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Safety in Marginalised Groups

Marginalised groups are those excluded from mainstream social, economic and cultural life. They are at markedly elevated risk of experiencing adverse patient safety outcomes, e.g. someone dies by suicide somewhere in the world every 40 seconds.

This theme builds on the work of the 2012-2017 NIHR Greater Manchester PSTRC on multimorbidity, patients' and carers' experiences of patient safety and mental health, as well as our co-design work with patients and members of the public, to help patients and carers take control of and self-manage safer care.

It focuses on impairment (e.g. sensory, cognitive), ethnicity/identity/language, specific adverse outcomes (suicide and self-harm), sub-populations (e.g. children and families), and environmental vulnerability (eg living alone, care homes/prisons).

Mental Health

This topic explores suicide and self-harm in primary care patients. It builds on work in the 2012-2017 Greater Manchester PSTRC on self-harm in older adults, medicines usage and suicide, and clinical management of depression and self-harm in adolescents and young people.

Read more about our research into mental health

The topic is further developing world-leading research programmes being conducted at The University of Manchester's Centre for Mental Health and Safety.

We are addressing two main questions:

  • When major changes to mental health services are implemented, what are the most important 'active ingredients' that serve to reduce risk of self-harm and suicide?
  • How does organisational context influence the beneficial impact of these service changes?

One of the key data sources being utilised is the unique National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, which is a UK-wide case series of all suicide deaths occurring in mental health services since 1996. The Inquiry datasets enable us to create a platform for developing a practical 'how-to' toolkit for mental health services to improve safety.

Other specific projects focus on:

  • developing and testing strategies to improve provision of psychological treatments following self-harm;
  • testing a brief theory-based psychological intervention (the 'volitional help sheet');
  • conducting cohort studies of key transitions after discharge from inpatient psychiatric care and release from prison to living back in the community;
  • examining clinical management and subsequent risks of self-harm and premature death among people diagnosed with common mental disorders in primary care (such as depression, anxiety disorders, and eating disorders).

Theme researchers are also involved in affiliated projects The Manchester Self-Harm Project (MaSH), the National Confidential Inquiry into Suicide and Safety in Mental Health, and an NHS England transformation programme to establish new and integrated models of primary and community mental health care across England.

Subtheme Leads

Key staff

Affiliated staff

  • Professor Carolyn Chew-Graham
  • Dr Faraz Mughal
  • Professor Jenny Shaw


Patients and Carers

This topic is conducting research to understand needs for supporting safety among marginalised groups, and to inform new interventions for meeting these needs.

Read more about our work with patients and carers

‌‌Communication barriers and ways to support effective communication for patient safety

There is an increased recognition of the importance of effective communication between users and providers of services to enable safer care.

We need to understand how best to enable this for marginalised groups, especially where communication is a particular concern, eg where people do not speak English or have sensory impairments.

We will consider how information and communication technologies might help or constrain information sharing for such groups. 

Changing roles and risks associated with self-management and new ways of delivering care

New models of delivering care and supporting self-management involve new roles and responsibilities for patients and families. This includes monitoring health (eg using new mobile phone apps), and sometimes more complicated management of medications and treatments.

Such changes bring new patient safety concerns, especially for groups that are more vulnerable due to age (eg children and older people), and when care is complicated because of multiple conditions, or where people live in environments that can make them more vulnerable (eg care homes and prisons).

Co-design of new interventions to support patient safety

We are building on the Greater Manchester PSTRC's track record of using experience-based co-design approaches to develop interventions, for example

We will draw on the new research above to inform co-design of new innovations and technologies for safety within marginalised groups and specific care contexts.

Theme lead

Key staff

Affiliated staff

  • Professor Sue Kirk
  • Professor Pauline Ong
  • Dr Waquas Waheed


  • Anna-Sophia Wawera