Search (CRIS) case register. The APMS is a nationally representative survey with information on mental and physical health, as well as experiences of social exclusion (e.g. homelessness). CRIS is a case register of the de-identified Electronic Health Records of patients using secondary mental health services in south London and will provide a clinical cohort with information on service use and deaths. Qualitative interviews will be conducted with people with lived experience of social exclusion to investigate barriers and facilitators when accessing healthcare.
Jayati Das Munshi
Rethink Mental Illness
3- Health, Biopolitics & Social Inequality
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