Log in
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.
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 Liberty Safeguards.
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 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.
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 research: