Dr Tessa Morgan is researching young people’s experiences of the mental health system at the Primary Care Unit. She completed her PhD in older couples’ experiences of end-of-life care with the Primary Care Unit in 2021. After returning to New Zealand during the COVID-19 period, she rejoined the Unit last year as NIHR Post-Doctoral Research Fellow with the Applied Social Science Group.
My undergraduate degree BA was in history and politics at the University of Auckland.
An activist friend mentioned a summer research project focusing on feminist issues in palliative care. I had to google palliative before the studentship interview. Fortunately, I’d taken enough papers on feminist topics to understand some of the gendered inequalities in care to be offered the opportunity.
With the support of my summer studentship supervisors, now friends, Prof. Merryn Gott and Dr. Lisa Williams, I became obsessed with family caregiving and challenging the gendered and ageist inequities deeply embedded in our care systems.
Following this summer of research at the School of Nursing, I was offered a part-time research assistant job in the Te Arai Palliative and End-of-Life Care. I switched my BA honours in History to part-time to be able to do this and have been in public health research ever since.
I love that public health research is focused on systems change through collecting evidence with service users themselves
I was awarded the Woolf Fisher Trust Cambridge Scholarship to conduct a PhD in the Department of Public Health and Primary Care in 2017. I continued with my interest in palliative care with the good fortune of having Professor Stephen Barclay as my primary supervisor. Early in my project I was able to consult with experts by experience in the Palliative and End of Life Care Research Group (PELiCAM) which shaped my doctoral topic.
I kept hearing stories about older couples who were caring for each other in very precarious situations, without any support
They only became known to health and social care when a full-on crisis occurred. I decided that I would focus my PhD on oldest-old couples who were providing end-of-life care at home as they seemed to be slipping through the cracks of health and social care.
It is so delightful to meet people by talking about ideas
Reading groups were my favourite part of my doctoral studies. During my PhD, I was the co-convener of the Gender and Working Lives and the Anthropology of Care groups at Cambridge. I learned to ask better questions and had my world opened up through sociology and anthropology.
Going straight into PhD without a Master’s degree was a big challenge
On the one hand, it was a benefit, as I was familiar with the practicalities of research e.g. how to get people to talk to you and how to process their data. However, I also had a lot of theory and methodology to scrub up on. Fortunately, Dr Robbie Duschinsky was my second supervisor and is essentially a walking bibliography for critical theory, so I always felt that I was in safe hands. I also benefited from talking to a range of clinical colleagues in the PCU who helped me to think through the practical implications of my project.
Through my PhD experience, I realised that my main research interest is about what makes health and social care systems ‘caring’ for vulnerable people. I really like how the Applied Social Science Group in the PCU connects theory to practical questions like this. When a qualitative researcher position came up to work with the group I was more than excited to apply.
There has been virtually no research asking young people what they want from mental health services
The research I am working on now will explore how young people are talked about by mental health services and compare those accounts with how they view their own experiences, which we will learn about through interviews.
The COACHES research looks at young people’s social care experiences
I’ll be co-leading the qualitative work within COACHES, a new NIHR-funded research programme led by Dr Robbie Duschinsky. We will be conducting a longitudinal case note analysis of 80 young people with safeguarding needs in the South London and Maudsley Child and Adolescent Mental Health Service (CAMHS).
This data will enable us to understand how these young people’s social care needs are being characterised and how this relates to the kinds of care they do or do not receive. Through case note correspondence, we will focus on the referrals process to understand what gets young people through the front door into CAMHS.
We will also look at the nature of interprofessional working across a range of service providers attempting to support these young people. This will be hugely relevant to primary care as typically when young people’s needs are not met by secondary care services, primary care is left holding the case.
The second part of the research involves interviewing young people with social work involvement about their mental health service access. This will give young people a chance to say what is working and not working for them.
From this we will be able to create policy suggestions to improve the system. The work will also let us see what resources young people in social care are already drawing on, such as their friends, teachers, ideas about the future, which are often overlooked in this group.
I’ll be working closely with three experts-by-experience
They have been through social care and mental health systems themselves and have so much valuable insight and knowledge that will guide this research.
I’ve had to navigate the mental health service for myself and family members and I am personally always so shocked how difficult it is to get help, even when you are asking for it. I can’t begin to understand what it is like for young people without family support or who are experiencing abuse or neglect at home.
This is a rare opportunity to directly inform system change
Part of my work is engaging with stakeholders from policy and practice. It seems there really is political desire to improve the mental health system for young people in social care, and achieve better integration of health and social care services.
Researchers can help name social injustices
We can bring recognition to social groups who are currently obscured from contemporary discussions. For example, our research will respond to the current research gap by asking young people in interviews to describe their challenges and share what they would like from mental health and social services.
To address injustice, researchers can work with communities of people already making change, to amplify their causes. This is also why it is essential that we do research alongside experts by experience, who know how to ask the right questions and who to connect with, to make sure our findings influence real change.
Image: Tim Dennell via Flickr (Talk to Coco)