I am a registered nurse by training, with an MSc in Global Public Health. My career choices have been driven by curiosity, interest, and the pull of what feels important. Following those instincts has led me from clinical and humanitarian work into research on migration and mental health, and ultimately to questions about how systems can better reflect the realities of the people they serve.
After completing my nursing studies, I worked for several years in hospital settings, primarily in oncology and haematology care. I later obtained a Master’s degree in Global Public Health and subsequently worked as a research assistant in my native Sweden. However, my interest in public health, and my desire to learn from an international perspective, led me to spend almost a year in Sierra Leone during, and shortly after, the Ebola epidemic that dominated the country.
From there, I moved into international humanitarian work with the International Federation of the Red Cross, mostly as a coordinator and team leader on emergency WASH (water, sanitation and hygiene) projects in contexts shaped by population movement. One of the most formative experiences was working during the Rohingya crisis in Bangladesh. Over time, migration and health stopped being “a topic” and became the lens through which I saw nearly everything.
Ana Hagström working for the Red Cross in Mozambique
But that lens wasn’t only professional; it was also personal. Growing up in Sweden with a Swedish father and a Spanish mum, I learned early what it can feel like to stand out: the smallest and brown, curly-haired, Spanish-loud kid in a class of tall, blonde children. It’s not the same as being a newly arrived migrant, of course, but it gave me an early sensitivity to how quickly people make assumptions, and how easily someone’s reality can be misunderstood.
When I returned home, refugee and migrant health became my work. Working in a refugee- and asylum health care clinic and teaching healthcare staff about migration-related health issues followed naturally, partly because the same pattern kept coming up again; good intentions, but limited understanding of the barriers people actually face. That’s what ultimately brought me to my PhD: exploring unmet mental health needs and barriers to accessing mental healthcare among migrants in Sweden.
A central part of this work was evaluating the implementation process of a community-based intervention designed to ease access and lower barriers for newly arrived migrants. It involved staff, migrants, and cultural mediators, and it was here that co-creation really clicked for me. Migrants, compared with the majority population, often experience worse mental health outcomes. They may be more likely to reach care through secondary mental health services rather than primary care at earlier stages, while also being at increased risk of conditions such as depression, anxiety and PTSD.
What I saw in practice was that barriers weren’t only logistical – they were also interpretive. The system often failed to “read” people’s realities. Co-creation and meaningful patient and public involvement (PPI) felt like a way to close that gap: not designing for people, but with them.
That focus on co-creation naturally led me into implementation work. Even the best intervention won’t change outcomes unless it fits routine practice. That’s why I joined Professor Claire Henderson’s group at King’s College London to work on the implementation of Advance Choice Documents (ACDs).
The ACD project aims to embed Advance Choice Documents for people who have previously been treated under the Mental Health Act, a practice supported by recent UK law. ACDs are designed to strengthen patient influence and shared decision-making if someone experiences a future crisis and needs psychiatric care.
ACDs can be described as a care plan in which the service user, together with the care team and next of kin, jointly discuss needs related to medication, the home situation, and the service user’s specific wishes for any future admission or contact with psychiatric services.
In doing so, they may also help reduce coercion, by ensuring preferences are clearly communicated and meaningfully considered. One aim of this work is practical: to generate recommendations for the NHS ahead of national roll-out, so other settings can learn from early experiences and adapt ACDs to their local context more easily.
My work on the ACD project has involved analysing meeting-notes data from clinical implementation groups to understand barriers and facilitators within everyday clinical practice at South London and Maudsley NHS Foundation Trust (SLaM), and to identify strategies to address them.
For example, looking at whether resources and strategies such as staff training support implementation, or whether barriers like limited time, lack of knowledge, or low motivation make ACDs harder to use routinely. By identifying what works best to overcome these barriers and build on existing strengths, we can tailor the approach to fit SLaM and share practical recommendations that other services can adapt to their own settings.
Working in England has also sharpened my reflections on context. The infrastructure for PPI, including advisory groups, seems stronger here, and the practice more established. Outcomes vary, and many patients and former patients would rightly argue there is still far to go in reducing coercion and strengthening influence over care. But there remains a clearer scaffolding for involvement.
In Sweden, local social psychiatry projects have tested similar approaches, but we still need to get better at integrating PPI methods into the core work. This is something I want to champion upon my return. Involvement is still too often treated as an “add-on”, rather than a core part of how we design, deliver and evaluate work.
We need to get better at building PPI into everything we do, from quality improvement in healthcare to public health interventions, so that the people most affected are genuinely in the driver’s seat. At the same time, we have to make sure the work is evidence-based and fits the local context, so involvement leads to better outcomes rather than just more consultation.
Looking ahead, I want to keep working at the intersection of co-creation research, patient involvement and implementation, using the tools I’ve gained through my PhD and my time at King’s to support more equitable mental healthcare in practice. I also want to write more. I see it as part of the “third task” researchers carry: communicating knowledge beyond academia, in ways that people can actually use.
Read more about the ARC South London adopted project evaluating the effectiveness of implementing Advance Choice Documents