Food insecurity in adults living with severe mental illness in Australia: an exploration of causes and experiences using a co-design approach

People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Food insecurity is linked to a range of negative socioeconomic and health outcomes. This study qualitatively explored causes and experiences of food insecurity for people living with a severe mental illness and used these findings to co-design a pilot intervention.

Two workshops and seven focus groups were conducted as part of a co-design process involving people living with severe mental illness experiencing food insecurity (n = 9) and mental healthcare professionals, including peer workers (n = 11). These co-design sessions involved qualitative exploration of causes, experiences and impacts of food insecurity, and the use of implementation science tools to develop a pilot intervention. Notes and transcriptions were analysed using reflexive thematic analysis and directed content analysis for different co-design stages.

Two key causes of food insecurity emerged: a lack of access and a lack of education; these were exacerbated by multiple compounding factors. Food insecurity was also perceived as having systemic, bidirectional effects across mental and physical health. Incorporating community and peer support into solutions was seen as key, with ambivalence around financial support. A pilot intervention model targeting education issues through a peer-supported skill-building programme and access issues through a financial supplement was developed and rated highly in terms of feasibility, appropriateness and acceptability.

Our findings reveal multifactorial perceived causes, experiences and impacts of food insecurity for people living with severe mental illness. To our knowledge, this is the first study to explore a lack of education as a core cause for this population group and to co-design a specialised intervention. The co-design methodology is a promising approach to developing practical and useful solutions to problems, using knowledge gained from the people involved in their implementation.