Understanding how to improve access, engagement, and depression treatment outcomes for underserved people in mental health services.

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The aim of this fellowship is to strengthen my position as an early career researcher and develop the basis of a programme of research that seeks to improve access to, and the effectiveness of, psychological treatments for common mental health problems, specifically depression. Depression is a common, debilitating mental health problem which consists of periods of low mood and/or loss of interest. Although we have psychological treatments available for depression, 50% of depressed people do not engage in therapy, and of those who do, only 50% get better. Rates of engagement in treatment for depression are even lower in people from diverse ethnic backgrounds. My PhD research focused on times when people receiving psychological treatment for depression might experience sudden "ah-ha" moments of depression improvement, or times when their depression worsened and then they disengaged from treatment. These depression changes are of interest as they are associated treatment engagement and better or worse treatment outcomes. I found important behaviours and self-beliefs were related to these times of depression change, but some research suggests that individual characteristics may also explain sudden symptom changes and how someone interacts with and responds to treatment. So far no one has examined how individual characteristics, such as ethnicity, relates to sudden depression change in therapy.In this fellowship I will use existing data to explore whether these individual characteristics are associated with depression change in treatment, as well as the number of therapy sessions received, and if this has implications for drop out and treatment outcomes. To help me further understand what mental health services are doing to help individuals from diverse ethnic backgrounds access, stay in, and benefit from treatment I will undertake a placement at the local NHS service 'Talkworks Talking Therapies for anxiety and depression' which provides psychological treatments for common mental health problems in adults, including depression, in Devon. Here I will work with the marketing lead to understand how they engage people from these backgrounds to attend therapy, and I will also examine existing service data to understand why these people do not attend the first therapy session of depression treatment and drop out of therapy. I will present my findings to the service and clinicians so they can work to improve access to, and engagement of, depression therapy for these groups of people. This will also provide me with a platform to build networks and collaborate with other academics and to cultivate new research ideas. Furthermore, I will also establish a public and patient group of people from these backgrounds to provide feedback on my research and help me to ensure my findings are accessible and publicised to a range of people. Additionally, this fellowship will also allow me to develop as an independent researcher. I will build upon my academic record to publish four completed PhD studies and any new research conducted in this fellowship to academic journals. To maximise the impact of my research findings I will present my research at conferences, seminars, and local events to a range of audiences. I will also attend training courses and workshops to continue to develop my research and analytical skills. The research conducted in this fellowship will form a basis for my future research and I will apply for further funding to continue researching how we can improve access, engagement, and our understanding of how therapies for depression work.