Understanding Right to Thrive outcomes - 2023

Understanding Right to Thrive outcomes

Understanding the outcomes and impact of Thrive LDN’s Right to Thrive programme on marginalised and racialised individuals and communities in London

Report by Meraal Arshad Imam (King’s College London).
01 December 2023.

Abstract

Marginalised and racialised communities (MRCs) experience significant challenges due to social experiences of exclusion and discrimination. The theories of intersectionality and social determinants framework have helped understand how one’s occupation of multiple identities can lead to further oppression, adversely impacting mental health and well-being. However, there is little research on intersectionality within the mental health field. Thrive LDN launched the Right to Thrive programme to fund grassroots organisations across London working with MRCs to improve their mental health and well-being through community-based interventions. In 2023, we interviewed six organisations that were funded by Thrive LDN to understand the impact of these interventions on their service users, mechanisms that led to these outcomes, and finally, how the Right to Thrive programme can be improved to better meet the needs of the organisations and MRCs. Our findings demonstrate that the interventions helped enhance the users’ mental and social well-being. The support provided to the organisations by Thrive LDN was crucial in achieving these outcomes. Additionally, core elements of the interventions were vital mechanisms. The findings resulted in essential recommendations to improve the Right to Thrive programme and make larger systemic changes to better meet the needs of MRCs. The study paves the way for the improvement of future Right to Thrive programmes and provides essential learnings for designing interventions that meet the needs of people with intersecting identities. It has implications for collaboration between the charity and organised sectors to address the needs of MRCs.

Keywords: Thrive LDN, Right to Thrive, marginalised and racialised communities (MRCs), mental health, intersectionality, social determinants, interventions, framework analysis

Introduction

The Global Burden of Disease Study in 2019 [1] reported that mental disorders account for 17% of the total years lived with disability in London. Some groups experience a greater burden of poor mental health than others [2]. This includes marginalised and racialised communities (MRCs), referring to groups that often experience exclusion from economic, social and/or cultural life, perhaps due to their race, language, gender, or migration status [3]. These groups may be subjected to “social, cultural, institutional and psychological ‘racialisation’ processes” [4, p.131] wherein they are perceived as inferior due to their identity [4]. MRCs experience unique mental health and well-being challenges exacerbated by their social experiences of stigmatisation and marginalisation [5]. Research suggests that in comparison to White British groups, there is a higher incidence of psychoses among African-Caribbean and Black African groups in the UK [6]. Early experiences of adversity, such as racial discrimination and childhood disadvantage, are possible socio-environmental risk factors for poor mental health [7]. Compared to White women, South Asian women have been found to have higher rates of distress and attempted suicides [8]. Similarly, LGBTQIA+ communities have an elevated risk of poor mental health than people who identify as heterosexual [9]. Additionally, people from the LGBTQIA+ community from low-income households have an increased likelihood of experiencing depression than their counterparts from high-income households [10], suggesting the impact of the intersection of sexuality and socioeconomic status on mental health.

These statistics are supported by the social determinants framework [11]. This framework highlights the impact of circumstances on one’s life and health [11]. Health inequities often exist along the social gradient [12], which can also be applied to mental health, whereby people with low social status experience a heightened risk of mental disorders [11]. Growing literature confirms the role of social determinants on mental health. A UK-based longitudinal study highlights discrimination’s detrimental and long-term impact on the mental health of ethnic minority groups [13]. Notably, social determinants and mental well-being have a bidirectional relationship [11]. Poor mental health can further impact social determinants, such as socioeconomic status [14].

Minoritised communities also experience minority stress, the unique and additional stress experienced by sexual minorities due to their identity and social experiences, as coined by Meyer [15]. Minority stress can be extended to ethnic minority groups, who experience stress due to stigma and prejudice [15]. Evidently, there is a pressing need to address the mental health and well-being concerns of MRCs.

Given the inequalities experienced by MRCs, it is vital to adopt an intersectional framework when discussing mental health and well-being. First introduced by Kimberle Crenshaw [16], the theory of intersectionality addresses the unique challenges faced by minority groups due to their multiple, intersecting individual identities (such as gender, race and sexuality) and social forces of oppression [17]. For instance, Black women experience inequalities due to the intersection of their gender and race. Put simply, multiple minorities may be multiply marginalised [18]. However, these differences in mental health outcomes based on identity, such as sexuality or race, demonstrate experiences of oppression rather than an innate vulnerability to illness [19].

Intersectionality has been extended to understanding mental health [15]. A study [20] that evaluated the intersection of gender, class and ethnicity in Sweden reported a higher risk of depressive symptoms among ethnic-minority women from low socioeconomic status than Swedish men with high incomes. A US-based study explored the intersection of gender identity, ethnicity and race [21]. Based on the findings, transgender adults – White and of multiple ethnicities – experience elevated odds of mental distress and depression compared to White cisgender adults [21].

These findings highlight the critical need for research focusing on the impact of intersecting identities and social experiences on the mental health of MRCs. Yet, there is a paucity of intersectionality research within psychology [17]. Additionally, intersectionality theory is not adequately integrated into mental health interventions to address the needs of marginalised communities [22]. Understanding intersectionality within mental health is necessary to provide improved and effective services and interventions for MRCs [23]. Further, there appears to be a dearth of evidence on the effects of community-based interventions on the mental health of minority communities [24]. This study would address a knowledge gap and contribute to an improved understanding of intersectionality within mental health. It would also contribute to the development of community-based interventions that would better address the intersecting needs of MRCs.

Launched under the London-wide Thrive LDN movement, the Right to Thrive programme recognises these inequalities and aims to promote the mental health and well-being of MRCs who experience poor mental health resulting from unfair treatment based on their identities [25]. To achieve this goal, Right to Thrive has funded 43 grassroots organisations since 2018 [25]. The programmes have seen the participation of Londoners with diverse identities, such as LGBTQIA+, refugees, Black groups and people of colour, engaging in interventions that aim to enhance their mental health and well-being while helping them develop skills and resilience [26]. The organisations planned varying interventions, including gardening, sports, support groups and resilience-building sessions [27].

The Right to Thrive interventions have provided important opportunities for MRCs to access community-based support. Learnings from the present study will help understand the impact of the intersectional programmes on the mental health and well-being of MRCs. Recommendations from this study would also contribute to the design of future Right to Thrive programmes, making them more culturally competent, thus improving their outcomes for MRCs.

This study had three primary objectives. It aimed to (1) understand the impact that the Right to Thrive interventions had on the mental health and well-being of marginalised and racialised communities and (2) understand the mechanisms that led to these outcomes. It also aimed to (3) establish recommendations to enhance the cultural and intersectional competence of the Right to Thrive interventions.

Methods

Study Design

The researcher chose a qualitative study design for this study, which is appropriate to adequately carry out research related to intersectionality [28]. Such a design ensures a rich and detailed understanding of the outcomes of Right to Thrive [29].

Participants

Participants were eligible for this study if 1) their organisation had received funding from Right to Thrive and 2) they were over 18. Participants were excluded from the study if they had applied for funding from Right to Thrive but were unsuccessful in their application.

Recruitment for the study was done via convenience sampling. Recipients of the funding were identified via data provided by Thrive LDN. Thrive LDN acted as the gatekeeper for the study and invited the eligible organisations to participate via email. Participants interested in the study directly contacted the researchers, indicating their interest. This was to maintain the participants’ confidentiality.

A comprehensive information sheet with the necessary details of the study was shared with the participants, and informed consent was obtained via an online consent form. The researcher assured the participants that their confidentiality would be maintained, and any identifiable information would be removed from the findings. They were also assured that participation in this study does not impact their relationship with Thrive LDN or future funding opportunities.

Ethical Considerations

Ethical clearance for this study was obtained from the King’s College London Ethics Committee (LRU/DP-22/23-34954).

Materials & Data Collection

Thrive LDN invited 43 organisations across London to participate in the study, from which nine showed interest by emailing the researchers, and seven signed the online consent form. One participant did not appear for the interview, and the final number of participants was six. This could be because the potential group of participants for this study was quite defined, and the risk of low participation was mitigated by inviting all organisations that have been funded by Right to Thrive. After signing the online consent form, each participant was allocated a unique study ID. The transcripts were anonymised using this unique study ID and stored in a protected SharePoint. Any identifiable information mentioned during the interviews was removed during transcript correction.

Data were collected through semi-structured interviews online via MS Teams, lasting up to 45 minutes. The topic guide for the interview was created in collaboration with the Thrive LDN team to ensure inclusive and accessible language. The topic guide elicited the experiences of the organisations with the Right to Thrive funding and its impact on MRCs. The semi-structured nature of the interviews allowed the participants to go beyond the questions and share other novel information related to the interventions. Further, the online nature of the interviews was convenient for the participants. With the informed consent of the participants, the interviews were video recorded. One participant did not consent to video recording but provided verbal consent to video recording, provided their camera was turned off during the interview. As per ethical guidelines, the video recordings were deleted once the transcripts had been edited. Each participant received Love2Shop e-gift cards worth £25 for their time.

The data collection began in May 2023 and ended in June 2023.

As an individual occupying intersecting minoritised identities, the researcher adopted a reflexive attitude during the data collection and analysis.

Analysis

The data was analysed using the framework method, which is part of the thematic analysis methods [30]. Developed by Jane Richie and Liz Spencer [30], framework analysis is a flexible yet structured approach to analysing qualitative data [30]. It reflects the experiences and observations of the participants [31], and was deemed appropriate for this study to understand the participants’ experiences with Right to Thrive. Framework analysis allows for data collection and analysis to be structured and informed by a priori knowledge obtained from the research aims [31]. An inductive approach was adopted, which includes open coding and analysing the data holistically while welcoming unexpected and socially located responses [30].

The seven steps of framework analysis were followed [30]. First, the video recordings were used to transcribe the data verbatim, and the transcripts were anonymised. Following this, familiarisation with the interviews was done by going through the transcripts and making notes of important points for interpretation. Third, coding was done, wherein the initial three transcripts were coded line-by-line to ensure a holistic understanding of what was shared by the participants. Fourth, the researcher developed a working analytical framework using these initial codes. Herein, based on the codes of the first three transcripts, the researcher created preliminary themes and subthemes. In the fifth stage, the researcher applied the working analytical framework to the subsequent three transcripts. The existing codes, themes and subthemes were applied, and new codes and themes were generated where needed. In the sixth stage, the data was charted into a framework matrix. This was done by charting the data onto a spreadsheet, wherein the rows were the individual participants, and the columns were the themes and subthemes. Charting helps organise the data in a manageable manner by allowing within-case and between-case analyses [32]. Illustrative quotes shared by participants were added to the chart. Finally, in the seventh stage, the researcher interpreted the data by mapping connections between and within cases through the framework matrix.

Results

The sample consisted of six participants whose organisations received funding from Right to Thrive. Each organisation worked with different target groups, including migrants and refugees, survivors of domestic violence, people with mental health diagnoses, Black groups and the LGBTQIA+ community. The organisations worked with diverse demographics, including non-English speaking people and people with disabilities.

The participating organisations had varying goals, including providing tailored support to the users, helping them develop resilience and agency and improving their mental well-being. As part of Right to Thrive, the organisations carried out a range of activities. Some organisations incorporated psychological and therapeutic elements in their community-based interventions. While some participating organisations used the funding to develop a new intervention, most used funds to continue an existing delivery. Some of the activities planned by the organisations were gardening, nature walks, communal meals, resilience support, one-on-one mentoring and counselling.

The analysis of the collected data led to the identification of five broad themes. These were (1) psychosocial benefits for the users, (2) support from Thrive LDN, (3) beneficial aspects of the interventions, (4) challenges in supporting the target group and (5) recommendations for improved support.

1.     Psychosocial Benefits for the Users

The interviews with the participants showed evidence of the benefits the Right to Thrive interventions had on the service users. The interventions had a positive impact on their mental health and provided the users with a space to communicate with others, thus improving their sense of social support.

1.1  Mental Health

The interventions helped improve various facets of the users’ mental health. One of the most significant benefits of the interventions was the users’ sense of confidence and empowerment. The service users were mostly people experiencing marginalisation, which could be due to their race, gender, sexuality, or an intersection of all. Participating in activities such as resilience work helped them learn how to self-advocate and display resilience. The participants also highlighted that the intervention aids their state of mind by helping the users feel calm, relaxed and at peace.

Many users come from underrepresented backgrounds, and often, they may not feel supported by the existing forms of support. The interventions helped the users feel understood and accepted.

MRCs often experience poor mental health due to their layered identities and social experiences of exclusion. It was found that the Right to Thrive interventions helped them gain essential benefits for their mental health in a supportive and inclusive setting.

1.2  Social Well-Being

A significant challenge faced by MRCs is isolation and lack of social support—for instance, experiences of discrimination for ethnic and sexual minorities. An important outcome of the Right to Thrive intervention was the social benefits. Most participants highlighted the role played by these activities in helping users develop social support by forming friendships and relationships. The users were also able to experience a sense of community.  

Often, MRCs struggle even more because they do not see representation in services, leading to their unique concerns going unaddressed. Several organisations aimed to incorporate a lived experience perspective or peer support in their delivery, providing users with support and connection. 

2.     Support from Thrive LDN

The psychosocial benefits to the MRCs from Right to Thrive interventions can be attributed to various important mechanisms, including the support provided to the organisations by Thrive LDN. Through the participants’ narratives, it was evident that while the financial support was of great importance, other forms of support provided by Thrive LDN were also valuable.

2.1  Financial Support

The most apparent support provided to the organisations by Thrive LDN was financial support via funding. The funding allowed the organisations to offer a new intervention or continue the delivery of an established intervention. For some participants, it bridged an important gap in funding. Additionally, the funding increased the capacity of the organisations to offer services on a wider and more flexible scale.

Through the funding, the organisations were also able to reduce economic and logistic barriers.

2.2  Networking Opportunities

Beyond the funding, Right to Thrive provided opportunities for the organisations which were key in helping them carry out interventions successfully. One of the prominent forms of support was the opportunity to network with Thrive LDN and other organisations that received the funding. This allowed the organisations to build relationships, share resources and co-promote.

However, while Thrive LDN created a supportive network, some aspects of it did not work out. Some participants perceived the community of practice and meetings put in place by Thrive LDN as burdensome, given the short duration of the funding.

2.3  Support from Thrive LDN Staff

In addition to networking opportunities, Thrive LDN also provided the organisation with support from their staff, which was perceived as helpful by many of the grantees. The participants highlighted that the Thrive LDN team was understanding, committed, and supportive.

Other resources offered by the Thrive LDN staff, including training and webinars, were also perceived as helpful by a few participants. However, most participants mentioned not being aware of these training webinars. This could be due to different sets of people interacting with Thrive LDN during the programme and participating in this research.

3.     Beneficial Aspects of the Interventions

The outcomes of Right to Thrive interventions were not only attributed to the support provided by Thrive LDN but were closely intertwined with the role played by the organisation itself. The organisations, through the interventions, provided beneficial forms of support, including client-centred support and skill-building.

3.1  Client-centered Support

The organisations focused on meeting the unique needs of the users and thus adopted a client-centred focus for the interventions. To achieve this, some organisations also formed personalised plans.

Further, the organisations supported the service users by allowing them to take things at their own pace based on their personal goals. Additionally, some organisations opted for one-to-one support, coupled with a therapeutic focus which was beneficial in addressing users’ needs.

3.2  Skill-building

Some organisations focused on helping service users learn skills, such as cooking. This was vital in helping them learn practical skills, manage stress, form relationships, and develop confidence that they may have been lacking due to their past experiences.

Further, the skill-building opportunities allowed the service users to engage in creative tasks to help them work through their past trauma.

4.     Challenges in Supporting Target Group

While the users experienced benefits from the interventions, the organisations faced significant hurdles in supporting them. Many of these were related to logistical barriers. Additionally, the organisations faced challenges in helping their target groups due to their histories of exclusion and stigma. Finally, given that some organisations received funding during COVID-19, the pandemic led to significant challenges in carrying out the interventions as planned.

