Friday 30 April 2021

Can putting distinct services under one roof prevent mental illness? We (cold) called in the experts to find out

In today's Fuse blog post, Fiona Duncan, Postdoctoral Research Associate from Durham University, writes about co-locating services to improve mental health and the perils of pulling together an expert panel during a pandemic. 

'Cold Calling' by Darren Tennant
This past year has been tough for many of us.  Financial worries, feeling socially isolated and lonely, facing unemployment, and missing opportunities for physical activity are just some of the things that have impacted on mental health and wellbeing during the pandemic.  This means that finding ways to improve mental health and prevent mental illness in our communities is more important than ever.

Over the past few months, I have been working on a NIHR School for Public Health Research (SPHR) project which aims to investigate how “co-located” services based in the community can be used to promote wellbeing.  A co-located service is where two or more distinct services are in the same physical space and the staff of each service interact with each other, either formally or informally.  Co-located services are often found within traditional health services like GP practices when welfare, legal and/or mental health services are delivered in the same building.  The project will investigate the benefits and disadvantages of co-locating in community spaces, rather than within traditional health services.  For example, a debt service within a faith institution, a welfare service in a library, a mental health support service in a sports centre, or a money advice service within a foodbank.  We are interested in finding out exactly how co-location helps to improve mental health and whether they work for all people in all circumstances, or just some people in certain circumstances. For instance, does co-location increase access, reduce stigma, or encourage a higher quality of service by allowing professionals to work together better?

To start this research, I was given the task of setting up and facilitating an expert panel workshop. The idea being that if we want to gain a deep understanding of how co-located services may or may not work then we should ask the people who actually design, fund or deliver these services in the real world.  We hoped that this workshop would consist of service practitioners, policy-makers, and commissioners at local authorities and people who work for organisations that provide funding for community projects. 

My first challenge in setting up the workshop was getting people to take part.  Where was I going to find these experts and would they be able to give up two hours of their time in the middle of a pandemic?  I was planning on the workshop being small (5-8 people) but, in the circumstances, I realised that I was probably going to have to ask a lot of experts to even hit this target!

I used a variety of approaches to find my experts.  I asked members of the wider research team to email any suitable contacts, we approached the other NIHR Schools and we advertised the study on twitter.  I also personally contacted some people that had participated in a previous research project and my colleague, Dr Emily Oliver from Durham University, mentioned the workshop during a webinar at which she was presenting. Through these methods, three experts signed up.  To get a few more people, I then started to ‘cold call’ potentially suitable people and organisations, including almost 40 local authority Directors of Public Health in England.  Despite the pressures that this group of people are currently under due to COVID, this ‘cold calling’ led to three more people agreeing to attend.

Having six people confirmed still felt like a very precarious position to be in, and it turned out that I was right to be nervous, as one person unfortunately had to pull out on the morning of the workshop. However, luck was on my side as at the last minute another expert who had found out about the workshop from a colleague at one of the organisations I had contacted, asked if they could come along.  Panic over!

The nerves kicked in again at the start of the event, as I had never facilitated a Zoom workshop before and it was clear that some of our experts were feeling nervous too.  This could have been a problem as we wanted them to freely and openly talk about the benefits and disadvantages of co-located services.  Luckily, Gillian Samuel, a member of our research team from the McPin Foundation, was able to facilitate a brilliant icebreaker exercise.  She asked everyone to talk about something that we all had in common, specifically, what we are looking forward to most when lockdown ends?  Everyone had some great answers to this question (the re-opening of Selfridges was my personal favourite answer) and this made for a more relaxed atmosphere.

This almost certainly helped the workshop discussions flow as our experts provided rich and detailed information about co-located services.  However, in some ways the workshop did not go as I had expected.  I thought the experts would talk about the benefits of their co-located services and the mechanisms involved in how these services work. I had prepared a long list of questions to prompt such a conversation, but it soon became clear that the panel had a lot to say about how co-located services quite often don’t work.  They were all clearly very passionate about what they do but expressed frustrations surrounding service delivery.  One theme to emerge was that co-located services are dependent on different types of professional working together, but the reality is that they often don’t communicate well with each other at all.

