Early intervention service in Birmingham to offer mental health services for young people
Clinical evidence suggests that half of all lifetime mental health illnesses begin by the age of 14 and three quarters by age 25 (excluding dementia). This is reflected by increased referral rates to Child and Adolescent Mental Health Services (CAMHS) in recent years. However, research by the Youth Mental Health Theme (2) of NIHR CLAHRC West Midlands revealed that many young people with first-episode psychosis face long and damaging treatment delays in their care pathways. As a result of this research, CAMHS in Birmingham will now be offered for young people aged 0-25. The new service will be provided by Forward Thinking Birmingham, a partnership led by Birmingham Children’s Hospital. The evaluation will be led by NIHR CLAHRC West Midlands own Theme 2 at the Universities of Warwick and Birmingham. This will assess its mobilisation and impact including those outcome indicators in the NHS Outcomes Framework. Find out more on the CLAHRC website.

First mental and physical health festival to take place in Manchester
Led by the NIHR CLAHRC Greater Manchester, THINKphysical: Manchester Mental Health Festival is the first festival of its kind that aims to raise awareness of the importance of improving the physical health of people with severe and enduring mental illness. People with this illness have a reduced life expectancy of up to 25 years compared to the general population. The week-long series of free events from 14-19 June will bring together service users, carers, the general public and academic, healthcare and charity organisations. An exciting variety of events will be taking place, including free health checks, creative writing sessions, and a biking demonstration by British Cycling, a rounders tournament, public lectures and even specially commissioned theatre productions. Throughout the week people will be able to get information on the side effects of antipsychotic medication, sign up to a register of people interested in taking part in research, and contribute to the development of a new questionnaire designed to measure satisfaction with physical healthcare. Find out more.
 
Accelerating Delivery of Psychological Therapies after Stroke: Psychological support for people with stroke
NIHR CLAHRC North West Coast’s  research project, Accelerating Delivery of Psychological Therapies after Stroke (ADOPTS) aims to improve the availability, accessibility and quality of psychological care that people receive following a stroke. Psychological problems, such as depression, are common after stroke and can have negative effects on stroke survivors and their carers. Although general psychological services exist (for example, Improving Access to Psychological Therapies services - IAPT), there is a lack of psychological support available for stroke survivors. Some IAPT services provide psychological support for stroke survivors, but it can be rare. This may be because of the range of difficulties that stroke survivors might have, for example, problems with communication, which make it more challenging for IAPT services to provide effective support. The research project aims to see if services that already exist for general psychological support (IAPT services) can be used and adapted to be useful for stroke survivors. We will develop an Implementation Package (pathways and training) that healthcare staff can use to ensure that stroke survivors receive suitable psychological support. For more information on the project, please visit the NIHR CLAHRC North West Coast website or contact Theme Leader, Professor Caroline Watkins - CLWatkins@uclan.ac.uk.

Mindfulness-based therapy could offer an alternative to antidepressants for preventing depression relapse
Researchers from Plymouth University Peninsula Schools of Medicine and Dentistry, supported by NIHR CLAHRC South West Peninsula (PenCLAHRC), were part of a team led by the University of Oxford, who carried out new research that suggests mindfulness-based cognitive therapy (MBCT) could provide an alternative non-drug treatment for people who do not wish to continue long-term antidepressant treatment. The results come from the first ever large study to compare MBCT – structured training for the mind and body which aims to change the way people think and feel about their experiences – with maintenance antidepressant medication for reducing the risk of relapse in depression.  The results were published in The Lancet in April. To find out more visit NIHR PenCLAHRC’s website.
 
Helping people who have experienced psychosis to stop smoking
South London and Maudsley NHS Foundation Trust (SLaM) is the second mental health trust in England to implement a smoke-free policy in line with National Institute for Health and Excellence guidance (NICE)  and the NIHR CLAHRC South London research team has helped the organisation to do this. They have helped to develop a Smoke-free Policy; they are supporting the introduction of systems whereby patients and service users can easily be referred for specialist help; they have helped prepare a new 'tobacco dependence treatment' pathway to support a smoke-free SLaM; and they have developed training to help mental health professionals help service users manage their tobacco dependence or stop smoking. Now NIHR CLAHRC South London researchers are sharing their experiences to help other NHS organisations go smoke-free: two members of the team – Debbie Robson and Mary Yates – feature in resources created by Public Health England to help professionals and managers implement NICE guidance. The videos are available via the Public Health England website. Visit the NIHR CLAHRC South London website to find out more.
 
FoxWeb at NIHR CLAHRC Oxford
Under its ‘Early intervention and service redesign’ theme, NIHR CLAHRC Oxford is supporting ‘FoxWeb’ a project assessing risk of violence in forensic psychiatric patients. The study involves piloting a web based tool – FoxWeb – developed to collect routine information on risk factors for violence from forensic psychiatric inpatients in Oxford Health. Data on violence risk factors will be collected on a regular basis at forensic inpatient units and correlated with any critical/serious incidents – such as interpersonal violence, damage to property, absconding, and self-harm – involving the patient. This will then be used to understand the risk factors for inpatient incidents in these patients. This is hoped to lead to the development of a reliable, feasible, accurate and scalable way of assessing and monitoring the risk of violence in these patients. This could allow carers to take the appropriate means to intervene before an incident occurs, not only potentially improving the health of the monitored patient, but other patients and staff who could be victims of any violence. Additional benefits may be the form of cost-savings to the NHS, achieved through reductions in clinical time and possible reductions in critical incidents in inpatient units.
 
Transition from Child & Adolescent Mental Health Services (CAMHS):
Young people in three NHS Trusts co-produce a Preparation Programme
Approximately half of all lifetime mental disorders emerge during adolescence; 75 per cent before the age of 25. Yet UK mental health services require young people to transition from child- to adult-centred services at 17-18 years, a period of complex physical, emotional and social change, and outcomes are often poor. NIHR CLAHRC East of England researchers are adopting a participatory, creative workshop approach with CAMHS users and recent leavers in three NHS Trusts. Participants will explore the factors they consider most important for transition preparation and bring them together in a Transition Preparation Programme, adaptable for use in CAMH Services throughout the UK. The active workshop approach encourages strong collaboration, creative thinking and offers participants the time and space to reflect on sensitive topics in a safe, supportive but enjoyable environment. Researchers have used similar techniques successfully in previous film projects with young people in care. Young people will co-host clinician working lunch sessions to gain clinical perspectives and there will be opportunities to learn some basic research skills. A programme produced by and for young people, tailored to their needs should allow young people to transition when they are most likely to cope and flourish in the adult world.  For more information contact Valerie Dunn - vjd20@cam.ac.uk.
 
NIHR CLAHRC Oxford and ECHO working to improve diagnosis rates of dementia in care homes
The ‘Enhanced Care Home Outcomes’ (ECHO) project aims to support the integration of physical and mental health care in care homes in Oxfordshire. One of its many objectives is to improve the diagnosis of dementia among care home residents. An integrated team of physical and mental health staff were brought together to in-reach to care homes by reorganising existing services, with the aim of improving patient experience and dementia diagnosis rates in this most vulnerable group of people. In October 2014 training, which combines two evidence based approaches, was delivered by a clinical psychologist to the new integrated team. This new model of practice has been implemented and staff provided training in the relevance of the research processes in this health care setting and the rationale for evaluating this novel implementation of the research evidence. Together with our partners Oxfordshire CCG, Oxford Health NHS Foundation Trust and Oxfordshire County Council, the NIHR CLAHRC Oxford is supporting the evaluation of this innovative service, and has contributed to establishing baseline information of dementia care practice across the Oxfordshire. To find out more please visit the NIHR CLAHRC Oxford website.

Improving the management and care of psychosis patients in the West
Members of the NIHR CLAHRC West team are working on a number of psychosis related projects, including looking at how people who have recovered from psychosis can be managed in primary care. They are also working towards setting up a Psychosis Health Integration Team (HIT) with Bristol Health Partners, which aims to improve outcomes and reduce unmet need in psychosis. They are exploring ways to identify patients with frequent readmissions and relapses, and how duration of untreated psychosis affects a patient’s outcomes. Primary care data is being used to develop a risk assessment tool to help GPs identify patients who are developing a psychotic illness. To find out more about these projects visit NIHR CLAHRC West’s website.
 
NIHR CLAHRC Oxford shows lower costs and improved outcomes for young people with Psychosis
Psychosis is a common and disabling disorder estimated to cost the UK economy £11.8 billion per year. Randomised Controlled Trials (RCT’s) of ‘Early Intervention in Psychosis’ (EIP) services for those aged 16-35 have shown that specialist community treatment teams can reduce inpatient bed use, improve clinical outcomes, and reduce costs. Yet, despite this evidence, many EIP services have either been lost, or strayed from the basis of the original model. In a collaborative project with Jansen Healthcare, led by Professor Belinda Lennox, the NIHR CLAHRC Oxford examined whether using EIP services in NHS practice, outside of an RCT setting, would also result in improved outcomes and cost-savings. The work showed clear evidence for savings of £5,200 per patient in EIP per year. These patients also had significantly fewer mental health bed days, reduced attendances at A&E, and improved occupational outcomes. Working with the Oxford Academic Health Science Network (AHSN) Early Intervention in Mental Health Network, NIHR CLAHRC Oxford fed this evidence back to clinicians, service managers, commissioners and Trusts, leading to plans for improving EIP services (including reinstatement in one Trust that had dismantled them) and paving the way for the AHSN to install this innovative mental health service for young people with psychosis more widely. To find out more visit the NIHR CLAHRC Oxford website.
 
Responding to the Winterbourne View scandal: community teams for adults with learning disabilities and additional mental health and/or behavioural needs
The Winterbourne View Hospital scandal in 2011 highlighted the problems experienced by community learning disability (LD) teams in supporting men and women with additional mental health and/or behavioural needs to remain in their local areas.  A multi-disciplinary NIHR CLAHRC East of England study, informed by the insights of a service user research advisory group, is carrying out a prospective, longitudinal, mixed-methods study examining the way in which five integrated (NHS and local authority) specialist locality-based community teams in one county-wide LD service work with adults referred for a mental health and/or behavioural need (such as dementia, self-injury, or physical aggression). Data collection includes: service user clinical and quality of life outcomes; stakeholders’ perceptions of their locality team; and collaborative work by each locality-based community team to understand service users’ difficulties and implement interventions. Local engagement events have taken place to present the emerging findings to inform the development of the community teams, while, nationally, the research team is contributing to strategies to enhance community LD teams so they are better able to service users with complex needs locally.  For more information contact Dr Isabel Clare - ichc2@medschl.cam.ac.uk.
 
Improving care for self-harm patients
NIHR CLAHRC West is working with the Bristol Health Partners Improving Care in Self-Harm Health Integration Team (STITCH HIT) to improve the experience of patients who have self-harmed, with the long term aim of reducing suicides in the city. STITCH have used patient experience design techniques, working closely with local self-harm groups, to assess existing services, develop new approaches and embed service change to improve the experience for this group of patients. For example, at University Hospitals Bristol NHS Foundation Trust psychiatric liaison services have been extended to cover the most common times these patients are likely to present at A&E. NIHR CLAHRC West is undertaking an economic assessment of this service change. STITCH will also work with NIHR CLAHRC West on research on engaging patients meaningfully in self-harm research, focussed on patient-centred outcomes for self-harm care and increasing patient involvement in research. Find out more about STITCH’s work.
  
Treatment resistant depression – the Delphi Project
Between 10 to 20 per cent of those treated for depression report ongoing poor outcomes. The Delphi Project came about as a result of a consensus meeting to prioritise mental health projects at NIHR PenCLAHRC. The project is assessing expert opinion and consensus on the use and appropriateness of the term ‘treatment resistant depression’ (TRD) in relation to antidepressant medication (ADM). The project is also addressing the need for research to investigate consensus on how ADMs have failed in some instances and whether psychosocial and/or qualitative factors should be taken into account. To date research has focused on how to help people whose depression has not been altered by ADM. To find out more visit NIHR PenCLAHRC’s website.
 
Defining the key features of community based mental health support for children and young people
NIHR CLAHRC East of England is carrying out a Delphi study to identify, measure, and develop consensus on the key features of community based mental health service provision for children and young people in the East of England. This study is particularly timely given the focus on the quality and configuration of children’s mental health services in the United Kingdom. Since the project began in January, the team have recruited 115 professionals from diverse sectors (health, education, social care, public health and justice) and 24 parents and 29 children and young people to participate in the three round study. Round 1 data collection was completed in April 2015 - questionnaires, focus groups and semi structured interviews were used to gather the opinions of participants as to what good service provision should look like in the region. Themes identified from these data will be used to develop a questionnaire for use in the subsequent consensus building rounds of the study.  A working group of commissioners and senior policy makers is being assembled to ensure that the evidence is reflected in future policy and commissioning priorities
 
Improving physical healthcare for people with serious mental illness 
People with serious mental illness, such as schizophrenia and bipolar disorder, have a significantly reduced life expectancy and a higher prevalence of physical health disorders than the general population. Central North West London NHS Foundation Trust (CNWL) has been working with NIHR CLAHRC Northwest London on a Health Foundation funded project to use quality improvement methods to develop and implement a tool to ensure all patients admitted to hospital have their physical healthcare needs met. The tool includes the assessment of physical health parameters to generate a Joint British Societies 3 (JBS3) Score, which estimates an individual’s lifetime risk of developing cardiovascular disease and provides a basis for discussing with patients how their risk can be reduced. This is being used alongside a patient centred physical healthcare plan that has been co-produced with service users. The Project Team will be presenting two posters on their work at the NIHR CLAHRC Greater Manchester’s THINKphysical: Manchester Mental Health Festival on 15 June 2015. To find out more visit NIHR CLAHRC North West London’s website  or contact Liz Evans, Mental and Physical Wellbeing Theme Lead - liz.evans@imperial.ac.uk.
 
AQUA-Trial (Assessing QbTest Utility in ADHD): Study Update
The AQUA-Trial aims to assess whether providing clinicians and patients with the results of an objective test of activity and attention (QbTest) leads to earlier correct diagnosis of attention deficit hyperactivity disorder (ADHD). NIHR CLAHRC East Midlands are currently working across eight different NHS Trusts (none sites) within England and have already reached their minimum target. They have an established ‘Network of Practice’ that meets approximately every three tofour months and includes local commissioners, clinicians, service users and researchers. For more information visit NIHR CLAHRC East Midlands’ website.
 
Collaborative Care:  The extended trial of a Mood Disorder Service
NIHR CLAHRC East Midlands Mental Health Theme is supporting the extension of the first RCT in which standard secondary care is compared with a specialist mood disorder service (SMDS) comprising a psychiatrist and psychotherapist collaborating to provide complementary, algorithm based, pharmacotherapy and psychotherapy for patients with chronic depressive disorder. The Mood Disorder Study started in 2009 within NIHR CLAHRC Nottingham, Derbyshire and Lincolnshire and successfully recruited to target, gaining additional sites in Cambridge and North Nottinghamshire. Retention rates have remained high and initial cost analyses suggest that by extending the follow up from two to three years a clearer and more pragmatic picture of the trajectory of the illness and its associated costs might be found. The follow up period will end in September 2015 and analysis of the preliminary dataset is underway. In addition to quantitative outcome measures, qualitative analysis of treatment uptake as well as the drivers and barriers to implementation of the service are also being explored. Initial reports from the SMDS are extremely positive and two of the study sites now have a permanent service in place. A further site has made significant improvements to its talking therapy service as a result of the study such that it is accessible to a greater number of patients. For more information contact Dr Cath Kaylor -Hughes
clahrc-moodproject@nottingham.ac.uk.
 
GP/community-based care for those with schizophrenia and bipolar disorder
NIHR PenCLAHRC experts are part of a national team which aims to help primary care and community based mental health services work more closely together, by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder. Called PARTNERS2, the project addresses the view of service users that too much emphasis is placed on medication and not enough on other, life-based issues. To find out more visit NIHR PenCLAHRCs website.

Managing mental-physical multimorbidity: Is collaborative care the answer?
The NIHR CLAHRC Greater Manchester team is delighted to have had the results of their research published in the BMJ: “Integrated Primary Care for Patients with Mental and Physical Multimorbidity: Results of a Cluster Randomised Controlled Trial of Collaborative Care for Patients with Depression Comorbid with Diabetes or Cardiovascular Disease”. Dr Peter Coventry, Senior Research Fellow and lead author of the paper, has written a blog to support and promote the work. His blog looks at the background to the trial and the rise of mental-physical multimorbidity. Find out more on the NHR CLAHRC Greater Manchester’s website.
 
DIAMONDS Programme: NIHR CLAHRC Yorkshire and Humber
A programme of work is being undertaken between Bradford District Care Trust, the University of York and the University of Leeds, supported by NIHR CLAHRC Yorkshire and Humber, with the aim of improving the healthcare of people with SMI and diabetes. The work programme will concentrate on developing an in-depth picture of people with Serious Mental Illness and diabetes and will consist of three studies:

• interrogation of large health service datasets in primary and secondary care
• comprehensive and Systematic reviews of the literature
• qualitative interviews with patients, carers and healthcare providers

These three strands of work will inform the development of better care for people with SMI and diabetes in the future. We will then test whether this is feasible to trial and implement. The final phase of the work programme will evaluate a newly developed method of healthcare for people with SMI and diabetes. This will result in a full multi-centred RCT with a process evaluation and evaluation of the effectiveness and cost effectiveness of a new method of care. For more information visit NIHR CLAHRC Yorkshire and Humber’s website.
 
Staff Smoking Survey
Implementing smoke-free services is an identified priority for a number of NHS mental health trusts, and mental health commissioners, including within Yorkshire and the Humber.  The aim of this survey is to provide information that will support local adult NHS Mental Health Trusts in planning for and implementing totally smoke-free mental health services, and provide a base line for evaluation purposes. The primary objectives of this study are to benchmark the smoking status of clinical and non-clinical staff working in participating mental health trusts across Yorkshire and Humber. For more information  including the aims and objectives of the four year project visit NIHR CLAHRC Yorkshire and Humber’s website.
 
Mental health assessment in Devon
The Peninsula Collaboration for Health Operational Research and Development (PenCHORD), supported by NIHR PenCLAHRC, has worked with mental health provider Devon Partnership NHS Trust to coordinate the provision of mental health assessment through a centralised ‘choose and book’ system. PenCHORD helped to analyse demand, advise on the number of appointments and the location of assessment centres. To find out more visit NIHR PenCLAHRC’s website.

Predicting successful outcomes in community mental health services
The Improving Access to Psychological Therapies programme has been successfully delivered across England, providing greater access to evidence-based therapies for those with a range of common mental disorders. Understanding the factors that predict a positive response to treatment can be important in maximizing the chances of a successful outcome. The NIHR CLAHRC Northwest London has brought together researchers from Imperial College London with healthcare professionals and researchers from Central and North West London NHS Foundation Trust, to identify these predictors. Analysis of data from more than 4,000 patients demonstrated initial severity of anxiety and/or depression, ethnicity, deprivation and gender play an important role in mediating responses to therapy. A predictive model was developed that was able to predict the outcomes of approximately 70 per cent of patients following initial assessment. Using this information it is hoped that services will be able to identify those patients that may not achieve a successful outcome and provide additional support to improve their chances.  The study can be read in more detail in a recent article published in BMJ Open. For more information please contact Liz Evans, Mental and Physical Wellbeing Theme Lead -  liz.evans@imperial.ac.uk.
 
DeCoDer – debt, depression and anxiety
Many patients seen in general practice who present with depression and related anxiety, also experience debt and prolonged absences from employment. Evidence suggests that there is a relationship between being in debt, depression and the risk of self-harm. A nationwide team including experts from Plymouth University Peninsula Schools of Medicine and Dentistry supported by NIHR PenCLAHRC, are exploring whether debt advice provided by Citizens Advice Bureau counsellors for patients with debt and depression, accessed through general practices, makes a difference to their recovery. To find out more visit NIHR PenCLAHRC’s website
 
Support project for prisoners on or near release who have mental health problems
A team of researchers from Plymouth University Peninsula Schools of Medicine and Dentistry, with colleagues from the University of Manchester, University College London and the University of Exeter, have support from NIHR PenCLAHRC for a project called ENGAGER 2. ENGAGER 2 is a five-year programme investigating the issues faced by prisoners with mental health problems near to and after release, and to develop and evaluate a system of care to address those issues. The project aims to develop and evaluate a way of organising care based on an integrated approach involving therapy, medication, housing, training and employment, and ensuring that care continues after release. To find out more visit NIHR PenCLAHRC’s website.
 
SchoolSpace network supports eating disorder research
Researchers in the Youth Mental Health Theme (2) of NIHR CLAHRC West Midlands have developed an excellent working relationship with teachers and pupils in local schools through the establishment of the ‘SchoolSpace’ network. This network of schools is committed to working with NIHR CLAHRC West Midlands on youth mental health research and has adopted the Theme’s website, as their key resource for providing general education and support about youth mental health. The Theme provides network schools with a range of bespoke training sessions, which include sessions on self-harm, eating disorders, anxiety and depression. SchoolSpace has been instrumental in supporting the success of a number of Theme 2 projects, including a longitudinal exploration of factors associated with the development of eating disorders. Find out more about the initiative.