Routes to Wellness

Co-designing a peer-led community approach to support the mental health of refugees
Routes to Wellness
Funded by the National Institute for Health Research (NIHR), this study aims to co-design a peer support model for improving refugees’ mental health and wellbeing.
The 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.
<p>Routes to wellness logo&nbsp;</p>
Figure 1. Logo
<p>Figure 2. Tanbur&nbsp;</p>
Figure 2. Tanbur

Project Overview

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 in the UK.
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.
<p>Figure 3. Friendship&nbsp;</p>

Figure 3. Friendship 

Collaborators

Adele Owen
Gloucestershire Action for Refugees and Asylum Seekers (GARAS)
Dr Al-Noor Abdullah
Coventry University
Avril Bellinger
Students and Refugees Together (START)
Celia Edwards/Scott Hudson
Livewell Southwest
Prof Glenn Robert
Kings College London

Research Team

Funding

NIHR Health and Social Care Delivery Research
*The funded project is titled ‘Forced to Flee: Co-designing a peer-led community approach to support the mental health of refugees’, however, with the input of public contributors, the public-facing title is “Routes to Wellness”.

Relevant links


Logo design workshop

<p>Art workshop, figure 5.&nbsp;</p>
Figure 5. Photo from the art workshop
<p>Art workshop, figure 6.&nbsp;</p>
Figure 6. Tanbur drawing in action

Logo design workshop with public contributors 

The logo and images used in this page were designed by the project’s public contributors in an art workshop co-facilitated with Devon & Cornwall Refugee Support. Through drawing and painting, the contributors convey how they make sense of the “Routes to Wellness” project. 
The Routes to Wellness logo (Fig.1) was produced by one of the workshop attendees; with the heart shape representing the letter R and cardiogram representing letter “W”. W is combined with the letter “O’’ creating an image of a person which adequately illustrates our person-centred approach to mental health. 
Another contributor expresses “Routes to Wellness” by creating an image of representing friendship support (Fig. 3). In addition, traditional Kurdish music instrument “tanbur” (or “buzuq”) was drawn to represent the memory of participating in locally held music events in Devonport (Fig. 2), where there were brown and green colours at the place. The instrument would worn through time, therefore the dry brush of brown in between the green and brown crescents to tell the time and the uses of the instrument. 
A contributor painted a woman figure in a boat heading towards Plymouth’s Smeaton's Tower surrounded by a whale which is the contributor’s dream to witness. The women’s heart opens with a hole representing low feelings, nevertheless, a robin emerges symbolising her hope for the future.  
<p>Hope in Plymouth artwork depicting a boat in the sea heading towards Smeaton's tower in Plymouth UK.&nbsp;</p>