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Psychosis devastates quality of life. Since 1995, work led by Professor David Fowler at The University of East Anglia (UEA) has made significant contributions to a series of UK and international trials which show that Cognitive Behaviour Therapy (CBT) is effective in reducing distress, emotional dysfunction and social disability in patients with chronic schizophrenia, and as part of early intervention services for first episode and at-risk patients. This work has had a major impact on mental health services as reflected in national and international mental health policy guidance, service development guidance, policy implementation guidance and training programmes for mental health workers.
Psychosis affects 3-4% of the UK population and is ranked as the third most disabling condition worldwide by the World Health Organisation. Research at the University of Glasgow has changed treatment and services for patients with psychosis by identifying therapies that improve emotional recovery and prevent psychosis relapse and by contributing to the development of early intervention services for individuals with a first episode of psychosis. This work has supported the inclusion of cognitive behaviour therapy (CBT) for psychosis in national clinical guidelines and the implementation of these guidelines via an expanded UK Department of Health programme. University of Glasgow research has also driven the development and expansion of local early intervention services for psychosis, the success of which has directly informed the current Scottish Government Mental Health Strategy.
Studies conducted at Imperial College, over the last 20 years, have improved the rational, evidence-based treatment of schizophrenia. Our research has covered symptomatology, neurocognitive function, medication side effects, and comorbid substance use, and involved clinical trials of pharmacological and psychosocial treatments. We lead national quality improvement programmes supporting the implementation of psychopharmacological practice standards. Our work has impacted upon the understanding, clinical assessment and treatment of this condition in both first-episode patients and established schizophrenia, and has improved prescribing practice and the identification and assessment of side-effects.
Over the last 20 years Imperial College research on the assessment and treatment of personality disorder has led to important changes in healthcare policy and the provision of services for people with these mental disorders. Our introduction of the first reliable assessment of the severity of personality disorder made it a much better understood and accepted diagnosis and led to current plans for changing the World Health Organisation (WHO) international classification of this disorder. Our research highlighting the impact of personality disorder contributed to the development of new services and our evaluation of these services led to them becoming more widely available throughout the NHS. In contrast, our evaluation of an intensive assessment and treatment programme for a select group of offenders with personality disorder showed that it was not cost effective. This programme has now been stopped and resources have been diverted to help treat a far wider group of people with personality disorder and offending behaviour.
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.
Psychosis is a serious mental illness for which treatment can be aided by psychological therapies. Researchers at King's College London (KCL) demonstrated that family environment is key to recovery and developed and validated a family intervention for psychosis. Family intervention for psychosis is a recommended treatment in NICE guidelines (2009), as well as by the Patient Outcomes Research Team in the USA. The NICE guideline committee was chaired and advised by KCL researchers. Family intervention for psychosis is part of training programs for clinical staff and has changed NHS practice. The KCL-led website mentalhealthcare.org.uk disseminates this research to families of those with psychosis.
This case study focuses on the research conducted by members of the UoA examining the services offered to service users and carers in secure settings. This includes forensic mental health services and prisons. It has had a significant impact on the development of professional practice in secure settings based on the views, experiences, and needs of service users and carers. It has established service user and carer engagement in research conducted in secure settings. It has also informed service and policy developments in the United Kingdom and internationally.
People who develop psychosis (1% of population) typically experience lengthy delays (months to years) before treatment. Researchers at the University of Manchester (UoM) established a concrete and significant association between delay in treatment of the first episode of psychosis and outcome. We demonstrated that outcome of psychosis could be improved considerably if these lengthy delays were reduced. This research influenced policy and practice in the UK and abroad. Policy changes included the establishment of early psychosis teams dedicated to early detection and treatment (50 in England alone). Practice changes included amendments to clinical guidelines in the UK and abroad that now require clinicians to respond urgently to a first episode of psychosis. These changes to clinical practice have increased the proportion of patients with a short DUP from 55.6 to 77.4%.
The CAMHS team at the University of Northampton have built expertise in CAMHS research that have regional, national and international impact, which has had an influence on regional practice in CAMHS, and through our training initiatives, has had an international reach. A key national priority for mental health service development and delivery for children has been widening access to the service to enable better interaction between specialist and universal services — enabling ease of referral, preventative mental health work, and a smoother experience of service provision for young people entering CAMHS. Expertise at Northampton builds on research evaluating the use of Primary Mental Health Workers (PMHWs) in Youth Offending Teams (YOTs) and with LAC (LAC), as well as research on professional training for mental health professionals more broadly. This research highlighted the importance of joined up working at the interface of primary and specialist services, to young people's access to mental health services, and to increase the responsiveness and appropriateness of these services in meeting young people's needs. Impact includes training of CAMHS workers, through both CPD initiatives and a Masters programme in CAMHS which has trained professionals from the UK and EU, as well as professionals from India and several African countries, who have used this expertise in CAMHS and primary care contexts around the world.
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.