Dr Felicity Thomas
Senior Research Fellow
+44 (0) 1392 724249 / 722820
South Cloisters 2.06
South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
I am a Senior Research Fellow in the Medical School and a Senior Research Fellow on the Cultural Contexts of Health in the College of Humanities.
After working for several years in the international development sector, I pursued doctoral research on the impacts of HIV and AIDS on rural livelihoods and social support networks in southern Africa. More recently, my work has focused on understanding and addressing the social and cultural factors that perpetuate health inequalities.
Drawing primarily on narrative, ethnographic and participatory approaches, my research examines the ways that people experience health and illness and make decisions over treatment use. I am particularly interested in understanding how certain health 'conditions' become medicalised, and the ways that this inter-relates with poverty, disadvantage and health-related inequalities. My current ESRC-funded project, DeStress (http://destressproject.org.uk), is concerned with understanding how moral narratives relating to responsibility and welfare reform influence the medicalisation of distress and the uptake of antidepressants and talking therapies in low-income communities in the UK.
My work has focused on the health and well-being of low-income communities, migrants and families with complex needs; sexual health and HIV; environment-related health inequities; and the promotion of healthy schools.
I am co-director (with Professor Mark Jackson) of the WHO Collaborating Centre on Culture and Health and work closely with the WHO Regional Office for Europe project on the Cultural Contexts of Health (http://euro.who.int/en/data-and-evidence/cultural-contexs-of-health).
I have undertaken a number of consultancies including work for UNAIDS, WHO, the Ministerio da Educacao in Brazil, and the Departments of Health and Education and Communities, NSW, Australia. I was also on the external evaluation team of the Ford Foundation's Global Dialogues on Sexual Health and Well-being programme.
Research group links
Poverty, pathology and pills: moral narratives and the medicalisation of distress (2016 - 2019, ESRC ref: ES/N018281/1).
The provision of effective treatment and support for mental distress is a stated aim of the British Government and many civil society organisations. Within low-income communities, use of antidepressant medications is relatively high. However, current strategies frame mental distress as a psychological problem that lies within the individual concerned. This not only suggests that such distress can be 'corrected' through medical treatment, but also masks the factors that often underlie the root causes of suffering e.g. poor living conditions, unemployment. At the same time, policies in place to restrict welfare support, and popular media e.g. Benefits Street, draw on moralising narratives that promote the idea that people should take responsibility for their actions and circumstances. This research is exploring how people in low-income communities perceive and respond to mental distress caused by material deprivation and social disadvantage. Addressing key knowledge gaps, attention will be given to understanding: i) the role of moral narratives in influencing decisions to seek medical support for mental distress; ii) how these narratives manifest within GP consultations and influence treatment decisions and patient wellbeing.
Research team: Felicity Thomas (PI), Katrina Wyatt (Exeter), Rose McCabe (Exeter) and Richard Byng (Plymouth).
Cultural contexts of health (on-going collaboration with WHO Regional Office for Europe)
Our experiences of health, and our interactions with those who care for us, are strongly influenced by the cultural contexts we inhabit. Yet whilst there has been a recent drive to understand the social determinants of health, the ways in which societal norms, value systems, working practice, traditions and beliefs impact on health pathways and outcomes are often ignored, as is the frequently positive, protective impact that culture can have in the face of certain health challenges. We are working with WHO to systematically investigate the cultural contexts of health and well-being across the European Region, and to embed humanities and social sciences research and methodological approaches into the public health sector. Current work here includes on-going collaborations relating to the culture and reform of mental health care in Central and Eastern Europe; reporting on the cultural aspects of antibiotic resistance; the development of a model for reporting on wellbeing across the WHO Europe Region; development of a toolkit on intercultural competence and diversity sensitivity within healthcare.
Mental health outcomes of early life trauma in Belarus and Ukraine (MRC TrACES fund 2018 - 2019)
Early life trauma (ELT) is known to be a key determinant of later life health and wellbeing. Within Belarus and Ukraine, high levels of ELT have been associated with some of the highest levels of suicide and substance abuse amongst young people and adults in the world. Whilst this situation has been widely linked to the significant social, political and economic upheavals experienced in the Central and Eastern European Region over the past three decades, there is a dearth of detailed analysis of the causes of early life trauma in Belarus or Ukraine, or the socio-cultural context in which it is experienced, understood and responded to. This is due in large part to the continuing dominance of psychiatric and biomedical models of understanding, which pay little attention to the socio-cultural factors underpinning people’s lives, and to the lack of funding that has been available for non-clinical research. This project involves running a series of workshops with partner organisations (Ukrainian Catholic University and Minsk Regional Centre for Psychiatry and Addiction) to bring together key stakeholders from diverse disciplinary and service provider backgrounds in Belarus and Ukraine in order to i) support key stakeholders and service providers working with those affected by early life trauma to better understand its causes and the ways that multiple traumas interact to establish risk for negative mental health, substance abuse and suicide; ii) identify the factors and mechanisms which promote resilience amongst those affected by ELT and protect against negative mental health, substance abuse and suicide.
