Collaborative care for older people with depression
Depression is common amongst the over 65 age group, with around 22 percent of men and 27 percent of women affected. Yet it often goes unrecognised and untreated in primary care.
Despite the prevalence, prior to the NIHR Clinical Research Network (CRN)-supported CASPER trial, there was little evidence to guide the primary care management of depressive symptoms and the prevention of more severe disorders in the over 65s age group.
The CASPER trial set out to evaluate whether the addition of a collaborative care intervention could prevent more severe depression in older people and help to reduce depressive symptoms in those with lower severity disorders. The team developed a collaborative care approach including behavioural activation - specifically aimed at older people with depressive symptoms - which could be delivered in conjunction with usual care provided by a GP.
The researchers found that those in the treatment group who received the collaborative care intervention were less likely to be severely depressed after a year than those in the control group, with a statistically significant benefit in terms of depression severity after just four months. Approximately half the number of people in the treatment group went on to develop clinical levels of depression than the control group - halving the rate of clinical depression onset.
Virtual reality for mental health
In 2017 the NIHR challenged research teams comprised of clinicians, academics and small and medium-sized enterprises (SMEs), to develop innovative technological solutions that could influence the patient care pathway, and improve patient outcomes.
Our panel selected one novel application that could transform the lives of people living with mental health conditions as the winner of the NIHR i4i Mental Health 2017 Challenge Awards. Professor Daniel Freeman and his team were awarded £4 million which will enable state-of-the-art psychological therapy to be delivered via virtual reality (VR) in the NHS to benefit patients with psychosis.
CBT for people with health anxiety
Health anxiety is an under-recognised but frequent cause of distress for patients that has only recently been recognised as a potentially treatable mental health condition.
The cognitive behaviour therapy for health anxiety in medical patients (CHAMP) randomised controlled trial examined the effectiveness of a modified form of cognitive behavioural therapy (CBT) for people with severe health anxiety - against a control group who continued to receive standard care from their outpatient clinics.
The study, funded by the NIHR Health Technology Assessment (HTA) Programme, recruited patients from six hospital sites across London, Middlesex and Nottinghamshire. The NIHR Clinical Research Network (CRN) provided four research assistants during the recruitment phase of the study and support from the NIHR CRN Mental Health Specialty.
The research found that CBT was a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improved generalised anxiety and depressive symptoms more than standard care.
Reducing the effects of financial hardship on depression and anxiety
Economic recession leads to more unemployment, debt, depression and suicide. Researchers at the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West did an analysis of studies where some kind of support or help was given to people in this situation. The help could be advice on managing debt, applying for jobs, going for interviews, or knowing which benefits to claim, or therapies such as cognitive behavioural therapy.
Their systematic review found that job clubs appear to be effective in reducing depression in people who lose their jobs, particularly those at high risk of depression. Evidence for other forms of support is limited.
Improving care in people who who self-harm
Over 30% of people who commit suicide have previously been in contact with health services following self-harm, and over 20% of people who self-harm repeat their action within 12 months. Although previous self-harm is one of the strongest risk factors for suicide, unemployment and easy access to high lethality suicide methods are the most potent influences on suicide rates.
Researchers funded by NIHR Programme Grants for Applied Research collected evidence to inform the National Suicide Prevention Strategy. As well as a reduction in suicide rates, the team were looking to use their findings to improve the care of people who self-harm in England, addressing the variation across hospitals.
The team identified patterns in access to medications and suicide levels, such as a reduction in pack sizes of paracetamol being followed by a 43% reduction of deaths over the next 11 years. They found that the withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010, based on previous trends.
Involving carers in mental health planning
Enhancing the Quality for user Involvement Care Planning in Mental Health Services (EQUIP) research project, funded by the NIHR Programme Grants for Applied Research (PGfAR) Programme, is examining ways to improve use and carer involvement in care planning in mental health services.
Their qualitative study, led by a researcher who was a carer herself, has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.
An animation based on their 2015 paper in BMC Psychiatry was winner of the video category in the 2017 NIHR Let’s Get Digital competition.
Find a mental health study in your area
You can find out more about mental health studies in your area through the Be Part of Research website.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
Support for mental health research
The mental health specialty is one of over 31 specialties which bring together communities of clinical practice to provide national networks of research expertise. It is made up of research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that the mental health studies that are included in our national portfolio of research receive the right support to ensure they are delivered successfully in the NHS.
Our specialty supports a large range of studies carried out in England with the help of people who use NHS and social care services and people who work in them. We work with experienced researchers and mental health professionals working in local universities and services. There is a dedicated workforce, including clinical studies officers, who support research projects by identifying and recruiting eligible participants and negotiating with NHS trusts on behalf of a study team.
We support research that deals with a wide range of conditions such as anxiety, depression, eating disorders, personality disorders, neurodevelopmental disorders, psychosis and addictions. Our portfolio includes studies that examine the diagnosis, prevention and treatment of mental health conditions such as:
- Reduction of anxiety and stress
- Intervention for ill-treated infants to improve mental and physical health
- Cognitive therapy for post-traumatic stress disorders in children and adults
- Cognitive therapy with stress-related and somatoform disorders
National Mental Health Specialty Group
Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for mental health. These clinicians lead research groups to promote and support mental health research within health and care settings in their regions.
At a national level the local leads come together to manage the national mental health clinical research portfolio. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. Our National Specialty Group of clinical experts offer advice and support to commercial and non-commercial customers looking to conduct research in the NHS.
Involving patients and carers in your research
The CRN Mental Health Specialty strongly recommends and encourages all studies to show that people with experience of mental health problems and/or carers of people with mental health problems have helped develop the research proposal, or will be involved in the project.
The Local Clinical Research Network (LCRN) teams can advise about the best way of getting input from people who are experts by experience. They can also offer you advice about getting relatives of people with mental health problems involved in your research.
Our specialty encourages people with personal experience of mental health problems to work with us, and get involved in individual research projects. The studies we support all aim to improve NHS services and treatments – and we believe the people who use those services and potentially benefit from the treatments, can give invaluable advice to researchers.
We involve people with experience of mental health problems in our day-to-day work, and introduce individuals to research teams who want expert advice when planning or carrying out their studies.
There are many ways to get involved in mental health research such as:
- Going to a one-off meeting to give advice on a specific research proposal
- Joining a research project steering committee that meets regularly
- Planning future studies with a group of researchers
- Advising research teams on the best way to recruit people as participants in their studies
- Experience has shown us that by working collaboratively we can really achieve great things.
For more information on local opportunities contact your Local Clinical Research Network to get involved in their work, or in research studies that are running locally.
Children and young people’s mental health research
One in ten young people will experience a mental health problem. Research can help us to understand the best ways to treat and prevent mental ill health and to preserve and promote good mental health. he specialty has developed a network of Children’s and Young Persons (CYP) Champions, to assist with the design of and delivery of research involving young people and their family members. If you would like to know more about the work of the Champions or find out who the CYP Champion is for a Local Clinical Research Network (LCRN), please email firstname.lastname@example.org
How to access support
Find out how to apply for Clinical Research Network support and how your study can benefit from our Study Support Service.
The Clinical Reseaech Network (CRN) Mental health specialty has developed close links with key stakeholders and clinical researchers to input into the delivery of studies and influence the mental health research agenda. We have also established a longstanding partnership with The McPin Foundation and MQ: Transforming Mental Health to recognise researchers involvement of service user and carer involvement in mental health research studies. Our close links and access to clinical research facilities across the UK, providing privileged access to high resolution neuroimaging and specialist clinical facilities. These working relationships help us meet delivery needs flexibly and jointly.”
We have close collaborations with the McPin Foundation and MQ: Transforming Mental Health through research as well as key patient involvement groups in the field of mental health.
In 2018, the NIHR CRN collaborated with the McPin Foundation and MQ: Transforming Mental Health to run an award scheme to recognise mental health portfolio research studies with excellent service users and carer involvement in all stages of the research process. The award provided an opportunity to spread good practice in the area, celebrate excellence and promote patient and carer involvement activities that research studies can implement to improve the quality and relevance of their research.
UK Mental health research organisations
The Scottish Mental Health Research Network (SMHRN)
The Scottish Mental Health Research Network (SMHRN) facilitates the development, set up and successful completion of mental health clinical research studies across Scotland.
Clinical Research Collaboration Cymru
Health and Care Research Wales provides an infrastructure to support and increase capacity in R&D, runs a range of responsive funding schemes and manages resources to promote, support and deliver research in health and social care.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRC undertakes research in mental health:
NIHR Medtech and In vitro diagnostics Co-operatives
NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests. The following MICs undertake research in mental health:
NIHR Applied Research Collaborations
NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. The following ARCs undertake research in mental health:
NIHR Mental Health Translational Research Collaboration
The NIHR Mental Health Translational Research Collaboration is a national network of centres of excellence in mental health translational and clinical research that facilitates collaboration with charities and industry partners.
Clinical Record Interactive Search (CRIS) database
The Clinical Record Interactive Search (CRIS) database, developed by the NIHR Maudsley Biomedical Research Centre (BRC), provides authorised researchers with regulated access to a wide range of pseudonymised information extracted from the SLaM electronic clinical records system.
The database enables researchers to safely and securely review real life scenarios using information from the Trust's clinical records. This means it is easier to see patterns and trends, such as which treatments work for some and don't work for others.
Work with our infrastructure
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: email@example.com
Our experts in the NIHR Clinical Research Network National Specialty Group can advise on delivering your mental health study across health and care settings.
Professor Kathryn Abel
Professor Kathryn Abel is the NIHR Clinical Research Network National Specialty Lead for Mental Health.
Professor Abel is Professor of Psychological Medicine and Reproductive Psychiatry & Honorary Consultant Psychiatrist at the University of Manchester. She trained in Oxford and London and undertook her psychiatry training at the Institute of Psychiatry from 1991-2001. She is an expert on women’s mental health focussing on maternal condition and its effects on offspring outcomes, gender sensitive service development, and reproductive psychiatry involving mothers, maternal mental illness and their children. She has held a number of prestigious research awards including a five year MRC Research Fellowship and is currently the holder of a European Research Council Consolidator award until 2021.
Professor Abel is principal applicant or co-applicant on a number of NIHR grants examining biological and environmental effects on patient outcomes, and holds grants to assess a range of women-centred services and service developments in the NHS. With SCIE, NICE, NHS Evidence and DHSC she developed an e-learning tool to improve reproductive (and pregnancy related) health in patients with mental illness and is currently funded to examine its use in clinical settings.
Professor Abel has a wealth of experience as a mental health clinician working with severe mental illness and in gender sensitive service development. She leads a group of 15 researchers, is a member of the Royal College of Psychiatry Academic Faculty Executive.