Forced to Flee: Co-designing a peer-led community approach to support the mental health of refugees

The process of displacement and resettlement often contributes to higher levels of mental distress for refugees. Researchers Debra Westlake, Kristin Liabo and Helen Lloyd met with refugees and service providers to co-design a study on this topic. Together, refugees and providers identified that access to health care could be challenging for displaced people due to language barriers and a lack of understanding of how to access help. These factors contribute to the adverse health outcomes experienced by refugees as one of the most vulnerable groups within the UK. Refugees and providers wanted to know if peer support might improve the mental health of refugees, but the team found a dearth of research from the UK on how to support refugees using these models. 


The aim of this study is to co-design a peer-led model and test if it is acceptable to refugees. Funded by the National Institute for Health and Care Research Applied Research Collaboration South West Peninsula (PenARC), this study will harness the collective skills of refugees, researchers, and service providers to develop and evaluate a peer-led model to support the mental health of refugees. This approach will use narratives to create a shared language about mental health. Peer support workers (PSWs) will work with refugees and use this shared language to identify health goals and help them access support.


We will use Experience-based Co-design to develop the PSW model, which will be tested in a 9-month trial in Plymouth and Gloucester using qualitative methods. Interviews, observations, and focus groups with refugees and professionals will provide data to help us identify key issues known as emotional ‘touchpoints’. Touchpoints capture significant personal and subjective experiences in relation to service needs and health concerns. Over a series of eight co-design workshops with providers and users, touchpoint data will be used to help shape the PSW model. These workshops will also develop the PSW training and delivery manuals, refugee-facing materials, and help identify outcome to measures for a future trial. A workshop will also help us refine the programme theory of how the model will work. Data collected and evidence from our literature review will inform this process along with refugee and service involvement during the workshops, which will consist of around 20 people. The outputs from these workshops will be presented at a community event to invite further feedback.

Six PSWs will receive training to provide the new support model. The workers will then work with up to 10 refugees each over a 9-month period. PSWs will enter into a narrative dialogue with each refugee to help understand what is contributing to their distress and help them identify mental health goals to improve this. They will also help them identify suitable community activities and services to help them achieve their goals.

We will interview refugees in contact with PSWs at 3 time points to assess their experiences of the PSW model; if it is acceptable, and if and how it has been helpful. PSWs will be interviewed to garner their experiences of delivering the model and what benefits or disbenefits they might have experienced. Data from interviews and focus groups will inform adaptations to the approach. Tests of the PSW model will run in both Plymouth and Gloucester.

Next steps

An advisory panel and local impact group will link the study to wider initiatives for refugees, and ensure learning is cascaded. Findings will be disseminated through refugee networks, the NHS and academic journals.

Associate Professor of Psychology at the University of Plymouth, Dr Helen Lloyd, is leading the study, and said: 

“We are thrilled that the NIHR have agreed to fund this important project, which is a product of a 3-year collaboration between researchers, refugees, statutory and non-statutory providers of refugee services. We are so excited to be working with the refugee communities in Plymouth and Gloucester, and our colleagues from Kings College London, The University of East London, the University of Exeter, and our statutory and non-statutory partners.”

<p>Dr Helen Lloyd<br></p>
<p>Avril Bellinger</p>

Avril Bellinger, Honorary Associate Professor in Social Work at the University of Plymouth, and Chair of Students and Refugees Together (START) said: 

“We have participated in the design of this research because it aligns with the strengths approach that is vital to our practice with refugees. This has provided a rare opportunity for START to collaborate on research that is grounded in people’s own experience and aspirations. 
"We’re looking forward to seeing the project develop and working with the team to further support the people we work with.”

NIHR ARC South West Peninsula (PenARC)

The National Institute of Health and Care Research Applied Research Collaboration (PenARC) for the South West Peninsula.

PenARC is a partnership between the University of Plymouth, the University of Exeter and NHS organisations across Devon, Cornwall and Somerset.

Learn more about PenARC