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MHPRU-1 Projects

Click on the below to find out more about our ongoing and completed projects
Autism and Mental Health Care

[Complete]

project summary

Autistic people (both children and adults) experience high rates of mental health problems, but autism is often reported being missed in mainstream mental health services, and mental health care is rarely tailored to their needs and often reported to be unsuitable. To inform policy in this area, we conducted a pair of co-produced systematic reviews of literature on strategies that have been developed to improve access, experiences of care and mental health outcomes for autistic adults, and children and young people. Within the scope of our reviews were bespoke strategies for autistic people with mental health problems, adaptations of standard interventions and services, and strategies to improve identification of autism in mental health services. The questions we investigated were:

  1. What strategies have been developed to improve mental health treatment and services for autistic people, and what is the acceptability and feasibility of these strategies?
  2. How effective are strategies that have been developed to improve mental health care for autistic people?

The protocol for our review is available here. A working group including MHPRU researchers, researchers with relevant lived experience, policy makers and experts in this field have worked together on this review. Partners include NHS England’s National Autism Team and the charity Autistica.

Dissemination
    Crisis and Acute Care Projects 

    [Project status: Ongoing]

    project summary

    Three MHPRU projects have been focusing on informing policy on acute and crisis care:

    1. Beyond Places of Safety (BPOS)  Evaluation. In January 2017, the Department of Health launched a £15 million project entitled ‘Beyond Places of Safety’, providing infrastructure support for innovative services for people experiencing a mental health crisis. During the pandemic, a delay in evaluating this work was agreed as many projects were not progressing as planned, but MHPRU has now collected data from managers of 18 innovative services set up through the scheme. We investigated their role within local crisis care systems, and what has helped or hindered their implementation – the results are now in pre-print. A further paper in preparation is examining the crisis café model in more depth.
    2. National Acute Care Systems Study:  In a linked project, we have aimed to survey crisis care models currently implemented in England and to explore what features of catchment area crisis care systems are associated with rates of hospital admissions. In our first paper from this study, we described crisis care systems in catchment areas nationwide, focusing on the emergency of innovative but as yet largely unevaluated models such as crisis cafes and triage teams.  In a second paper, now in pre-print, we have investigated what characteristics of local crisis care systems and what models are associated with variations in admissions and compulsory admissions.
    3. Mapping of alternatives to inpatient care: For our third inpatient care project, MHPRU researchers are working with NHS-E policy makers, lived experience researchers and national experts on a mapping of alternatives to inpatient care. This includes alternatives to acute inpatient care for both adults and children and young people, as well as alternatives or approaches to reducing length of stay in forensic or long-stay wards. First outputs are expected by May 2023.
    publications
    Community Sentencing Treatment Requirements

    [Project status - Completed]

    project summary 

    Community Sentencing Treatment Requirements, including Mental Health Treatment Requirements, are available as part of community or reduced prison sentences in England and Wales since 2003; although, they are not commonly used despite the high prevalence of mental health issues among offenders. The Department of Health, in collaboration with the Ministry of Justice carried out a pilot project in Birmingham, Milton Keynes, Northampton, Plymouth and Sefton. A protocol for using Community Sentencing Treatment Requirements was disseminated to a local steering group which was encouraged to use the protocol to develop local pathways and procedures to facilitate the use of Community Service Treatment Requirements. The NIHR Mental Health Policy Research Unit were tasked to carry out a qualitative service evaluation exploring the perspectives of professional stakeholders regarding the implementation of a new community sentencing protocol across the five pilot sites in England.

    The MHPRU found most interviewees optimistic about the implementation of the new community sentencing protocol with one theme highlighting the benefits of the protocol such as addressing gaps in service provisions, facilitating access to other services and increasing options in community sentencing. Despite this, another theme highlighting the challenges implementing the protocol were noted such as sustainability of funding and service users’ needs and motivation and multi-agency working. The study highlights the value of the new protocol and the importance of facilitating Mental Health Treatment Requirements as increased accessibility of Mental Health Treatment Requirements can provide better sentencing options, improve access to mental health services and address an important previous gap in services. Although, there were key challenges highlighted with implantation of the protocol and the need for a well-functioning pathway for those with more severe mental health issues.

    Publications
    Complex Emotional Needs Project

    [Project status – In dissemination]

    We have carried out a substantial programme of research on the needs of people with “complex emotional needs”, who may have received a “personality disorder” diagnosis. This research was initiated to inform policy commitments in the 2018 NHS Long Term Plan.

    We adopted the term “complex emotional needs” because of concerns regarding the stigma associated with “personality disorder” diagnosis, and the imprecision of such diagnoses. This followed discussions at an initial workshop, and with experts by experience and profession. We have continued to use it, as increasingly NHS services do, as a way of referring to the broad group of service users who may have received a “personality disorder diagnosis” when using mental health services, or have comparable needs. However, we do not see this as definitively the best choice of terminology, and would very much welcome more work on best ways of assessing and describing needs in this area.

    We worked with a group of academic experts, clinicians, and lived experience researchers on this programme, publishing a group of reviews and qualitative studies, as listed below. Some key findings include:

    • Service users and clinicians concur on the need for services that prioritise therapeutic relationships, continuity of care, kindness and compassion, and a holistic focus on social and clinical needs. As well as continuity of care, stigmatising views and pessimistic views among health professionals, especially in primary and generic secondary services, are often an impediment to good quality care.
    • Therapeutic pessimism is hard to justify, as many participants in studies of “personality disorder” treatments improve substantially with any specialist treatment, or even with none, often to the extent that they no longer meet “personality disorder” criteria. 
    • The evidence base on effective and cost-effective services is mainly limited to specialist psychotherapies: most of these are similarly effective, with a lack of evidence on which work better for whom. Research lags behind other areas of mental health care, with a lack of evidence in areas including treatments for people with comorbidities, or younger and older people, trauma-focused and trauma-informed approaches, support for parents, socially-focused and co-produced interventions, and service design.

    This overview presentation gives a summary of the CEN programme.

    The Centre for Mental Health summarised our work and drew out conclusions for policy and service delivery in their report 'Dismissed because of my Diagnosis'

    Engagement and events: 
    Publications
    COVID-19 and Telemental Health Projects

    [Project status - Complete]

    Project summary 

    At the onset of the COVID-19 pandemic in 2020, the MHPRU revised it work programme so as to be able to initiate a large programme of responsive work aimed at examining the impact of the COVID-19 pandemic on mental health care and people living with mental health conditions. We began by conducting a group of rapid projects during the early stages of the pandemic, including:

    1. A rapid review of literature of all types on the current and potential impacts of COVID-19 on mental health services and the people who use and work in them, and on what worked and did not worked in mitigating these impacts. This was conducted in the first three months of the pandemic and published in preprint in July 2020, making it one of the earlier sources of evidence on this topic.
    2. A report on an online survey of mental health staff from all sectors and professions in the UK about the impact of COVID-19 on services and the success or otherwise of innovations and adaptations to manage these impacts.
    3. A qualitative study conducted jointly with the UKRI Loneliness and Social Isolation in Mental Health Group to understand impacts of the pandemic and any potential strategies to mitigate negative impacts, from the perspective of people with lived experience of mental health problems. An initial series of interviews was followed by a further follow-up interview after around 6 months.
    4. Systematic review on the COVID-19 and the epidemiology of mental health problems. Following a request from policy makers, we have been are reviewing published literature on the impact of the COVID-19 pandemic on mental health in Europe.The focus is on three questions:
      1) What changes have there been to the incidence or prevalence of mental health conditions?
      2) What changes have there been to mental health symptoms, social functioning and quality of life among people already living with mental health conditions? and,
      3) What changes have there been to mental health service use?
      We are considering both changes at the onset of the pandemic, and as it continued, though most published research is from the first year (2020). This work has now been presented to policy makers and has been accepted for publication by Lancet Psychiatry. 

