Mental health review consultation by lq9085

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									Strategic Review of Mental Health and Wellbeing


Review Consultation Paper

                August 2009
Introduction

The Medical Research Council (MRC) has been given the role to lead on mental
health as a public health theme on behalf of the Office of Strategic Coordination
of Health Research. As part of this, the MRC is now developing a research
strategy for mental health across the biological, medical and health research
sectors. Key drivers behind the exercise are the significant burden of mental
health on care systems and society and the increasing priority of mental health
for a number of key policy leaders. The review will consider future research
opportunities and tractable priorities for investigation. It will recommend a
strategy for investment over both the short to medium term.

In order to deliver a strategic framework for mental health research and a
potential bid to the next Treasury spending review, a Strategic Group
(membership and Terms of Reference at Annex 1) was set up. This group agreed
to divide mental health into four themes (see below) to be overseen by Sub-
groups. As part of their work, each Sub-group held a workshop with an invited
group of experts. Each Sub-group then summarised the workshop outcomes by
answering a series of generic questions.


Themes for mental health review

      Anxiety and depression
      Psychosis and severe mental illness
      Intellectual/learning disabilities and neurodevelopmental disorders
      Pathways to mental wellbeing


The Review Consultation

The MRC wishes to further consult a wide range of individuals, groups and
organisations to increase the opportunity for potential stakeholders to present
views and evidence. This consultation is based on the questions addressed and
the themes that emerged at the four Sub-group workshops. The views drawn
from this further consultation will inform the ongoing work of the review and feed
into the recommendations to be reported in December 2009. Responses to the
consultation will be considered alongside further discussion by the Strategic
Group.


Consultation Process

A series of questions are set out below that cover the key cross-cutting issues of
the review. We would welcome your views on any or all of the questions. We
suggest you give your response as a series of bullet points in order to facilitate
analysis of the responses. Please send in your comments by 19th September
2009.

Responses    should    be   emailed          to    Dr     Leanne     Rivers    at
leanne.rivers@headoffice.mrc.ac.uk




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Method of Evaluation.

An analysis will be undertaken on a question by question basis. Feedback from
the responses to the consultation will be posted on the MRC Website at
www.mrc.ac.uk when the final report has been considered by the MRC Strategy
Board.

Confidentiality

Please note that any information you provide may have to be disclosed in
accordance with the Freedom of Information Act (2000) and the Data Protection
Act (1998). Where any respondent wishes their response to remain anonymous
this will be considered by the review team. Any individual’s names and personal
contact details will be removed.




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Mental Health and Wellbeing: Consultation Questions.

The questions below are grouped around four cross-cutting issues:

   a) Opportunities for UK mental health research based on current strengths
      and weaknesses
   b) Research Infrastructure and personnel
   c) Engaging stakeholders
   d) Specific, thematic priorities


a. Opportunities for UK mental health research based on current
strengths and weaknesses


Question 1: What weaknesses in UK research into mental illness and wellbeing
are apparent and in which areas could the UK make an impact with some
targeted investment?

Response from MHRUK
1. The main weakness has been lack of funding. There is also a concern that
research into mental illness is ‘risky’ in that the people who are the subjects of
the research may lead chaotic lives and may therefore be difficult to research.
There have however been many successful pieces of research into mental illness
which are exemplars of what can be achieved.
2. Targeted investment into basic research building on UK strengths.
3. Targeted investment into research into wellbeing where there is some very
good work eg Recovery, social inclusion, employment

Question 2: Related to the above, what are the research opportunities in the
light of other UK and international activity? What strengths should the UK play to,
and what should we avoid doing?

Response from MHRUK
1. We do not have a sufficiently broad view of all UK research strengths but
imaging (eg fMRI) is one strength. In general terms looking at our strengths and
investing in them.
2. One small area where there is particular expertise is in forensic mental health
research – this is unlikely to ever be funded by private money (eg charities) so
effectively would have to be from public (government) sources.
3. Opportunities because of the NHS infrastructure and the Mental Health
Research Network.

