People with long-term mental health problems face profound social exclusion. They also die much younger than the general population from preventable causes. Despite a considerable body of research highlighting much higher rates of the main chronic and life-limiting diseases, later detection, and sub-optimal and fragmented care for people with severe mental illness (SMI), these inequalities appear stubbornly entrenched. Social exclusion for this population is characterised by an invisibility at policy and social levels and the challenges in meeting these complex needs with primary and secondary care services are immense. Using participatory approaches with stakeholders and experts by experience (stage 2), we identified the key challenges for implementation of social prescribing for people with SMI. These include: (1) diffusion of service responsibility and fragmentation of care; (2) limited (or absent) psychosocial support towards community engagement; (3) public and self-stigma leading to over-reliance on in-house (institutional) care; (4) policy confusion and neglect on SMI; (5) uneven distribution and ephemerality of community assets. Although social prescribing (SP) offers a potential solution by encouraging access to health-supporting amenities and resources and interagency collaboration, there is scant SP research for this population. The health and social care needs of this population require imaginative and nuanced models of health care that can accommodate their various and intersecting medical, social, and psychological needs while simultaneously influencing the environmental contexts in which they exist. The Challenging Health Outcomes/Integrating Care Environments (CHOICE) coalition has co-designed a delivery model which enhances interagency cooperation while providing more capacity at the community level to assess, appropriately prescribe, and provide flexible, sustained support to use a wide range of resources (assets, e.g., arts, leisure, and sports). In stage 3, Community Navigators based in our partner organisations will be trained in behaviour change techniques to encourage, guide and support people with SMI to use these resources. We will also extend the use of peer-support. This approach is intended to facilitate, incrementally, a virtuous cycle of improved self-esteem, self-efficacy, and social inclusion that enhances quality of life and wellbeing. Because research of this type has not been done before, our multi-disciplinary research team will undertake an adaptive mixed methods research programme to examine: (1) the outcomes of this approach; (2) the barriers and facilitators in implementing the CHIOCE model, such as the real-world issues of interagency cooperation and communication; (3) the needs and challenges of the voluntary and community partners; (4) the contextual and structural factors that might influence how the project works. Importantly, we will seek to gain a deeper understanding of CHOICE through our experts by experience who have a powerful and central role in the coalition and in the research process. Due to the embeddedness of all the key stakeholders in the CHOICE coalition, the findings will have a major impact on research, policy and practice in social prescribing, social inclusion, and health of people with SMI.

The Troubles describes the social-historical phenomenon occurring between 1969 and 1994 when the sectarian conflict in Northern Ireland was at its most extreme. Those 25 years have had a profound impact on the social, political, economic, cultural and spatial structures of Northern Ireland ever since. The consequent reaction by government, security and statutory authorities bore witness to a profound material impact upon inner-city communities resulting in architectural and spatial disconnection and disengagement with the economic and social structures that manage, govern and regulate the built environment. This review focuses on a specific aspect of material impact, the built structures installed within the inner-city to divide streets, disconnect spatial continuity, mitigate against vehicular flow and limit pedestrian movement. These vary in implementation and include walls, bollards, landscaping and the locating of housing across the path of existing streets. This material impact is extensive across inner-city Belfast. Whilst the sociological and economic impact of The Troubles has received much research attention the impact of these built interventions has yet to be systematically assessed. This review recognises the inner-city exemplar of Ballymacarrett, East Belfast as a community of disconnected people and disconnected spaces. The considered implementation of these divisive built structures has served to fundamentally fragment and spatially disconnect this community. This review conceives of a community as an intrinsic ecosystem of people and the built environment and addresses the challenging issue of engaging a disenfranchised and disconnected community with a broad range of stakeholders and academic research. The review process is a catalyst for inclusive discussion that involves a team of project partner stakeholders, directly linking the review process with the agencies with the remit and funding to implement urban regeneration and social housing policy review and change. The aims of this review are to utilise knowledge gained from academic and practice-based research methods to inform and stimulate discussion amongst key stakeholders with active inclusion from policy makers and the community. Such discussion has the stated aim of developing a policy discussion mechanism that will continue to progress the issues highlighted by the review beyond the review period. These aims meet address the objective of engaging research with non-academic stakeholders; empowering the related community; developing a methodological framework that is transferable to other contexts. The creation of buildings and spaces is a complex scenario involving stakeholders across the social, political and economic spectrum. As a consequence built artefacts contain much embedded information pertaining to a wide variety of perspectives that concern, and have potential to engage, the community within which they are installed. The research team of an architect and a fine art photographer presents a cross disciplinary approach to analysing this context. The disciplines have been aligned to provide a historical record that is accessible to a diverse audience of community, policy, politics and academia. Architectural and spatial analysis will identify Case Studies of built structures that will be documented and illustrated through conceptual photographic representation. Built structures will be utilised as mechanisms to extract data of historical and contemporary importance, eliciting new knowledge. Disconnections will be highlighted and former connections illuminated. The key relationships that are revealed will be essential tools towards addressing the very real architectural and spatial issues within inner-city Belfast communities. Such analysis will present a new perspective to the social, political, economic, cultural and spatial factors that shaped physical change in this community in a distinct and extreme period in cultural history.