    The priority area identified by policy makers for further rapid work was telemental health: we therefore initiated a further programme of work to understand the impact of shifting to video and phone calls for mental health care delivery, both in the pandemic and in more usual circumstances. Major outputs included:

    1. An umbrella review summarising the pre-pandemic literature on the effectiveness of telemental health and on implementation outcomes.
    2. A systematic review of literature on telemental health in the first year of the pandemic, synthesising evidence on delivery, uptake, experiences and outcomes following the global shift towards remote mental health care in the COVID-19 global emergency.
    3. A systematic review of the implementation of telemental health (both before and during the pandemic), investigating evidence on the impact of planned strategies to optimise uptake and delivery of telemental health.
    4. An economic review of the evidence (both before and during the pandemic) on the costs and cost-effectiveness of telemental health
    5. A qualitative study on service user experiences of telemental health during the early phase of the pandemic
    6. A rapid realist review, drawing together our previous programmes of work, other published literature and stakeholder views (including both service users and clinicians) to develop theory on what works for whom in which contexts in telemental health.
    Summaries of this work:

    On COVID-19 Impact on mental health care:

    • A video of a public event with MQ on the Covid-19 systematic review
    • A blog reporting on our dissemination event in December 2020 on the impact of COVID on mental heath care with links to the slides from the event
    • Brief overview slide set 

    Centre for Mental Health Briefing on Mental Health Services and COVID-19: This briefing contained a summary for policy makers of our early work on the COVID-19 pandemic’s impact on mental health care

    Mental Elf blogs summarising this work:

    Immediate impacts and future focus:

    • Video of a public event with Mental Elf to disseminate this programme of work
    • Podcast on the experience of co-production in our qualitative work on the impact of COVID-19, made for the Institute of Mental Health conference at UCL
    • Epidemiological review of Covid-19 associations with mental health: We have summarised our findings in these slides. A paper is under review. 

    On telemental health:

    • Our summary slides on our telemental health programme of work
    • Connected: Centre for Mental Health’s summary report based on our work on telemental health
    • This Mental Elf blog by Pip Clery summarises the main publications of our telemental health programme
    • Our infographic summarising top tips on telemental health for clinicians

    MHPRU Podcasts on telemental health:

    Cost of Loneliness

    [Ongoing]

    Project Summary 

    Loneliness is a distressing and common experience. The negative physical and mental health problems associated with loneliness include depression, anxiety, and general mortality. Despite such health implications, little research has been conducted to establish the relationship between use of healthcare services and loneliness. Specifically, few studies have examined the economic impact of loneliness and the cost-effectiveness of strategies to help manage the problem.

    In this project, we will examine the economic cost of loneliness. We will do this primarily with a systematic review. This will include literature on the economic consequence of loneliness and the cost-effectiveness of approaches to address loneliness. We will also carry out scoping of existing datasets in England, to establish those that include potentially useful information on loneliness and economic consequences for future research. Finally, we will integrate our findings to develop a conceptual model of the economic consequences of loneliness.

    publications
    • Study protocol outlining what will be done in this review
    Early Intervention in Psychosis 

    [Project Status: Ongoing]

    Project Summary

    This project has aimed to investigate inequalities in the implementation of psychological interventions in Early Intervention in Psychosis (EIP) services. The data from three years of the National Clinical Audit of Psychosis (NCAP) spotlight reports have been utilised to analyse the differences in receipt to Cognitive Behavioural Therapy for Psychosis (CBTp) and family intervention across a range of ethnic groups. The data has will also been analysed according to Early Intervention in Psychosis (EIP) teams and trusts. The study has had two main objectives:
    i) to examine the association between ethnicity and receipt of CBTp and family intervention; and
    ii) to investigate the role of individual-level factors, i.e. age, gender, and employment, in the association between ethnicity and receipt of CBTp.

    publications

    The EIP project has been extended to include the investigation of other NICE mandated interventions, including physical health screening and the receipt of the antipsychotic clozapine. 