Question 3: What are the immediate and tractable priorities for investigation
that would make an impact using existing resources (say £3-5m) in the short
term (next 2 years)?

Response from MHRUK
1. Possibly utilisation of existing cohort studies




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Question 4: What should be the medium and longer-term aims of a mental
health strategy that would improve public health for which additional investment
would need to be sought at a level of, say £10m, over the next 2-7 years?

Response from MHRUK
1. We assume this question means a mental health research strategy? If so
research into causes of mental illness, particularly in relation to biological and
neurological aspects and genetics
2. Development of new drugs for schizophrenia would make a big impact.
3. Reducing stigma is crucial to improving public health.
4. Improving opportunities for employment and volunteering for people with
mental illness would improve public health and should be evidence based – with
gaps in the evidence filled where needed


b. Research infrastructure and personnel

Question 5: How best could we exploit current cohorts to examine factors
influencing mental health and wellbeing? Are any new cohorts needed and if so,
for what purpose?

Response from MHRUK
1. Existing cohorts may well provide good epidemiological information about
common mental health problems but the psychoses are too rare for general
population cohorts to provide enough cases.
2. Cohort studies of children with eg ADHD or conduct disorder if they do not
exist already could be a high priority for treatment trials and also learning about
what influences their later life chances.

Question6: What are the opportunities and barriers to access to biological
resources (e.g. genetics, bioinformatics or biological samples), clinical networks,
imaging etc.

Response from MHRUK
1. Informed consent might be a particular problem (not unique to studies of
mental illness but possibly rather more difficult because of issues of mental
capacity)

Question 7: How can information technology and e-resources be harnessed for
the promotion of research into mental health and wellbeing?

Question 8: What are the priorities in building capacity and providing research
training for personnel in mental health?

Response from MHRUK
1. Research training: this should be part of the training for psychiatrists, nurses,
psychologists and other allied health professionals working in mental health
settings and while in training.
2. Encouraging health professionals to undertake research with experienced
researchers
3. Capacity building through a range of PhD bursaries, post-doctoral fellowships
and career management with experienced supervisors and mentors, so that there
is a good career pathway for people with talent



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c. Engaging stakeholders

Question 9: How could users best be engaged in the design of studies?

Response from MHRUK
1. Experience with the adoptions procedure for the Mental Health Research
Network, where one criterion for acceptance of a study is real service user
contribution to design, suggests that engaging with service users in a non-
tokenistic way can improve the design of studies and address issues such as what
might make informed consent difficult.
2. Mental health service users and their carers can be very powerful advocates for
changes in services. In cancer research people with cancer have been very
powerful advocates for research. Engaging with mental health service users could
pay dividends in dispelling anxieties about research and demystifying it. (See
below the comment on www.TriMe.org.uk as means of doing this.)
3. In the NHS development of communities of interest around research in the
context of Membership of NHS Foundation Trusts which are research active might
be a way of engaging service users in research.
4. It is important to differentiate service user led research which is likely to be at
the social science end of the spectrum from the hard science end which is less
likely to engage service user interest unless very well presented in lay terms; the
real progress is likely to be made at the hard science end.

Question 10: Do you have any views on how the MRC could develop stronger
links between academia and industry to facilitate drug development and
evaluation?

Response from MHRUK
1. There is undoubtedly a need for better treatments for major psychoses
including schizophrenia to be developed and working with industry is essential if
this is to happen.
2. In the NHS we have the ideal test bed for clinical trials and an infrastructure to
support it (the Mental Health Research Network) but we suspect that psychiatrists
may be research-averse outside the major research centres.
3. More work needs to be done to encourage industry to invest in research in this
country and this will mean incentives for clinicians to participate in research.

Question 11: What role could interdisciplinary research play in the longer-term
strategy in delivering public health needs (i.e. within biomedical research and
within population and social science?)

Response from MHRUK
1. Better understanding causes of mental illness will lead to possibilities for
prevention and also early detection. Interdisciplinary research will be essential to
capitalise on the opportunities offered by the hard science. Economics, social
science, nursing, psychology for example will all have a part to play.

Question 12: Consider how the MRC and OSCHR partners might develop a joint
strategy with stakeholders to reduce stigma and raise the profile of the health
needs of those affected by mental health issues.

Response from MHRUK




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1. The stigma associated with mental illness is probably the main reason why
there has not, up to now, been a charity dedicated to research into causes of and
cures for mental illness. There are numerous examples of charities devoted to
other conditions eg specific cancers, that have been started by the families of
those suffering from that condition. This does not happen in the families of people
suffering from mental illness. In many ways this is a chicken and egg situation. If
there was more hope for those suffering from mental illness which would come
out of discoveries from research, then there would be more willingness to support
research. There are two initiatives that may have a positive influence: the Time to
Change Campaign and the Recovery Movement. Working with Time to Change
might be explored readily.
2. The Department of Health funded a web site called TrIme (www.TrIMe.org.uk)
which posted lay summaries of research into mental illness for people with mental
health problems and also for the general public. Revitalising this site could be a
very positive move.


d. Specific, thematic priorities

Question 13: Are there any specific areas of UK mental health research that are
under funded?

Response from MHRUK
1. Research into common mental illness is underfunded given the high prevalence
(1 in 4 at some point in a lifetime with a burden in terms of disability adjusted life
years of mental illness exceeding that of cancer and heart disease)
2. Suicide research is underfunded.
3. There are few clinical trials though the MRC Trial Platforms initiative was
helpful in developing ideas and pilot studies for trials. Psychological therapies and
trials of combinations of drugs and psychological treatments would be particularly
welcome
4. Forensic mental health is an area where funding is particularly difficult to win.
Reasons for this may included a perception that it is a minority interest (yet
people with mental illness with a history of offending are a huge drain on the
economy).



Question 14: What are the specific priorities in the following topics?

a) Underpinning research and aetiology

Response from MHRUK
1. This seems to be the area where investment could best be targeted by MRC
and other major funders. Without much better knowledge of aetiology and
mechanisms we cannot progress towards prevention and cure.




b) Prevention of disease and conditions, and promotion of wellbeing
c) Detection, screening and diagnosis



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d) Development and evaluation of treatments and therapeutic interventions
   (including clinical trials)

Response from MHRUK
1. Trials into psychological interventions with and without drug treatment are of
high priority
2. New drug treatments for schizophrenia without the side-effects of existing
drugs

e) Management of diseases and conditions (including Service Delivery and
   Organisation)

Response from MHRUK
1. New Horizons the successor to the National Service Framework for Mental
Health (currently out for consultation) makes no reference to research yet there
are service developments within it which will need to be researched. The NIHR
SDO Programme is well placed to fund such research if the specific research
questions can be well-articulated.

f) Health and Social Care Services Research




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                                                                         Annex 1


Membership of Mental Health Strategy Group*
Professor Christopher Kennard (Chairman: University of Oxford)
Professor Sally Ann Cooper (University of Glasgow)
Professor Nicholas Craddock (Cardiff University)
Professor Bill Deakin (University of Manchester)
Professor John Geddes (University of Oxford)
Professor Guy Goodwin (University of Oxford)
Professor Jonathan Hill (University of Manchester)
Professor Rene Khan (University of Utrecht)
Professor Peter McGuffin (Kings College London)
Professor Barbara Sahakian (University of Cambridge)
Mrs Marjorie Wallace (SANE)
Dr Glenn Wells (NIHR)
Professor Til Wykes (Kings College London)

* other members and stakeholders will be co-opted

Terms of Reference

      i)     To consider the strengths and weaknesses of the MRC/NIHR
             portfolio of mental health research in the light of other UK and
             international activity

      ii)    To advise MRC/NIHR on future research and training opportunities
             and tractable priorities for improving mental health activity

      iii)   To recommend a strategy for investment in mental health research
             over the short to medium term (2 to 7 years), addressing the
             biological, psychosocial and public health needs of the area activity

      iv)    To advise on the optimal approach for future investment

      v)     To advise on future capacity building needs

      vi)    To consider ways of reducing the stigmas attached to mental health
             and raising the profile of the mental health needs of the population




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