Understanding young people's engagement with psychological therapies through a social inequalities lens

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The ultimate aim of future Fellowships is to ensure psychological treatment is appropriately and sensitively adapted to the population it is being delivered to; evidence suggests that this results in improved outcomes at a personal and societal level. This Fellowship, will further this aim by:1. Reconsidering data already collected from a different perspectivePsychological or talking therapies are increasingly used to help people with common mental health problems, such as depression. There is a need for treatments that can be delivered to greater numbers of people; one way to increase reach, is through delivery by less-specialist staff. Behavioural Activation (BA) is one such simple, brief talking therapy that uses a manual to guide practitioners. My PhD explored whether BA was helpful to young people with depression attending Child and Adolescent Mental Health Services (CAMHS) and whether it could be delivered by staff with limited psychotherapies experience. Whilst researching BA, a theme from the data revealed that some patients' and families' experienced unanticipated difficulties in engaging with therapy. Rather than being related to mental health problems, these barriers seemed instead to be rooted in social, environmental or economic circumstance. My PhD was not designed to investigate this further. During the Fellowship, I will re-examine this data. Through focused reading of the literature and guidance from my mentor, I will build an analysis 'framework' of factors indicating disadvantage that I will apply to existing data from:- A focused ethnography in CAMHS (documents/interviews/observation) and interviews (with those delivering BA) to understand staff perspectives of how inequalities experienced by patients may interfere with treatment.- Interviews with young people receiving BA (and accompanying parents) to assess whether experiences differ based upon socioeconomic position. Families living in more affluent areas will be analysed together, and compared with those from more deprived communities (based upon partial postcodes). As an additional measure of deprivation, I will explore adverse childhood experiences between groups. If families from disadvantaged social groups did encounter greater challenges during treatment, it would be particularly concerning because mental health difficulties are over-represented in these groups.2. Publishing my findingsFollowing advanced training on these social issues, I will use the findings from the re-analysis to design a 'logic' model detailing the resources, activities, outputs, outcomes and impact of addressing barriers to CAMHS treatment for disadvantaged youth. This is a visual way to present and share understanding of these relationships in a policy context; illuminating gaps in knowledge and identifying ways clinical services could respond. I will write about my work in different publications, and publicise the research using social media.3. Making and maintaining connectionsAlongside clinical networks built during my PhD, I will identify and communicate with interested stakeholders, to support the work undertaken during and after the Fellowship. I will share acquired knowledge and findings via in-person workshops (utilising existing conferences and networks such as the White Rose Doctoral Training Partnership [WRDTP]) and virtually (by hosting a webinar). This will increase the visibility of my research and foster shared problem-solving.4. Developing funding proposalsReturning to my data will maximise the value of the publicly-funded research already undertaken and the logic model will determine future research directions. Statistical training will expand my personal skillset, providing greater breadth of opportunities for exploring these research questions. With the support of identified stakeholders, I will submit an application to external funders aimed at providing equitable care and timely patient benefit; positioning myself as a future leader.