Research team: Felicity Thomas (PI), Mark Jackson, Dzmitry Krupchenka, Olga Kazakova, Orest Suvalo
Reducing inequalities in psychological support for people affected by cancer (Engaged Reearch Exploratory Award, 2018)
High levels of cancer exist within low-income communities in the UK. Since the publication of best practice guidance (National Cancer Equality Initiative 2010), efforts have been made to increase parity of cancer healthcare and treatment. Yet whilst people’s medical needs are increasingly well met, little attention has focused on supporting their mental health and emotional wellbeing, crucial when over half now live for ten years or more following diagnosis (Macmillan 2014). People diagnosed with cancer often report feeling overwhelmed with despair, grief and depression, factors that can be vastly exacerbated when they and their families are living concurrently with material hardship and deprivation.
The NHS Cancer Strategy (2016) calls for accelerated commissioning of support services, such as those provided through specialist counselling and psychological support. However, this is not provided routinely within NHS care, and little is known about the factors that influence referral to, or awareness of, this kind of service, or the long-term impact counselling has on service users. Working with partner organisations We Hear You (WHY); Wessex Cancer Trust and The Harbour, this project sekes to: identify lived experiences and gaps in current service provision for low-income groups; ii) provide a forum for low-income communities to feed in to the development and implementation of local Sustainability and Transformation Plans (STPs); iii) identify research priorities to help reduce inequalities in the provision of psychological support for people affected by cancer.
Research team: Felicity Thomas (PI), Lorraine Hansford
Co-creating strategies to address child poverty (Engaged Research Exploratory Award, 2017)
Working with Barnardo's, a Children's Centre and parents from low-income backgrounds, this work provided a forum for parents to voice their experiences, needs and priorities relating to child poverty. This work fed into the Plymouth Child Poverty Action Plan and has played an influential role in the development of the City Council's approach to co-creating strategy and commissioning with service users from low-income backgrounds.
Research team: Felicity Thomas, Lorraine Hansford
- 2016 Economic and Social Research Council
The provision of effective treatment and support for mental distress is a stated aim of the British Government and many civil society organisations. Within low-income communities, use of antidepressant medications is relatively high. However, current strategies frame mental distress as a psychological problem that lies within the individual concerned. This not only suggests that such distress can be 'corrected' through medical treatment, but also masks the factors that often underlie the root causes of suffering e.g. poor living conditions, unemployment. At the same time, policies in place to restrict welfare support, and popular media e.g. Benefits Street, draw on moralising narratives that promote the idea that people should take responsibility for their actions and circumstances. This research aims to explore how people in low-income communities perceive and respond to mental distress caused by material deprivation and social disadvantage. Addressing key knowledge gaps, attention will be given to understanding: i) the role of moral narratives in influencing decisions to seek medical support for mental distress; ii) how these narratives manifest within GP consultations and influence treatment decisions and patient wellbeing. The objectives are to: 1) Use focus groups and ethnography to explore how moral narratives are used/resisted in the lives of people in low-income communities in relation to mental distress. 2) Use semi-structured interviews and video recordings to explore how moral narratives manifest within GP consultations. 3) Conduct repeat interviews and use audio-diaries to explore how individuals experience, talk about and embody mental distress following medical consultation. 4) Advance theoretical understandings within the fields of medical sociology, anthropology and public health by analysing how the medicalisation of socially and structurally induced distress affects wellbeing. 5) Identify responses to mental distress that effectively support people and inform ethical debates on the medicalisation of distress in a way that benefits patients, and assists practitioners and policy makers. This 30 month programme of research consists of two stages: 1) 96 people from 2 low-income areas will participate in focus groups to explore how moral narratives are used/resisted in people's daily lives. Groups will be divided by gender and age to identify differences between social groups. 2) Analysis of 60 video-recorded consultations between GPs and people from low-income backgrounds presenting with mental distress. In-depth analysis of 30 consultations will identify how GPs and patients interact (verbally and physically) and the ways this interaction influences decision-making to prescribe/accept or withhold/reject treatment. Further insights will be gained through interviews with 10 GPs in the study sites and repeat interviews with 40 people who have attended a GP consultation for mental distress. The first interview will focus on the person’s experiences of distress and the role of moral narratives in i) their decisions to seek medical consultation, and ii) in their responses to the treatment or intervention prescribed/accepted or withheld/rejected. The second interview will enable participants to reflect on their experiences of mental distress within the wider context of daily pressures e.g. poor living conditions, to reflect on their decision to seek medical support, and to reflect on the outcome of the GP consultation. The research programme is intended to have strong and distinctive impacts in academic, policy and user communities. This will be achieved by advancing understanding of i) people’s use/resistance of moral narratives of responsibility (why? when? how? where? with who?); ii) the relationship between moral narratives and the medicalisation of distress; iii) the ethical implications of prescribing antidepressants for distress induced by poverty/deprivation; iv) identification of GP-patient interactions that enable positive wellbeing.
Publications by category
Publications by year
I have a strong interest in interdisciplinary teaching at undergraduate and postgraduate levels and am keen to expand the medical curriculum to bring in the perspectives afforded by the humanities and social sciences. I am currently teaching on the following modules:
HISM017 Critical Approaches to Medical Humanities
HISM Medicine Across Borders
- HISM017 - Critical Approaches to Medical Humanities
- HISM026 - Medicine Beyond Borders: History and Politics of International Health