'Helping others gives people so much meaning in their life'

You are originally from Canada. What are the differences you've seen in community and society after moving to the University of Birmingham?

I really noticed the poor state of housing, how the cost of living crisis was impacting people, and the levels of poverty. I feel like despair and hopelessness permeate everything here, and it's present in a lot of people's lives. I work with an organisation called the Intergenerational Foundation. Their aim is to advocate for the government to better support the needs of younger generations in the UK. Right now, across advanced economies, the needs of older generations are better met than those of younger people, and vast inequities between age groups and generations have emerged over the past 10 years. There is a growing movement across advanced economies that recognises younger generations have it so much worse than our parents' generations, and that seeks to build some political momentum around that.

How did your research interests develop?

After I'd finished my masters, I was working as a research assistant at an early intervention service for psychosis in Montreal, Canada. It was a very integrated clinical/research environment and I got to know what clinical care was like for young people experiencing psychosis.

I also learnt about the research on first-episode psychosis and one of the things that I noticed was that even though the early intervention for psychosis movement is much more recovery-oriented and hopeful than how psychiatry was in the '60s, '70s and '80s, I still felt like the ethos of it was still quite pessimistic and focused on symptoms, functioning, going back to work, and going back to school. Those are all important things – but I just felt like there was something missing.

Then through conversations with people with psychosis, I wanted to do a research project for my PhD focused on post-traumatic growth following psychosis – how people try and find ways to grow or develop new meaning in their life through experiencing a psychosis for the first time. I spent five years working on that. 

What I found was after a first episode of psychosis young people grow in all kinds of different ways. A lot of them talk about feeling stronger than they were before because they realised that they have these strengths that they've had to rely on or build through their recovery from psychosis. Many participants talked about experiencing improved relationships with other people, shedding relationships with people who were toxic, and increased spirituality. 

I did a follow up study with some participants and asked them how they felt they'd changed since the initial study I conducted. A lot of them started talking about how they wanted to draw on their own lived experience to give back to other people and to make the world a better place.

I then went to the United States where I worked with Larry Davidson at the Yale Program for Recovery and Community Health. I did research focused on the ways that people draw on their own suffering to give back to others. Lived experience could serve as a catalyst or a facilitator for giving back. 

All of this work was going on during the Covid lockdowns, so it was hard to build relationships and do good work at that point. But one of the takeaways from all that work was about the power of community and community organisations in general, community defined broadly, being important for people to experience recovery, growth, hope for the future meaning in their life.

That led me to looking at experiences of community and belongingness and how that shapes recovery and mental health outcomes. I went back to Canada and because it was during Covid I couldn't recruit many people so that project didn't really take off as much as I wanted. Then I came to Birmingham and I'm continuing with that research thread, but now I'm more focused on issues of intergenerational inequities.

We're going through the climate crisis, financial hardship and a cost-of-living crisis. Young people in general, and young people from marginalised backgrounds, are more impacted by these crises than older, more privileged people. My work is about trying to see how this state of polycrisis; these overlapping crises that are affecting young people disproportionately, is impacting their mental health and their ability to recover from mental health problems fully. 

I'm interested in how these crises make people feel like they have a purpose in life, how it shapes their sense of mattering, and how they feel they belong in the world. I'm also very interested in seeing how community organisations are helping to respond to these challenges in addition to traditional or early intervention services for mental health problems.

I think it's safe to say in psychology there's a good understanding of the power of community, but do you think that filters down into more medical settings in mental health? We have a movement towards social prescribing in the UK, but would you say more needs to be done to embrace community and its positive impacts?

I feel like it's a little bit more advanced in the UK than it is elsewhere. You mentioned social prescribing; that's something that doesn't really happen in Quebec where I'm from. We have community mental health teams that help to support people with significant psychiatric disabilities but not to the extent that you see with social prescribing. I think what ends up happening is traditional services do what they do and then community organisations and peers, just regular people, end up filling the gaps that traditional mental health services are unable to provide.

I know you've written about the potential for clinicians to encourage post-traumatic growth, but are there certain conditions for that? Is there more clinicians could be doing?

I guess just having more awareness that it occurs and then having an open mind, but not an expectation that people will experience post-traumatic growth. You can't be prescriptive or forceful about it because that could lead to a lot of harm, inadvertently, I think. If someone has gone through something very traumatic they're just trying to survive, talking about post-traumatic growth or saying 'Let's try and grow' that could be extremely dangerous, so I'm always wary of that. 

