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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 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.
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.
Adults with learning disabilities (LD) often cannot adequately report illness and there is evidence that treatable illnesses go undetected. As a direct result of Cardiff University research on health checking adults in primary care, the Welsh Government and the Department of Health now provide funding for all adults with LDs across England and Wales to receive an annual health check that employs Cardiff University methods. Current data on take-up (N=78,000 per year) and evaluation of results show that nearly 250,000 adults with LDs have had new health needs identified and treatments initiated during the REF assessment period (2008-2013). Nearly 40,000 adults per year will have new health needs identified and treatments initiated as a result of the health checks, with approximately 3,500 of these being potentially serious conditions.
Dr Lina Gega's research has been instrumental to the development and take-up of computerised Cognitive Behavioural Therapy (cCBT) and other technology-mediated interventions for common mental health problems in the UK and internationally. Gega's adjunct on-line methods form a key foundation for the training of professionals to support cCBT, and the National Institute for Health and Care Excellence (NICE) guidelines now include cCBT for first line intervention for common mental health problems. These developments have resulted in a greater patient reach for cCBT internationally, with resultant decreases in waiting time for patients (with associated economic benefit) and improved outcomes.
Research by the University of Southampton into maternal and child health in the developing world has contributed significantly to the design of better health policies by governments, international agencies, and non-governmental organisations. The research broke new ground in identifying the urban poor in developing countries as among the groups most at risk of poor maternal and child health. Its findings have informed policy and funding priorities at national and international organisations including the Department for International Development (DFID) and the United Nations; influenced health practitioners in Africa and Asia; and led to better health care outcomes in countries which were the focus of the research.
Evidence about the need for and provision of health visiting services generated through research undertaken at King's College London (KCL) has underpinned major changes in national policies for health visiting. Our findings about health visitors' practice, availability and distribution of services and effectiveness in terms of parenting/child outcomes, revealed both shortfalls in provision and opportunities for improvement and led to the development of a new caseload weighting tool and funding model for service planning. The accumulated evidence from this research helped convince the UK Government in 2010 to commit to 4,200 more health visitors by 2015 — a workforce expansion of nearly 50% — in a time of austerity and restraint elsewhere in the public sector.
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.