Although I wasn’t expecting the panel to say these things, I’m glad they did.  It helps us to understand how co-located services are working, or not, and is very important if we want to improve services and therefore improve mental health and prevent mental illness in our communities. This information will also be very helpful in the next part of our study where we will be interviewing people who work at and use selected co-located services.

Fiona works on the NIHR School for Public Health Research (SPHR) Public mental health programme through Fuse's membership of the School.


1. 'Cold Calling' by Darren Tennant via, copyright © 2014 (Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)):

Friday 23 April 2021

How do we improve diversity in research?

Posted by Vicki McGowan, Research Associate, Newcastle University

Public involvement and engagement in research is not a new concept. Without members of the public engaging with our work as participants, we would not have advanced our knowledge and understanding of the social world over the last few hundred years. More recently the Covid-19 vaccination would not have been so rapidly produced without generous support from the public in giving up their time (and bodily fluids) to advance our understanding. What seems to be a more relatively recent idea is the involvement of the public in developing the research itself and setting the agenda based on their experiences. Newer still is the idea that there should be a diversity of voices at the table where these decisions are made. In 2014 the Due North report made a series of recommendations to address inequalities between the North and South of England.

In order to take forward these recommendations academics across the North developed the Fuse led Equal North network which aimed to build a community of academics, policy makers, and practitioners across the region to work collaboratively on addressing the North-South health divide. This community came together in workshops to identify priorities for addressing this spatial inequality, and around 250 professional participants highlighted poverty, austerity, and unemployment as key research areas to ‘level up’ the northern regions (Addison et al, 2019).

Equal England academic and practitioner priority setting workshop hosted by Fuse

But, this was only one part of the story.

It was an important side of the story, and I’m sure many members of the public would agree that poverty, austerity, and unemployment were – and indeed are – priority topics, but we needed their perspectives to ensure we were developing research that addresses these drivers of inequality and doesn’t widen them further.

But also, we’d been talking about tackling inequality at the same time as maintaining unequal access to decision-making by not including all key stakeholders in the discussion. So, when the NIHR School for Public Health Research funded the expansion of Equal North to become Equal England, we increased our practitioner membership to over 800, but we also ensured that we could take forward recommendation 3 from Due North: 
“Share power over resources and increase the influence that the public has on how resources are used to improve the determinants of health”
The Equal England Public Network was born in late 2019. Following the practitioner model developed in Equal North, we aimed to create a space for members of the public to share lived experiences and influence the work that we do and undertake some public priority setting exercises to see how these align with the Equal North work. We’d also share information about key events, new evidence, and generally keep people updated with health inequalities research as we do the practitioner network.

That was the plan, now the action. How do you develop a diverse network to engage with members of the public with lived experience of poverty, austerity, and unemployment?

One option could be to contact the numerous, and brilliant, existing Public and Patient Involvement (PPI) groups that operate across the country. Why reinvent the wheel? If that wheel only comes in one style and doesn’t fit my bike then we may have a problem. These established groups might not accurately represent the diversity we see in our communities.

Also, these can be established groups that by their tenure already have the confidence and capacity to exert influence over research agendas and I wanted to make sure we had representation from people who don’t usually have their voices heard in the communities that are affected by the priority areas identified through Equal North.

To ensure we were accessible to a diversity of voices we aimed to pilot the network in North East England to build on the Equal North findings and implement three phases:

Phase 1: Connect with local grassroots groups that are embedded in their communities, promote the network at relevant community events, generally get out into communities across the North East and get to know people, develop trust and sign people up to our mailing list.

Phase 2: Invite members to a series of local conversations, present the findings from Equal North and discuss whether people thought these were important for their communities, whether there were other priorities, and what we needed to do to address them.

Phase 3: Co-develop research proposals around these priorities and dissemination activities with academics and practitioners – making sure the public experiences were disseminated widely and incorporated into future planning.

