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.

Our Research

Organisational Resilience in Healthcare

Funder: Patient Safety and Translational Research Centre, Imperial College London. £10,000

Duration: 31-10-2019 to 31-10-2020

City Lead: Dr Mary Lavelle

Team members: Professor Janet Anderson; Professor Ara Darzi, Imperial College London; Natalie Sanford, King’s College London.

Brief Project summary: The safe and effective management and treatment of patients relies on multiple healthcare professionals, from a variety of healthcare disciplines, working collaboratively together to share knowledge and information and coordinate tasks. Frequently failures of care are a result of poor team communication and gaps between professional groups. Organisational resilience is the ability of a system to adapt safely to pressures or changes within it. Resilience Engineering looks for ways to improve a systems’ ability to successfully adapt under varying conditions. Systems with resilient performance are able to flexibly: respond, monitor, learn and anticipate.

Employing ethnographic observation of healthcare teams, the aim of this study is to examine organisational resilience in hospital settings. Specifically, this project will identify the sources of pressure or stress in the workplace; understand how teams adapt to such pressures and identify areas where organisational resilience could be improved.

Investigating the feasibility of using body worn cameras to identify effective de-escalation practice in mental health settings

Funder: City, Pump Priming Funding £9,851.00

Duration: Feb 2020 - Oct 2020

City Lead: Dr Mary Lavelle

Team members: Professor Rose McCabe; Professor Janet Anderson.

Brief Project summary: Body worn cameras, similar to those used by the Police, have recently been introduced in selected NHS Trusts to record staff management of patient aggression in acute mental health inpatient wards. National and international guidelines suggest that healthcare staff should calm aggressive patients using verbal and nonverbal communication, also known as ‘de-escalation’. However, de-escalation is not evidence based and fails in approximately one third of cases, resulting in staff using physical restraint, seclusion (isolation in a locked room) and/or forced medication. These methods contribute to psychological and/or physical harm of patients and staff. Our team have developed observational frameworks to analyse communication and teamwork in mental health settings. Application of these frameworks to footage of de-escalation incidents from body worn cameras in acute inpatient mental health settings provides a unique opportunity to identify the staff behaviours that lead to effective de-escalation. However, analysis of body worn camera footage is challenging. The person wearing the camera is not visible in the footage therefore triangulation and synchronisation of multiple videos is required. Furthermore, the addition of multiple people may obscure views and make it difficult to annotate sound. This study will examine the feasibility of using video footage collected through body worn cameras to identify the behavioural patterns that lead to effective de-escalation.

Dialogical Reasoning in Patients with Schizophrenia (DRiPS)

Funder: Riksbankens jubileumsfond

Duration: 2017-2020

City Lead: Dr Mary Lavelle

Project Team: Dr. Ellen Breitholtz; Dr. Christine Howes; Professor Robin Cooper, Department of Philosophy, Linguistics and Theory of Science at the University of Gothenburg.

Brief project summary: One of the most debilitating features of schizophrenia is patients’ difficulty interacting with others. An important part of successful interaction is the ability to reason – not only about the relation between the discourse and the world, but also about the reasoning of other dialogue participants. This project aims to investigate and model how people reason in natural language dialogue, using the notion of enthymemes and how this reasoning ability is different in patients with schizophrenia. We hypothesise that the social cognition impairments seen in patients with schizophrenia are underpinned by difficulties associated with the resources used in reasoning as it occurs in everyday interaction. Through analysis of a unique corpus of patients’ triadic interactions we have the opportunity to explore reasoning in patients’ face-to-face dialogues to investigate this theory. Furthermore, we will identify and analyse verbal and nonverbal markers of social impairments during reasoning, using state of the art methods from computational linguistics and gesture research.

Specifically, this project will address the following questions:

1. In terms of natural language reasoning, how do patients with schizophrenia differ from their healthy interlocutors (patients’ partners) and how do both of these groups differ from participants in dialogues without a patient (controls)?

(a) How do the participants reason – are there differences between the groups in terms of the arguments they use and how they express them?

(b) Are there differences between the groups during reasoning sequences in terms of verbal dialogue behaviour (e.g. the use of repair, specific words and expressions)?

(c) Does the use of head and hand gesture during reasoning sequences differ between patients, patients’ partners and controls?

