Title: Developing a consensus on mental health recovery for modern slavery survivors.
Funder: Department of Health and Social Care

Abstract: Background: Modern slavery and human trafficking are crimes involving the violation of human rights and include activities such as sexual exploitation, forced labour and domestic servitude. An estimated 40.3 million people are enslaved worldwide, including 136,000 in the UK. Modern slavery is an important policy area. Survivors have often experienced extreme violence and psychological abuse. International and national policy highlights the importance of addressing mental health. However, policy in this area crosses multiple departments and offices. This means that it can be disjointed and conflicting. One particularly challenging area is the definition of recovery. Recovery has become the foundation of mental health provision. It situates people with mental health problems as active recipients in their care. It is not the amelioration of symptomatology, but a personal journey to understand the events that have occurred. Survivors experiences of what recovery means to them, is under reported. However, policies such as the 2018 Human Trafficking Care Standards, S.49 Modern Slavery Statutory Guidance and the Home Office Recovery Needs Assessment are replete with references to it. To start to address this gap, NIHR funded a qualitative study exploring survivors experiences of mental health and recovery (the MOMENTS-1 study). This application is for a follow-on study using the MOMENTS-1 data as the starting point for a Delphi consultation to co-produce a survivor informed definition of recovery for use within policy documents. Aim: To co-produce a survivor-informed definition of mental health recovery to support improved policy making in relation to modern slavery. Objectives: (1) To conduct an online Delphi consultation with experts to explore the core components of a definition of recovery. (2) To co-produce survivor-informed policy outputs to support improved decision-making. Methods: A Delphi consultation and consensus workshop. Delphi is a technique defined by its use of experts and a series of questionnaires interspersed with feedback to provide information on group opinion. Approximately 25 -30 purposively sampled experts from each of 5 groups (policy makers, statutory health services, NGOs and academics) will be approached to participate. The initial list of items for the Delphi will be developed from the MOMENTS-1 qualitative data and a rapid literature review. Delphi rounds will continue until the consensus estimate is stable. If an item receives an endorsement from 70% of participants consensus will be considered to have been reached. Timelines for Delivery: 12 months (December 2020 &ndash; November 2021). Month 0-3: ethics and governance approvals obtained; item identification completed; early engagement with policy makers and other stakeholders; Month 4 &ndash; 9: Delphi participants identified; survey circulated; data analysed; consensus meeting held; Month 10-12: dissemination to relevant policy audiences, other key individuals and organisations. Final report to funder. Anticipated Impact and Dissemination: Outputs will be targeted, with tailored messages and will include policy briefings, social media content and a report launch and policy orientated conference. The success of the impact strategy will be evaluated by collecting testimonial as required.

Lay abstract: Modern slavery refers to the exploitation of individuals through activities such as forced sex work, forced labour, forced criminal activity and the sale/exploitation of children. There are an estimated 40.3 million enslaved people worldwide, including an estimated 136,000 people in the UK. Modern slavery survivors have often experienced extreme violence and psychological abuse. As a result, mental health problems such as anxiety, depression, psychosis and post-traumatic stress disorder (PTSD) are common. Recovery has become the foundation of mental health service provision globally. It recognises that to be able to lead a fulfilling life, individuals need more than the treatment of symptoms. Supporting recovery for survivors of modern slavery is referred to widely in UK government policies. However, recovery is not clearly defined in these policy documents, and survivor experiences are not central. Very little is known about what helps survivors to recover, or indeed even what the term recovery means for them. To start to address this gap, the National Institute for Health Research (NIHR) funded a study exploring survivors experiences of mental health and recovery. The study started in July 2019 and runs until March 2021. It involves interviews with 30 survivors to understand their experiences. Early findings show that recovery is a diverse concept, including practical, emotional, social and psychological elements. This application is for a follow-on study, using the first study s findings to co-produce a survivor-informed definition of mental health recovery for use in a policy context. We will use an established method called a Delphi Consultation to identify whether agreement exists about the meaning of recovery between five important groups: survivors; policy makers; statutory health service staff; non-governmental organisation staff; and researchers. The approach involves asking participants to rate questionnaire items about possible aspects of recovery over several rounds, with later rounds including information on how other participants have rated items. A consensus workshop will be then convened to finalise the definition with survivors, policy makers and other stakeholders. Survivors will be involved throughout the process. A survivor co-applicant (Dang) will be a member of the project management team and a lived experience research advisory board will be convened to advise on the conduct of the research. Survivors will also participate in the consensus process. We have consulted with key stakeholders on this project, including the Independent Anti-Slavery Commissioner (IASC) who expressed high interest levels. Our translation of research into policy will be further aided by our current &ldquo;buddying scheme&rdquo; with the UK Home Office Modern Slavery Unit (MSU), which pairs researchers from the University of Nottingham s Rights Lab (including the PI) with MSU officials to exchange knowledge.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH