Self-Harm and suicide ideation (i.e. thoughts about dying by suicide) are two of the most important known risk factors for death by suicide. Increasing suicide rates are a major public health concern and Northern Ireland consistently has the highest rate of suicide in the UK and Ireland. Recent policies to reduce the rates of suicide nationwide are now including a focus on reducing self-harm and suicide ideation as these are precursors to suicide. However, little is known about what causes self-harm and suicide ideation, how these two factors are related and what impact they have on mortality risk either individually or in combination. Understanding the individual level, household-level, area-level and health related predictors for self-harm and suicide is of vital public health importance so that intervention services can be targeted accurately. Northern Ireland is unique in that it has a national Registry of Self-Harm that has collated information on all presentations to emergency department for self-harm and suicide ideation since 2012 (approximately 8,000 per/year) and the research team has secured access to these data from the data custodians in each of the Health and Social Care Trusts. The proposed project will link these data to additional health, social services, Census and death data to generate a unique dataset of health and social information to achieve a better understanding of the risk factors associated with self-harm, suicide ideation and death by suicide. Our researchers partners in the Public Health Agency and each of the five Health Trusts have acknowledged that the increased knowledge from this project could be instrumental in shaping future policies around the prevention and treatment of self-harm and suicide ideation. The overarching aim of the project is to be the first ever population-wide cohort study of both self-harm and suicide ideation, investigating a range of demographic, physical health, mental health and psychosocial factors to tease apart the strength of association between each of these factors and the outcomes of interest to better understand those most at risk. The project will address three overlapping research questions: (i) Which factors are most associated with self-harm/suicide ideation/both, (ii) What happens after self-harm/suicide ideation, and (iii) an evaluation of the 'card before you leave' scheme. The extensive detail in the Registry of Self-Harm, enhanced by linkage to the Enhanced Prescribing Database (population-wide data on all prescriptions dispensed in community pharmacies in NI), the Social Services Client Administration and Retrieval Environment data (population-wide data on interaction with social services), mortality data from the death register and the 2011 Census data, will be used to explore a range of predictors and outcomes of both self-harm and suicide ideation. Prescription medication data will allow for an investigation into whether or not individuals are using their own medication to self-harm by self-poisoning. Census data will allow for the identification of individuals within households to investigate whether individuals are using medication from other household members. We will capitalise on a naturally occurring experiment within the data to evaluate the 'card before you leave' scheme (a treatment pathway for self-harmers deemed low risk) which was rolled out in 2010 by examining outcomes pre- and post-intervention and identifying those individuals eligible who do and do not avail of the scheme. This project will be the first to link the Registry of Self-harm to other data sources and will become a pioneer study to facilitate access to this data for other researchers across the UK. The project will also provide a significant training opportunity for ADRC-NI support staff and the associated researchers, including the named early career researcher.

Those living in low-income areas have a much higher risk of long-term conditions such as diabetes, heart disease, depression, and frailty. Our lifestyle, such as how active we are, what we eat and if we smoke or drink alcohol in excess can greatly increase our chance of having one of these diseases. The environment that we live in, such as if we live close to or visit parks, canals, and forests, can help us live a healthier life. However, communities living in low-income areas can have poorer access to such spaces or use them less. They also have less voice in decisions affecting their local spaces, at either local or national level. We propose a new partnership: researchers, clinicians, practitioners (such as urban designers) and policymakers all working with local citizens who have the most to benefit from better access to and use of quality spaces. We will work collaboratively to identify poor quality and underused spaces through citizen-led approaches. We will then work with them to develop and/or modify outdoor spaces so that they are high quality and fit for purpose. These actions can be as small as window boxes in schools, or as large as the development of new greenways or reshaping policies regarding land use to protect our green spaces. We will also work to identify ways in which we can promote such spaces for everyone, ensuring that no community is excluded form benefit. The important aspect is that local communities are fully involved in decisions about what they want, and what they will use, thus becoming central to the decision-making process. They will also be involved in the evaluation of these actions, enabling them to directly see how the process has benefited their communities. An important part of putting actions and solutions in place is understanding if they work (or not). Data plays an important part in measuring success, particularly if the same data can be collected consistently across the different actions. Another part of the partnership will be establishing a way of bringing multiple sources of data together so we can effectively determine what works across multiple projects and settings. So, whilst citizens can be involved in collecting data about whether the space has improved their health and wellbeing (through a bespoke app), we can also use other data on health, wellbeing and the environment that is routinely collected by local councils and governments. The main research will take place in three different cities - Edinburgh, Belfast and Liverpool - all with some similar features (such as large urban areas with lower income communities) and distinct features (such as geography and culture). Each city already has policies and programmes in place to improve green and blue space, but there is much room for improvement. Working with the local citizens we will test a range of different methods and approaches, and be able to collect a large amount of data. This data can then be used to understand what works for whom and why across the cities. We can then use this knowledge to predict what could be effective over a much wider area, and also what does not work. We can also make some decisions around what is good value for money, and what is not. We also understand that individual small actions within local communities (or even within cities) are not going to solve the problem, which is why we are also going to focus on how our research can help inform future policies and programmes. Our programme of work will take a whole life course approach which will ensure inclusive environments for all; working with our youngest citizens in particular will ensure early cultural change levers are activated, empowering a new generation with lifelong health and wellbeing.

Understanding human behaviour and how it shapes organisations, communities and societies is needed to address global challenges such as the environmental, economic and health crises that we face now and in the future. Currently, behavioural research is not well coordinated in the UK. It also doesn't always ask the right research questions, involve people with the best skills, make good use of existing data, take advantage of innovative research methods or produce findings that can be used to make positive changes. The Behavioural Research UK Leadership Hub (BR-UK) will change this. BR-UK brings together a team from England, Scotland, Wales and Northern Ireland that includes experienced researchers from many different backgrounds and partners from government, the wider public sector, charities and businesses. We will work with communities to better understand behaviour and conduct research to improve lives and livelihoods. BR-UK will deliver a detailed work programme for the first 18 months. At the same time, we will expand our initial plans for the longer term to be reviewed by the funder, the Economic and Social Research Council (ESRC). In the first 18 months, we will: - Carry out a scoping study to look at needs, priorities and opportunities for behavioural research and set up a national network of researchers and research users - Determine how behavioural research can be more sustainable to make the best use of available funding - Identify (with our international advisory board) under-used global evidence as well as methods and theories to improve behavioural research excellence - Conduct 'demonstration projects' to show how the team can work together to use existing data and speed up the application of models and frameworks to provide rapid results. Topics include how behavioural advice was used during the Covid-19 pandemic, how we address some current issues like speeding on our roads, how to combine large amounts of data more efficiently and how well public support for different policies to help tackle climate change can be transferred between countries - Set up & test a responsive-mode consultancy service where organisations can ask questions about how behavioural research could help them with their policies or practices, and be matched to team members with relevant expertise. Looking ahead, BR-UK will organise our work around four Work Packages (WPs) and Themes (T). Work Packages are about HOW we will do things, and our Themes are about WHAT we will focus on. These are: WP1: Capability Building; WP2: Data and Technology; WP3: Methods and Evidence Synthesis; WP4: Engagement and Involvement; T1: Environment and Sustainability; T2: Health and Wellbeing; T3: Resilient Communities: and T4: Organisations, Markets and the Economy. We will conduct new studies across WPs and Themes. Examples of research questions to illustrate the range are: how to better use mobile phone technologies to engage people long-term to stop smoking or reduce their alcohol consumption; how to help regulators and the police keep children safer online and tackle internet crime; how to help people and organisations shift to transport that is better for the environment; how best to work with local and national governments to better understand the needs of their local communities when making policy decisions. As a Leadership 'Hub', BR-UK will work with other parts of the programme ('spokes' including a centre to train students and early career researchers as they develop. We will be flexible, and reserve part of the funding that could lead to new studies when sudden events like a new threat, emergency or event occur. We are well positioned to carry out rapid reviews of existing research to help governments and organisations know what behavioural evidence exists to inform decisions, and to identify evidence gaps. We will be ready to adapt and bring in new members with skills and experience that are most needed as BR-UK evolves.

The number of people worldwide living with dementia and cognitive impairment is increasing, mainly due to people living longer, so we want to figure out how where we live affects dementia and brain health as we get older. Some research suggests that where we live might influence our brain health. For example, poor air quality in towns and cities, can lead to a decline in brain health. As more of us now live in towns and cities, it is important that the environment where we live is scientifically designed and improved to maximise our brain health. The complex social and physical environments where we live make some people more vulnerable than others to developing cognitive impairment. In other words, the factors that account for who is most likely to develop cognitive ill-health due to the environment has less to do with 'how' we live and more to do with 'where' we live. We do not know how these factors interact to make urban environments a problem for brain health, nor which are the best policies and interventions for promoting healthy ageing and brain health for our poorest communities. Our project will provide evidence for policies and practices that provide supportive urban environments to promote healthy ageing, including promoting brain health. This could include using creative urban designs to support people to adopt and maintain healthier lifestyles such as being more active. However, this needs a strong evidence base with expert community advocates who can articulate how supportive urban environments can improve brain health. Our research has the following steps: 1. First, with the help of stakeholders, including those from business, industry, and local government, and a review of existing research, we will represent the relationships between our biology, our lifestyles and our environment in a diagram illustrating how they likely interact to affect brain health, because visual thinking can help stakeholders better identify possible intervention sweet-spots to improve brain health. 2. By analysing data from over 8,000 older people in Northern Ireland, and linking this to information about where they live, such as the amount of air pollution, the toxins in soil, or how walkable their neighbourhoods are, we will explore how different environmental factors relate to brain health. 3. Next, we will collect new data on a subgroup of 1,000 older people including more in-depth measures of brain health and better measures of physical activity, using GPS devices worn around the waist that monitor our locations. This will allow us to explore how the urban environment influences our brain health. 4. Then, we will explore how aspects of our biology play a role in how the urban environment affects our brain health. 5. We will host workshops with local citizens to 'sense-check' our findings and co-develop promising prevention approaches. In these, we will explore the acceptability, affordability, feasibility and sustainability of new initiatives to improve the environmental influences on brain health. This might include, for example, policies on: expanding the car-free areas of the city to reduce air pollution; increasing the number of footpaths and cycle paths to encourage walking and cycling; improving public transport to reduce car use. As a result of our research we will produce: 1. A map of the system in which our genes, lifestyle behaviours and urban environments interact to affect brain health, to help guide stakeholders towards policies and programmes that can improve brain health. 2. An evidence base exploring how where we live affects our brain health. 3. A suite of potential policies and interventions to improve brain health and promote healthy ageing 'tested' (in terms of acceptability and feasibility) with older people, business, industry, policymakers and other stakeholders.

There is strong evidence that natural environments within urban areas, such as parks, woodlands, lakes and beaches, have positive impacts on health. These urban green and blue spaces (UGBS) could be huge assets for protecting and equalising health if they were available, accessible, valued and well-used, particularly by less advantaged groups. The problem is that they are not. This is largely because the many policies, organisations and communities involved in designing, creating, managing, promoting, maintaining and using UGBS are disconnected. Also, the voices of less advantaged communities that UGBS could be helping most are either not heard or not persuasive. Perhaps as a consequence, those communities are much less likely to benefit from these spaces. We know that the UGBS we have are not the UGBS we need to make the best possible contribution to better and more equal health. GroundsWell aims to change that. We propose a new partnership - researchers working together with communities and those who currently create and control UGBS, to plan, design and manage it better so that it benefits everyone, especially those who need it most. The main research will take place in three cities - Belfast, Edinburgh and Liverpool. These have sufficient similarities (such as large and diverse low-income communities) but also distinct features (such as geography and culture) making them, collectively, an ideal laboratory. Each city already has policies and programmes in place to improve UGBS, but there is much room for improvement. GroundsWell will take a systems approach. This means understanding the multiple and interconnecting components of policy-making, practice, perception and people which together affect the presence, location, character and use of UGBS. It also means working to transform the system so that the components function together. To do this, GroundsWell will mix co-development of new theoretical frameworks, novel data science including simulation, health economics and policy analysis, but at its heart will be community engagement and partnership. We will develop and use meaningful community engagement, co-production and citizen science to understand the system, identify how and where it is broken, and co-create solutions. We anticipate interventions aimed at how the UGBS system operates, and small-scale interventions around actual spaces and their use. Data play an important part in understanding systems. GroundsWell will develop an accessible, trustworthy and policy-relevant system to collate, collect, house and share data on UGBS across the three cities. These data will be used to help the whole Consortium understand the UGBS there, identify possible interventions, and then assess whether they work, for whom and why, creating feedback loops to help us continually monitor, learn and adapt what we do. Novel simulation approaches will also be used to suggest interventions, and in particular what could be effective beyond the three cities. Health economics will suggest what would be best value for money. An important part of putting actions and solutions in place is understanding if they work (or not). Evaluation of our actions and the Consortium as a whole will be undertaken in partnership with our communities, drawing on the new data system we establish, and enabling them to directly see whether and how the process has benefited them. In particular, we will assess and share our impacts on health inequalities. We are realistic about the likely scale of our impacts. Small actions within existing UGBS and local communities are unlikely to affect population level health and inequalities within our funded period. That is why we are going to focus on improving the UGBS system as a whole, laying foundations for long-term benefits. We know that the use and enjoyment of UGBS is something that adults pass on to their children. If GroundsWell can improve and equalise the role of UGBS, it will achieve a lasting impact.