4.1  Logistical Challenges

Most of the participants highlighted the logistical challenges. These majorly had to do with funding limitations, as well as the limited time that was available to carry out the interventions. This could have resulted in a lower-than-expected participation rate for some organisations. The participants shared that the logistical challenges were also related to the tangible barriers experienced by the users in terms of commute, privacy, and access to technology.

4.2  Challenges due to Exclusion

In addition to the tangible barriers experienced by MRCs, they also have histories of exclusion and stigma due to their identity and social experiences. These experiences can impact their ability to engage in interventions, thus acting as a barrier to supporting them. The interviews revealed that their traumatic histories can set them back and make the healing process challenging and overwhelming.

Further, these communities also face difficulties in accessing services due to a lack of recognition of their unique needs keeping their identities and histories in mind.

4.3  COVID-19-related Challenges

A significant challenge encountered by organisations in delivering the interventions was the transition from in-person to online delivery during COVID-19. Many people from MRCs are digitally excluded, perhaps due to financial barriers, making online interventions less accessible.

While service users faced challenges due to a sudden lack of social support during the pandemic, they also felt a sense of support by being connected digitally.

5.     Recommendations for Improved Support

The participants shed light on the challenges they faced in delivering the interventions and supporting their target groups. These experiences allowed them to further highlight crucial recommendations to improve the competency of Right to Thrive to better address the intersecting needs of MRCs. The participants went a step further and suggested recommendations to tackle systemic barriers to better meet the requirements of people with intersecting identities.

5.1  Logistical Recommendations

Throughout the interviews, it became clear that there is a need to improve the logistics of the Right to Thrive programme to allow organisations to plan their interventions better. These recommendations essentially had to do with an improved timeline, including more time to apply and plan and increased time length of the funding since the 3-month funding may be too short. The recommendations also called for adjusting expectations from the organisations based on the duration of the funding.

Another important recommendation was improving the support available to the organisation by considering their feedback.

5.2  Addressing the Unique Needs of Service Users

Most service users come from MRCs with intersecting identities that are excluded due to stigma and prejudice. Additionally, their marginalised identities intersect with financial and privacy constraints, which can make it increasingly difficult to access services. It is then important that interventions challenge these hurdles to better help such communities, which can be done by offering flexible and unique services, such as childcare, which would then allow women from marginalised communities to access services.

Further, the interview highlighted that given the history of exclusion that MRCs face, it is crucial that any initiative aiming to aid MRCs is non-discriminatory and accessible to minority groups.

Finally, as is clear, much of the existing support fails to consider the unique needs of people with intersecting identities. It is beneficial and crucial that the Right to Thrive programme adopts a London-wide perspective to help these communities.

5.3  Tackling Systemic Barriers

Significant systemic barriers exist as hurdles in supporting MRCs. One of these is the lack of a lived experience perspective and diversity in services. It is essential to increase diversity among volunteers, who can better support these communities. Diverse recruitment then becomes essential to adequately support MRCs.

Another barrier that needs addressing is the lack of support from organised services. This includes GP services, social workers and educators. Often, the service users cannot access these services due to financial constraints. It then becomes vital for services to have better provisions, such as subsidised services, to support MRCs.

To address the novel challenges that MRCs experience, it is vital that systemic barriers are considered.

Discussion

The present study aimed to understand the impact of Thrive LDN’s Right to Thrive programme on the mental health and well-being of MRCs. To achieve this, the programme funded grassroots organisations across London that work with people with intersecting identities. The service users participated in various activities, including communal meals, gardening, and one-on-one mentoring. The Right to Thrive interventions planned by the organisations positively impacted the service users’ mental health and social well-being. This became evident through the narrative of all participants, who reported that the users felt calm, relaxed, and understood and experienced improved social support. These findings are supported by existing literature, which suggests such activities can positively affect mental health and well-being by improving resilience, motivation, and self-esteem, reducing stress and increasing social contact and belongingness [33, 34, 35]. Additionally, research suggests that mentoring programmes can benefit MRCs, such as refugees, by helping them manage the stress of adapting to a new country [36]. Research also confirms that community-based services help MRCs develop a sense of trust, promoting access to services [37]. Research also suggests interventions need to focus on mental health awareness and issues uniquely relevant to the marginalised community [38, 39]. However, when addressing these issues, it is important to exercise caution and not generalise them to all members of the marginalised community, thus stereotyping them further. Instead, these issues should be uniquely assessed for each service user.

