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Research conducted at Strathclyde has shown that current pathways which focus on education and public information are failing to transform attitudes to mental health amongst low-income communities and black & ethnic minorities. Drawing on this research, an annual Mental Health Arts Festival has been created. Since 2008 the event has engaged over 40,000 people, and is now one of the largest arts and social justice festivals in Europe. The Festival has affected the ways in which these `hard to reach' groups are involved in addressing stigma and mental health, has changed approaches to the delivery of mental health awareness lessons in schools and communities, has led to NHS boards building the festival into their health improvement policies and strategies, and has been a central part of the Scottish Government's national anti-stigma `see me' campaign. The idea of a dedicated arts festival has been replicated elsewhere in the UK and internationally, and is transforming the attitudes and behaviour within black and minority ethnic and low-income communities to mental health.
The Centre For Community Mental Health (CCMH) is a research team within the Centre for Health and Social Care (CHSCR). CCMH develops and supports research that reduces stigma and social exclusion and which empowers people with mental health problems to lead fulfilling lives in their own communities. The impact of this research has challenged prevailing beliefs and practices and led directly to changes in practice, organisational processes and service design across the world.
Our studies of voice hearing, in adults and children, have shown that it may not always be associated with mental illness and that cognitive behavioural therapy is effective for many people. Our work has led to the development of the Hearing Voices Movement and the International Hearing Voices Network, which now spans 22 countries and which enables people who hear voices to find bespoke solutions and lead normal lives.
The impact of our work on community-based approaches to the management of acute and long term mental ill health led, first, to the development of assertive outreach and crisis resolution teams that reduced hospital admissions by treating people at home; second, our work has led directly to service redesign in many different countries.
Our studies of special and underserved social groups in relation to mental ill health have demonstrated the multiple barriers to services that many people experience. The impact of these studies has included changes in organisational practices to promote greater engagement with service users.
University of Nottingham research in the field of recovery has had a major influence on changes in mental health policy. It has led to a new model of service provision both in the UK (including through NICE guidance and the NHS's outcomes framework) and internationally (including in Western Europe, Scandinavia, Canada, Australia and Asia). The work has contributed to a reduction in the use of mainstream services and has enhanced the quality of life enjoyed by people with mental health problems. It has also been central to the Department of Health's Implementing Recovery through Organisational Change programme, which has pioneered the use of Recovery Colleges and peer support workers in mental health care in the UK.
Research carried out by LSHTM into mental disorders in low- and middle-income countries has promoted new approaches to mental health care and influenced donors, practitioners and policy-makers, contributing to changing global priorities in this area. WHO launched a flagship action plan based on the research, governments and NGOs made substantial financial allocations for implementing the research innovations, and the findings have been translated into treatment guidelines used to train health workers in managing mental illness in many countries.
Suicide is one of the most serious adverse outcomes in mental health services. NCISH research is based on a comprehensive and internationally unique database (99,000 suicide deaths; 25,000 patient suicide deaths). NCISH impacts upon practice and policy by providing definitive figures on suicide to clinical services and government, producing data-driven safety recommendations and demonstrating that these recommendations reduce suicide. Based on NCISH research, overall patient suicide rates fell by 26% (2004-11), in-patient deaths fell by 58% (2001-2010), and individual recommendations may have prevented between 200-300 patient suicide deaths per year. A new vehicle for impact delivery is the social enterprise Safer Care Ltd (founded 2013), which has already reviewed 4 Trusts and, by reinvesting future income in the social enterprise, we will continue to meet the specific needs of mental health services.
This case study concerns a body of research by Dr Julie Ridley, Dr Helen Spandler and Dr Karen Newbigging into Self-directed Support (SDS) and Direct Payments (DPs), which examines perspectives and experiences of policies to promote choice, control and flexibility in social care, and provides a critique distinguishing between rhetoric and reality. Early qualitative and action research focused specifically on mental health, including work for the Scottish Executive (Ridley) and the Department of Health (Spandler), leading to cutting-edge policy critiques (Spandler), engagement with the field to distil key implementation themes (Newbigging) and later, to broader based evaluation of SDS policy implementation in Scotland. Collectively and over time, this work has had a direct influence on social care policy and law across the UK, as outlined below.
In the context of Law Commission reports on legislation in mental capacity, in 1999, Tony Holland published a ground-breaking review on capacity and an empirical study of the capacity of people with mental disorders. Through Holland's role as one of two expert advisers to a Parliamentary Pre-legislative Scrutiny Committee in 2003, this work directly informed the Mental Capacity Act 2005 and the Code, both of which remain current. With full implementation of the Mental Capacity Act in 2007, Holland's studies from 2008 refined concepts of capacity and best interests for clinical practice; and have examined other aspects of the Mental Capacity Act including advocacy, the Mental Capacity Act in different clinical settings, and the Deprivation of Liberty Safeguards.
As a result of the research into mental toughness carried out at the University of Hull, the 4 `C's model is now used Worldwide. Working with partners in industry, health, education and sport sector, the model and its associated measure, have been shown to be related to mental and physical health, performance and achievement, and to identify areas for development and provide potential strategies to do this.
The model developed is now the most cited globally, and the associated measure — the MTQ48 — is the most frequently used measure of mental toughness. The model has been used to evaluate levels of mental toughness and also provide a basis for effective interventions and their evaluation.
Professor Cary Cooper as chair of the Science Coordination team of a government Foresight programme led the development of evidence-based policy and a longer-term vision to optimise `Mental Capital and Wellbeing in the UK in the 21st Century'. He was also lead scientist on one of its five programme pathways — `Work and Wellbeing'. The MCW Foresight findings showed that in England alone, mental ill health costs the economy £77bn a year, demonstrating the significance of the research. The findings were presented to the highest levels of government in the UK and Europe, businesses, academia and interested parties. As a result there has been a significant drive and awareness to improve factors that affect wellbeing for example revised flexible working arrangements under the Children and Families Bill. Cabinet Secretary Lord Gus O'Donnell corroborates that `the report made politicians realise that they needed to care about wellbeing and that attacking mental health issues was a key way to raise wellbeing'.
Impact resulted from the unit's sustained research in the field, including the leadership of a large EU Framework 6 action project `EMILIA' - the Empowerment of Mental Illness Service Users: Lifelong Learning, Integration and Action, and the follow up project, PROMISE. The findings identified how to reduce social exclusion among people with serious mental illness through lifelong learning and by improving participation in service delivery, education and training, as well as paid employment. The research recommendations were included in a joint EU/WHO policy statement and subsequently rolled out across European Union Member States. The research impacted on the development of European and national policies regarding mental health service users and, through further knowledge transfer activities and the incorporation of the recommendations by a network of providers in 43 countries, also impacted on the profession and mental health service users directly.