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Research at the Bamford Centre

Our research at the Bamford centre is varied and focuses on five main areas: younger people, older people, mental health services, population studies and suicide studies.

IMPACT – Improving Mental Health Pathways and Care for Adolescents in Transition to Adult Services in Northern Ireland

Funded by : R&D Division of the Public Health Agency NI

About the Project

This three year study aims to determine what is the best way to organise the interface between services for children, young people and adults in order to support the transition from childhood to adulthood.

A similar study in England (TRACK) found only 4% of young people experienced the ideal transition. Many such young people may find that on reaching adult services there is a lack of appropriate treatment and care. Many others, particularly young men with complex problems, disengage from services only to make contact later with more intractable problems.

IMPACT is a mixed methods study in which we will examine the transition of young people aged 16-18 years referred to CAMHS, detailing their pathways to adult services and the involvement of community and primary care services. We will explore health and social outcomes including engagement and satisfaction with the service. The study will examine barriers to effective transition and will include professional and family perspectives. The team is comprised of experienced health service researchers, including academic psychiatrists from the UK, Northern Ireland and the Republic of Ireland who have expertise in CAMHS and early intervention services, in collaboration with senior NHS managers and young service users. The findings from this study will significantly contribute to the improvement in early intervention and continuity of care for young people in Northern Ireland.

Project Aims:

  • How do mental health services in the Health and Social Care Trusts in NI differ in their policies and provision of care for young people in the transition to adult services?
  • How do social factors influence health pathways and outcomes among young people?
  • Which factors influence adolescents’ engagement with services and continuity of care?
  • What are the barriers and facilitators to CAMHS collaboration with adult mental health service, primary care and relevant community based agencies?

Key People:

NISAW – Northern Ireland Study of Adolescent Wellbeing

About the project

With young people’s mental health of increasing concern, and research demonstrating a link between stress, substance abuse, bullying, and poor mental health, the Bamford Action Plan (DHSSPS, 2009a) included schools as key contributors to facilitate early intervention. Furthermore, an association between emotional wellbeing and academic achievement is well known, with early detection and timely intervention through the provision of access to the appropriate services leading to improvement in wellbeing and academic performance. With this in mind we are inviting ten post-primary schools in Northern Ireland to participate in a study aiming to investigate how young people in Northern Ireland seek help for emotional difficulties. A similar study was carried out in England, where it was found that less than 30% of adolescents regarded their family doctor as a source of help for emotional problems. It is hoped that the study can add valuable information to existing knowledge and that the new findings will go some way to improving access to mental health services for young people in Northern Ireland in order to assist timely intervention.

The population sample will consist of adolescents aged 13-16 years attending secondary schools (both grammar and non-grammar) in Northern Ireland. Data on their needs, attitudes and beliefs will be observed and recorded using a mixed method approach of cross-sectional data collection through a structured questionnaire and semi-structured focus group interviews.

Project aims:

The overall aim of the study is to build an evidence base for the provision of primary care and psychological and other care services for young people – their location and type, acceptability and accessibility. In particular, we wish to understand better

(a) young people’s attitudes and relationship with their family doctor; and

(b) school-based and community-based psychological services. To do this we need a better understanding of the help-seeking needs and preferences of young people.

Using quantitative and qualitative methods we will explore

(a) the extent to which young people from various social backgrounds and setting are likely to differ on their attitudes, beliefs and preferences for psychological care and counselling; and

(b) the factors that influence helpseeking preferences and choices.

Staff and collaborators:

MARQUE – Managing agitation and increasing the quality of life in people with dementia

About the project

MARQUE is a five year long study taking place all over England. Responding to the government’s ‘Challenge on Dementia’, MARQUE aims to increase knowledge about dementia, agitation and personhood. Agitation is extremely common in people with dementia and causes distress to themselves, family carers and paid carers. Agitation is currently tackled on an individual level, not an organisation level.

The research will involve observing and interviewing a wide range of people with dementia and those who care for them at home, in care homes and in hospital in order to better understand how agitation is currently managed, barriers to good practice and how care could be improved.

We will use this information to develop, test and implement a manual to train staff about how to reduce agitation and improve quality of life in care homes. We will also develop a plot home intervention and  will further develop another manual to improve people with dementia’s end of life for ‘terminal agitation’.

MARQUE aims to

  • Build on theories of personhood in dementia to understand agitation, resilience and compassion to improve public debate and discourse.
  • Make agitation as much as a part of dementia care as risk assessment.
  • To improve and maintain quality of life in people with dementia whether at home, in a care home or in hospital.

More information can be found at: www.ucl.ac.uk/psychiatry/marque or follow the MARQUE project on twitter @MARQUEProject.

Key People:

Chief Investigator:

  • Professor Gill Livingston

Principal Investigators:

Palative Care Needs of People with Serious Mental Illness in Ireland

Despite an increase in the life expectancy of the general population over the last two decades, the disturbing reality is that those with severe mental illnesses are now dying younger than they were 30 years ago (Saha et al. 2007).

The School of Nursing, Midwifery & Health Systems University College Dublin and the Bamford Centre for Mental Health and Wellbeing, Ulster University, are undertaking an all-Ireland study to identify the palliative care needs, if any, of individuals who have a diagnosed mental illness.

This study, which is one part of a larger Structured Research Network (SRN) project focusing on palliative care needs of vulnerable groups, is funded by the AIIHPC set within a social justice framework.

The SRN project seeks to

Explore the personal characteristics, process and context that impact on experiences of hospice and palliative care where evidence suggests disadvantage in terms of access, service provision and outcome.

  • Describe factors and processes that are either beneficial or detrimental to achieving good hospice and palliative care outcomes.
  • Understand how social systems, (economic, cultural, political and affective) impact on decision making of people who experience inequality in relation to hospice and palliative care services across the island of Ireland and to utilise such evidence to develop best practice approaches which strengthen relationships and facilitate greater awareness of the hospice and palliative care needs of people currently excluded by virtue of misunderstanding, diminished recognition and/or prejudice.

The mental health study seeks to identify how people who have a diagnosed mental illness and coexistent palliative care needs are identified as requiring palliative care services, are referred to those services and how they and their carers engage and interact with palliative care services.

The study also seeks to identify how palliative care services respond to and intervenes with patients who have a pre-existing existing mental illness and palliative care needs

Why are we conducting this research?

Enduring mental illness is estimated to affect 14% of the population (Kessler et al. 2005). The burden of this illness is compounded by co-morbidities, particularly metabolic and cardiovascular disease, and raised mortality rates.

People with mental illness continue to be disadvantaged as they are less likely access or to be offered, health screening. Consequently, those with a serious mental illness live up to 25 years less than the general population, with the vast majority of the gap in life expectancy being accounted for by physical illness (Mitchell et al. 2011; Wahlbeck et al. 2011; De Hert et al. 2011).

For those with a diagnosis of schizophrenia, the prevalence of cardiovascular morbidity and mortality is estimated to be 2 to 3 times greater than the general population, 35% to 250% higher in those with bi-polar disorders, and up to 50% higher in major depression (De Hert et al. 2011). People with schizophrenia taking antipsychotic medication are reported to be three times more likely to die from sudden cardiac death than the general population (Koponen et al. 2008; Ray et al. 2009).

People with mental illness are also at increased risk of obesity, associated with metabolic syndrome, and evidence is mounting for an association between psychotic disorders and diabetes (Mitchell et al. 2011; De Hert 2011).

The association of obesity and metabolic syndrome with antipsychotic medication is well established affecting 15 to 72% of those taking them and weight gain effects established, particularly with Clozapine and Olanazapine (De Hert 2011; Mitchell et al. 2011).

A range of other physical health conditions have also been identified as being more prevalent in people with enduring mental health issues including hepatitis (Types B and C); respiratory disease including tuberculosis, pneumonia and chronic obstructive pulmonary disease; musculoskeletal disorders including osteoporosis; and sexual health disorders.

Accessing Health Care

Mental illness acts as barrier to accessing and obtaining effective medical care, particularly when diagnostic overshadowing results in the misattribution of physical symptoms (Thornicroft, 2011).

Mental illness has an impact on patient initiated health behaviours and people with mental illness frequently have poor compliance with treatment regimes. However, it is also recognised that those with mental illness are likely to receive less, and poorer quality, physical healthcare than other population groups. Patients with mental illness are less likely to receive standard level diabetic care, are likely to experience a lack of screening and intervention for dyslipidaemia and hypertension, as well as low rates of surgical interventions such as stenting (Wahlbeck et al. 2011; Thornicroft 2011).

Confusion continues to exist as to which division of health services, primary care or mental health care, should take responsibility for monitoring and intervening in physical health and while attempts have been made particularly in the USA and UK to address these issue through incentive schemes and publication of guidelines, evidence indicates that sub-optimum physical health care continues for people with mental illness (Mitchel et al. 2009; 2011).

Conclusion

It is imperative that these health disparities are reduced by closing the gaps in equality and access to physical health care for people with SMI in order to improve their life expectancy and general physical health.

The demand for a multidisciplinary approach for the physical health management of individuals with severe mental illness is emphasised by Chaudhry et al., (2010). – primary care clinicians, psychiatrists, psychiatric nurses, dieticians, internal medicine specialists, pharmacists, community mental health workers, patients and their carers.

In addition, any successful strategy of service improvement in a health care setting must involve co-ordination of disciplines and restructuring of services that are often fragmented (Bodenheimer, Wagner & Grumbach, 2002).

Key People

QuEST - Quality and Effectiveness of Supported Tenancies

Around 60,000 people with mental health problems live in supported accommodation in England, typically receiving one of three types of support:

  1. Residential Care
  2. Supported Housing
  3. Floating Outreach

However, little is known about the quality, cost and effectiveness of these services.

The QuEST Project aims to deliver the first standardised quality assessment tool for supported accommodation, a detailed description of supported accommodation services in England and those who use them, evidence on clinical and cost-effectiveness of these services and to explore the feasibility of a trial to test the clinical and cost effectiveness of two models of supported housing.

This NIHR-funded project will run for five years (2012-2017).

Chief Investigator

  • Professor Helen Killaspy – Professor and Honorary Consultant in Rehabilitation Psychiatry, Division of Psychiatry, University College London

Co-Investigators

  • Professor Stefan Priebe – Head of Department, Social and Community Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary’s University
  • Professor Michael King – Professor of Primary Care Psychiatry, Division of Psychiatry, University College London
  • Professor Sandra Eldridge – Professor of Biostatistics, Joint Centre Lead, Blizard Institute, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary’s University of London
  • Professor Paul McCrone – Professor of Health Economics, David Goldberg Centre, Health Service and Population Research, Institute of Psychiatry, King’s College London
  • Professor Geoff Shepherd – Senior Policy Advisor, Centre for Mental Health
  • Maurice Arbuthnott – North London Service User Research Forum, Division of Psychiatry, University College London
  • Professor Gerard Leavey – Director, Bamford Centre for Mental Health and Wellbeing, Ulster University
  • Jake Eliot – Policy Officer, National Housing Federation
  • Wendy Wallace – Chief Executive, Camden and Islington NHS Foundation Trust
  • Professor Sarah Curtis – Professor of Health and Risk, Institute of Hazard and Risk Research, Durham University

Research Team

  • Sarah Dowling – Project Manager, QuEST Project, Division of Psychiatry, University College London
  • Isobel Harrison – Research Associate, QuEST Project, Division of Psychiatry, University College London
  • Joanna Krotofil – Research Associate, QuEST Project, Division of Psychiatry, University College London
  • Peter McPherson – Research Associate, QuEST Project, Division of Psychiatry, University College London
  • Sima Sandhu – Researcher, Social and Community Psychiatry, Wolfson Institute of Preventative Medicine, Queen Mary’s University

REAL - Rehabilitation Effectives for Activites for Life

The REAL (Rehabilitation Effectiveness for Activities for Life) Study is a national programme of research into inpatient mental health rehabilitation services, funded by the National Institute of Heath Research and supported by the Mental Health Research Network.

The fundholders were Camden and Islington NHS Foundation Trust and the research was a collaboration between University College London, King’s College London, Sheffield Hallam University and South London and Maudsley NHS Foundation Trust.

The programme had four main objectives:

  1. To provide a detailed understanding of the scope of current mental health rehabilitation service provision in England including the characteristics of those who use them and the content and costs of care delivered.
  2. To develop a staff training intervention to facilitate service users’ activities.
  3. To test the clinical and cost-effectiveness of the staff training intervention through a cluster randomised controlled trial.
  4. To carry out a longitudinal study to identify the components of care associated with better clinical outcomes.

The results from the main trial will be published shortly.

Key People:

Chief Investigator:

  • Professor Helen Killaspy

Steering group:

  • Professor Michael King
  • Prof Frank Holloway
  • Professor Tom Craig
  • Professor Gerard Leavey
  • Dr Sarah Cook
  • Dr Catherine Hill
  • Dr Tim Mundy
  • Marieke Wrigley
  • Professor Tony Johnson
  • Gemma Dorer
  • Professor Paul McCrone
  • Maurice Arbuthnott
  • Wendy Wallace

Research Team:

  • Mr Nick Green
  • Mrs Isobel Harrison
  • Ms Melanie Lean

More information on the study can be found here: http://www.ucl.ac.uk/REAL-Study/

Other Programmes include: