Mental Health Research

Centre for Mental Health Research

The Centre for Mental Health Research carries out collaborative research to improve the quality of mental health care.

The Centre has an international reputation for co-produced research with young people, adults and older adults experiencing mental health problems in national and global settings. Our work focuses on reducing health inequalities by improving patient access, experience and outcomes, through novel methods, psychosocial interventions and models of care. Collaboration and co-production with people with lived experience of using mental health services, and the staff that provide these services, is at the heart of our research. We employ service-user researchers as faculty and have an award-winning Service User and Carer Advisory Group Advising on Research (SUGAR).

Our work is centred around five core themes: Understanding and Improving Communication in Healthcare, Understanding and Addressing Inequalities and Marginalisation in Mental Health, Perinatal Mental Health, Supporting People in Crisis, and Intersection of Mental and Physical Health. We have particular strengths in exploring these areas using mixed methods and innovative approaches including micro-analysis of video footage, 3D motion capture of non-verbal behaviour and digital/ e-interventions. We draw on a range of qualitative and quantitative methods from detailed ethnography through to national randomised controlled trials of novel interventions and work with large national datasets.

We work alongside clinicians in numerous NHS Trusts, academic partners in leading universities in the UK and internationally, professional bodies (e.g. Royal College of Nursing, Royal College of Psychiatrists) and charities (Alzheimer’s Society, McPin Foundation, National Survivor User Network, Samaritans, The Health Foundation). The Centre receives funding from a range of sources including the NIHR, ESRC, NHS Digital, the Dunhill Medical Trust and the British Academy.

People

Members

  • Professor Rose McCabe, Professor of Clinical Communication (Centre Lead)
  • Lolita Alfred, Lecturer in Mental Health Nursing
  • Katie Anderson, Research Assistant Service User Research
  • Dr Sally Barlow, Senior Lecturer
  • Dr Kirsten Barnicot, Lecturer in Mental Health Services Research
  • Dr Clara Bergen, Research Fellow
  • Professor Steve Gillard, Professor in Mental Health
  • Dr Lucy Goldsmith, Postdoctoral Research Fellow
  • Dr Juanita Hoe, Reader
  • Jenna Hunter
  • Dr Mary Lavelle, Senior Research Fellow
  • Jo Lomani, Research Assistant Service User Research
  • Dr Grace Lucas, Lecturer
  • Kaidu Mustapha-Saliho, Lecturer in Mental Health Nursing
  • Madeline O'Caroll, Senior Lecturer
  • Dr Sally O’Keeffe, Research Fellow (Programme Manager)
  • Dr Louise Phillips, Senior Lecturer in Mental Health
  • Eleni Profyri, Research Assistant
  • Professor Jacqueline Sin, Professor in Mental Health Nursing
  • Neha Shah

  • Affiliated Members

  • Janet Anderson
  • Profesor Susan Ayers, Professor of Maternal and Child Health
  • Dr Martin Cartwright, Senior Lecturer
  • Dr Rose Coates, Research Fellow
  • Michelle Ellis, Senior Lecturer
  • Angela Harden, Professor of Health Services
  • Professor Katerina Hilari,  Professor of Acquired Communication Disorders
  • Vivian Holmes
  • Dr Sofia Llahana, Senior Lecturer
  • Sally McManus, Senior Lecturer
  • Dr China Mills, Senior Lecturer
  • Stanton Newman, Professor of Health Psychology
  • Dr Kathleen Mulligan, Senior Research Fellow
  • Dr Justin Needle, Senior Lecturer
  • Dr Louise Williams, Research Fellow
  • Octavia Wiseman, Research Assistant
  • Dr Heather Yoeli, Qualitative Research Fellow

  • PhD Students

  • Nafiso Ahmed
  • Amy Delicate
  • Tracy Dorey
  • Liz Dudeney
  • Susannah Hermaszewska, NIHR Pre-Doctoral Research Fellow
  • Oliver Matias
  • Jenny McLeish
  • Cherie Morgan
  • Aaliyah Shaikh
  • Marlon Stiell
  • Aneta Zarska
  • Our Research

    Our five core Research Themes are:

    • Understanding and Improving Communication in Healthcare
    • Understanding and Addressing Inequalities and Marginalisation in Mental Health
    • Perinatal Mental Health
    • Supporting People in Crisis
    • Intersection of Mental and Physical Health

    Understanding and Improving Communication in Healthcare

    Agency, Social Identity & Justice in Mental Health: A Collaboration with Young People, Clinicians & Academics across Philosophy, Ethics & Neuroscience

    City Lead: Professor Rose McCabe (CI)

    Team: Lisa Bortolotti (University of Birmingham), Matthew Broome (University of Birmingham), Michael Larkin (Aston University); Rachel Temple (McPin Foundation)

    Funder: MRC/ESRC/AHRC, £94,267.71

    Duration: April 2020 to March 2021

    The project has established a new collaboration involving young people, their families, clinicians and academics across philosophy, ethics, psychology and neuroscience to investigate agency, identity and justice in youth mental health. We will analyse verbal and non-verbal communication in mental healthcare encounters involving young people to examine how agency is fostered or thwarted, and test novel interview methods with young people.