This study also aimed to understand the mechanisms that led to these outcomes. The findings suggest that the outcomes could be attributed to the support provided to the organisations by Thrive LDN, including financial support, networking opportunities, and support from staff. Thrive LDN challenged traditional funder-grantee relationships by providing additional beneficial forms of support, such as networking opportunities and support from Thrive LDN staff, as highlighted by the participants. The importance of this kind of support is supplemented by existing literature, including mentorship by the funder and opportunities for skill learning and networking [40]. However, the findings revealed that support via communities of practice provided by the funder had paradoxical effects and were deemed burdensome by some participants. This is in contrast to much of the research, which suggests that communities of practice have significant organizational and individual benefits [41]. Still, communities of practice are not a one-size-fits-all solution [42], and participants’ feedback must be considered to create beneficial and appropriate support for them.

There were other mechanisms responsible for these outcomes as well. This includes client-centred and personalised support offered by the organisations, which considers their needs, goals and pace. This supports findings that personalised support in community-based settings is effective [43]. Further, skill-building activities also allowed users to learn new skills while forging social relations. One organisation helped the service users learn the skill of gardening, which has been backed by research for improved mental health and important emotional, social and physical benefits [44]. Overall, the literature confirms that community-based interventions that employ skill development strategies are effective [45].  

While these mechanisms were vital in achieving the outcomes, the organisations also experienced significant challenges in supporting their target group. A key challenge was logistics, as some shared needing more time to plan the interventions and, sometimes, needing the funding to be longer. This seems to be commonly experienced by community-based initiatives, as funding may often be too short or too much may be expected of organisations within the limited funding period [40, 46]. The service users also faced restrictions related to commute and privacy which was a challenge.

Another challenge had to do with the exclusion faced by service users with intersecting identities. MRCs often have histories of trauma and exclusion, which can make participating in interventions overwhelming. It is then crucial that their needs and pace are considered. Further, the interviews suggested the existing support systems do not consider the traumas and histories of MRCs, due to which their needs often go unaddressed. It has been reported that institutional attitudes towards minority identities can hinder access to services [37]. For instance, the literature suggests that globally, health research has not adequately addressed the mental health needs of LGBTQIA+ communities [47]. Further, LGBTQIA+ service users often experience stigma when accessing mental health care and a lack of knowledge about their specific needs by mental health professionals [47]. Such experiences of exclusion within the system can impact their access to services [47]. Finally, some organisations faced challenges due to COVID-19, which led to online delivery and restricted group sizes. This was difficult because MRCs are often digitally excluded [48] and may be unable to access online interventions, highlighting the critical need to bridge the digital divide.

Having faced these challenges first-hand, participants provided recommendations to improve the intersectional competency of the Right to Thrive programme so it could better meet the needs of the organisations and MRCs adequately. They suggested improving the timeline of the application and funding and improving the support available to the grantee organisation. Similar learnings have also been obtained from the evaluation of another community-based programme, including recommendations for flexible and secure funding to provide medium-term to longer-term support [40].

Furthermore, the participants provided insights into the unique needs of the service users as well as how larger systemic barriers need to be tackled to enhance the mental health and well-being of MRCs. The data highlights that service users experience significant challenges such as economic strains, poor mental health, and commuting barriers, making it difficult for them to access services and activities, which is congruent with existing literature [49]. The participants recommended ways in which users’ unique needs could be addressed, such as by providing support through childcare so the users could engage in services.

The participants also highlighted Thrive LDN’s strength: their capacity to adopt a London-wide approach, ensuring communities are not overlooked. They emphasised the importance of ensuring that funding initiatives and applications to them are non-discriminatory and accessible. A community-based funding scheme’s evaluation in Ireland reports that most applicants were from established organisations, and marginalised groups are often excluded from application due to a lack of skills required to apply for funding [50]. Thrive LDN could mitigate this risk by providing additional support during the application process to ensure that more hard-to-reach communities are able to engage with the application.