By February 2020, Phase 1 was going well with 35 members of the public signing up to the network. And then…

We were forced to cancel all face-to-face activities due to Covid-19. The country shut down and the vast majority of people I’d engaged with over the past few months were now focused on supporting their communities through the crisis.

People are furloughed and so volunteer at food banks, people lose their jobs, they lose loved ones to the virus, the grassroots level is not interested in me trying to encourage them online to talk about inequalities that PRE-EXISTED the virus and are now being made even worse. The public network gets locked down and we pause activity thinking it won’t be long before we’re back chatting over coffee.

A year later and we’re still not able to get together in person and our coffees are stone cold! However, during this time of crisis I focused on maintaining the network rather than trying to grow it. I kept in contact with our members via the mailing list and shared opportunities for engagement and to participate in, and develop, research. It didn’t seem right to actively pursue growth during a pandemic but, as our members represent wider groups within their communities, they have shared these opportunities and this has resulted in more members of the public signing up. We now have 57 official members from across the country who have been supporting and influencing the work we do. Amazingly during a pandemic, our public partners have supported the development of several health inequalities projects, contributed to covid-related inequalities research and influenced decisions over national priority funding around inequalities and prevention from the NIHR Applied Research Collaboration (ARC).

Key messages for ensuring diversity in research 

Identify trusted partners

Engage with your existing networks but identify people who are already trusted in their community. These people are probably the most important, whether we’re in a Covid or non-Covid world. Find them and work with them. Approach grassroots organisations, church leaders, sports groups, charities, hang out in coffee shops, community centres, pubs (when permitted!).

Actively seek out diverse groups

Don’t assume members of diverse groups will respond to your advert on Twitter, you must actively engage with groups and organisations that represent marginalised communities. If you’re unsure use tools like PROGRESS+ and HIAT as a guide to check you’re providing equity of access for members of diverse communities (these consider ethnicity, LGBT+, rural/urban, age, disability, economic disadvantage etc.).

Boots on the ground

Leave the comfort of your (home) office! Opportunity does not knock at your door, you need to go out and seek it. Pre-Covid this means being present in community spaces, libraries, coffee shops, markets and schools. During Covid this means using existing networks, online sessions, and setting up WhatsApp groups.

Give something back

Always give something back, that may be reimbursing people for their time or providing opportunities for training and skills sharing – and here I don’t just mean assuming we have skills that they want, perhaps members of the community want to share their skills with us. Develop reciprocal relationships, don’t just take from communities to boost your career!

Be patient

Developing trusted, meaningful, and reciprocal relationships takes time. Be patient. Do not underestimate how long it can take – I’ve been working with some groups for 6 years!

Manage expectations

But if you don’t have 6 years, be honest with people that your work is time sensitive and clearly articulate what you need and how people will be reimbursed if they’re able to help you. Don’t promise the moon on a stick if you can’t deliver!

Finally, blogs are also a great way to connect with diverse groups so don’t forget to add some shameless promotion: if you’re a member of the public reading this and would be interested in joining our network you can sign up here.

For more information about the development of the network, and other experiences of improving diversity in research, you can view a recording below of a recent joint NIHR School for Public Health Research / School for Primary Care Research webinar.

Friday 16 April 2021

The other third wave: a mass epidemic of very individual pain

Posted by Jack Nicholls, Lecturer in Social Work at Northumbria University

*Content/trigger warning: mental health, depression, suicidal feelings.

