Area of Research: Mental Health
Section 1: Summary of main strands/themes for research
A) Policy topics
Children and Young People’s Mental Health (including perinatal mental health, link to Children and Families PRU)
Recent increases in the prevalence of probable mental disorders amongst children and young people (CYP), and a growing body of evidence of the importance of childhood experience for adult mental health creates an urgency to build understanding in the following areas:
- Tackling disparities: how to effectively prevent, assess, diagnose and treat poor mental health and specific mental health conditions amongst vulnerable groups and those with the worst disparities both in childhood and adulthood e.g., ethnic minority groups and LGBTQ+; looked-after children; those with co-occurring conditions.
- Prevalence: What are the key factors contributing to observed increases in common mental disorders and eating disorders/disordered eating, and how can rising prevalence be reduced and reversed?
- Treatment: What are the impacts of early diagnosis of mental health conditions on children and the long-term support mechanisms/pathways following diagnosis that lead to the best clinical and social outcomes? How can early identification of those at high risk of personality disorder be improved, and can we better understand models of care that will reduce prevalence?
- Prevention and early intervention: Measuring and understanding the effectiveness and long-term impacts of different interventions and delivery models (including partnership working) that, for example, build social and emotional skills and resilience for mental health and wellbeing; provide early help; and/or strengthen protective factors (such a positive relationships) across a variety of settings (family, school, community). What are local success factors and components of successful delivery at scale?
Prevention and social determinants
A stronger understanding of the relationships between social determinants and mental health/wellbeing, including the below factors, and the key components of population level interventions that effectively address their specific impacts:
- crime and the criminal justice system;
- social cohesion, migration, and loneliness;
- employment, income and debt;
- learning disability, autism and other long-term conditions;
- the COVID-19 pandemic and related social impacts; and
- geographic disparities, ethnic disparities, and how to effectively deliver interventions across different geographical and cultural contexts to reduce inequalities.
As part of this, it will be key to examine what interventions will work to address intergenerational cycles of disadvantage and mental health behaviours, and the effects of interventions which are supported by local partnership working and different approaches to working with communities.
System Capacity, Provision and Quality – including community, primary, and acute mental health services
- Workforce: adequacy of supply and how to increase sustainably; diversity and cultural competency; current capabilities and efficient use of current skills; development and management, including in children's and adult social care.
- Quality: how does this vary, and what are the impact of reforms to the NHS and adult social care, including the provision of clear pathways of care and management of multiple long-term conditions.
- Technology-enabled interventions: effectiveness, equity and efficiency of such interventions in mental health, including their implementation and unintended consequences. How can we safely and effectively integrate these with self-prevention/self-treatment and clinical settings?
- Disparities: understanding barriers and enablers to early access to community and primary mental health services for marginalised groups; developing and implementing culturally competent interventions to meet diverse needs.
- Other issues: the provider market (including non-NHS) and its impact on outcomes; system capacity and the estate.
The Mental Health Act and treatment of severe mental illness
A Draft Mental Health Bill was published for pre-legislative scrutiny in June 2022. Alongside several non-legislative reforms, its intention is to shift the balance of power to the patient and ensure that detention under the Act only happens as a last resort to help someone get better, and for the shortest possible time. Further research into severe mental illness and its treatment, including under the Act, would inform guidance and implementation plans. Research would be valuable in the following areas:
- Understanding the impacts of detention decisions on future mental health and wider social outcomes (including interactions with employment, the criminal justice system, and physical health).
- Understanding the causes of disparities in outcomes under the Mental Health Act and approaches to reducing them, including racial disparities and the experience of detainees with learning disabilities and autism.
- Evaluation activity related to reforms to the Mental Health Act (and associated non-legislative changes), including pilots for improving the management and support of severely mentally ill patients.
Self-harm and suicide prevention
- Evaluation of ongoing and planned efforts to prevent suicide including following the Suicide Prevention Plan (to be published in 2023); potential interventions at frequently used locations for suicide; ongoing support offer for adults who have self-harmed or have indicated suicidal ideation.
- Testing interventions to reduce risk (e.g., primary care) and disparities in risks, considering ethnic minority groups, LGBTQ+, Gypsy, Roma and Traveller communities.
- Further developing understanding of the links between domestic abuse, self-harm and suicide and testing effective interventions to reduce risk among victims, perpetrators and children impacted by domestic abuse.
Holistic approaches integrating physical and mental health
Understanding the following will be key to reducing the prevalence of both physical and mental health problems and closing the SMI mortality gap, including:
- Understanding the interaction and association between physical and mental health conditions to enable design of interventions that take a whole person-centred approach.
- The potential impacts, and considerations for design, of large-scale and integrated interventions that target dual risk factors for physical and mental health conditions in at-risk groups
- Evaluation of nationally led measures to improve the integration of mental and physical health care.
B) Cross-cutting research themes and methods
Measuring outcomes and understanding patient pathways – quantitatively demonstrating the full impacts of treatment and interventions, particularly prevention and early intervention and some areas of clinical care, remains a persistent challenge. We would like the MHPRU to have a focus on bringing together data through data linkage; development of metrics; scoping feasibility of new longitudinal studies; and understanding patients’ health-related quality of life and experiences of healthcare using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs).
Data linkage – there are a number of administrative datasets that could in theory be linked and exploited to better understand a range of key questions, from pathways or wider social impacts of mental health services.
Evaluation – we require the Unit to support delivery of robust evaluations of a wide range of reforms and new programmes, including delivery of (smaller scale) process and impact evaluations, and providing advice and scoping for larger-scale evaluations.
International comparisons – the PRU should develop relationships with international counterparts, and identify robust cross-national studies, to help better understand what works well in other systems, and what learning can be applied in England.
Section 2: Details of policy context and background
Mental health services are seeing unprecedented political attention and investment, while services are facing exceptional challenges. There is evidence of increasing prevalence and acuity of mental health problems amongst both adults and children, particularly exacerbated during the COVID-19 pandemic, and service capacity and workforce expansion has struggled to keep pace. Several landmark policy initiatives are under development or underway, such as the implementation of the Transforming Children and Young People’s Mental Health Green Paper reforms, the NHS Long Term Plan, reforms to the Mental Health Act, the Mental Health and Wellbeing Plan and the Suicide Prevention Plan. Reforms of the wider healthcare system, such as the move towards Integrated Care Systems, reforms of parts of the healthcare system such as those following the Fuller Review, and wider policy agendas such as the Levelling Up missions will also have significant impacts on the landscape of mental health care and provision, and the mental health and wellbeing experiences and outcomes of people in England.
Against this backdrop, it is critical that we have a pipeline of high quality, policy relevant mental health research that can inform and support decision making, both in the now and for the long term.
Section 3: Justification for research topics
The findings of the MHPRU’s research will inform the strategic and policy work of a range of Directorates within the Department for Health and Social Care (DHSC), particularly that of the Mental Health and Disabilities Directorate (MHDD) and the Office of Health Improvement and Disparities (OHID), whose focus is on advice, analysis and policy development/ implementation related to improving population health, prevention and equity. MHDD includes policy leads for adult mental health, including older people’s and perinatal mental health, and children and young people’s mental health and wellbeing.
More widely, it will help to support the Department’s duty, under the single equalities legislation, to prevent or counter discrimination against individuals or groups and to promote equalities. The PRU will help inform the strategies and work programmes of our relevant delivery partners and Arms Length Bodies (ALBs), which include NHS England and Health Education England.
Section 4: Other related research activity of which the Unit will need to be aware
There are a number of other government bodies and ALBs with research programmes relating to mental health including wider work funded by the National Institute for Health and Care Research (NIHR) and research from NHSE, the Office for National Statistics, Office for Life Sciences and the National Institute for Clinical Excellence. The work of this unit will need to be set within the context of this range of research and make links/build on other research, where possible. Any work programme on children should engage both The Department for Education (DfE) and DHSC.
Other PRUs will focus on areas that are of strong interest to mental health, and indeed will be focussing on mental health more within their own work. The MHPRU should work collaboratively to ensure that mental health is well represented in their work, in prominence and research design. For example, it should work with the Health and Social Care Workforce PRU to understand issues around recruitment and retention across different mental health professions, and with the Economics of Health and Care Systems and the Adult Social Care PRUs to build understanding of how delayed mental health discharges can be reduced.
Funded by NHS England and its counterparts in the devolved administrations, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) has collected in-depth information on all suicides in the UK since 1996. As well as maintaining this research database, the centre works collaboratively with national and international academic and health colleagues in the area of suicide prevention research in order to improve prevention services and training. Their research increasingly focuses on people not in contact with mental health services.
The Multicentre Study of Self-harm in England has conducted a series of related studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. The research centre also provides representative and reliable data on self-harm in England, based on information collected in five general hospitals, one in Oxford, three in Manchester and one in Derby.
Section 5: Other issues relevant to this programme of research
This provides an indicative sense of the potential agenda, and is not definitive:
Department of Health and Social Care (2021). People at the Heart of Care: adult social care reform white paper. [Accessed August 2022].
Public Health England (2015). Promoting children and young people’s mental health and wellbeing. [Accessed August 2022].
National Institute for Health and Care Research (2022). 22/25 HSDR Evaluating the implementation of the Transforming Children and Young People's Mental Health Provision Green Paper - Commissioning Brief. [Accessed August 2022].
NHS Race & Health Observatory (2022). Ethnic Inequalities in Healthcare: A Rapid Evidence Review. [Accessed August 2022].
Organisation for Economic Cooperation and Development (2021). Health at a Glance 2021. [Accessed August 2022].