Tag: National Institute for Health Research

CAMH crisis animations

Over the last few years I’ve been a part of a team led by my Cardiff colleague, Dr Nicola Evans, synthesising the evidence in the area of mental health crisis responses for children and young people. Here is a link to the project, which has been funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery (HSDR) Research Programme.

Now, with the project having concluded, an animation with English and Welsh language versions has been produced. Here they are:

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Crisis responses

In recent months I’ve been part of a team, led by Nicola Evans, bringing together the evidence in the area of responses for children and young people in mental health crisis. Our working definition of a ‘crisis response’ has been the provision of a service in response to extreme psychosocial distress, which for children and young people may be provided in any location such as an emergency department, primary care, a specialist or non-specialist community service, a school, a college, a university, a youth group, or via a crisis support line. Our objectives have been:

  • To critically appraise, synthesise and present the best available evidence on the organisation of crisis services for children and young people aged 5 to 25 years, across education, health, social care and the third sector.
  • To determine the effectiveness of current models of mental health crisis support for children and young people.
  • To explore the experiences and perceptions of young people, families and staff with regards to mental health crisis support for children and young people aged 5 to 25 years.
  • To determine the goals of crisis intervention

As a project team we’ve been informed by a stakeholder advisory group, and have cast a wide net by searching not only for research but also other relevant evidence including guidance, case studies and more. Methodologically, therefore, this review bears comparison with others I’ve previously written about on this site including the RiSC study and MENLOC. More on this crisis care evidence synthesis to follow in due course.

Getting started in research

Currently I’m serving a term as Director of Postgraduate Research in the School of Healthcare Sciences, which means I have responsibilities for our PhD and our Doctorate in Advanced Healthcare Practice (DAHP) programmes. For aspirant researchers a doctoral degree is a necessary qualification, with the PhD culminating in the production of a thesis of some 80,000 words whilst the DAHP in Cardiff combines taught modules and a shorter thesis of no more than 50,000 words. In the School we have numbers of students in the thesis stage of their DAHP degrees, but this particular programme no longer recruits new entrants. The PhD, though, continues to attract people from the UK and around the world and information on it can be found here.

October is the first opportunity in each academic year for postgraduate student enrolment, and compared to the numbers of people commencing their undergraduate and taught postgraduate studies our newly starting students are small in number. This is to be expected, but this also takes me to the general observation that the health professions need many more people to get involved in research and knowledge creation.

Information on developing research careers in the mental health field can be found at the NIHR Incubator for Mental Health Research website. There is lots of value here, including advice on first steps, on sources of funding, and on finding support and mentorship. There are case studies, too, of people from a range of backgrounds and at different stages of their research careers (including people studying for doctorates), and a whole section aimed at nurses.

Meanwhile, the Royal College of Nursing has launched the Annie Altschul Collection, an online repository of doctoral degrees completed by mental health nurses. The repository is searchable, and is also themed, with hyperlinks to the full text of each included thesis where these are available.

The MENLOC study (again)

In July 2020, with colleagues I received peer review feedback on our draft MENLOC study final report, about which I’ve written before.

Final reports from studies funded by the National Institute for Health Research are sizeable affairs, typically running to 40,000 words or so and detailing the minutiae of what’s been done, and what’s been found. Once peer and editorial review has been satisfied draft reports progress to pre-publication, involving the careful copyediting of the text. Finally, once everything is typeset each report appears in a single issue of the open access journal bearing the name of the funding programme through which the research award was originally made. The screenshot I’ve included in this post is from the NIHR’s comprehensive information for authors, which takes grantholders through the process.

In the case of MENLOC the journal in which our final report will be published is Health Services and Delivery Research, and we’re expecting publication to be sometime in the spring of 2021. In the meantime, this current version of our plain English summary captures what we’ve done and what we’ve found:

We brought together evidence from research, policies, guidance and case studies in the area of end of life care for people with severe mental illness. End of life care refers to the help given to people with life-threatening conditions in their expected last 12 months. Severe mental illness refers to a range of issues for which care is usually provided by specialist mental health services.

An advisory group, including people with experience of mental health and end of life care, helped us throughout our project. We searched research databases, journals and online sources. We assessed research articles for their quality, and summarised their content. In one review we combined content from research with content from policy and guidance. In another review we combined the content of the case studies. We wrote synthesis statements summarising the research evidence, and assessed how confident decision-makers should be in these.

We included 104 documents overall. We synthesised research, policy and guidance under themes reflecting their content: the structure of mental health and end of life care services; professional practice; providing and receiving care; and living with severe mental illness. We synthesised case studies under themes relating to: delays in diagnosis; making decisions; treatment futility; supporting people; and the experience of care.

Our project has implications for care. Partnerships should be built between mental health and end of life care staff, and people should be supported to die where they choose. Care staff need education, support and supervision. A team approach is needed, including support for advocacy. Physical health care for people with severe mental illness needs improving so that life-threatening conditions can be recognised sooner.

Future research should involve people with severe mental illness at the end of life and their carers. Research is also needed evaluating new ways of providing and organising care.

MENLOC is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 17/100/15).

The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care

In addition to responding to these detailed reviewers’ and editors’ comments, as our MENLOC report continues on its way we’ll also be preparing papers for publication, and thinking about next steps in this programme of research. We’ve discovered that very little is known about how best to provide care at the end of life to people with severe mental health problems, making this a wide-open area for researchers and people concerned with service improvements.

Catch-up post 3: research under lockdown

One of the consequences of NHS resources being mobilised so decisively towards meeting the threat of the novel coronavirus has been the cessation of much face-to-face nursing and health services research other than that connected with COVID-19. A response in March 2020 from the NIHR included the instruction to delay the setting-up of new non-COVID projects, and to pause ongoing studies, in order that the infrastructure supporting NHS research be brought to bear almost exclusively on efforts to tackle the pandemic.

In this context, I have also observed how the online survey has become the method of choice for researchers wanting to immediately understand the effects of the COVID crisis on wellbeing and work. In April 2020, a team led by Chris Bundy from the School of Healthcare Sciences in Cardiff University launched a coping during coronavirus survey, whilst a team including Healthcare Sciences’ Danny Kelly invited nurses to take part in the first of three planned surveys reporting experiences during the crisis. The Mental Health Policy Research Unit, meanwhile, has opened its programme of COVID-related research with a survey for people working in mental health services.

WCEBCMeanwhile, one type of research relatively unaffected by the coronavirus outbreak is the evidence synthesis. In Cardiff we have the Wales Centre for Evidence Based Care and, in the early months of 2020, I joined a team led by Nicola Evans and Wales Centre colleagues to start work on a synthesis of the evidence in the areas of service organisation, effectiveness and experiences for children and young people in mental health crisis. Our plans include database searching plus online searching for grey literature, policies and guidance. More to follow as the project unfolds, which in April saw us deep in title and abstract screening.

Catch-up post 1: End of life care for people with severe mental illness

menloc logo 5In the first of a short series of catch-up blogposts on this site, this non-pandemic related one refers back to February 2020 and the submission of the draft final report for the MENLOC study.

MENLOC has been an evidence synthesis into end of life care for people with severe mental illness,  funded by the National Institute for Health Research Health Services and Delivery Research Programme. I’ve introduced the project on this site before, and the bulk of our work is now done. At some future point we’ll receive peer review comments back on the (very large) document we’ve submitted, and once our responses have been written, returned and accepted the report will progress towards publication in the National Institute for Health Research Journals Library. Next up will be shorter publications in journals, about which I can post more as we progress.

Introducing the MENLOC study

menloc logo 5A big part of my work this year is this recently funded evidence synthesis in the area of end of life care for people with severe mental illness. This is a cross-university study, supported by the National Institute for Health Research (NIHR) Health Services and Delivery (HS&DR) Research Programme, which also features service user researchers and a stakeholder advisory group populated by people with experience in both the mental health and end of life care fields.

Here, from our protocol, is a summary of what we’re up to:

The aim of this project is to synthesise relevant research and other appropriate evidence relating to the organisation, provision and receipt of end of life care for people with severe mental illness (including schizophrenia, bipolar disorder and other psychoses, major depression and personality disorder) who have an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure and who are likely to die within the next 12 months.

Outputs from the project will be tailored to stakeholders, and clear implications will be drawn for the future commissioning, organisation, management and provision of clinical care. Recommendations will be made for future data-generating studies designed to inform service and practice improvements, guidance and policy.

In this context, summary objectives are to:

  1. locate, appraise and synthesise relevant research;
  2. locate and synthesise policy, guidance, case reports and other grey and non-research literature;
  3. produce outputs with clear implications for service commissioning, organisation and provision;
  4. make recommendations for future research designed to inform service improvements, guidance and policy.

This review will be conducted according to the guidance developed by the Centre for Reviews and Dissemination (CRD) and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Reflecting Evidence for Policy and Practice Information (EPPI) Centre principles, opportunities will also be embedded into the project to maximise stakeholder engagement for the purposes of both shaping its focus and maximising its reach and impact.

Searches will be developed initially using Medical Subject Headings (MeSH) and text words across health, social care and psychology databases from their inception. In consultation with a stakeholder advisory group, supplementary methods will be developed to identify additional material including policies, reports, expert opinion pieces and case studies. All English language items relating to the provision and receipt of end of life care for people with severe mental illness and an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure will be included. All included citations will be assessed for quality using tools developed by the Critical Appraisal Skills Programme (CASP), or alternatives as necessary if suitable CASP tools are not available. Data will be extracted into tables, and subjected to meta-analyses where possible or thematic synthesis with help from NVivo. Strength of synthesised findings will be reported where possible using GRADE and CerQual.

Information derived from the processes described above will be drawn on in an accessibly written summary. Uniquely, this synthesis will comprehensively bring together evidence on factors facilitating and hindering high-quality end of life care for people with severe mental illness, who have an additional diagnosis of advanced, incurable, cancer and/or end-stage lung, heart, renal or liver failure, and evidence relating to services, processes, interventions, views and experiences. Implications will be stated for the improvement of relevant NHS and third sector care and recommendations will be made for future research.

menlocRight now, having convened a first advisory group meeting, we’re busy searching and sifting for evidence mostly through reviewing citations identified in a series of comprehensive database searches. I’ll be posting more here as the study progresses, but for the detail a good place to go is here for the published protocol.

Risk for children and young people in mental health hospital

Over the last year or two I’ve used this blog to publicise information about the RiSC study, an evidence synthesis into ‘risk’ for young people in mental health hospital. We’ve now produced an accessible summary, outlining what we did in this project and what we found. For a copy, click the front cover of the summary reproduced below:

Mental Health Nurse Academics UK meets in Nottingham

I was unable to make Thursday evening’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement event hosted by Patrick Callaghan at Nottingham University. My congratulations to Ian Norman and to Marion Janner, this year’s very worthy award winners. As it happens, Ian was one of my PhD examiners. My following of Thursday’s proceedings from afar, via Twitter, tells me I missed a treat.

I was, however, able to make the trip to Nottingham for Friday’s summer term meeting of Mental Health Nurse Academics UK (MHNAUK). This was held in the new, and rather impressive, Institute of Mental Health building:

Here’s a picture I took of the sculpture, titled House for a Gordian Knot, displayed at the entrance to the Institute’s main building:

We had three local presentations. First up was  Paul Crawford, who gave a broad overview of the Creative Practice as Mutual Recovery research programme which he leads, followed by Andrew Grundy giving an account of qualitative findings from the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. EQUIP is an important, NIHR-funded, programme of work which (along with COCAPP and COCAPP-A) is producing evidence of how care planning is being done and how it might be improved. Here’s a photo, taken and shared by Karen Wright, of one of Andrew’s final slides outlining steps to successful user involvement in this process:

Tim Carter talked us through his freshly-minted mixed methods PhD, in which he investigated the use of a preferred-intensity exercise programme for young people with depression. I thought this to be a very well-designed study, which generated considerable discussion around the active ingredients of the intervention and plans for a future follow-up.

Elsewhere Lawrie Elliott, editor of the Journal of Psychiatric and Mental Health Nursing, was welcomed by the group to give an update on developments at the journal in his first year at the helm. I really liked what I heard, and said as much in our discussion. Quality of papers, and relevance to mental health nursing, are being prioritised. Word limits have been increased to allow for more in-depth analysis in accepted articles. To extend its reach the journal now has a Twitter account, which can be followed by clicking the following link:

Ben Thomas from the Department of Health opened a discussion on the future of the Student Mental Health Nursing Conference, the inaugural event having taken place at the O2 Arena in London in February this year. As I understand it, much of the organising was done by staff and students at Greenwich University: well done, them. A group of MHNAUK members representing different universities has agreed to collaborate to keep this initiative going, and with a view to turning it into a cross-UK, rather than an England-only, opportunity.

Following David Sallah’s meeting with MHNAUK in York in March 2015, Joy Duxbury and Steven Pryjmachuk chaired a discussion on the current status of the Shape of Caring review. Since returning from Nottingham I have found that Health Education England is planning to sound out opinion through a series of events running into the autumn. Details are to follow.

Thanks particularly to John Baker, in the weeks leading up to this latest meeting MHNAUK published a response strongly criticising the announcement that the National Institute for Health and Care Excellence (NICE) was ending its work in the area of safe staffing. This decision, defended two days ago by Jane Cummings (Chief Nursing Officer at NHS England), has also been challenged by others including Sir Robert Francis and now the Council of Deans of Health. The Safe Staffing Alliance campaigns in this area, and MHNAUK will continue to make a contribution via a further response the outline of which was agreed in Nottingham. As a reminder of some of the key evidence supporting the importance of registered, graduate, nurses for quality and safety follow this link to an earlier post on this site and this link to a recording of Linda Aiken delivering the Winifred Raphael Memorial Lecture at the University of South Wales on October 1st 2014. And, for those interested in how #safestaffing is shaping up differently across the countries of the UK, follow this link for a record of the progress of the Safe Nurse Staffing Levels (Wales) Bill through the National Assembly for Wales. Following this link brings you to a report reviewing the evidence, commissioned by the Welsh Government and produced by a team led by Aled Jones in the Cardiff School of Healthcare Sciences.

Fiona Nolan shared progress on her survey of mental health nursing research interests and expertise in UK higher education institutions. And, finally, on behalf of the organising and scientific committee Russell Ashmore, Laoise Renwick and I took the chance to update MHNAUK members on progress for the 21st International Network for Psychiatric Nursing Research conference.

#NPNR2015 takes place at the Manchester Conference Centre on Thursday 17th and Friday 18th September 2015. We think the programme is shaping up perfectly, with keynote speakers including England’s National Clinical Director for Mental Health Dr Geraldine Strathdee, Prof Shôn Lewis from the University of Manchester, Mark Brown who ran One in Four magazine and is now involved with The New Mental Health, and André Tomlin who runs The Mental Elf service. We have symposia, workshops and concurrent sessions with papers accepted from presenters around the world, a walking poster tour and the opportunity for fringe events. Make your booking now!

Health and Care Research Wales

Last week I had the opportunity to join colleagues at the Millennium Stadium for the launch of Health and Care Research Wales. This is the new name for what was, until very recently, the National Institute for Social Care and Health Research (NISCHR).

I’ve written before about the reorganisation of the research infrastructure here in Wales (see here and here), and Thursday’s event was an important unveiling of the outcome of recent deliberations. For a shortcut, here’s the public information video:

And, for a single-page diagram of how everything is fitting together, follow this link. As this shows, one of the things Health and Care Research Wales has done is to (re)commission a number of Centres and Units, an example of the former being the National Centre for Mental Health (NCMH).

By the looks of things, funding streams are to remain much as they were under NISCHR, with opportunities for PhD, post-doctoral and project awards to follow. Researchers in Wales can continue applying for support to many (but not all) of the National Institute for Health Research (NIHR) programmes. This is vital, because it is through this mechanism that funding is available for studies into health services and delivery (amongst other things). This is an area of research in which Wales has no dedicated funding stream of its own, and in which the new Centres and Units may be interested to varying degrees. 

Finally, a word on a Welsh Government centrepiece, HealthWise Wales. This is aiming to prospectively, and electronically, recruit many thousands of people into future health and social care research.