Published: 26 January 2021
The NIHR has funded four new research projects to support patients with serious mental health problems detained under the Mental Health Act.
The £3 million new research projects aim to reduce the number of compulsory hospital admissions for people with mental health conditions and improve the experiences of patients and their families and friends.
The research, funded by the NIHR Policy Research Programme, will support the government’s newly announced reforms of the Mental Health Act and provide evidence to policy makers rolling out the reforms.
The Mental Health Act (1983) covers the assessment, treatment and rights of people with a mental health disorder. Under this act a person can be detained, or ‘sectioned’, and treated without their agreement if they are at risk of harm to themselves or others.
Since the act came into force, the rates of compulsory detentions in mental health hospitals have more than doubled. Black British people are over four times more likely than white British people to be detained under that legislation.
Following an independent review of the Mental Health Act in 2018, the government has launched landmark reforms of mental health laws to deliver parity between mental and physical health services, put patients’ views at the centre of their care, and tackle the disproportionate detention of people from black, Asian and minority ethnic (BAME) communities.
The four new research projects funded by the NIHR aim to improve patient experiences and outcomes under the Mental Health Act, targeting specific recommendations by the independent review for research on tackling the rising rates of detention and understanding the experiences of people from minority ethnic communities and family and friends of people who have been detained.
One of the new research projects will specifically consider the experiences of black African Caribbean men detained under the Mental Health Act and develop an approach to reduce detention rates and improve their experiences.
Professor Joy Duxbury OBE, Professor of Mental Health Manchester Metropolitan University and lead researcher of the ImprovE-ACT project, said: "Given ongoing concerns about the high rates of detention of vulnerable individuals and associated trauma for them and their families, this has the potential to be a crucial piece of research.
“We hope to co-create an authentic and effective intervention that will be produced by and for those most affected in a meaningful way. Most importantly we need to ensure that the voice of previously silenced communities is heard.”
Two other projects will focus on reducing the number of people admitted or readmitted to compulsory care under the Mental Health Act.
Professor Kamaldeep Bhui and Dr Roisin Mooney at the University of Oxford will invite service users and mental health staff to use photography to capture their experiences of compulsory admission, which will then be used to inform a new approach to reducing the number of people receiving compulsory care.
Professor Bhui and Dr Mooney said: “We are so delighted to be leading this important creative and experience-driven policy research to improve the care of people with mental health problems, especially if they receive care under the powers of the Mental Health Act. We know this disproportionately affects some ethnic groups and anticipate the research will provide a strong evidence base - grounded in people’s experience - for therapeutic and policy advances.”
Professor Sonia Johnson and Dr Brynmor Lloyd-Evans at University College London will adapt a successful approach to crisis planning to reduce compulsory admission in people who have been detained before under the Mental Health Act.
Professor Johnson said: “People who have been ‘sectioned’ under the Mental Health Act at least once are at high risk of experiencing this again, as our team showed in carrying out the NIHR Mental Health Policy Research Unit’s evidence review for the Independent Review of the Mental Health Act.
“There is currently remarkably little evidence on how to prevent this, and good evidence that it can’t be done through coercion. We are very excited to be setting up a research team that will include both clinicians and people with relevant lived experience to develop a strategy that we hope can move things forward with this major challenge.”
The fourth project, by Dr Domenico Giacco and colleagues at Coventry and Warwickshire Partnership NHS Trust, will develop and test a method for one-to-one peer support for family members and friends of patients treated under the Mental Health Act, a group that reports feeling isolated and unsupported.
Dr Giacco said: “This research tackles an important recommendation of the Mental Health Care review - providing appropriate support and information to carers.
“Sadly, the stress of caring can lead to psychological distress and even physical or mental health problems. On the other hand, if the expertise by experience of carers is valued and supported, this can have positive and rewarding aspects and be highly beneficial to other carers, to service users and to the NHS and the society at large.”
Improving the experiences of black African Caribbean men detained under the Mental Health Act: a co-produced intervention using the Silences Framework (ImprovE-ACT)
Professor Joy Duxbury OBE, Manchester Metropolitan University
This research will use a co-production method called experience-based co-design to understand the experiences of black African Caribbean men who are detained under the Mental Health Act and what is important to them and their families. This approach will be used alongside the Silences Framework. Both of these methods are driven by inclusive methods and the use of stories, mapping key touch points and sharing events to understand the perspectives of vulnerable populations.
The researchers will use this information and the views of professionals - such as mental health practitioners, social workers and the police - to co-develop and test the feasibility of an intervention to reduce detention rates and improve the experiences of black African Caribbean men.
Experience based investigation and Co-design of approaches to Prevent and reduce Mental Health Act Use: (CO-PACT)
Professor Kamaldeep Bhui and Dr Roisin Mooney, University of Oxford
This research will recruit service users who have experienced at least one compulsory admission to hospital in the previous year, and mental health staff, from seven cities across England. These participants will be invited to use photography, along with titles, captions, or descriptions, to capture their experiences of compulsory admission.
In each city, this information will be shared among a group service users, carers and mental health staff, who will work together to design and test a new approach to reduce the number of people receiving compulsory care and ethnic inequalities in use of the Mental Health Act.
Development, Feasibility Testing and Pilot Trial of a Crisis Planning and Monitoring Intervention to Reduce Compulsory Hospital Readmissions (the FINCH Study)
Professor Sonia Johnson, University College London
This research project will learn from a programme in Switzerland where crisis planning - including developing individualised strategies for monitoring for early signs of crisis and empowering patients to develop and put into practice crisis prevention plans - has shown promise in reducing compulsory admission in people who have been detained before under the Mental Health Act.
The research team developing and testing these strategies will include people with relevant lived experience and mental health professionals. They will adapt the programme to the UK and test it in an initial trial. This will be a vital first step towards a large multi-site study giving a more definite answer as to whether a UK version of the programme prevents compulsory admissions and is good value for money.
One-to-one Peer support for family members and friends of patients treated under the mentAL health act (OPAL)
Dr Domenico Giacco, University of Warwick and Coventry and Warwickshire Partnership NHS Trust
This research will explore how one-to-one carer peer support can be best provided to carers of people treated under the Mental Health Act in England, using a model that has been successful in Germany.
The researchers will work with carers, service users and clinicians to develop a programme to train carers to deliver one-to-one carer peer support. Carers will be supported to train other carers using a ‘train the trainer’ model. Experiences, costs, engagement of carers and carer peer supporters, any adverse events and the impact on quality of life of carers and on caregiving stress will be assessed.