In Herefordshire and Worcestershire, over half of rural residents live in areas of significant deprivation, and suicide rates in Herefordshire (11.9 per 100,000) exceed the English average (10.7 per 100,000), with the most deprived groups 19% more likely to die by suicide. This matters because rural mental health needs are poorly understood and underserved. The region’s only NHS trust has just 5.3 full-time research staff and 11 principal investigators covering a vast area, and recruited only 65 participants to secondary mental health studies in 2022/23—8% of regional recruitment. Groups seldom heard include people over 75, those in remote areas, informal carers, and the digitally excluded. These populations remain research-naive, limiting understanding of how rurality affects mental health. If this programme succeeds, it could transform how mental health research reaches isolated communities. Instead of relying on GP surgeries or travel to distant clinical trials units, researchers could develop methods that work without digital access or long journeys. The findings could inform how other rural Integrated Care Systems across the UK design services for deprived, dispersed populations—potentially reducing suicide rates and improving access to care for those currently excluded from both research and treatment.
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Herefordshire and Worcestershire (H&W) are rural counties. In Worcestershire, over a quarter of residents live in rural areas and in Herefordshire this increases to over half of residents. Both counties have areas of significant rural deprivation. Of the 62 rural Lower Layer Super Output Areas (LSOAs) across Herefordshire, 28 fall within the 20% most deprived rural LSOAs nationally and 2 of these are in the most deprived 10% nationally1. 10% of people in Worcestershire live in the most deprived quintile. The H&W Integrated Care System (ICS) serves this large, rural population, with many rural areas situated at long distances from larger urban centres. Rural deprivation presents challenges for service providers. These have been recognised by the ICS who are prioritising work designed to reduce health inequalities. Factors which contribute to higher risk of poor mental health and / or elevated suicide risk3 are evident across rural H&W: People who may be both stigmatised and socially marginalised People living in remote and / or deprived areas who are socially isolated Those with access to means of suicide Those living in high conflict or violent relationships Those with a lack of healthcare access The recorded prevalence of serious mental illness (SMI) has increased in Herefordshire to 0.83% 4 and 0.72% in Worcestershire 2. Rates of contact with secondary mental health, learning disability and autism services across the counties are rising (an additional 4,000 people in 2022 from 38,940 the previous year 2). There were 46 detentions under the Mental Health Act recorded in H&W (59 per 100,000 people in 20/21), with just over two times higher rates of detention for the most deprived groups 2. Age-standardised mortality rates for suicide in Herefordshire (11.9 per 100,000 people in 20-22) are higher than England (10.7 per 100,000 people)5 with those in the most deprived areas approximately 19% more likely to die from suicide than the county population in general. The male suicide rate in Worcestershire is currently significantly higher than the England average 2. Delivery of NIHR portfolio secondary mental health research across the region is led by Herefordshire and Worcestershire Health and Care NHS Trust (HWHACT). The research delivery workforce at HWHACT comprises of 5.3 wte permanent staff who are charged with working across a huge geographical region. The limited availability of Principal Investigators in HWHACT (n=11) inhibits capacity and there are no Chief investigators within HWHACT. The UoW is the only university in the ICS region. Recruitment rates to portfolio secondary care mental health studies across H&W are relatively low. In 22/23, HWHACT recruited 65 participants, 8% of total regional recruitment. The nearest clinical trials units are based at Warwick Medical School or the NIHR / Wellcome Trust Birmingham Clinical Research Facility, incurring travel time and costs for H&W residents. GP practices are engaged with research recruitment across H&W; 78 practices recruited to primary care mental health studies in 22/23. However, this relies on people being registered with a GP, having the means to travel to their GP and, increasingly, having access to digital services. Groups who are seldom heard in research include 6: Those over 75 years People who are stigmatised and / or socially marginalised People living in remote areas Informal carers Those who are digitally excluded These factors intersect and there are high numbers of residents across our rural areas exposed to multiple factors. We have an important population across H&W which could advance understanding about rurality and mental health. Currently this population remains research naive. This MHLA programme would enable us to unlock potential across this region, offering quality research to our patients and residents. This would be transformative for our region, but also for our understanding of rural mental he
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