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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.
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.
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.
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.
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.
Schizophrenia affects 1.1% of the adult population. It is one of the most debilitating of the psychiatric disorders, leading to costs of approximately £12Bn/year in the UK. Historically one of the major gaps in service provision has been any approach to prevention, whether primary or secondary. University of Birmingham pioneered the concept and practice of early intervention in psychosis, which is a key feature and indication of schizophrenia. This has gone on to have national and international impact on mental health care. This approach has been recommended in NICE Guidance, the Mental Health Strategy and is a requirement of the NHS Operating Framework for 2011/12. It has resulted in improved outcomes. Evaluation of this approach has found that is preferred by clients, reduces the suicide rate, reduces lost productivity due to illness and over three years the long term benefit of early intervention is between £17,427 and £36,632 per patient compared to standard care. In addition the success of early intervention in schizophrenia has impacted on wider mental health policy and practice, resulting in the development of similar approaches in other areas of 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.
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.
The pioneering work undertaken at UCL has had a major impact on clinical practice for the treatment of self-harming, suicidal patients with a diagnosis of borderline personality disorder and the techniques have been drawn on in extensions to other common mental disorders including eating disorder, substance misuse, and antisocial personality disorder. This treatment, known as mentalisation based therapy or MBT, has since been applied in a range of clinical settings including inpatient and outpatient work in the UK and internationally. This case study presents two areas in particular where our research has been applied: the treatment of personality disorders, and in work with troubled adolescents.
The Greenwood Institute of Child Health is a unique collaboration between the University and public service providers such as the NHS, which aims to improve psychological outcomes for children in high-risk settings. From 1993 to 2013, Greenwood's research has highlighted the increased risk of mental health, drug dependence and criminal activity among children who suffer trauma — through abuse, living in care, homelessness or war. Greenwood's programme of research has identified the complex and persistent needs of vulnerable children and contributed to changes in policy guidelines and service provision across social care in the UK (foster care / adoption, juvenile detention and homelessness) and abroad (war). Collaboration between researchers at the Greenwood Institute, service providers and practitioners has been instrumental in the establishment of clinically relevant and cost-effective care pathways, while community engagement has led to improved service provision and outcomes for vulnerable children and their families / carers in the UK and further afield.