    Find out more here: UKRI project page - 'Agency, Social Identity & Justice in Mental Health: A Collaboration with Young People, Clinicians & Academics across Philosophy, Ethics & Neuroscience'

    A New Global Teaching and Research Partnership on Patient Involvement in Healthcare Decisions

    City Lead: Professor Rose McCabe (PI)

    Team: Hunan University, China; University of California, Los Angeles; University of Osaka, Japan; Universidade do Vale do Rio dos Sinos (UNISINOS), Brazil;

    Funder: City University Global Seed Fund

    Duration: January 2020 to November 2020

    Improving quality of life and health outcomes of patients with psychosis through a new structured intervention for expanding social networks (SCENE)

    City Lead: Professor Rose McCabe (Co-I)

    Team: Stefan Priebe (Queen Mary University of London, CI)

    Funder: National Institute for Health Research, £2,709,552

    Duration: June 2017 to November 2022

    People with psychosis tend to perceive and interpret events differently from those around them, and are often socially withdrawn. In the NHS, these patients receive medication, practical support and sometimes talking therapies. Yet, these treatments have limited benefit, and many patients remain socially isolated. This can lead to a further decline in health with more hospital stays and poor quality of life.

    The proposed research will try an approach that is different from what health services currently do. We will carry out several research studies, involving patients and different health professionals throughout the process. In the planned intervention, a health professional will discuss with a patient all current social contacts and possibilities to expand the social network. The two will agree on some new activities and have further meetings over a six month period for more discussions and support.

    The idea is that patients will expand their social networks and through this have a better quality of life, fewer symptoms and better chances to avoid crises. The research will interview patients in different parts of the country to find out what their social networks are, how these networks can be expanded, and how the internet might be used to support this. We will also discuss with patients and health professionals how to refine the intervention so that patients will accept it and benefit from it. We will then test the intervention with 24 patients to see how it works.

    Based on the findings we will revise the approach, and then ask more than 500 patients across different locations in England to participate in a larger study testing whether the new approach does actually improve patients quality of life and mental health. Finally, we will see how the intervention can be best implemented in the NHS and work with patients and professional groups to share our findings widely.

    Find out more here: NIHR project page - Improving quality of life and health outcomes of patients with psychosis through a new structured intervention for expanding social networks

    Music-assisted programmes: Developing communication in autism spectrum disorder through music-making (MAP)

    City Lead: Professor Jacqueline Sin (co-I)

    Team: Dr Fang Liu (CI), Dr Tim Williams, Dr Tom Loucas (University of Reading)

    Funder: European Research Council Proof of Concept Grant, €150,000

    Duration: September 2019 to September 2021

    The project aims to develop a set of music-assisted intervention programmes (MAP) to increase spoken language ability in 24-60-month old nonverbal or minimally verbal children with autism spectrum disorder (ASD). We compare the MAP with standard speech and language therapy in children aged three to five-year old through an online randomised controlled trial.

    Learn more about the MAP study.

    Tackling chronic depression - adapting and testing a technology supported patient-centred and solution-focused intervention (DIALOG+) for people with chronic depression (TACK)

    City Lead: Professor Rose McCabe (Co-I)

    Team: Stefan Priebe (CI), Vicky Bird (CI), Raj Choudhury, Susan Collinson, John Geddes, Tim Kendall Sally Kerry, Andrew Molodynski, Anita Patel,  Stephen Pilling, Jonathan Warren
    Funder: National Institute for Health Research, £2,489,869

    Duration: October 2018 to March 2022

    Approaches for chronic depression are limited, and people often continue to have a poor quality of life. In previous research we developed an intervention called “DIALOG+” which helped patients with schizophrenia. DIALOG+ involved mental health staff using a tablet computer to ask patients about their satisfaction with different areas of life. Patients and staff then worked together to find solutions to concerns raised. This process was repeated several times.

    After using DIALOG+, patients were more satisfied with life and had fewer symptoms. We think DIALOG+ might also work for people with depression. Firstly, we will see if DIALOG+ is acceptable by asking people with depression their opinions on the approach so we can adapt it to their needs. We will then do a small study with nine staff members and 45 patients with depression to gain further experience with DIALOG+ and check whether a larger study testing it would be possible.

    We will then carry out a larger study in four different areas in the UK to test whether DIALOG+ really helps patients with chronic depression. This will include 112 care coordinators and 448 patients, half of whom will use DIALOG+. The other half will not use DIALOG+, and will act as a comparison group. We will ask all participants to fill out questionnaires at the start of the study and after six and 12 months. We will then compare the two groups using these questionnaires to see if patients receiving DIALOG+ show improvements. If the approach is successful, we will develop an internet training programme for different health professionals and test it with nurses, people working in General Practice surgeries, and assistant psychologists.

    Find out more here: NIHR project page - Tackling chronic depression - adapting and testing a technology supported patient-centred and solution-focused intervention (DIALOG+) for people with chronic depression (TACK) 

    The role of language and communication in facilitating earlier referral to hospices

    City Lead: Professor Rose McCabe (CI)

    Team: Ann Rhys (Hospiscare), Jenny Hayes (Hospiscare), Ruth Parry (University of Loughborough), Tina Naldrett (Hospiscare)

    Funder: Hospiscare, £47,940

    Duration: October 2021 to September 2022

    There is evidence of the benefits of early conversations and referrals to a hospice for people with life-limiting conditions. There is evidence that earlier access to palliative care improves care and outcomes. However, doctors, including GPs and medical specialists (e.g. in cardiology and neurology), often do not refer people to palliative care until very late in their illness: “at the beginning of the end”. Physician discomfort at broaching the referral to a hospice is a significant barrier to earlier referral. Meanwhile, patients and families who received hospice care report that they would have liked to have more information about hospice when the illness was labelled terminal. Practitioners, like others, avoid difficult conversations and do not wish to raise the word ‘hospice’ .This study will address this challenge by focusing on language and ‘what words to use’ when broaching the first conversation with patients about referral to a hospice. We will produce videos to support practitioners to have earlier conversations about a hospice to improve patients and families journeys after being diagnosed with a life-limiting illness.