This post is a contradiction. It starts with the experience of one person, extrapolates out from that to consider the potential hardships faced by others, and then argues that this extrapolation may be unsafe from a policy and practice perspective. Our topic is the long-term mental health consequences of the pandemic, of lockdown and social restrictions, and of its easing – specifically, those consequences we have not necessarily seen coming, because to those who do not know, they do not seem logical.
Katsushika Hokusai: The Great Wave off Kanagawa

I have knowingly lived alongside depression for nearly two decades. There have been long periods where it has been minimal and manageable, and others where it has nearly destroyed me. Many who experience mental ill health in any form will recognise this undulating pattern, and that the peaks and troughs can have exactly nothing to do with how well life is going objectively. I’ve felt perfectly steady in situations of very high pressure. Conversely, the lowest point of the last few years was at a prestigious conference. I was presenting my work – an opportunity I had been looking for since starting my research – while internally considering whether I wanted to remain alive. I doubt any of the audience would have suspected, because I performed the role of the good presenter. I did what was expected – by them, by me, by the world. More recently, but less severely, I had a short but acute period of utterly disabling depression after submitting my PhD thesis. Something excellent and long-awaited had happened. Celebration was expected, even in lockdown, but I wanted only drawn curtains and my duvet.

During the pandemic, we have had over a year of restriction, upheaval, loss, fear and strain. There has been some discussion of the impact on psychological wellbeing, but nowhere near enough. It has become an afterthought to vaccines and viral containment, which is understandable, and to macro-economics, which may be less so. Alongside we mental illness veterans, hundreds of thousands of people have consciously experienced moderate or severe mental ill health for the first time in their lives.

What particularly concerns me however is the psychological impact of the easing of lockdown. With all its hardship, pandemic restrictions have been our reality. The end of lockdown will represent a change to that reality. It will be accompanied by returning to workplaces, pubs, cinemas, planes, trains and shopping centres.

For some, the change back will be more jarring than they can currently anticipate, even if, like the submission of my thesis, it is on the face of it a ‘good thing’. We are facing a third wave of mental distress. There are those of us who have managed symptoms for years, and those who recognised their genesis in lockdown. There is a strong chance that after the jubilation, many will start noticing that they aren’t feeling how they think they should. They may try to rationalise it – ‘I wasn’t on the frontline, I didn’t lose anybody, I wasn’t furloughed – why the hell do I feel like this?’. If we are not careful, no-one will tell them that this is normal, if awful, and they are entitled to help.

I am unbelievably fortunate. I understand my condition well. I am by-and-large not shamed by it. I have friends, family and colleagues who understand it and me. I have a job with a degree of flexibility. For all of those wonderful protective factors and others, all that privilege of acceptance, the first stage of any episode is still denial, and the second is the instinct to run, hide and dynamite all my bridges. For anyone going through this for the first time, and particularly going through it when they think they should be celebrating like it is VE day, the loneliness, alienation and self-doubt could be pernicious and devastating. It could be fatal. In the context of public policy, planning and rebuilding, and particularly for those who do not want to go back to ‘normal’ but to create a fairer reality, we need to be prepared to offer a pro-active and public response to varied and individual suffering. At the point of both collective relief and collective exhaustion, we need to be ready to be accepting and kind. And we need to do it now.

Below are links to support organisations relating to the issues raised in the post: 
Link to an interview with Owen Paterson MP, who lost his wife to suicide last year

Katsushika Hokusai, (CC0 1.0), via Wikimedia Commons

Friday 9 April 2021

Feeling like an imposter? Learn to get comfortable with ambiguity

Peter van der Graaf, Fuse Knowledge Exchange Broker, Teesside University and Travis Sztainert, Knowledge Mobilization Specialist, Frayme

Do you ever feel like your lack of ability or knowledge is going to be exposed? In that case, you might suffer from Imposter Syndrome! Knowledge Mobilisers work across boundaries and are asked to perform tasks that they don’t feel “qualified” for, triggering feelings of anxiety and failure. What causes these feelings and how can we overcome them? In an attempt to answer these questions, we compared experiences across the pond by reflecting on our roles as Knowledge Mobilisers in Canada and in the UK. We argue that these feelings should not be avoided but harnessed by turning imposter syndrome into a useful repertoire for the role.

"Piled Higher and Deeper" by Jorge Cham

In March the annual UK Knowledge Mobilisation Forum took place, which brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used. This year, the Forum was held online for the first time, and one of the sessions was dedicated to interactive posters. Participants could preview posters in GoogleDocs and leave comments and questions for the presenters, who were later interviewed to respond to the feedback left on their posters.

In our poster, we explored why Knowledge Mobilisers are particularly prone to feelings of being an imposter. They work in a competitive specialist profession; everyone strives to be a guru, but at the same time their work occurs in the background. It often goes unrecognised if done well (and shows up particularly bad if it fails!) but is time-intensive with work often being unclear, making it feel like you’re not moving forward.

Our poster - see the full version here

Developing trusting relationships between knowledge producers and users often requires complex and lengthy conversations, which only increase the risk of being exposed as an imposter. At the same, there are limits to collaboration (not everybody wants to work together or share their knowledge), which can add to feelings of failing at your job as a knowledge broker.

Moreover, the role requires you to be a neo-generalist with varied expertise and, therefore, there is always more to learn. Organisational change and consequently personal change (the one certainty of working in the health and care sector) are always on the horizon, meaning that you have to continuously adapt your role. In addition, system changes often change the knowledge and evidence that is required by users and this increases transaction costs (time and resources spent on adapting knowledge) for boundary workers.

However, there is a lack of ‘professionalisation’ of the field and training is scattered: this can make you feel like you’re missing essential skills and knowledge. During the poster session we conducted a quick poll to ask how many participants had received formal training in knowledge mobilisation: 83% had not. Or as one of the participants summarised: Knowledge Mobilisation is a Cinderella service. Being undervalued by funders, universities and professional organisations means you are often faced with a lack of resources and unable to do your job. In fact, it is often expected that Knowledge Mobilisation can be done “off the side of the desk” or in addition to work as a researcher or policy maker. Thus, a paucity of time and space is set aside to adequately tackle complex issues.

To overcome these challenges, the first rule of Knowledge Mobilisation is that you need to be comfortable with ambiguity. Feeling like an imposter is not (in itself) bad, is a normal part of the learning process, and can be harnessed. Skills are most often developed on-the-job, and feelings of imposter syndrome can help drive you to learn more, do better, and be open to new concepts and experiences. Overconfidence can lead to a lack of insight into your weaknesses, which in turn can lead to actually becoming an imposter. Accept that you have shortcomings and areas for improvement. It’s okay not to know what you’re doing, or not to have all the answers. Think of yourself as an enthusiastic learner who is gaining experience and expertise - imposter syndrome will help you to stay humble.

Being open and honest about not having all the answers can actually be seen as a strength. As one participant pointed out in response to the poster: it helps to level power differences between partners by showing that you don't hold all the power (and are human like everyone else) and therefore empowers those working with you. It's ok for them not to know it all too and therefore may prompt questions that people may otherwise have been afraid to ask, leading to more open conversations, and strengthening relationships and trust. It can also mean that, when you are sure of answers, others know that they can trust you because you have previously shown that you would not say you knew something when you did not.

Participants described this as a cyclical process, where feelings of imposter syndrome drive new learning, which increases your confidence to go into new situations that lead to fresh experiences of imposter syndrome, starting the cycle again. Forum members also emphasised the importance of operating as a team: the vast amount of skills required as a Knowledge Mobiliser (keynote speaker Annette Boaz mentioned connectivity, charm, inclusivity, empathy, creativity, integrity, curiosity, diplomacy and humility for starters), means it is almost impossible to develop these skills as an individual. Teams of Knowledge Mobilisers can bring these skills together and use different skills at the same time.

Moreover, acting like an imposter can be a valuable role: by communicating out of character a knowledge broker can help to make sense of differences in knowledge use. Adapting to the audience and stage required helps knowledge brokers to translate differences in performances between policymakers, practitioners and academics. Knowledge Mobilisers should not fear being an imposter but instead learn to embrace imposter syndrome!

If you are interested in learning more about imposter syndrome in knowledge mobilisation, take a look at:

Friday 2 April 2021

Working together to tackle inequalities and inactivity

Posted by Sophie Phillips, Fuse & NIHR School for Public health Research (SPHR) funded PhD Researcher, Department of Sport and Exercise Sciences, Durham University, and Dr Rachel Mowbray, Insight Coordinator, County Durham Sport, Active Partnership.

