Title: Global Health Research Group on Disrupting the cycle of GEndered violence & Poor Mental health among Migrants in precarious Situations (GEMMS)
Funder: Department of Health and Social Care

Abstract: The mental health and psychosocial (MH) consequences of precarity experienced by migrants is widely acknowledged as a global health challenge. Migrants inhabiting and moving across ‘precarious situations’ are at high risk of Gendered Violence (GV), at both the interpersonal and structural level. Combined with the inability to report or access healthcare and other systems of protection, and invisibility in policy and planning results in excess burden and entrapment in a damaging cycle of GV and MH. In order to inform the design of appropriate interventions that address these burdens, it is necessary to improve our understanding of the relationship between drivers of risk among migrants in precarious situations. Responding to conceptual, empirical and intervention gaps affecting this global public health crisis, we build on existing interdisciplinary expertise and prior collaborations to establish a Global Health Research Group on GEndered violence & Poor Mental health among Migrants in precarious Situations’ (GEMMS). GEMMS brings together clinical, psychosocial, sociological and public health expertise within the University of Essex with expertise from South Asia and Southern Africa to advance this agenda. _x000D_ Aims & objectives: Working in four precarious situations with diverse migrant groups in India, Myanmar, South Africa and Zimbabwe, we aim to create the necessary conceptual and methodological tools and actions that may create solutions to disrupt the damaging cycle of GV & poor MH and improve migrants' wellbeing, via following Work Packages (WPs):_x000D_ WP1: Situational Assessment And Data Appraisal – evaluate existing evidence and service gaps to inform the design of research and intervention tools and conceptual framework to advance other WPs. _x000D_ WP2: Lived Experiences – conduct research with migrants, health providers using mixed methods integrated with Participatory Action Research to generate new knowledge about: _x000D_ • burden and lived experiences of the intersecting risks of GV and poor MH_x000D_ • socio-economic determinants and contextual mechanisms _x000D_ • distribution and accessibility of resources that support resilience and well-being._x000D_ WP3: Actions & Interventions - Drawing on WP1 &2, develop a participatory approach to co-design actions and a training and support intervention for healthcare workers and service providers _x000D_ _x000D_ Methods: Our research methods involve a situational assessment and review of existing evidence; a cross-sectional survey and longitudinal phone tracing survey to understand changes in risk over time and place; and qualitative interviews and participatory workshops with affected migrants, healthcare workers and service providers to co-design actions to address the risks to GV and PH. _x000D_ _x000D_ Anticipated impact: _x000D_ • Improved knowledge will lead to the development of a responsive conceptual framework to assist in understanding & responding to the mutually reinforcing cycle of GV & MH in migrants in precarious situations._x000D_ • Appropriate, supportive actions are co-developed with key stakeholders, including affected migrants, to reduce the syndemic risk of GV & improve MH in migrants in precarious situations._x000D_ • Key stakeholders at the community, national and global level are informed and equipped to influence policy processes in order to support action towards SDGs 3, 5 and 10_x000D_ • Partnerships and activities will continue beyond the grant cycle, supporting GEMMS in becoming a global reference point for migration and health.

Lay abstract: The link between Gendered Violence (GV) and poor Mental and psychosocial Health (MH) is widely acknowledged, yet poorly understood. Interventions that address these global health challenges generally focus on either GV or MH and ignore the damaging cycle whereby GV reinforces poor MH and vice versa. They are limited in their reach and only address the needs of sedentary populations. As a result, there is little uptake among migrant groups, especially those living in precarious situations (e.g. people displaced due to conflict and disaster, rural poor moving in search of livelihood opportunities). These situations are associated with chronic precarity in work and living conditions, barriers to healthcare access, and increased exposure to violence and burden of ill-health. Such precarity creates different risks, responses, and resilience to GV and poor MH over time and in different places. Appropriate and effective interventions require better understanding of the intersecting risks to GV and poor MH, factors determining these risks, and how they change over time and place. _x000D_ _x000D_ The GEMMS research group brings together academics and practitioners with relevant expertise and experience in six institutions across four countries over a four year action research programme. We will develop an evidence-informed intervention to provide on-going support to migrants in precarious situations in SA and India, and border spaces in Myanmar and Zimbabwe. The research group will establish a programme of work to generate new knowledge, improved understandings and co-designed training and public health solutions. We apply theoretical and empirical insights to support efforts to improve the lived realities of migrants in precarious situations through participation of affected populations in research. Ultimately, our vision is to create the necessary tools, actions, and an intervention pathway to disrupt the damaging cycle of GV and poor MH in order to improve the wellbeing of migrants in precarious situations, including responsive interventions that can address migrants’ changing needs over time and contexts._x000D_ _x000D_ Objectives_x000D_ 1. Evaluate existing evidence and service gaps to inform the design of research and intervention tools. _x000D_ 2. Conduct research with migrants in precarious situations, health workers and service providers using mixed methods within a Participatory Action Research framework to generate new knowledge about: i) burden and lived experiences of the intersecting risks of GV and poor MH; ii) socio-economic determinants and contextual mechanisms that shape these risks; iii) distribution and accessibility of resources to support resilience and well-being. _x000D_ 3. Drawing on the new knowledge generated, co-design: i) a training and support intervention for healthcare workers and service providers and ii) actions informed by a public health approach to address underlying causes.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE