Update 15 June 2023: Supplementary clarifications on the research specification have been provided. Please see end of this Research Specification
Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 Applications | 11 July 2023, 1 PM |
| Notification of outcome of Stage 1 Application | October 2023 |
| Deadline for Stage 2 application | 28 November 2023, 1 PM |
| Notification of outcome of Stage 2 Application | April-May 2024 |
| Project Start | July 2024 |
| Project Duration | 18-24 months |
| Budget | £400,000 |
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project on improving access to mental health support and services for ethnic minority children and young people (ages 5-25). It seeks to understand, for common mental health conditions, what types of support are working for who, across different age groups and communities. The research should also explore what barriers to accessing these supports currently remain and what might be done to overcome these.
Background
Mental health problems are increasingly common among children and young people (CYP) ages 5-25 in England. Although incidence rates are higher among people from some ethnic minority backgrounds, there is evidence to suggest that CYP from ethnic minorities are less represented in NHS services than would be expected from the wider population composition. Furthermore, evidence suggests that CYP from non-white British ethnic backgrounds have greater difficulties accessing sources of mental health support, different levels of engagement with mainstream mental health services and may prefer to seek advice and support in different ways than their white British peers.
Failure to provide CYP with the right support at the right time can cause both short-term and long-term adverse effects. If mental ill-health is left unaddressed, a child or young person’s mental health can deteriorate to the point that they need specialist care or end up in crisis. Evidence suggests that mental health users from ethnic minority backgrounds are more likely than their white British counterparts to be referred to inpatient and emergency services and to be admitted involuntarily.
Furthermore, unaddressed mental ill-health in childhood can have wide-ranging impacts on a young person’s life chances and may cause economic, social and individual costs into adulthood. For example, adults with mental health problems are more likely to have other disadvantages including lower incomes, lower probability of being in work and higher probability of being in receipt of benefits, increased risk of problems with physical health and increased involvement with the criminal justice system, both as victims and perpetrators.
Given the complexity of determinants that can impact access and engagement with services, and the variation in these factors among both ethnic groups and differing mental health needs, it is crucial that mental health policy is informed by relevant research.
This research will enable policymakers to make informed decisions across government, the NHS and the broader sector by understanding how we can improve access for ethnic minority CYP, and subsequently help to achieve the NHS Long Term Plan [1] commitment that all children and young people who need NHS support should be able to access it by the end of the decade.
This research call therefore seeks to understand what forms of mental health support are working well for ethnic minority CYP, and how we can further improve access by understanding and addressing any unexplored barriers to support.
Research priorities
The specific research questions we would like this research to address are:
- What types of support for common mental health conditions are CYP from ethnic minority backgrounds accessing, how do these vary by ethnic minority group and how effective are these in terms of outcomes?
- Are there ethnic minority groups who are still not accessing either formal or informal support? If so, why?
- What barriers/challenges remain for CYP from ethnic minority groups in accessing support for common mental health conditions, and what types of support/interventions might help overcome these?
The research should span across the whole CYP age range (5-25 years). We appreciate that applicants might utilise age groupings; these are welcomed but should be logically split. We expect the research to look at specific ethnic groups where applicable and reflect the diversity of experiences among this cohort. Any type of support for common mental health conditions for CYP ages 5-25 years would be appropriate to include in the research, but we would particularly welcome applicants to consider a range of interventions (e.g., NHS, schools, voluntary sector, online support, informal networks, faith groups, etc) with a primary stated aim of improving mental health/wellbeing.
Applicants are welcome to suggest suitable approaches, however; we envisage that this research may need to be phased. For example:
- Initial mapping and case study activity to understand what forms of mental health support ethnic minority CYP currently access (spanning NHS, voluntary sector, informal networks of support, etc). Followed by;
- Detailed qualitative work to determine how we might improve access and support, for example by conducting interviews with CYP and key organisations who provide support to this group (NHS support services, charities delivering counselling, youth groups etc.)
The chosen research methodology should recognise the diversity within the ethnic minority CYP cohort and potential regional differences. Applicants may wish to draw upon previous research in this area, for example the ARIADNE Project (AddRessing the ImpAct of coviD-19 paNdEmic on the access to and experience of mental health care of people from Black, Asian and Minority Ethnic groups.) The successful applicants should also be proactive in engaging with CYP from ethnic minority backgrounds to help shape the research.
New Guidance on Health Inequalities data collection within NIHR PRP Research
Inequities and inequalities in the provision, access to and experience of health and care services is a high priority area within the Department of Health and Social Care and the NIHR and is present in the majority of funded projects. We are now assessing all NIHR research proposals in relation to health and care inequalities. NIHR asks researchers to explore issues of inequality and inequity in the research being proposed.
Our goal is also to facilitate more widespread and consistent reporting of data on health and care inequalities relating to the primary outcomes of NIHR funded research. Applicants should, if feasible, collect or analyse data related to health and/or care inequalities, we request that this stated in the proposal. This is a new request from the NIHR PRP and we will be continuing to monitor queries and make any necessary clarifications, as needed.
We understand that research projects may employ different methodologies, and focus on different populations. We ask that you please clearly identify in the research plan section of the application whether your application has a health and care inequalities component. If the project uses quantitative methods, please include detail of the core set of data that will be collected or analysed. Submission of the data collection will be a condition of final reporting that will need to be submitted to NIHR PRP when the grant has finished. If a health and/or care inequalities component is not included, please explain clearly why this does not fit within your research.
Specifically for this project, it may be useful to consider whether any particular groups are particularly impacted by discharge delays, and whether interventions have any differential impact for different groups. This may include consideration of local / regional variation, deprivation or characteristics covered by the Equality Act.
A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available online, this may be useful to refer to as it provides additional information.
Further details about this new request can be found in Appendix A.
Eligibility
Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.
Technical requirements / Expertise required
- CYP Mental Health
- Ethnic Minority (Mental) Health
- CYP Mental Health Service Provision
Outputs
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting, including to discuss the draft project plan.
Ongoing dissemination of findings throughout the life cycle of the project will be required to support ongoing policy development. This includes timely reports for the advisory group as well as an interim and final report and/or slide deck at the end of the project outlining key findings and recommended policy actions. A strategic dissemination plan following the final report would also be desirable.
Budget and duration
Applications will be assessed on value for money, we would not expect them to cost more than £400K.
The duration of the project should be as short as is consistent with delivering a high-quality study.
Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, NHSE, CYP and families with lived experience, Directors of Public Health or other experts and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
- Provide regular feedback on progress
- Produce timely reports to the advisory group
- Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.
It should be noted that this research call relates to another research call ‘The effectiveness of the open access “hub” model of early intervention and prevention support for children and young people’s mental health and wellbeing’. We would therefore expect the successful applicants for both of these calls to communicate between teams, as there are areas of overlap that would benefit from shared knowledge and learnings.
The Department of Health and Social Care intends to work with NHSE to maximise the impact of this research. We may therefore expect the successful applicants to engage with appropriate boards and steering groups within NHSE, to take a more strategic, central approach to tackling CYP mental health inequalities.
Supplementary clarifications on the research specification
In response to queries from one or more applicants since first publishing this research specification on 30 May 2023 the following clarifications are provided:
- A query has been raised over the requirement for the research to span all age groups in the CYP range (5-25 years), and more specifically whether a focus on young adults would be appropriate. Response 15 June 2023: There is a need to consider the wider CYP age group including primary school age children, however it is acknowledged that this broad age range could pose challenges for the research. As such, it is agreed that initial mapping work should cover the full age range of 5-25 years, but more detailed qualitative work can take an in-depth focus on a particular age grouping if there is a clear rationale for this.
References and key documents
- NHS Long Term Plan, 2019.
Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research
Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.
Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.
For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group.
For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.
We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used.
We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section.
* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.
** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.
*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.
Example data table for submission at the end of the funded research project
(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.
| Variable | Outcome (an appropriate average for this subgroup, usually the mean) | Number of observations | Additional information about variation if appropriate, e.g. range, standard deviation |
|---|---|---|---|
| Age | 0 | 0 | Additional information |
| Sex | 0 | 0 | Additional information |
| Gender | 0 | 0 | Additional information |
| Disability | 0 | 0 | Additional information |
| Ethnic Group | 0 | 0 | Additional information |
| IMD Group | 0 | 0 | Additional information |
| Region | 0 | 0 | Additional information |