    The role of staff and team communication in reducing seclusion, restraint and forced tranquilisation in acute inpatient mental health settings

    City Lead: Dr Mary Lavelle (CI)

    Team: Janet Anderson (Kings College London), Juanita Hoe (City), Rose McCabe (City), Syeda Tahir

    Funder: National Institute for Health Research, £241,868.00

    Duration: March 2021 to February 2024

    Over 100,000 patients are admitted to acute mental health wards annually, 40% involuntarily. Wards are under incredible pressure due to high bed occupancy rates and staff shortages. Only patients who are extremely unwell are admitted, experiencing symptoms of psychosis (hearing voices), mania or severe depression. In England, 80% of nurses report experiencing patient aggression. Staff manage aggression through communication; talking to patients to try to calm down their aggression. This technique is called de-escalation . However, often de-escalation is unsuccessful, leading to restraint, seclusion and forced tranquilisation of patients. This study will be the first to examine staff and team communication in mental health wards, identifying the communication that leads to successful de-escalation. Four acute inpatient mental health wards will be recruited; two with low and two with high rates of restraint. Sixty-four de-escalations will be video recorded (32 successful, 32 unsuccessful) Staff and team communication will be analysed from video using established tools. Statistical analysis will identify the specific communication that leads to successful de-escalation. Ward observations will examine how teams discuss and plan for patient aggression. One-to-one interviews with patients (n=16) and staff (n=20) will examine their experience of de-escalation.

    Find out more here: NIHR project page: The role of staff and team communication in reducing seclusion, restraint and forced tranquilisation in acute inpatient mental health settings

    Understanding and Addressing Inequalities and Marginalisation in Mental Health

    Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM)

    City Lead: Professor Rose McCabe (co-I)

    Team: S Priebe (Queen Mary University of London, CI), Alex Copello, Charles Musters (East London NHS Foundation Trust),  Giles Berrisford,  Jelena Jankovic , Justine Cawley (East London NHS Foundation Trust), Nikolina Jovanovic,  Olivia Protti  (East London NHS Foundation Trust), Qulsom Fazil, Syeda Tahir

    Funder: NIHR Health Services & Delivery Research, £444,534.

    Duration: May 2019 to June 2021

    Women who have mental health problems during pregnancy and in the first year after giving birth (called the perinatal period) can face a number of difficulties in seeking professional help. The difficulties in seeking help are probably more pronounced for women from ethnic minorities. In order to improve services for these women we need to better understand how women from ethnic minorities get into contact with perinatal mental health services and whether these services are acceptable to them. We will explore this in the proposed research which will be carried out in four steps. In the first step we will investigate two large national databases in order to see to what extent women from different ethnic minorities use mental health services during the perinatal period. In the second step, we will collect additional information from specialist perinatal mental health services in two areas with large ethnic minority populations- Birmingham and East London. We will assess to what extent women from ethnic minorities do not attend appointments at specialist services and how they are referred to two Mother and Baby psychiatric hospital units. In the third step we will carry out in-depth interviews with women from South Asian and Black ethnic minority groups who experienced perinatal mental health problems, with their partners and family members/carers, and with different health professionals about their attitudes, expectations and experiences. In the fourth step we will, together with other stakeholders (women with lived experience and their families, commissioners, health professionals and community organisations), discuss the best way to make use of our study findings in order to improve mental health services that women from different ethnic minorities receive during the perinatal period.

    Find out more here: NIHR project page: Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM)

    Adult Psychiatric Morbidity Survey 2022

    City Lead: Sally McManus

    Team: National Centre for Social Research, University of Leicester, Violence and Society Centre  (City)

    Funder: NHS Digital,

    Duration: June 2021 to September 2024

    Every seven years a major assessment of the nation’s mental health is carried out. The Adult Psychiatric Morbidity Survey (APMS) series provides England’s National Statistics for the monitoring of mental health trends and treatment access in the household population. Information about people’s characteristics and circumstances are collected, allowing for inequalities to be examined. It’s being conducted by the National Centre for Social Research and University of Leicester in collaboration with the Violence and Society Centre at City, University of London. The survey is funded by the Department for Health and Social Care and commissioned by NHS Digital.

    Find out more here: National Study of Health and Wellbeing

    Co-production project to improve access to primary healthcare for refugees and asylum seekers experiencing mental distress

    City Lead: Susannah Hermaszewska (CI)

    Team: Jacqueline Sin (City), Angela Sweeney (King’s College London), Angelina Jalonen (Refugee Council)

    Funder: School of Health Sciences, Research Sustainability Fund & Higher Education Innovation Fund, £3,340

    Duration: December 2020 to June 2021

    All asylum seekers and refugees in the UK are entitled to free primary and secondary healthcare with the NHS. Whilst levels of mental and physical health needs in this population are high, utilisation of primary healthcare services remains low.

    Recent research has shown that refugees seeking help from primary healthcare services are hampered by discriminatory policies of these services, such as refusal to register patients without proof of legal status or address, but also their lack of knowledge about the UK healthcare system, language and cultural barriers, fear of disclosing sensitive information, and stigma associated with mental health.

    The aim of this coproduction project is to develop and disseminate informative resources to support help-seeking and aid communication about health needs between asylum seekers and refugees and primary healthcare practitioners. This project is being undertaken in partnership with the Refugee Council, a nation-wide organisation, which provides therapeutic services, advocacy, and support to asylum seekers and refugees in the UK. The resources will be co-produced with members of the refugee community, therapists at the Refugee Council and General Practitioners serving the refugee community.

    Find out more and download the resources here: Refugee Council therapeutic wellbeing resources

    Co-designing culturally engaging alcohol intervention to reduce harm in Nepal

    City Lead: Professor Jacqueline Sin

    Team: Ranjita Dhital (University of Reading, co-CI), Adhijit Nadkarni (London School of Hygiene & Tropical Medicine), Anup Adhikari (Programme For Improving Mental Health (PRIME) Nepal Collaborators), Edwin van Teijlingen (Bournemouth University), Glenn Robert (King’s College London), Nagendra Luitel (Transcultural Psychosocial Organisation (TPO) Nepal),

    Funder: City’s Global Challenges Research Fund, £15,473.81

    Duration: December 2020 to July 2021

    Alcohol causes approximately 3.3 million deaths annually, representing 5.9% of all deaths worldwide. In low-income countries like Nepal, morbidity and mortality risks are greater per litre of pure alcohol consumed than in higher-income countries.

    This cross-disciplinary study will explore and expand on the multi-country Programme for Improving Mental Health Care conducted at one of the sites, Chitwan District, Nepal. This is an area with significant mental health and alcohol problems, where non-significant findings were reported when a psychological alcohol intervention was delivered in primary care settings by trained community-based counsellors.

    This study will be the first to use Experience-based Co-design (EBCD) and Photovoice to explore how community assets (including the arts, culture, heritage sites, green spaces, community associations and volunteer groups) can be best incorporated in co-designing an alcohol intervention for future evaluation in a low-resource country. The co-designed intervention will be developed to a stage ready for piloting and evaluation. We hope this will lead to the development of a culturally engaging alcohol intervention to provide sustainable and long-term health and social benefits.

    Dementia-Patient Aligned Care Team (D-PACT)

    City Lead: Professor Rose McCabe (Co-I)

    Team: Thomasina Oh (University of Plymouth, CI), Paul Clarkson (University of Manchester, CI), Richard Byng (University of Plymouth, CI), Academic and Clinical Collaborators

    Funder: NIHR Programme Grant for Applied Research, £2.4 million

    The D-PACT programme will address the lack of evidence on the most effective support for people with dementia, by developing and evaluating a system for dementia support based within general practice that will provide post-diagnosis care for people with dementia and their carers.

    The team have developed a Dementia Support Worker intervention that provides ongoing support to meet the needs of people with dementia and their carers. Subsequently, a randomised controlled trial will test the effectiveness of the intervention.

    Find out more here: University of Plymouth: Dementia - Person Aligned Care Team

    Improving recognition, understanding and differentiation of autism and personality disorder: A mixed-methods lived experience study (I-RAP)

    City Lead: Kirsten Barnicot (CI) and Jennie Parker (CI)

    Team: Elissa Doel, Eloise Stark, Rose McCabe, Will Mandy

    Funder: The McPin Foundation (Words That Carry On) and City University of London, £110, 042

    Duration: October 2021 to September 2024.

    People diagnosed with personality disorder can often be marginalised within health services. People with lived experience and clinicians say that autism may be missed or misdiagnosed in some people diagnosed with personality disorder, particularly in people identifying as female or assigned female gender at birth, and that this can cause serious harm through people being misunderstood, feeling unheard, and being offered inappropriate and inadequate support.

    Using a co-production model, we will first conduct in-depth qualitative and cognitive interviews with women with a personality disorder, autistic women, women who have both sets of experiences, and clinicians, to explore their perspectives on: (1) Similarities and differences in lived emotional, behavioural, cognitive, identity and interpersonal experiences; (2) Limitations of current assessment tools in evaluating and distinguishing autistic traits in women diagnosed with a personality disorder; and 3) Facilitators and barriers to seeking and gaining a diagnosis of autism.

    We will then draw on the qualitative findings to test quantitative hypotheses about the best ways to assess and differentiate autism and personality disorder. We will generate a set of key dos and don’ts that clinicians can use when considering autism as an alternative or additional explanation for the experiences of a person currently diagnosed with a personality disorder. We will identify a set of distinguishing features that clinicians can use to differentiate autism from personality disorder in women, as well as identifying shared features that are not useful for making this distinction.

    Meta-ethnography and migrant distress: where are transgender forced migrants in global mental health research?

    City Lead: Susannah Hermaszewska

    Team: Jacqueline Sin (City),  Angela Sweeney (King’s College London), B Camminga (Wits University, Johannesburg) Riley Botelle (King's College London).

    Funder: National Institute for Health Research, £69,641

    Duration: March 2020 to June 2021

    We are conducting a systematic review and meta-ethnography of inter-disciplinary literature on the lived experiences of transgender forced migrants. The aim of this review is to deepen the understanding of what factors impact the mental health of transgender forced migrants, and to understand the mental health and healthcare needs unique to their transgender identity, and their forced migrant status.

    This review aims to explore and outline the barriers and facilitators transgender individuals face accessing healthcare during migration and in their host countries. During this project, we are also looking closely at the ethical and methodological implications of using a meta-ethnographic approach to carry out research with exceptionally marginalised communities.

    Recovery in Mind - Reaching Communities

    City Lead: Professor Jacqueline Sin

    Team: Angela Ryan, CEO of Recovery in Mind and the Recovery in Mind team

    Funder:  The Big Lottery Fund, £78,000.00

    Duration: April 2019 - September 2021

    Recovery in Mind Recovery College (RiM) was first established in June 2016, led by Angela Ryan, an experiential expert. RiM, like all recovery colleges, adopts an educational philosophy and offers a range of educational courses about mental health and recovery for the local residents, including individuals affected by mental health conditions, carers and health care professionals.

    The participants are regarded as “students” who play an active role to learn and take on self-management skills and move on with their life despite ongoing mental health challenges. All RiM courses are co-run by “Peer Workers”, i.e. experts through experience and mental health professionals.

    In 2019, RiM has obtained funding from a Big Lottery Reaching Communities Grant to extend and expand its capacity to deliver a range of courses to West Berkshire residents, across two years. Research study is run in parallel to provide a rigorous evaluation of such provision. Hence, this study aims to:

    1. Evaluate the impact of the RiM courses in promoting students’ wellbeing and subjective perception of recovery
    2. To explore students’ lived experience of recovery journey through the RiM courses
    3. Evaluate and explore the health-related outcomes and lived experience of recovery in the Peer Workers.

    Taiwan-UK Sex, Gender and Sexuality Health Network: making connections, establishing commonality, forwarding research

    City Lead: Sally McManus

    Team: Ford Colin Hickson (London School of Hygiene and Tropical Medicine, CI), Cheuk Yin Li (Co-I), Isaac Yen-Hao Chu (Co-I), Nai-Ying Ko (Co-I),

    Funder: Economic and Social Research Council,

    Duration: August 2021 to January 2023, £24,965

    With the support of an ESRC-MOST UK-Taiwan Networking Grant, this project will establish the Taiwan-UK Minority Health Network and strengthen future collaboration. The project is led by LSHTM with the aim of developing a sustainable network of researchers in Taiwan and the UK. It involves co-developing a battery of alternative measures of sex, gender and sexuality that will facilitate cross-cultural queer health research, as well as improve measurement of these human qualities in health care services in both countries.

    Find out more: UKRI project page: Taiwan-UK Sex, Gender and Sexuality Health Network: making connections, establishing commonality, forwarding research

    What difference does it make? An intersectional framework to measure mental health harms in women and men associated with different thresholds of violence and abuse: a systematic review and meta-analysis

    City Leads: Professors Steve Gillard and Jacqueline Sin (Co-Is)

    Team: Nadia Mantovani (St Georges University of London, CI), Angela Sweeney (King’s College London), Sarah White (St George’s, University of London), Lucy Allwright (Against Violence and Abuse), Emma Brett (Anglia Ruskin University)

    Funder and award: The Violence Abuse & Mental Health Network UK Research and Innovation, £25,000

    Duration: January 2020 to February 2021

    This systematic review and meta-analysis will combine the results of quantitative studies to provide an analysis of measures of effect of the mental health harms associated with different kinds and thresholds of violence and abuse (VA), which will include types, frequency, severity and duration of VA. These associations will be further analysed between women and men to assess the gendered nature of violence, and in relation to other social inequalities analysis as specified above.

    Perinatal mental health

    Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM)

    City Lead: Professor Rose McCabe (co-I)

    Team: S Priebe (Queen Mary University of London, CI), Alex Copello, Charles Musters (East London NHS Foundation Trust),  Giles Berrisford,  Jelena Jankovic , Justine Cawley (East London NHS Foundation Trust), Nikolina Jovanovic,  Olivia Protti  (East London NHS Foundation Trust), Qulsom Fazil, Syeda Tahir

    Funder: NIHR Health Services & Delivery Research, £444,533.95

    Duration: May 2019 to June 2021

    Women who have mental health problems during pregnancy and in the first year after giving birth (called the perinatal period) can face a number of difficulties in seeking professional help. The difficulties in seeking help are probably more pronounced for women from ethnic minorities. In order to improve services for these women we need to better understand how women from ethnic minorities get into contact with perinatal mental health services and whether these services are acceptable to them. We will explore this in the proposed research which will be carried out in four steps.

    In the first step we will investigate two large national databases in order to see to what extent women from different ethnic minorities use mental health services during the perinatal period.

    In the second step, we will collect additional information from specialist perinatal mental health services in two areas with large ethnic minority populations- Birmingham and East London. We will assess to what extent women from ethnic minorities do not attend appointments at specialist services and how they are referred to two Mother and Baby psychiatric hospital units.

    In the third step we will carry out in-depth interviews with women from South Asian and Black ethnic minority groups who experienced perinatal mental health problems, with their partners and family members/carers, and with different health professionals about their attitudes, expectations and experiences.

    In the fourth step we will, together with other stakeholders (women with lived experience and their families, commissioners, health professionals and community organisations), discuss the best way to make use of our study findings in order to improve mental health services that women from different ethnic minorities receive during the perinatal period.

    Boosting baby behaviour and bonding in parents with enduring difficulties in managing emotions and relationships (BOOST)

    City Lead: Dr Kirsten Barnicot (CI)

    Team: Eloise Stevens (Central & North West London NHS Foundation Trust), Jane Iles (University of Surrey), Jennie Parker (Central & North West London NHS Foundation Trust),  Maddalena Miele (Central & North West London NHS Foundation Trust), Mike Crawford (Imperial College London), Ola Ajala (Camden & Islington NHS Foundation Trust), Paul Ramchandani (University of Cambridge), Sushma Sundaresh (Oxleas NHS Foundation Trust), Tara Lawn (East London NHS Foundation Trust)

    Funder: NIHR Research for Patient Benefit, £238,399.00

    Duration: June 2017 to January 2021

    The term "personality disorder " describes a set of experiences involving enduring difficulties in managing emotions and relationships with others. Research has shown that children whose parents experience these difficulties face an increased risk of developing their own socioemotional difficulties. Parent-infant interventions could be helpful by offering parents early support with the parent-infant relationship; however, the effectiveness of such interventions has never been evaluated in this group of parents.

    Research with other vulnerable families has shown a brief six-session video-feedback intervention - the video feedback intervention for positive parenting - can improve the parent-child interaction and reduce the risk of child socioemotional difficulties, by helping parents understand and respond sensitively to their child’s behaviour.

    The BOOST trial aims to establish whether parents with enduring difficulties in managing emotions and relationships, who have a child aged between 6 and 36 months, consent to and complete this video feedback intervention, how they think it could be improved, and whether it is feasible to test it in a larger trial in the future. We piloted the intervention in a small group of parents, used their feedback to modify the intervention, and then conducted a feasibility randomised controlled trial to compare the video feedback intervention to treatment-as-usual.

    Optimising video feedback for perinatal mental health (BOOST-2)

    City Lead: Dr Kirsten Barnicot (CI)

    Team: Eloise Stevens (City), Jane Iles (University of Surrey), Jennie Parker (Central & North West London NHS Foundation Trust),  Maddalena Miele (Central & North West London NHS Foundation Trust), Sushma Sundaresh (Oxleas NHS Foundation Trust), Rajinder Kaur Ballman (Central & North West London NHS Foundation Trust), Tara Lawn (East London NHS Foundation Trust)

    Funder: The Barts Charity and Central & North West London NHS Foundation Trust, £52, 635

    Duration: April 2021 to March 2022

    When a new mother experiences mental illness, this can have negative effects not just on herself, but also on her relationship with her child and on her child’s future development and mental health. The NHS Long-Term plan states that increasing access to interventions to improve parent-infant relationships should be a priority. However, we have very little evidence on what parent-infant interventions actually work when implemented in real-world NHS services.

    Our team has recently evaluated the video feedback for positive parenting intervention (VIPP) in perinatal mental health services for women experiencing mental illness in the first year of their child’s life. Mothers are videoed interacting with their babies, and given positive and non-judgemental feedback. We found potential benefits for mothers and children receiving VIPP, in how confident mothers felt and how they interacted with their children, and in children’s mental health.

    However, VIPP is currently designed for infants aged above 6 months. To help more women using perinatal mental health services, we have now adapted VIPP for younger babies and have also added tips on what strategies parents can use to feel calmer if they are feeling stressed while interacting with their child. We now need to pilot the modified intervention with Mums using perinatal mental health services, to check it is feasible for clinicians to deliver, and to gain Mums' and clinicians' feedback.

    We will train clinicians in perinatal mental health services to deliver the modified intervention. We will evaluate how well perinatal mental health staff are able to deliver the intervention; mothers’ attendance and feedback; changes in mothers’ responses to their babies’ communication, parenting-related stress, parental self-confidence and bond with their baby. We will assess these using questionnaires and videos of the mothers playing with their babies, as well as by carrying out feedback interviews with mothers and clinicians.

    Supporting People in Crisis

    Improving outcomes in patients who self-harm – Adapting and evaluating a brief psychological intervention in Emergency Departments (ASsuRED)

    City Lead: Professor Rose McCabe (CI)

    Team: Sally O'Keeffe (City), Jenna Hunter  (City), Mimi Suzuki (East London NHS Foundation Trust), Alan Simpson (Kings College London), Borislava Mihaylova (Queen Mary University of London), Chris Dickens (University of Exeter), Domenico Giacco (University of Warwick), Helen Smith (Devon Partnership NHS Trust), Mary Ryan (PPI representative), Navneet Kapur (University of Manchester), Peter Aitken (Devon Partnership NHS Trust), Peter Riou (Royal Devon and Exeter NHS Foundation Trust), Richard Byng (Plymouth University), Sandra Eldridge (Queen Mary University of London), Stefan Priebe (Queen Mary University of London), Will Lee (University of Exeter), Vera Araujo Soares (Newcastle University),

    Funder: National Institute for Health Research Programme Grant for Applied Research, £2.7 million

    Duration: May 2019 to April 2024

    The study will investigate how to better support people who attend Emergency Departments (EDs) who have thoughts of taking their own lives or have harmed themselves. We will adapt and test a promising new approach used in other countries and evaluate its benefits in the UK context. This will involve therapeutic assessment, safety planning and rapid follow-up support after leaving the ED. This approach will be tested in a national randomised controlled trial.

    Visit The ASsuRED Project page

    ENRICH into practice: informing the successful introduction of peer workers into mental health services (ENRICHMENT)

    City Lead: Professor Steve Gillard (CI)

    Project Team Members: Alan Simpson (Kings College London), Alison Faulkner (National Survivor User Network), Paul Binfield (East London NHS Foundation Trust), Rachel Eborall (South London and Maudsley NHS Foundation Trust), Rahul Bhattacharya (NHS England), Sarah White (St George’s University of London).

    Funder: NIHR Programme Development Grant, £150,000

    Duration: June 2021-Dec 2022

    This study builds on the 5-year NIHR-funded ENRICH peer support research programme to optimise implementation of peer support in mental health services and so maximise benefits. We will conduct in-depth analyses of quantitative and qualitative data from the ENRICH trial, alongside new interviews with peer workers, clinical teams and the people they support to coproduce enhanced guidance on implementing peer support, and new training modules on diversity and peer support in complex needs services.

    We will coproduce an online version of the ENRICH peer support handbook, training manual and fidelity index, supporting remote delivery of peer support post-COVID. Most members of the team explicitly bring their experiences of mental distress and peer support to the study team, working alongside lived experience and clinical advisory groups.

    The study is complemented by a grant from the City HEIF fund - Community, culture and peer support in mental health services: a participatory knowledge exchange project – extending the work to community organisations in East London.

    Evaluating Mental Health Decision Units in acute care pathways (DECISION): A quasi-experimental and health economic evaluation

    City Lead: Professor Steve Gillard (CI)

    Project team: Lucy Goldsmith (City), Jo Lomani (City), Katie Anderson (City), Chloe Crowe (North East London Foundation NHS Trust), David McDaid (LSE), Geraldine Clarke (The Health Foundation), Heather Jarman (St George’s Healthcare NHS Foundation Trust), Jared Smith (St George’s University of London), Kati Turner (St George’s, University of London), Sonia Johnson (UCL).

    Funder: National Institute for Health Research, Health Services & Deliver Research £418K

    Duration: March 2019 – February 2021

    This project aims to establish the effectiveness and cost effectiveness of new mental health decision units (MHDU) – short stay units that aim to improve the experience of metal health crisis care, and to reduce mental health presentations at Emergency Departments and unhelpful psychiatric admissions – and to explore the optimal configuration of MHDU as part of the mental health crisis care pathway.

    An interrupted time series design in four mental health NHS Trusts, complemented with a synthetic control study using national data sets, will establish the effectiveness of MHDU while a cohort study will explore the impact of visiting a MHDU on individual crisis care pathways. In depth qualitative research, developed and undertaken by researchers with lived experience of mental distress and using mental health services, will explore people’s experiences of crisis, staying on a MHDU and the impact of visiting the unit on future support for crisis, as well as the expectations and experiences of staff working on MHDU and on the crisis referral pathway.

    Data from all studies will be used to inform the economic evaluation, modelling the cost benefits of different configurations of MHDU in the crisis pathway.

    Learn more about the DECISION project

    Experience based investigation and co-design of approaches to prevent and reduce Mental Health Act use (CO-PACT)

    City Lead: Professor Rose McCabe (Co-I)

    Team: Roisin Mooney (Queen Mary University of London, CI) and Kam Bhui (University of Oxford, CI)

    Funder: National institute for Health Research £703,887

    Duration: February 2021 to January 2023

    Summary: The Mental Health Act allows professionals to admit people to hospital against their will. People from black and minority ethnic communities are more likely to get care this way. This can be distressing, reduces trust, and is costly.

    We will work with mental health services in London, Manchester, Leeds, Birmingham, Bradford, Oxford and Derby. In each city, we will recruit 20 service users who have experienced at least one compulsory admission to hospital in the previous year. We will use a creative process involving photography to capture their experiences. The first meeting will explain the approach. We will ask people to take photos about their experiences of compulsory admission.

    In two more meetings, we will ask people to add titles, captions, or descriptions to tell their stories. We want to know what may prevent compulsory care. The captions can be written, or audio or video recordings. Twenty mental health staff from across the seven cities will do the same. In each city, we will share this information with five service users, five carers and five staff members. Staff can be psychiatrists, psychologists, social workers, nurses, police, lawyers, commissioners, and policy experts. This group will meet three times and design a new approach, to reduce the number of people receiving compulsory care.

    A fourth meeting will bring everyone together to consider their experience when they tried to apply the approach, specifically what works, for whom and how. We will ask everyone how they found working on the project using a questionnaire. They will be able to write freely. This will help us understand what helped and if anything changed for them. Using information about changes in care or practice, we will estimate costs and benefits.

    Find out more here: NIHR project page: Experience based investigation and co-design of approaches to prevent and reduce Mental Health Act use (CO-PACT)

    One-to-one peer support for family members and friends of patients treated under the Mental Health Act (OPAL).

    City Lead: Professor Rose McCabe (Co-I)

    Team: Domenico Giacco (University of Warwick, CI).

    Funder: National Institute for Health Research, £734,346.00

    Duration: January 2021 to December 2023

    Summary: The research aims to establish a new approach to support family and friends of patients treated under the Mental Health Act (MHA). Previous research has showed that most carers feel isolated and unsupported. They need help to overcome feelings of frustration and guilt and to restore relationships with their loved ones and services. Peer support among patients has proved to be popular and effective in mental health services with limited costs.

    In this project we will explore how one-to-one carer peer support can be best provided to carers of people treated under the MHA in England. We will organise workshops and one-to-one interviews with carers, service users and clinicians to generate ideas on how one-to-one carer peer support can be delivered in England. We will then develop the training programme using a train the trainer model and test it in two stages. Experiences, costs, engagement of carers and carer peer supporters, quality of life of carers and any adverse events will be assessed. We will host workshops with key stakeholders: carers, users, professionals, academics, policy makers, and charities, to explore: a) how carer peer support can be organised and funded in England; b) how to test benefits and/or undesirable effects on a larger scale.

    Find out more here: NIHR project page: One-to-one peer support for family members and friends of patients treated under the Mental Health Act (OPAL)

    Self-harm and suicide in males

    City Lead: Oliver Matias (PhD student)

    Team: Kirsten Barnicot and Rose McCabe (Supervisors)

    Funder: National Institute for Health Research

    Duration: October 2020 to September 2023

    Summary: Men who self-harm have previously been found to be almost three times more likely to die by suicide than women who self-harm, and men who have previously attempted suicide have been found to be more than 5 times more likely to die by suicide than women who have previously attempted suicide. One of the main reasons known for this discrepancy in suicide rates is that men use more lethal methods of suicide than women. Another reason may be that ‘traditional masculinity’ prevents men from expressing their emotions or seeking help.

    British women are more positively-orientated towards talking about their emotions than British men; and British men are less comfortable talking to a therapist or counsellor than British women. It has been suggested that psychological therapies may not be appropriate for men due to our inherently feminised mental health services. A recent Cochrane review of psychosocial interventions for self-harm in adults found that [some] interventions tended to benefit females more than males. However, the authors were only able to perform subgroup analyses by sex for 5/48 potential studies. The first part of the PhD will be to assess the effects of psychosocial interventions for self-harm compared to comparison types of treatment in males versus females.

    Trauma-informed care in the emergency department for patients who self-harm

    City Lead: Aneta Zarska (PhD student)

    Team: Kirsten Barnicot, Mary Lavelle and Rose McCabe (supervisors)

    Funder: City University of London

    Summary: Emergency Departments are often the first point of contact with the healthcare system following a self-harm episode or a suicide attempt. However, patients presenting with mental health issues often describe that the ED environment can trigger fears and traumatic memories (re-traumatization), and that ED staff approach them in ways that exacerbate the stress they are already experiencing.

    A trauma-informed approach (TIC) to care for patients at suicide/self-harm risk appears very relevant due to the strong associations between trauma exposure and suicidality/self-harm. However, the infusion of TIC across EDs in the UK has not yet been explored/established, and there has been a lack of attention to the potential benefits of TIC for patients who self-harm. The PhD project aims to fill in this gap with four interlinked projects.

    Firstly, a systematic review will evaluate

    1. training interventions for generalist ED providers
    2. psychosocial interventions delivered by ED generalists when treating patients presenting with self-harm and suicidality
    3. the extent to which the interventions’ components align with those of TIC.

    Secondly, qualitative interviews with UK emergency department staff will examine ED providers’ understanding of the link between trauma and self-harm/suicidality, and their experiences and perspectives regarding TIC, with a specific focus on patients presenting with self-harm.

    Thirdly, qualitative interviews with people presenting to the emergency department will explore their experiences of self-harm and treatment in the ED, with a specific focus on the traumatic nature of these experiences. Finally, we will reach consensus on the principles of trauma-informed care in the ED for patients who present with self-harm by inviting key stakeholders, comprising of both ED staff and service users, to reflect on and reach agreement on this issue using a Delphi approach.

    Intersection of mental and physical health

    A mixed-methods study to assess self-management and develop a Position Statement on patient education and support services for patients with adrenal insufficiency

    City Lead: Sofia Llahana (CI)

    Alfred Potter Research Award by Addison’s Disease Self-help Group, £10,000.

    Duration: March 2021 to February 2022.

    Team: Christine Yeadinak, Oregon, USA; Kathleen Mulligan, Mark Haddad, City, University of London; Stephanie Baldeweg, UCH.

    Development and randomised feasibility trial of a theory-based digital behaviour change intervention to support self-management for people with Adrenal Insufficiency (Support-AI)

    City Lead: Sofia Llahana (CI)

    Team: Ashley Grossman , Christine Norton, Kathleen Mulligan, Shashi Hirani, Stanton Newman, Stephanie Baldeweg,

    Funder: NIHR HEE/ICA Post-doctoral Clinical Lectureship, £543,913

    Duration:  Sept 2021 to August 2024.

    Development of an Intervention to Support Mental and Physical Health Professionals to Manage Type II Diabetes Mellitus Care in People with Severe Mental Illness

    City Lead: Tracey Dorey (PhD)

    Team: Kathleen Mulligan (City), Mark Haddad (City), Alan Simpson, Hayley McBain

    Funder: East London NHS Foundation Trust, £95,320

    Duration: October 2018 to October 2021

    Summary: The project aims to develop a theoretically informed and evidence-based intervention to support mental and physical health professionals manage Type II diabetes mellitus in people with a severe mental illness. This is a mixed-methods study across three work packages (WP).

    WP1 informs selection of candidate intervention components. WP2 consists of three smaller projects (WP2.1a: Innovation Tournament, WP 2.1b: Challenge Committee, WP 2.2: e-Delphi) within which participants assess the candidate intervention components across a range of criteria and provide innovative ideas for delivery.

    The ideas are refined by the challenge committee and the resulting intervention package(s) are assessed for acceptability through an eDelphi consensus event. WP3 consists of semi-structured interviews whereby participants are asked to provide their experience and expertise to support development of a contextualised programme theory of how the intervention is expected to work, for whom and in what circumstances.

    Past Research