Often, the existing forms of support do not integrate lived experience perspectives into the design of services [38], as a result of which unique needs of these communities go unaddressed. The participants recommended incorporating lived experience perspective into interventions to ensure that services consider users’ histories and experiences to offer effective support. Past literature ascertains the importance of adopting this perspective, such as via peer support. A comprehensive literature review [51] suggests that people with lived experience can help promote hope, agency and self-esteem and reduce stigma, which is vital for personal recovery. This could also be facilitated by increasing diversity in the charity sector by paying the volunteers. This is essential because, typically, people from MRCs do not have the privilege to volunteer due to the barriers they face, such as financial constraints [52]. While incorporating lived experience and peer support into interventions has benefits, challenges related to it are considerable. This includes challenges related to boundaries between the case worker with lived experience and the service users, as well as stress that could be experienced by the lived-experience worker [51].

Finally, the participants recommended changes to the organised sectors, such as GP services, wherein support needs to be made available to MRCs, such as by waiving high fees for services. While this is a difficult feat to achieve, given the understaffing and high workload within National Health Services (NHS) [53], a step towards this can be taken through collaboration between such services and the charity sector. This is endorsed by NHS’ Five Year Forward Review, which calls for stronger partnerships between NHS and the charity and volunteer sector [54].

Strengths & Limitations

A strength of this study is its inclusion of organisations that work with diverse groups and communities, including people with mental health diagnoses, survivors of violence, refugees, the LGBTQIA+ community and Black groups. This allowed for diversity within the data and highlighted the barriers experienced by these groups and their unique needs.

A limitation of this study was the small sample size. This is because the population for this study was already quite defined. While the interviews provided rich data, a larger sample size would have benefited the study. Further, the findings have low generalizability since the study only focused on London-based organisations.

Another limitation identified during the data collection was that one of the initial participants assumed that the researcher was a part of the Thrive LDN team, which became apparent only towards the end of the interview. This could have led to them giving biased responses to the questions, perhaps due to social desirability or wanting to be considered for future funding. The researchers immediately mitigated the limitation by reminding the subsequent participants that the research was independent of Thrive LDN before the commencement of the interview.

Implications

Perhaps the most apparent implication of the study is the learning it provides for future Right to Thrive programmes. The participants offered substantial recommendations, such as improved timelines, better forms of support and continuation of the funding. A broader implication of this could be to apply these learnings not just to help Thrive LDN become more culturally adapted in addressing the unique needs of MRCs but also to aid Thrive chapters worldwide.

Additionally, the study has important implications for the larger systemic structures, such as the existing forms of support available within the charity and organised sectors. The participants’ narratives highlight the importance of increasing diversity within the staff so the users feel seen and understood. In addition to including a lived experience perspective, the study highlights the importance of offering pay so that more people from marginalised backgrounds can volunteer and support service users. It is also vital that organised sectors, such as GP services, consider barriers faced by MRCs and accordingly offer services that are subsidised and accessible. Integration and collaboration between sectors, such as the charity sector, policymakers, funders, people with lived experience, mental healthcare, and healthcare providers, are vital to achieving these goals.

Finally, this study paves the path for future research. Learnings from this study can be useful for conducting future research on the impact of community-based interventions for MRCs and for designing socio-culturally sensitive interventions that aim to help people who experience novel challenges due to their occupation of multiple marginalised identities.

Conclusion

To conclude, the findings of this study suggest that the Right to Thrive interventions had significant benefits for the mental health and social well-being of people from MRCs. Two sets of mechanisms led to these outcomes – the support provided by Thrive LDN to the organisations and the benefits aspects of the interventions offered by the grantee organisations. Despite these benefits, the organisations faced significant challenges in supporting their target group. The study led to important recommendations to improve the Right to Thrive programme to enhance its intersectional competency and meet MRCs’ needs better. The study also highlights substantial recommendations to make broader systemic changes to serve these groups better.

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