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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.
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.
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.
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.
Time to Change (TTC) is a national programme to reduce stigma and discrimination related to mental health. King's College London (KCL) researchers have conducted most of the original research that led to the intervention, had a major role in planning TTC with two leading mental health charities, Mind and Rethink Mental Illness, and have led the evaluation of the programme. That TTC is making a difference across England is evidenced by gradual positive changes in attitudes and behaviour. KCL measures are also being used by the UK Government and to evaluate anti-stigma campaigns in Denmark, New Zealand and Sweden.
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.
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 describes the impact of practice-led research in health and social care settings. There are three main areas of impact to this research:
Research by Bhui 1996-2013 showed striking differences by ethnic group in diagnosis and management of mental health disorders due to a complex interplay of socio-cultural factors and different perspectives of patients and professionals. Impacts included: [a] the development and implementation of a UK-wide mental health policy 'Delivering Race Equality'; [b] a national training and workforce development programme that shifted the conceptual paradigm from the cultural competencies of individuals to system-wide intervention (called `cultural consultation'); [c] service development research `Enhancing Pathways into Care' (EPIC) to implement findings and draw lessons across four NHS Trusts; [d] incorporation of research findings into national and international guidelines, and influence on mental health legislation and policy; and [e] a new phase of research on implementing findings.
Housing and regeneration programmes both in the UK and internationally have struggled to have lasting impacts upon the places where they are enacted. The University of Glasgow's research and learning programme, GoWell, has worked across a wide range of policy sectors together to improve the circumstances of deprived communities. Specifically, GoWell has: supported the framing of strategy and policy objectives around social regeneration and health outcomes; assisted the definition and understanding of policy problems, such as around the link between `overprovision' of alcohol outlets and local crime rates; proposed the design of new policy instruments such as the Scottish Neighbourhood Quality Standard; and contributed to the monitoring and evaluation of policy implementation by showing how health and wellbeing indicators could be used to measure responsiveness to residential change.