2. How do these factors interact and can we give a precise account of any differences?

ASsuRED: Improving outcomes in patients who self-harm – Adapting and evaluating a brief pSychological inteRvention in Emergency Departments

NIHR Programme Grants for Applied Research, £2.7 million

Duration: May 2019 – April 2024

City Lead: Professor Rose McCabe

Project team members: Dr Sally O’Keeffe; Dr Jenna Hunter; Mimi Suzuki

Co-aps:

Dr Peter Aitken, Devon Partnership NHS Trust

Professor Vera Araujo Soares, Newcastle University

Professor Richard Byng, Plymouth University

Professor Chris Dickens, University of Exeter

Professor Sandra Eldridge, Queen Mary University of London

Dr Domenico Giacco, University of Warwick

Professor Navneet Kapur, University of Manchester

Dr Will Lee, University of Exeter

Professor Borislava Mihaylova, Queen Mary University of London

Professor Stefan Priebe, Queen Mary University of London

Dr Peter Riou, Royal Devon and Exeter NHS Foundation Trust

Dr Mary Ryan, PPI representative

Professor Alan Simpson, Kings College London

Dr Helen Smith, Devon Partnership NHS Trust

Brief project summary: 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 know that the conversation between the individual and the mental health professional they see is critically important. Although there are many examples of good care, current practice across the NHS varies widely with no research evidence to support best practice. 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.

Learn more about the ASsuRED project

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

Funder: MRC/ESRC/AHRC MR/T04618X/1; £94,267.71

Duration: April 2020 – Mar 2021

City Lead: Professor Rose McCabe

Team: M Broome; M Larkin; L Bortolotti; R Temple

Learn more about the Agency, Social Identity & Justice in Mental Health project

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

Funder: NIHR HS&DR, £444,533.95

Duration: May 2019 – June 2021

City Lead: Professor Rose McCabe

Team: S Priebe, Queen Mary University of London

PACT-Dementia-Patient Aligned Care Team

Funder: NIHR RP-PG-0217-20004; £2,477,93

City Lead: Profesor Rose McCabe

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

Funder: Hospiscare, £47,940

City Lead: Professor Rose McCabe

The BOOST trial: Boosting Baby Behaviour and Bonding in Parents with Enduring Difficulties in Managing Emotions and Relationships

Duration: 01-06-2017 to 31-01-2021

Project lead at City: Dr Kirsten Barnicot (CI)

Funder and award value: NIHR Research for Patient Benefit, £238,399.00

Project team members:

Professor Mike Crawford, Imperial College London (Co-I); Dr Jane Iles, University of Surrey (Co-I); Jennie Parker, Independent (Co-I); Professor Paul Ramchandani, University of Cambridge (Co-I); Ola Ajala, Camden & Islington NHS Foundation Trust (Collaborator); Dr Maddalena Miele, Central & North West London NHS Foundation Trust (Collaborator); Dr Tara Lawn, East London NHS Foundation Trust (Collaborator); Dr Sushma Sundaresh, Oxleas NHS Foundation Trust (Collaborator)

· Brief project summary: 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.

Risk Assessment and Increasing Safety in Dementia (RAISe-Dementia) study

Duration of project: February 2019 – January 2022

Funder and award value: Dunhill Medical Trust - £242,282

City Project Lead: Dr Juanita Hoe

Project team members: Professor Gill Livingston (UCL); Professor Gianluca Baio (UCL); Dr Sergi Costafreda (UCL); Helen Souris (NHS England and NHS Improvement); Emily Van de Pol (Camden & Islington Mental Health NHS Trust); Frank Arroja (Alzheimer’s Society Research Network)

Brief project summary: The RAISe-Dementia study aims to examine the risk assessment tool for people with dementia, which is currently being used in Camden and Islington NHS Foundation Trust by the Islington Dementia Navigator Risk. The Islington Dementia Navigator Risk Assessment Tool is used to generate a plan for people with dementia and stratifies the level of risk to inform frequency and method of follow-up. We intend to evaluate its validity, the feasibility of the risk management plans derived from it, their acceptability and outline costs. We will examine

1. Validity - How well the tool identifies risks (compared to gold standard semi-structured clinical assessments)

2. Feasibility - Whether the plan derived after using the tool is implemented over the subsequent 6 months.

3. Acceptability - What people with dementia, family carers and workers think of the process and how it can be improved?

We aim to provide a validated, valuable tool for use by professional and support staff working with people with dementia throughout the UK. If shown to be effective in practice, it would promote positive risk enablement, offering a tailored approach to the management of risk and support person-centred care in people with dementia living at home. This is consistent with best practice and is relatively inexpensive and translatable to wider clinical settings.