In today's Fuse blog post, Sophie and Rachel tell us about collaborating during Sophie's secondment at County Durham Sport between January and March 2021.

It seems obvious that we would work together, right?

I conduct research in an academic institution and Rachel promotes evidence-based working in an Active Partnership which collaborates closely with Durham County Council. Our day-to-day roles are quite different. But, we have a shared goal: to tackle inequalities that stand in the way of physical activity engagement and support children and adults to be more active. By working together, combining knowledge, skills, and connections, we think we can make even greater progress towards improving people’s health and wellbeing.

How is academic research positioned within the physical activity landscape?

Physical activity policy and practice is a large and complex system made up of many different organisations, approaches, and settings. Academia is often positioned as external to the system, trying to create impact from the outside through activities referred to as ‘pathways to impact’. But in reality, academic research could be a crucially important element of the system in its own right (but often doesn’t have that position). Can positioning academic research as part of the system (as opposed to outside the system) make creating impact less of a hurdle and more of an opportunity?

Through my secondment to County Durham Sport, academic research has been embedded into the local Active Partnership. This gave me a huge opportunity to make an impact (on a daily basis!) by simply talking to others in different parts of the system. By sharing my knowledge and passion through conversations, I felt like I could make a real difference. Sharing information and ideas can challenge and influence thinking. This can (and does) influence the way things are done.

What are the benefits of an embedded researcher in policy or practice?

Non-academic audiences often cannot access academic publications in meaningful ways because of financial barriers and/or because of the academic format. Having Sophie embedded in our organisation brought academic research to life and into the conversations happening between practitioners, policy makers, and non-academic researchers. These conversations allowed us to access the most up-to-date and robust information about physical activity. In the same way, County Durham Sport were able to offer extensive knowledge of the local physical activity system and inequalities. Working together, we created a stronger evidence-base on which to tackle the challenge of inactivity.
Sophie: I was able to communicate knowledge from academic research papers on physical activity into meaningful insight for County Durham Sport. One of the pieces of work I conducted during the secondment was a report on early years physical activity and movement. This included translating evidence from academic research papers into meaningful and accessible outputs (including reports, overviews in tables, and presentations). I was also able to engage with different stakeholders and physical activity providers across multiple settings, who are involved with local early years provision. This helped to bring together both the research evidence and the current local landscape, to make evidence-based and actionable recommendations about future early years provision.

Take-home messages from our collaborative experience…

Our day-to-day roles are very different, as are the expectations and outcomes of our work. Although this presents some challenges (such as differing timescales and required outputs), ultimately, we share a goal - to tackle inequalities that stand in the way of physical activity engagement, support everyone to be more active, and help to improve people’s health and wellbeing. Finding this common ground can foster true collaborative thinking and drive connections between academic and non-academic players in the physical activity system. Integrating our different perspectives and approaches is beneficial and necessary to create meaningful system change.

Rachel: Tackling big issues (like inequalities in physical activity) requires a collaborative and evidence-based approach. I would encourage other third sector organisations to engage directly with academic researchers - both to learn from their expertise, and to share your own experience of practice or policy. We can achieve more working together than we can alone!

Sophie: My experience of collaboration with County Durham Sport has been invaluable. It has influenced the way I think about conducting and communicating research. I would encourage other public health research PhD students to explore the opportunities of engaging in a short time with policy and practice partners in their field, to help view their work from different angles.

Sophie’s academic research is about measuring the physical activity and movement behaviours of pre-school aged children. Her secondment at County Durham Sport was funded by UK Research and Innovation (UKRI) QR Strategic Priorities Fund awarded through Durham University.

Rachel promotes evidence-based partnership working to tackle inequalities in physical activity through her role with County Durham Sport, Active Partnership funded by Sport England.


2 & 3. Photo of Rachel ( and Sophie ( with thanks to County Durham Sport.