19/108 Public mental health interventions
Deadline for submission: 17 March 2020, 1pm
• What are the most effective* interventions, outside the NHS, aimed at enabling populations to achieve good mental health and to prevent mental health problems?
Mental health is profoundly important, not only because of its own value for living, but also because it is a critical determinant for physical health (1). Mental illness represents the largest single disease burden in the UK with a significant human and social cost. No other health condition matches mental illness on prevalence, persistence and breadth of impact, and the annual economic costs of mental illness have been estimated at £105 billion in England alone (2).
Public mental health is a term that underlines the need to emphasise the neglected element of mental health in public health practice. In its entirety, it spans promotion, prevention, effective treatment, care and recovery (3). Aspects of the public mental health approach which focus on the wider prevention of mental illness and promotion of mental health in the whole population across the life course (2), correspond well with the remit of the Public Health Research (PHR) programme, which seeks to support research evaluation outside the NHS context.
In 2016, the Mental Health Task Force reported to NHS England (4) calling for the UK to be a world leader in the development and application of new mental health research, noting the biggest existing gaps include research into children’s mental health, the promotion of good mental health and prevention of mental ill health, and the links between mental and physical health. Furthermore, the following gaps in evidence were identified by the Faculty of Public Health and Mental Health Foundation (3): infant mental health, mental health in working age and later life and the lived experience of people with mental health problems, including within the population subgroups such as BME groups. The 2017 green paper on transforming children and young people’s mental health (5) sets out various supporting commitments including further research to improve the evidence base in a number of areas.
For this call, the Public Health Research Programme wishes to commission research on the effectiveness of non-NHS interventions that enable populations to achieve and sustain good mental health and/or prevent mental health problems from developing. The Programme is interested only in receiving applications that seek to influence factors that operate at community, institutional and societal levels. It is not interested in receiving applications for interventions that operate at an individual level or for populations defined by a mental illness diagnosis. The Programme is also interested in applications that are targeted at people in groups, demographics or communities with greater vulnerability and exposure to adversity, such as those living with challenges that are known to be corrosive to good mental health. Areas of research may include (but are not limited to):
- Evaluation of interventions where a holistic range of outcomes is considered, linking mental health and other aspects of physical and emotional health
- Evaluations of interventions aimed at preventing mental health problems arising and promoting good mental health which target children and young people, e.g. on their transitions in and out of secondary school, the relationship between social media and mental health or the effectiveness of whole school-based interventions
- Evaluation of mental health literacy and awareness programmes undertaken in different settings
- Studies that examine local community-based interventions that support community resilience and address risk and protective factors for positive mental health
- Evaluation of workplace-based mental health interventions
- Evaluative studies that focus on interventions to support mental health in working age and later life, and might include those which seek to prevent depression in older people
- Studies that shed light on how interventions in public mental health can be scaled-up successfully.
A range of study designs and outcome measures could be used that can provide robust evidence of effectiveness and take into account the lived experience of those with mental health problems in diverse population groups. Researchers will need to identify and justify the most suitable methodological approach(es). Researchers will also need to specify key outcome measures and specify how these will be measured in short, medium and long terms.
Researchers may wish to consider evaluating natural experiments comparing the effects of different approaches and different settings in design and delivery of programmes to achieve good mental health and prevent mental health problems.
Researchers should demonstrate the relevance of their proposed research to evidence users. Fully-funded inclusion of evidence users in research teams is encouraged. Researchers might want to consider how they will share their findings with relevant decision makers. They will be expected to be aware of other studies in their area of work and ensure their proposed research is complementary.
Studies should generate evidence to inform the development or implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi- and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.
The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered. Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.
The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - are also of interest.
For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.
* ‘Effectiveness’ in this context relates not only to the size of the effect, but it also takes into account any harmful or negative side effects, including inequitable outcomes.
Remit of call:
All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) programme. Please go to http://www.nihr.ac.uk/phr for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream - http://www.nihr.ac.uk/phr
The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.
The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.
Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.
Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The NIHR PHR programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.
The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the NIHR PHR programme is unable to fund intervention costs.
The NIHR PHR programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at firstname.lastname@example.org with details of your proposal and the other funder prior to submission.
All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.
Notes to applicants
The NIHR PHR programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.
Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications.
The NIHR Clinical Research Network (CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.
Clinical Trials Units are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.
In line with the government’s transparency agenda, any contract resulting from this tender may be published in its entirety to the general public. Further information on the transparency agenda is at:
(1) Lancet Editorial, What can public health do for mental health? June 2016 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30887-X/fulltext?rss=yes
(2) Royal College of Psychiatrists (2010), No health without public mental health: the case for action http://www.rcpsych.ac.uk/pdf/Position%20Statement%204%20website.pdf
(3) Faculty of Public Health and Mental Health Foundation (2016) Better Mental Health For All: A public health approach to mental health improvement
(4) Mental Health Taskforce (2016) A report from the Independent Mental Health Taskforce to the NHS in England
(5) Department of Health and Social Care (2017) Transforming children and young people’s mental health provision: a green paper