NIDUS (New interventions for Independence in Dementia) study

Project duration: March 2018 - February 2023

Project lead at City: Dr Juanita Hoe

Funder and award value: Alzheimer’s Society - £1,981,505

Project team members: Professor Claudia Cooper (UCL); Professor Jill Manthorpe (KCL); Dr Kate Walters (UCL); Dr Iain Lang (University of Exeter); Dr Penny Rapaport (UCL); Dr Julie Barber (UCL); Professor Kenneth Rockwood (Dalhousie University, Canada); Professor Laurie Butler (Anglia Ruskin University); Dr Vasiliki Orgeta (UCL); Professor Robert Howard (UCL); Miss Rachael Hunter (UCL); Dr Anne Laybourne (UCL); Professor Murna Downs (University of Bradford); Dr Kathryn Lord (University of Bradford); Professor Gill Livingston (UCL)

Brief project summary: This Alzheimer’s Society funded Centre of Excellence will develop and test evidence-based training and support programmes to help family (NIDUS-family) and paid home carers (NIDUS-professional) to provide high quality care to people living with dementia. These programmes have been co-developed with family carers, people living with dementia, home carers and health professionals to ensure the needs of people living with and affected by dementia are incorporated.

Learn more about the NIDUS project

Achieving Quality and Effectiveness in Dementia care Using Crisis Teams (AQUEDUCT) study

Project duration: September 2015 - September 2020

Project Lead at City: Dr Juanita Hoe

Funder and award value: NIHR - £1,998,595.00

AQUEDUCT aims to discover what practice is currently provided by teams that manage crisis in people with dementia, and what best practice may look like. The study will develop a resource kit for dementia crisis trials and perform a randomised controlled trial to investigate if the resource kit has better outcomes in terms of hospital admissions, quality of life and costs.

Project team members: Professor Martin Orrell (University of Nottingham), Professor David Challis (University of Nottingham), Professor Tom Dening (University of Nottingham), Professor Fiona Poland (University of East Anglia), Professor Esme Moniz-Cook (University of Hull), Dr Brynmor Lloyd Evans (UCL), Professor Susan Michie (UCL), Professor Stephen Morris (UCL), Mr David Prothero (PPI representative)

Learn more about the AQUEDUCT project

Developing strategies to support reaching and coordination for individuals living with Alzheimer's disease

Project duration: January 2019 - December 2020

Project member at City: Dr Juanita Hoe

Funder and award value: Alzheimer's Society Junior Fellowship - £199,977

The project intends to translate biomedical methodology and findings from visual and motor neuroscience fields in supporting the independence of individuals with posterior cortical atrophy (PCA) and typical Alzheimer’s Disease experiencing diminished reaching. The project aims are primarily to identify the optimal conditions for reliable reaching and coordination based on the following: presentation and positioning of both external objects and body parts, and effects of multisensory cues.

Project Team: Dr Keir Youg (Project Lead UCL), Professor Sebastian Crutch (UCL), Professor Brian Day (UCL).

SCAMPI: Self-Care Advice, Monitoring, Plannong and Intervention

Project duration: March 2017 - May 2020

Project Lead at City: Dr Juanita Hoe

Funder and award value: ESRC - £980,000.

The SCAMPI project will develop a new form of digitalised toolkit that will allow someone living in their own home with a chronic condition, together with their relatives, carers and healthcare professionals, to self-manage both their care of the condition and life with it, sometimes in novel and creative ways.

Project Team:

Professor Neil Maiden (City, University of London), Professor Feng Li (City, University of London), Professor Paul Burstow (University of Birmingham), Dr Shashi Hirani (City, University of London), Dr Simone Strumpf (City, University of London), Dr Dympna O’Sullivan (University Dublin)

Learn more about the SCAMPI project

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

Project duration: October 2019 - October 2021

Funder and award value: East London NHS Foundation Trust - £95,320

The project aims is 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.

Project Team

Tracey Dorey (City Project Lead)

Dr Mark Haddad

Dr Kathleen Mulligan

Dr Hayley McBain (external partner)

Professor Alan Simpson (external partner)

Rethinking Strategies for Positive Newborn Screening Results Delivery (ReSPoND)