But I think just having that awareness, having an open mind, is the only thing that I would recommend. Right now there aren't really any specific tools or specific guidelines that have been developed that could help psychologists facilitate post-traumatic growth following psychosis specifically, or mental health problems specifically, but there are tools and manuals for growth facilitation more broadly which might be of use.

You mentioned your work has moved to looking at intergenerational inequities, what questions are you hoping to explore from that point of view?

There's really nothing out there looking specifically at intergenerational unfairness and youth mental health so I've been trying to lay the foundation for this body of work. There are a lot of large-scale quantitative studies that have looked at this but nothing really ties that to mental health on a smaller scale. The first thing that I tried to do with a master's dissertation cohort last year was conduct a critical review to build a conceptual foundation for how intergenerational injustice might be impacting young people's mental health.

Another component of that is to show that critical consciousness-raising, critical action, and political activism might be an effective way to raise awareness about the impact of intergenerational injustice on youth mental health. By raising awareness and then also engaging in different types of activism there can be a benefit to one's mental health. 

Along with my research assistant, Becky Williams, I have been conducting a qualitative study looking at how young people subjectively feel like things are worse for them relative to their parents and how it's impacting their sense of belonging and mental health. We've been asking some specific questions about how they're experiencing the crises around housing, the cost of living, and the climate.

A lot of the young participants that we've recruited have experienced several devastating challenges… they're trying to cope and survive crises that their parents' generation and their grandparents' generation didn't really have to worry about. One participant spoke about how they just wanted to start a family but even though they'd tried their best to earn as much money as they could, they were just unable to afford much in the way of rent or groceries, never mind be financially able to have a child and care for a child. 

Hearing that is just absolutely devastating because there is all this annoying, nativist rhetoric around how young people have a duty to reproduce, but how can young people have children if this is the context that they're living in? Many people in our generation (millennials) and younger people just can't afford to have a child and that should be so much more shocking that it seems to be.

Another thing that is worth mentioning is the state of private renting in the UK is leading to a lot of anxiety and depression among young people which is another thing that's coming out in the interviews. So many participants are just completely paralysed, anxious and depressed because they're worried about being evicted if they ask for repairs. They can't afford to move and some homes are barely suitable to live in because they're full of mould. It's unbelievable and out of control.

Have any of your findings over the years particularly surprised you?

For me it was how common post-traumatic growth is among young people who have a psychosis. When I first started that body of work I thought it would be very rare, I didn't think anybody was gonna say, 'oh, yeah, I've grown after a psychosis' because we know that psychosis is really devastating. When I gave participants a questionnaire measuring their post-traumatic growth levels, the results followed a normal distribution – to me that was completely shocking because I didn't think anybody was going to say, 'I subjectively feel like I'm stronger now because I had psychosis'.

The second surprising thing was the power that giving back and helping other people has towards one's own recovery from mental health problems. I've found a very, very strong effect in the work that I've done. One of the participants from the qualitative component of that study spoke about how before they started drawing on their experiences to give back to others, they felt like they hated people – but then they started giving back to their community and felt completely transformed. Helping others gives people so much meaning in their life and so much purpose and some said this is what they needed to do to sustain their recovery going forward. I thought that element would be important but I didn't think it would be at that magnitude for a lot of people.

Given your relatively recent move to Birmingham and your work on communities, are you working with any community groups in the city?

Yes, I am a Deputy at the Centre for Urban Wellbeing at the university, which is directed by Professor Jessica Pykett and Dr Laura Kudrna, and has a lot of connections with community organisations around Birmingham. Since I'm new to the city and the UK I don't know many people so it's been really great to be part of that centre. I've been introduced to some cool community organisations with the Birmingham Voluntary Service Council (BVSC). Along with Jessica Pykett and BVSC, we've put together a joint PhD project for PhD researchers to look at the influence of trust within community organisations.

Jessica Pykett and I have been working with Birmingham Settlement which is a community organisation in Ladywood which is next to Edgbaston Reservoir. They put on a neighbourhood festival last summer. Academics from the University of Birmingham and community leaders gave talks to residents and whoever was walking around. I gave a talk about citizenship and mental health and recovery, which was super cool. Jessica and I supported the evaluation of the festival for Birmingham Settlement which they can use to show its effectiveness and power. It was really well attended – I think there were over 1,000 people there.

There's also a youth empowerment organisation which is based in London called Reach Out to All which is coming to Birmingham. I'm going to help them evaluate the effectiveness of a workshop that they're going to deliver to young people to help them become young leaders.