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Ben’s story – Let’s reverse the trend in mental health needs

By Professor Ben Barr, M-RIC Co-lead for our population mental health research

At the heart of all my work is a passion to address health inequalities. Disadvantaged communities suffer more than others from health problems– and that’s particularly true of mental health.

I started my career as a nurse; I trained at the Whittington Hospital in London and worked in A and E; from there I worked for humanitarian charities in war zones such as Tajikistan and Lebanon.

The work was about malaria and typhoid control, diseases which particularly affect people living in poverty. I studied at the London School of Hygiene and Tropical Diseases and went on to work in the Health Protection Agency on hospital-acquired infections, training as a public health consultant in the North West – which is how I later ended up in Cheshire and Merseyside.

The reason I worked in infectious diseases was because they were the biggest problem in those low-income countries; coming back to the UK, it was mental health that was the big epidemic.

Most health conditions disproportionately affect disadvantaged communities, but that is even more the case with mental health problems. My focus has always been on equity and health inequalities and mental health is the biggest issue for health inequality in the UK.

I think that my focus is based on a desire for social justice and trying to do something to make the world fairer

Lots of things are preventable but surely the thing we can clearly do something about, is the injustice of the fact that some people’s lives are affected by poor health just because of where they happen to have been born, or the circumstances in which they live.

My academic career began while working as a public health consultant in Blackburn; I studied for a Phd, exploring the effect of employment and welfare policies on mental health and I had a doctoral fellowship from NIHR – National Institute of Health and Care Research.

I worked with Margaret Whitehead in Liverpool, who has had one of the biggest influences on health inequalities strategies in the UK; and my focus since then has been on understanding how we can develop social and welfare policies that reduce health inequalities, particularly in mental health.

As a public health consultant I worked in the NHS and local government across the North West, in Blackburn, Cumbria, Barrow, West Lancashire and Liverpool, at a time when there was big focus on health inequalities through the national strategy between 2000 to 2010.

I joined M-RIC to lead on work that was already underway, working across the system – Mersey Care NHS Foundation Trust, the integrated care system and local authorities in Cheshire and Merseyside – to try and develop applied research that’s embedded within that system.

We’ve built a team that works closely with all these organisations and helps to make decisions in relatively real time, using the data held for the public, to bring about change. We started off with one data scientist who sat with the business intelligence team in Liverpool Clinical Commissioning Group, using a small grant from the Health Foundation.

We then developed the use of linked regional data to evaluate interventions and understand needs, including understanding how households with complex needs are using services and the impact that integrated services have and how they could improve outcomes for patients.

Now, we have a team of about 15 data scientists working with NHS and local government analysts, using the data to better understand where the needs are and where there are groups of people whose needs are not currently being met; and being able to evaluate what’s working and what isn’t.

I think we are getting better at working together, helped by having rapid access to the data which can form a basis for better understanding how services can be integrated. Now, we have a view across the population, understanding who is using what service.

This is how it could work: Picture a household of people with physical and mental health problems including children using services for mental health or learning difficulties as well as physical problems such as asthma.

Maybe the adults have a combination of chronic health conditions and social issues such as poor housing and living in a high level of poverty. Lots of their services are not connected very well, whether that’s physical and mental health; social care, health and welfare; or joining children and adult services, to help the transition as children grow up and move into adult services.

Rather than individuals being supported by lots of different services, we want to support the whole household, particularly those with children, because doing that better has the potential to improve outcomes for children.

Children are affected by the health and wellbeing of their parents and others in their household so if we can support the adults better, we can also improve the outcomes for children.

We aim to align services – there is lots of support potentially available for households struggling with employment, debt and financial issues and we’re working with Citizens Advice and Liverpool City Council welfare services, to see how we can target help to those households.

We are looking at mental health services in relation to the transition from children to adult services and how we can improve access for teenagers; and when people end up in A and E, what can we put in place to make sure they aren’t just sent home to do the same thing again.

The impression I get is that the resources out there aren’t necessarily going to the right places and redirecting some of that better could help improve the situation.

In five years time my hope is that we will have reversed the trend in mental health problems, among teenage girls in particular. If people can get the support they need earlier and we can help address some of the social causes of those problems, then we can potentially reverse that trend.

The ‘how’ is the question we need to answer, that is why we do the research.

Other roles held by Professor Ben Barr include:

• Head of World Health Organisation Collaborating Centre for Policy Research on Determinants of Health Equity – taken over from Professor Dame Margaret Whitehead in 2020.
• Principal Investigator for a research project with City of Preston looking at their economic strategies and a particular approach to community wealth building, which led to improvements in mental health and wellbeing.
• Lead for the Improving Population Health Theme for NIHR Applied Research Collaboration (ARC) North West Coast.
• Lead for the LiLaC collaboration of Liverpool and Lancaster Universities within the NIHR Public Health Intervention Responsive Studies Teams (PHIRST), evaluating public health interventions for local government across the UK.
• LiLaC co-investigator within the NIHR School for Public Health Research.
• Principal investigator for NIHR project ‘Evaluating the health impact and cost-effectiveness of Ways-to-Wellbeing, a whole system approach to mitigate poverty over the life course’.

Find out more about the population mental health work package: