Mental Health and Co-morbidities - CLAHRC Community e-newsletter Issue 83

Published Date: 31 May 2019

Welcome to the community e-newsletter for the NIHR CLAHRCs, bringing you news from across the thirteen collaborations and the health services research community.


East of England: Cross-CLAHRC Care Homes event bringing together researchers and key stakeholders to explore research, priorities and collaborations 23.7.19, London - Save the Date  
Peninsular: are offering six fully funded PhD studentships, with a deadline for applications on 31st May - Apply here

CLAHRC East Midlands
Antidepressants in obesity and depression in primary care
Despite the prevalence of depression in obesity, there are no specific services for managing people with both obesity and depression, nor is there current guidance on antidepressant use in obesity. 
One of the studies in the Enhancing Mental Health theme, is exploring drug safety in relation to the prescription of antidepressants in those who are overweight/obese and the association between antidepressants, obesity, cardiovascular disease and diabetes. To do this, the team will be using a large primary care database. 
The information will be used to inform prescribing of antidepressants to people who are obese or overweight who also have depressive disorders. The researchers will prepare prescribing briefings for GP and mental health prescriber education, the strategic clinical network for mental health, Academic Health Science Network, NICE and for patient and public involvement groups in mental health and in obesity. 
Read more

Phone or video call therapy improves health anxiety and saves money, study finds
A study by mental health experts from NIHR CLAHRC EM has found that easy-access, remotely-delivered psychological treatment can significantly reduce extreme health anxiety in people who repeatedly go to the doctor, or hospital emergency departments.
The researchers from the University of Nottingham’s Institute of Mental Health along with NIHR CLAHRC EM carried out a multi-centre trial to compare the effects of cognitive behavioural therapy (CBT) delivered by phone or video calling, to standard treatment via their GP and the mental health referral system.
The study found that the randomly selected group of patients who received sessions of remote CBT via telephone or online video calling had markedly reduced health anxiety in the 12 months after the start of this treatment and the cost savings to the NHS were more than £1,000 per patient.
Read more

CLAHRC East of England
Mindfulness-based interventions for mental health promotion: a collaborative review study
Mindfulness courses to increase well-being and reduce stress have become very popular. The research evidence supporting this provision is growing but still weak with small studies, poor data analysis and high variability. It is unclear what mindfulness training is good for, how it performs in comparison with other feel-good practices, and what is best for whom in what circumstances.
Dr Julieta Galante, NHS NIHR Postdoctoral Fellow at the Department of Psychiatry, University of Cambridge. Her Fellowship will include a comprehensive review of the evidence, with authors of the best designed trials being invited to share data and re-analyse it together. Public members and professional stakeholders are being involved in the research from the outset. This study will show whether preventative mindfulness courses really help people or they are ‘just a fad’. It will inform who to offer mindfulness to, and in what ways.
Contact Julieta; Twitter @MSSatUoC

CLAHRC North Thames
How would patients with psychosis like to be in contact with a volunteer: face-to-face or digitally?
Volunteer befriending can be used to address the social isolation patients with psychosis risk experiencing. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely.
new paper by NIHR CLAHRC North Thames researcher Mariana Pinto da Costa details her study, part of her PhD, exploring the views and interests of patients with psychosis about these different formats of volunteering. The findings have contributed to the development of an intervention using smart-phones to connect people with psychosis and volunteers – the Phone Pal.
Contact Mariana

CLAHRC North West Coast
Health care practitioners’ views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities
Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. 
Methods - Semi‐structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. Responses were analysed using thematic analysis.
Results - Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities.
This study provides suggestions for future research, policy and practice consideration.
Read More

CLAHRC North West London
Social theory helps understand QI processes in a project to improve the physical health for people with serious mental illness
Stuart Green, CLAHRC NWL Public Health research fellow, undertook research exploring the social process of co-creating knowledge within quality improvement (QI). He used an ethnographic approach to unpack the social construction of a QI case study. The QI project aimed to address physical health co-morbidities of people with serious mental illness through the introduction of a physical health ‘pathway’ within an acute mental health unit. It used the CLAHRC NWL systematic approach to QI to introduce new evidence-based clinical practices, starting in 2014 on a single ward and scaling-up across five additional wards in 2016.
The research highlighted the nature of improvement work as both a social and technical process that uses and creates knowledge. However, issues of responsibility and accountability posed a significant challenge to the delivery of the QI project and subsequent changes to clinical practices, which needed to be addressed.
Read more

Implementing evidence-based depression care in the Oxford Cancer Centre (OCC)
10% of cancer patients have major depressive disorder. This is known to reduce adherence to cancer treatment, impair quality of life and limit peoples return to normal activities, even after successful cancer treatment. ‘Depression Care for People with Cancer’ (DCPC) addresses this, integrating traditional cancer care with psychological and pharmacological depression treatment.
This project takes findings from clinical trials and works to determine how best to implement them in the real-world setting of the NHS – the first step towards wider roll out across the NHS and maximising patient benefit. This solution comprises a screening system, for identifying symptoms of depression in cancer patients, and the DCPC treatment approach itself. It is being implemented and evaluated in the Oxford Cancer Centre. A steering committee including patients and carers was also set up to help guide the implementation.
Read more here and here

CLAHRC Oxford: Evaluating CAMHS services in Oxon and Bucks
In the Oxford Early Intervention Theme we have been working together with local commissioners to evaluate some exciting changes in local child and adolescent mental health services, primarily to tackle the significant number of children who do not access services in a timely manner.
The services have set up new school-based mental health services and clinical collaboration with third sector partners. It is hoped that these changes will improve the accessibility of and engagement with mental health services as early as possible in the course of a child’s illness.
In Oxfordshire, for example, we have an ‘InReach’ service into all local secondary schools, where a member of the CAMHS team visits each school for half a day each week. Although these changes have been welcomed by user groups, there remains a need to evaluate whether outcomes have improved and, with a mixed methods approach, we are doing this.
Read more

The Engager project – developing and evaluating mental health care for prisoners
PenCLAHRC research has found that prisoners have a high prevalence of mental health problems and that comorbidity between mental health problems, substance misuse and personality disorder is the norm rather than the exception. Few prisoners engage with services to address their mental healthcare needs and this can lead to difficulties after release.
An ongoing collaboration focusing on mental health care for prisoners between PenCLAHRC, the University of Plymouth, Faculty of Medicine and Dentistry and the University of Manchester is conducting the Engager Project, to develop and evaluate a collaborative care intervention for offenders with common mental health problems, near to and after release. The project has developed an integrated approach to organising care involving therapy, medication, housing, training and employment, and ensuring that care continues after release from prison. It conducted a randomised controlled trial to evaluate the clinical, social, and economic impact of the intervention.
Read more

Developing an Integrated Psychological Medicine Service to improve patient outcomes
Anxiety and depression are around 3 times more common among hospital attendees than the general population, and in co-existence with other medical and surgical problems can lead to worse patient outcomes.
NHS providers are not always equipped to provide high quality psychological care to people attending hospital. A lack of staff training, increasing patient numbers and difficulty accessing psychological care mean that anxiety and depression often go untreated.
A PenCLAHRC project, with the Royal Devon and Exeter Hospital, aims to improve patient outcomes through the development of an Integrated Psychological Medicine Service. It aims to reduce physical and psychological morbidity, increase engagement in self-care, improve quality of life, shorten hospital stays and reduce healthcare and work absence. A specialised induction for all new staff will be introduced to foster compassion, develop routine screening processes for psychological problems, developing care pathways to link with local services and investigating a pro-active liaison psychiatry service.
Read more

Bristol Self-Harm Surveillance Register data enables self-harm research projects
Data from the Bristol Self-Harm Surveillance Register, the first 'real time' register in the UK, is enabling a number of studies into self-harm in the city region. CLAHRC West researchers are analysing data from the register to shed light on the types of people who are self-harming and trends in self-harm in the population served by the Bristol Royal Infirmary and Southmead Hospital. This work supports Bristol’s hospital psychiatry services and the Suicide Prevention Group led by Bristol City Council, while also enabling a number of in-depth studies.
The Register has been used to record detailed information on patients presenting to hospital for self-harm since September 2010. It is a database in the Emergency Department at the Bristol Royal Infirmary, part of University Hospitals Bristol NHS Foundation Trust.
Read more

Reducing drug use in female street sex workers: DUSSK feasibility study
Most female street sex workers in the UK are affected by illegal drugs, such as heroin and crack cocaine. For most of these women, drug use reinforces their dependency on sex work and adds to their health and social problems. The need to finance their drug use, and often that of a partner, underpins their involvement in sex work. Drug intoxication also means they are less able to protect themselves whilst working.
CLAHRC West have developed an evidence-based plan to improve the results of drug treatment for these women, by organising NHS and voluntary sector services to work together. This approach involves creating a stigma-free environment for street sex workers to discuss their work in drug treatment groups, as well as addressing trauma as part of the drug treatment. We are in the process of drafting papers for this project.
Read more

CLAHRC West Midlands

Eating Disorders and Psychiatric Co-morbidities
‘Co-morbidity’ is defined as ‘the presence of more than one distinct condition’ in an individual. Psychiatric co-morbidities include depression, anxiety and obsessive-compulsive disorder. Whilst present within a range of diagnosable mental health conditions, these disorders are highly comorbid with eating disorders (ED). Typically occurring simultaneously or following initial onset of an ED, they can result in poorer outcomes, higher rates of mortality, chronic illness, low health related quality of life and increased social and psychosocial impairment. To assist in early detection and intervention, there is an urgent need for greater understanding of co-morbidities in young people with EDs; Research will enable better understanding of the development of ED in adolescence and provide the basis for integrated treatment models to improve outcome. Current longitudinal work within CLAHRC-WM aims to explore prevalence, stability and risk factors associated with partial ED in school settings with students (13-14 years).

CLAHRC Yorkshire and Humber
Exploring the Role of Lived Experience in Mental Health Training 
Whilst there is emergent evidence suggesting the benefits of involving people with lived experience in mental health training, this is somewhat patchy and has restricted our deeper understanding of the topic. This report therefore summarises outcomes from a set of linked activities funded through Sheffield Health and Social Care NHS Foundation Trust’s Research Capacity Fund, that sought to synthesise the existing literature, practice knowledge and lived experience of people working in this area, with a view to co-producing relevant research questions to address significant gaps in evidence and making initial recommendations for good practice.
Through a practice review, literature review and coproduction workshops (led by the TK2A theme of  CLAHRC YH) we synthesised and developed 7 themes to explore. 
Read more 
Contact Professor Rachael Finn

MiMoS study
Working with the NIHR CLAHRC YH, TK2A theme, the Mimos study aim is to examine how sexual assault referral centres (SARCs) identify mental health and substance use problems (both pre-existing and emerging problems) and how the SARCs work with other agencies to ensure that service users get the right help, at the right time, in the right place. The NIHR HS&DR programme has funded two studies (The MiMoS study and the MESARCH study) to examine several key areas in order to see how well SARCs are working, and how things could be improved, to make sure that people who attend get their needs met. 
The focus is on understanding how staff and services work well together, as well as identifying what doesn’t work so well.  At the end of the research we will make recommendations to improve the care for people with mental health and substance use following sexual violence.
Read more
Contact Dr Rebekah Shallcross