Mental Health Projects

Projects

Culturally-adapted Family Intervention (CaFI) for African Caribbeans with schizophrenia and their families

Culturally-adapted Family Intervention (CaFI) for African Caribbeans with schizophrenia and their families: A feasibility study of implementation and acceptability.

Aims

i) culturally-adapt an existing family intervention
ii) test the feasibility of recruitment and implementation
iii) evaluate its accessibility and acceptability among African Caribbean patients and their families.

Method

Randomised controlled trial.

Background

African Caribbeans have the highest prevalence of schizophrenia, most difficult relationships with mental health services and greatest persistent inequalities in care of all ethnic groups in the UK(1-3). The National Institute for Health and Clinical Excellence (NICE) recently updated schizophrenia guidelines(4); highlighting the lack of evidence-based psychological interventions for ethnic minorities in general and African Caribbeans in particular.

People

John Baker

Edge D (PI), Abel K, Barrowclough C, Tarrier N, Drake R, Baker J, Bhugra D, Grey P, Cahoon P, Lewis S, Berry K & Cotterill S.

Funding body

NIHR Health Services and Delivery Research, £324k

Contact

John Baker

Link to project website https://www.bmh.manchester.ac.uk/research/projectdetails/?ID=2986

Implementing the Six Core Strategies (6CS) – UK: Working in partnership to minimise harm to patients and staff 

(6CS) – UK: Working in partnership to minimise harm to patients and staff by reducing the use of physical restraint.

Aims

to reduce the incidence of harm caused to patients and staff as the result of a 40% reduction in physical restraint by June 2016

Method

The project uses a restraint-related patient safety initiative called 6CS-UK. The team will measure the harm caused by restraint, and other outcomes such as patient and staff relationships.

Background

Physical restraint is used to prevent individuals in mental health services from harming themselves or others. It continues to be used routinely despite adverse effects reported from both patients and staff.

People

John Baker, Duxbury J (PI), Cullen J, O’Hare B, Hooton S, Whittington R, Downe S, Baker J, McKeown M, Price O, Thomson G, Jones F, Sutton C, Le Bel J, Brown A

Funding body

The Health Foundation. £450k

Contact

John Baker

Link to website: http://www.health.org.uk/programmes/closing-gap-patient-safety/projects/implementing-six-core-strategies-uk

Implementation of an intervention for reduction of inappropriate polypharmacy prescribing

Aim

To explore service user, advocates and professional (Doctor, Nurse, Pharmacist) perspectives on the scope for patient mediated interventions to reduce antipsychotic polypharmacy in forensic mental health inpatient environments.

Objectives:

To develop understanding, from a service user’s and professional advocate’s perspectives, of the behaviour(s) and process(s) surrounding antipsychotic polypharmacy prescribing and continuance in forensic mental health inpatient settings;

To understand the likely barriers and facilitators from a service user’s and professional advocate’s perspectives to the use of/involvement in potential “patient mediated interventions” in forensic mental health inpatient settings;

Method

Qualitative interviews with service users and staff.
Scoping review (Arksey and O’Malley, 2005) to consider the content and implementation of an intervention for reduction of inappropriate polypharmacy prescribing.

Background

National attempts at improving medication safety in mental health have failed to maximise the potential that exists by co-producing safety interventions alongside service users (Paton et al. 2008). Antipsychotic polypharmacy is a common clinical scenario (Langan & Shajahan, 2010). In this study, we are not drawing distinctions between appropriate and inappropriate polypharmacy, considering all polypharmacy prescribing as potentially posing risks to patient safety. We are interested in understanding how polypharmacy prescribing occurs and the views service users, advocates and prescribers hold about antipsychotic polypharmacy.

People

Carl Thompson, John Baker, Kathryn Berzins , Inna Kochetkova (University of Leeds), Sarah Eames (LYPFT)

Funding body

NIHR Collaboration for Leadership in Applied Health Research and Care (Yorkshire and Humber) Research Capacity Funding  ????

Contact

Inna Kochetkova

Early facilitated discharge in acute mental health

Aims

To evaluate the delivery of an early discharge service from acute mental health wards to inform service development and identify research priorities.

Method

Phase 1a ‘Rapid Review’ of the literature to assess what is already known about early discharge from acute mental health wards
Phase 1b Service evaluation re-analysis To provide a collated analysis of service data from across three Home Treatment teams providing an Early Discharge
Phase 2 Stakeholder Consultation To ensure that findings from phase 1 are meaningful and acceptable to people who commission, liaise with, deliver and receive care and treatment.
To engage stakeholders in discussion and debate about the future of early discharge services and identify priorities

Background


The process of discharge from acute mental health wards is complex and stressful for the person and their support network. The first two weeks following discharge are associated with increased risks to the person’s safety and recovery. Despite these risks, going home as early as possible can help people maintain important relationships, reduce the stigma they experience and is desired by many people experiencing acute distress.
The impetus for providing specific services and interventions to ‘facilitate’ discharge have their origins in the USA and Australia and early discharge has been a feature of UK policy for the delivery of Crisis and Home Treatment services for over a decade. Whilst systematic reviews have been conducted focusing on crisis and home treatment teams as a whole, none focus specifically on early facilitated discharge.

People

Dr Nicola Clibbens, PhD, MA(Ed.), RN (Mental Health), Lecturer Mental Health, School of Healthcare, University of Leeds
Ms Deborah Harrop, BA(Hons), MA, PGCert, FHEA, Information Specialist, Centre for Health and Social Care Research, Sheffield Hallam University
Ms Sally Blackett, BSc Mental Health Nursing, RMN, RMNH, Practitioner, Crisis and Home Treatment, Rotherham, Doncaster and South Humber NHS Foundation Trust

Funding body

The Burdett Trust for Nursing, £7999k

Contact

Nicola Clibbens <N.Clibbens@leeds.ac.uk>

Supporting young mothers (aged 14-25) in the first two years of life

Supporting young mothers (aged 14-25) in the first two years of life:  a randomized control trial (RCT) of the NSPCC Minding the Baby (MTB) home visiting programme

Aims

The primary aim is to promote caregiver sensitivity, and, secondly, to promote both maternal and child socio-emotional outcomes.

Background

Young mothers living in adverse contexts often are exposed to significant and chronic environmental difficulties including poverty, social isolation and poor education and typically have to cope with personal histories of abuse and mental health issues.  MTB is an interdisciplinary intensive home based visiting programme developed to support first time young mothers, which integrates primary care and mental health approaches into a layered and integrated intervention programme delivered from the last trimester of pregnancy to the child’s second birthday.

Method/Design

This is a NSPCC sponsored multi-site randomised control trial (RCT) with a target recruitment of 200 first time mothers (<26 years old) exploring the effectiveness of an integrated and preventive home visitation intervention programme for vulnerable first time young parents and their babies. 

Multimodal and trans-theoretical inter-disciplinary and integrated interventions are delivered by a nurse/midwife and a social worker/psychotherapist in accord with the fidelity of the model.  Relationship among the clinician(s), mother, and baby is the primary agent of change. Interventions focus on maternal mental health issues as wells as parent-infant interactions, parental needs and concerns and developmental outcomes.  Clinicians receive intensive training in the unique incorporation of the physical and mental health components of the interventions involved as well as on-going inter-disciplinary reflective supervision.

The School of Healthcare is contracted to deliver interdisciplinary mentalization based clinical supervision and monitor fidelity to the programme model.

Key Collaborators:

NSPCC, University College London, University of Leeds, Anna Freud Centre, Yale Child Study Centre, Yale School of Nursing.

Funding body

NSPCC, Maximum Fee of £114,816.00 (March 2015 – October 2017) for the services provided by Freshwater and Mountain (except expenses).  In addition £27,000 for a part funded studentship.

Contact

Dr. Gary Mountain, Associate Professor in Child and Family Health, School of Healthcare. 

Re-imagining professionalism in mental health

Re-imagining professionalism in mental health: towards co-production with the Universities of Huddersfield, Oxford (St Catherine’s College) and York

Aims

The aim of this seminar series is to develop ideas on how to encourage and develop co-production in mental health.
Objectives
1. To interrogate diverse understandings of co-production critically in order to recommend changes to practice, policy and commissioning and education which will inform new approaches to professionalism in mental health.
2. To assess the usefulness and applicability of democratic professionalism as a conceptual model informing co-production in mental health.
3. To develop in collaboration with stakeholders a strategic plan for establishing interdisciplinary and cross-stakeholder understandings of co-production which support the development of professionalism in mental health through influencing practice, commissioning and education in mental health.

Method

The seven part ESRC seminar series aims to focus on developing new approaches to professionalism in mental health. This initiative is building an extensive network of partners amongst service users and carers, with statutory and public organisations, and with the third sector.

Research partners include: The Collaborating Centre for Values Based Practice, St Catherine’s College, University of Oxford

Background

Reimagining professionalism in mental health: towards co-production is an ESRC seminar series which focuses on developing new approaches to professionalism in mental health. Our understanding of co-production is that it should involves authentic power-sharing between service users, carers and professionals. From our personal and professional experience, we know that the term co-production is sometimes applied when authentic power-sharing is very far from being a reality. 

People

Pamela Fisher,

Co-investigators:

'John Playle' <J.F.Playle@hud.ac.uk>; Elaine McNichol <e.mcnichol@leeds.ac.uk>; Albert William Dzur <awdzur@bgsu.edu>; 'Martin Webber' <martin.webber@york.ac.uk>; John Baker <J.Baker@leeds.ac.uk>; 'McClelland Norman (LEEDS AND YORK PARTNERSHIP NHS FOUNDATION TRUST)' <norman.mcclelland@nhs.net>; Hannah.Howe@vol

Funding body

ESRC

Contact

Pamela fisher

Website link: http://medhealth.leeds.ac.uk/homepage/730/towards_co-production_esrc   

SPICES: Seclusion and Psychiatric Intensive Care Evaluation Study

Completed research projects

Aims/objectives

Objectives: To assess the outcomes of seclusion and PICU care (study 1) and to describe differences in the management of disturbed patient behaviour related to differential availability (study 2).

Methods

Design: The electronic patient record system at one Trust was used to compare outcomes for patients who were and were not subject to seclusion or PICU, controlling for all other significant variables. Economic costs were also compared (study 1). Nursing staff at eight hospitals with differing access to seclusion and PICU completed attitudinal measures, a video test on restraint use timing, and an interview about the escalation pathway for the management of disturbed behaviour at their hospital. Analysis compared differences by access to seclusion or PICU (study 2).
Participants: Patients admitted to acute wards in one NHS Trust 2008-13 (study 1); nursing staff at eight randomly selected hospitals in England, with varying access to seclusion and PICU (study 2).
Main outcome measures: Aggressive behaviour, cost (study 1); utilisation, speed of use and attitudes to the full range of containment methods (study 2).
Results: Controlling for all other relevant variables, patients subject to seclusion or PICU compared to those who were not were more likely to be aggressive afterwards. The cost of their care was higher (study 1). Hospitals without seclusion rooms used more rapid tranquillisation, nursing of the patient in a side room accompanied by staff, and seclusion using an ordinary room. Staff at hospitals without seclusion rated it as less acceptable, and were slower to initiate manual restraint. Hospitals without an onsite PICU used more seclusion, de-escalation, and within eyesight observation

Background

Seclusion (isolation of a patient in a locked room) and transfer to psychiatric intensive care (PICU, a specialised higher security ward with higher staffing levels) are two common methods for the management of disturbed patient behaviour within acute psychiatric hospitals. Some hospitals do not have seclusion rooms or easy access to an onsite PICU. It is not known how these differences affect patient management and outcomes.

People

Len Bowers
Alexis Cullen 
Evanthia Achilla
John Baker
Mizanur Khondoker
Leo Koeser
Lois Moylan
Sophie Pettit
Alan Quirk
Faisil Sethi
Duncan Stewart
Paul McCrone
Alex Tulloch

Funding body

NIHR Service Delivery & Organisation, £335k

Contact

John Baker