Project duration: October 2017 - September 2020

Funder and award value: NIHR HS&DR - £444,521.40

Project Lead at City: Dr Jane Chudleigh

Annually, circa 10,000 parents of babies born in the United Kingdom (UK) are given a positive newborn screening (NBS+) result 2-8 weeks after birth. Despite guidance, NBS+ results are inconsistently delivered across UK-regions and many parents are dissatisfied with how NBS+ results are communicated. Expansion of UK NBS to include nine conditions means added pressure for a cost effective approach to communication of NBS+ results. As most infants will be asymptomatic when parents receive the NBS+ result, it is vital that communication is done carefully to avoid potential negative effects on future concordance with treatment and relationships with health professionals. Concordance and trust are important to ensure timely uptake of confirmatory diagnostic testing and instigation of necessary treatment to maximise outcomes for the child. Poor communication can affect parent-child bonding and ongoing parental and social relationships. As such, family systems theory will be the theoretical basis for this work. Study aim: To co-design, implement and evaluate interventions to improve delivery of NBS+ results to parents. Primary research question: Can parents and staff co-design interventions to improve delivery of NBS+ results to parents that can be successfully implemented into routine practice in a cost effective manner? Secondary research questions: - How are NBS+ results currently delivered to parents for the condition specific groups (CSGs) and what are the perceived benefits? - What are the current experiences of staff delivering, and parents receiving, NBS+ results for the CSGs? - What aspects of the new, co-designed interventions and local approaches to implementation are important in terms of improving the delivery of NBS+ results? - What are the costs associated with the delivery of the new, co-designed interventions and subsequent use of healthcare services and how does this compare with the costs associated with current strategies? - Which outcomes will be important to include in a subsequent evaluation study of the new, co-designed interventions from a stakeholder perspective? Study design: A mixed-methods study underpinned by family systems theory using four phases with defined outputs: Phase 0: Establish project management arrangements and secure ethics and HRA approvals. Phase 1: A national survey using telephone interviews with all NBS-laboratories in England and representatives of clinical teams to explore current approaches for communication of NBS+ results and inform selection of two study sites for phases 2-3. Outputs: (i) description and cost of current communication practices (ii) selection of two study sites for Phases 2-3. Phase 2: Experience-based Co-design will be used in the selected study sites to develop interventions for communicating NBS+ results to parents. Output: Interventions for the four CSGs. Phase 3: A parallel process evaluation, underpinned by Normalisation Process Theory and economic analysis of the interventions in the two selected case study sites. Outputs: (i) process evaluation and economic analysis of the interventions in routine practice (ii) information about suitable outcome measures for a future study. Phase 4: Determine final interventions and design of a future evaluation study Outputs: (i) Design of a future evaluation study (ii) list of suitable outcome measures and relevant resource use and cost Dissemination Everyone directly involved in the study will be sent a summary of research findings. Study findings will be disseminated on the blog, national NBS websites. Additionally, findings will be shared via the website of relevant charities and support groups associated with these conditions (CF Trust, Sickle Cell Society, British Thyroid Foundation, National Society for Phenylketonuria, CLIMB). Finally, results will be disseminated by the usual academic routes at relevant national and international conferences and published in relevant international peer reviewed journals (including the NIHR HS&DR journal).

Project Team:

Dr Ellinor Olander

Dr Fiona Ulph (external partner)

Dr Louise Moody (external partner)

Dr Mandy Bryon (external partner)

Professor Alan Simpson (external partner)

Professor James Bonham (external partner)

Professor Kevin Southern (external partner)

Professor Stephen Morris (external partner)

Learn more about the ReSPoND project

Grants

2019 - 2024 Professor Rose McCabe. ASsuRED: Improving outcomes in patients who self-hard - Adapting and evaluating a brief pSychological inteRvention in Emergency Departments. NIHR The Secretary of State for Health £2,662,192.00

2019 Dr Mary Lavelle. Investigating the feasibility of using body worn cameras to identify effective de-escalation practice in mental health settings. City, Pump Priming Funding £9,851.00

2019 Dr Mary Lavelle. Evaluation Support for General Practice Nursing Programme. Health Education England £5,000.00

2018 - 2023 Professor Rose McCabe. Dementia - Person Aligned Care Team. NIHR The Secretary of State for Health £57,754.00

2017 - 2022 Professor Rose McCabe. SCENE: Improving quality of life and health outcomes of patients with psychosis through a new structured intervention for expanding social networks. NIHR The Secretary of State for Health £39,212.00

2018 - 2022 Professor Rose McCabe. TACKling chronic depression - adapting and testing a technology supported patient-centred and solution intervention (DIALOG+) for people with chronic depression. NIHR The Secretary of State for Health £29,833.00

2019-2022 Dr Juanita Hoe. Risk assessment and increasing safety in dementia-RAISE dementia study. DMT The Dunhill Medical Trust £242,282.00

2016-2021 Dr Juanita Hoe. Achieving quality and effectiveness in dementia using crisis team (AQUEDUCT). NIHR The Secretary of the State for Health £7,703.00

2018-2020 Professor Alan Simpson. Development of a feasible, acceptable and evidence-based training package to reduce restrictive practices through enhancing the use and effectiveness of de-escalation techniques in adult acute and forensic mental health units. NIHR The Secretary of the State for Health £7252.00

2016-2020 Professor Alan Simpson. Enhanced discharge from inpatient to community mental health care (ENRICH): a programme of applied research to develop, pilot and evaluate a peer support intervention to enhance discharge. NIHR The Secretary of the State for Health £195,389.00

2013-2019 Dr Mark Haddad. ENGAGER 2: Developing and evaluating a collaborative care intervention for prisoners, with common mental health problems, near to and after release. NIHR The Secretary of the State for Health £14,250.00.

Past Research

  • Safewards
  • COCAPP: Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study.
  • COCAPP-A: Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings.