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
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
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.
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
Our research has directly informed the development of services that are
supporting recovery from mental ill health by enabling mental health
service users to:
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
implementing the research innovations, and the findings have been
translated into treatment
guidelines used to train health workers in managing mental illness in many
King's College London (KCL) researchers developed and disseminated the
Camberwell Assessment of Need (CAN) which provides a scientifically
rigorous and flexible approach to assessing the mental health and social
needs of people with a wide range of disorders. Mental Health services
around the world are striving to increase the patient-centeredness of
their care. The CAN supports this needs-led care planning to help
transform mental health policy and practice. KCL work has resulted in CAN
being the most internationally recognised and researched assessment tool
available. The CAN is widely used in mental health policies and locally
adapted versions are routinely used in clinical practice within both
statutory mental health services and nongovernmental organisations in the
UK and around the world.
Recent NHS policy has prioritised improving access to cost-effective
psychological interventions for people with mental health problems.
Research by Lucock at the Centre for Health and Social Care Research
(CHSCR) has contributed to meeting this challenge by developing and
evaluating self-help interventions which can be provided by a range of NHS
staff without professional psychotherapy or mental health training. This
work has resulted in the creation of the Self-Help Access in Routine
Primary Care (SHARP) initiative, a programme that gives practitioners
materials and training which enable them to deliver brief self-help
interventions supported by a dedicated website and a range of leaflets
that recognise service users' need for easy-to-understand material.
Feedback from practitioners on the website and training has been positive.
There is evidence of positive impacts of the training on practitioners'
confidence in their ability to deal with anxiety and depression, and in
greater use of Cognitive Behaviour Therapy (CBT) approaches with patients.
Evidence from testimony demonstrates impact on practice. Research also
provides evidence of benefit to patients in terms of reduction of anxiety
and depression and goal attainment. The research has also influenced
national guidance on best practice.
Alternatives to acute admission in mental health are crucial, not least
because of the high cost of inpatient care. We have carried out a major
research programme that includes the only randomised controlled evaluation
of crisis resolution teams and the only major UK study of crisis houses,
which are community-based, residential alternatives to hospital admission.
This programme demonstrated the efficacy of community treatment and has
significantly influenced decision making at a local and national policy
level, including commissioning guidance and three sets of NICE guidelines.
This has contributed to changes in the way acute services for severely
mentally ill adults are configured in the NHS, and internationally.
This case study describes the impact of practice-led research in health
and social care settings. There are three main areas of impact to this