    Evaluation of Every Mind Matters

    [Project status – Reporting Stage]

    Project summary

    Every Mind Matters (EMM) is a public health campaign and website which were launched by Public Health England in October 2019 to provide the public with information about common mental health problems. It includes a wellbeing action planning tool, ‘Your Mind Plan’. Sections about the Coronavirus and for Young People were subsequently added to the EMM website: https://www.nhs.uk/every-mind-matters/

    The MHPRU led an independent, mixed-methods evaluation of EMM with four components:

    1. Measurement: Development of three new measures of mental health literacy (recognition, action, vigilance) suitable for the content of EMM and use in general population samples.
    2. Change in outcomes over time and their relationship to EMM awareness or use: Quantitative analysis of data from repeated bespoke surveys of nationally representative samples before and since the launch of EMM using the above measures of mental health literacy and others.
    3. Economic evaluation: Analysis of the Health Survey for England 2019 dataset to assess whether awareness of EMM moderates the relationships between wellbeing and help-seeking, and wellbeing and the costs of primary care use; and modelling using the repeated bespoke surveys to examine the cost-effectiveness of the campaign.
    4. Experiences of the EMM campaign and web resources: Qualitative interviews to explore individuals’ views of the campaign, use of the web resources, any barriers participants encountered or suggestions for improvement of EMM. We followed advice from the MHPRU Lived Experience Working Group to purposively include a sub-sample of participants with severe or long-term mental health problems who were aware of the campaign but may or may not have used the website.
    engagement and events
    publications
    Peer Support Project

    [Project status: In progress]

    Project summary

    The therapeutic value of working from the perspective of lived experience of mental distress, of using services and of supporting friends and family is increasingly being recognised within mental health services around the world.  An increase in the prominence of peer support roles has long been called for by people with personal experience of mental health conditions and others supporting recovery-focused mental health service provision.  There is now a national drive to expand the peer support workforce across England.  Roles are rapidly diversifying within both statutory and third sector services and an increasing range of interventions are being offered.  However, little is known about experiences of peer supporters themselves, how they are integrated into the workforce and what forms of peer support may be most valued by people using services.  The aim of this linked group of projects is to develop an understanding of the roles of peer support workers in mental health services across England and what the national picture of peer support work looks like.  In order to do this, we are conducting a group of projects. Two are already in progress:

    1. We conducted an umbrella review (systematic review of systematic reviews) of scientific literature on mental health peer support. Our aim was to provide a broad overview of the current state of evidence relevant to mental health peer support across sectors and conditions, and to identify significant evidence gaps.  The protocol for this review is here, and a link to the full review is available below under our dissemination.
    2. We are carrying out a qualitative study, with our Lived Experience Working Group members centrally involved in planning, data collection and analysis and writing up, to investigate peer support workers' experiences across the UK mental health care sector. We are trying to understand how they experience their roles, the support they get, the way they fit into teams and the improvements they think might be helpful. Interviews have been completed and findings should be available by the end of July 2024.

    We are also considering following on from this conducting a rapid realist review of what works for whom in telemental health, and a national survey of peer support workers in mental health.

    DISSEMINATION
    Screen Time and Young People’s Mental Health

    [Project status – Ongoing]

    Project Summary

    To develop meaningful evidence-based policy guidelines, a crucial first step is to ensure the right research questions are being asked. This project aimed to identify the most important and unanswered research questions about screen use and adolescent mental health from the perspective of young people, their parents and educators. Findings from this research will help shape future research and policy guidelines that will benefit young people in the future.

    The study design was informed by the James Lind Alliance Priority Setting Partnership approach. There were three main steps to achieve the study aim:

    1. A consultation survey and interviews with experts in the field of screen use and adolescent mental health.
    2. Participatory discussion groups with young people (11-25 years old), parents and teachers.
    3. A list of research questions developed based on the latter two inquiries. This list was circulated in a public consultation survey for young people, parents and teachers to identify their top 10 research priorities on screen use and adolescent mental health.

    This project was conducted in collaboration with McPin Foundation and the Centre for Mental Health. Research was guided by a steering group comprising researchers, third sector partners, clinicians, parents/carers and young people. A Young People's Advisory Group contributed at each stage.

    Consensus was reached for the prioritization of four topics for future research: (i) the impact of exposure to adult content on young people's mental health and relationships; (ii) the relationship between screen use and the well-being of young people from vulnerable groups; (iii) the impact of screen use on brain development; and (iv) the relationship between screen use and sleep.

    Additionally, young participants prioritized questions about online bullying, advertisements targeting young people, and the relationship between social media and specific mental health conditions. Research topics of interest arising specifically during the pandemic included the effects on adolescent mental health of exposure to constant news updates and online racial bias, and how young people take part in activism online.

    PPI: Members of the MH PRU Lived Experience Working Group (LEWG) and Lived Experience Advisory Network (LEAN) are members of the project working group.

    Screen time Infographic 2
    Engagement and Events
    • Blog: When it comes to youth mental health, let’s focus on screen-use not screen-time by The Mental Elf
    • Blog: This blog summarises the involvement of the McPin charity in this study.
    • Blog: This report from our partners Centre for Mental Health provides a great summary of findings of this study. It also includes an excellent video from one of the peer researchers involved.
    • QUAHRC Methods Podcast: This podcast focuses on the co-production, with members of our team with different perspectives exploring the co-production process.
    • Blog: This further McPin report discusses reasons for young people to get involved in mental health research
    Publications 
    Social Needs Project

    [Project status: Ongoing]

    Project summary 

    In this project, we aimed to provide an overview of evidence-based and promising models of support to help improve the social circumstances of people living with a mental health condition across eight life domains. The areas of life we looked at were: money and debt; housing; work and education; social isolation; family and caring roles; crime victimisation; offending; rights, inclusion and citizenship.

    Reports from this projects have been provided to policy makers to feed into into cross-governmental initiatives to implement the NHS Long Term Plan and other policy initatives.

    The work includes:

    1. A systematic review of evidence from systematic reviews and trials regarding effective models of support to improve the social circumstances of people living with a mental health condition – completed in 2021 and now published. This showed that the areas in which there is strongest evidence are employment and housing, with many evidence gaps elsewhere.
    2. A report to DHSC summarising evidence of the impacts of changes in social security policy on claimants’ mental health and wellbeing – completed in July 2022.
    3. A scoping review and expert consultation aimed at identifying promising models of support to improve the social circumstances of people with serious mental health conditions that have not been evaluated in randomised controlled trial. We have identified potentially useful models across a range of domains, and submitted a report to inform cross-governmental policy. We have also drawn on this work for a paper reporting on a typology of models of social intervention, now available in preprint.
    engagement and events:
    Publications
    • A review of evidence from literature reviews and trials about effective social interventions for people with mental health conditions.
    • A report for DHSC providing a narrative summary of how the welfare benefits system impacts claimants’ mental health and wellbeing.
    • An overview of models of support and broad approaches to improving the social circumstances of people with serious mental health conditions - preprint.
    The Mental Health Act Review 

    [Project Status - Completed]

    PROJECT SUMMARY

    In 2017, the United Kingdom government announced an Independent Review of the Mental Health Act for England and Wales.  The aim was to understand the rapid rise in detentions, particularly among people from Black, Asian and Minority Ethnic (BAME) groups, to clarify the interface between the Mental Health Act and the Mental Capacity Act (2005), and to review recent developments in human rights. The Mental Health Act Review working group commissioned nine pieces of research which were conducted  by the Mental Health Policy Research Unit in 2017/18. MHPRU Deputy Director, Dr. Brynmor Lloyd-Evans, was a member of the MHA Review working group which helped the Review Chair and Vice Chairs agree and draft the Review’s recommendations.

    ENGAGEMENT AND EVENTS 
    Publications
    Trauma Informed Care

    [Project status: Ongoing]

    Project Summary 

    This research programme aims to explore and map the use of trauma informed care approaches in inpatient, acute and crisis mental health care settings. The principles of trauma informed care (as outlined by Sweeney and Taggart, 2018) include: i) foregrounding the understanding of the prevalence and impact of trauma, ii) seeking to actively reduce traumatic practices in mental health services, iii) and creating a therapeutic environment where communication, collaborative working and empathy for service users is prioritised. These principles are crucial in mental health care settings where levels of trauma are higher than among the general population.

    The primary research project is a scoping review, led by academic, clinical and lived experience researchers. It will firstly explore and map current trauma informed care service provision in our settings of interest. Subsequently, we aim to investigate the experiences and views of both service users and staff relating to their engagement with trauma informed care, the way trauma informed care influences interpersonal relationships in our settings of interest, and how trauma informed care impacts on the way individual services and broader organisations operate.

    Protocol is available here. 

    publications