Published on February 24, 2014
Enhancing Mental Health (EMH) Theme Richard Morriss, Professor of Psychiatry and Community Mental Health, Theme Lead CLAHRC East Midlands University of Nottingham CLAHRC East Midlands is hosted by Nottinghamshire Healthcare
Current prevalence of mental health disorders in Europe Mental retardation 1.0 opiate dependence 0.4 OCD GAD 0.7 Eating disorder 0.9 Cannabis dependence 1.0 1.7 Specific phobia Psychotic disorder 1.2 Personality dis. 1.3 6.4 PTSD Social phobia 2.3 2.0 Conduct disorder Agoraphobia 3.0 Alcohol dependence 2.0 3.4 Somatoform disorders ADHD Panic disorder 4.9 1.8 5.0 0 Dementia 5.4 Unipolar depression 6.9 Insomnia 7.0 Anxiety disorders 14.0 0 2 4 6 8 10 12 14 Wittchen et al 2011 European Neuropsychopharmacology 4 8 12
Enhancing Mental Health Theme • All projects on common mental health conditions with both national and local policy (from CCG and/or HWB plans) to implement. • Already evidence to show effectiveness • Requires one piece of research to be completed before put into practice e.g. evidence in secondary care, policy in primary care. • CLAHRC research project also a model for how an intervention would be carried out in usual practice. • Uses same staff as in NHS practice, same setting, same outcomes or most relevant outcomes • 3 phases of projects, PhDs, direct involvement of practitioners, service users in projects in research and implementation.
Repeat use of emergency care Randomised controlled trial (RCT) of remotely delivered CBT for health anxiety in regular users of unscheduled care vs treatment as usual. Policy. CCG incentivised to reduce emergency admissions. Emergency admissions and contacts due to high health anxiety. IAPT given £400 million per year. Remote delivery of psychological treatment (mobile phone, internet, skype) – AHSN priority Expertise. RCT of CBT for health anxiety reduced health anxiety for 2 years (Lancet). CLAHRC NDL regular attenders project Research issue. Evidence base (6 RCTs) – none in UK primary or community care. CLAHRC study – IAPT unacceptable. Remote treatment at right pace with right therapist acceptable. Research question. Is remote delivered 6-10 session CBT for repeat unscheduled emergency care with health anxiety clinically and cost effective versus treatment as usual?
Repeat self harm and depression RCT of feasibility and acceptability of remotely delivered CBT for depression and repeat self-harm in young people (16-30 years). Policy. CCG incentivised to reduce emergency admissions and most prioritise suicide reduction. Suicides and admissions due to self-harm are on the rise. Depression and self-harm predict suicide and repeat self-harm. NICE CG133 - offer 10 session of problem solving therapy for repeat self-harm. No workforce to do this (IAPT and secondary care psychological treatment exclude). Only 25% attend face to face psychological treatment – 90% adolescents with depression with remote use. Expertise. CBT for depression in people suicide risk piloted in CLAHRC NDL. RCT of problem solving in this group done by staff in CLAHRC EM. Research question. Is remote delivered 10 session problem solving based CBT for depression and repeat self-harm feasible and acceptable and if so clinically and cost effective?
ADHD and objective testing RCT of new technology to improve diagnosis and management versus usual care in children and young people with ADHD. Policy. CCGs incentivised to adopt new technologies if evidence to support their use. Lack of objectivity and variation in diagnosis and management of attention deficit hyperactivity disorder (ADHD). 5% of all children. Children given stimulant medication. Qb Tech (Anglo-Swedish SME company) developed more objective measurement of attention and hyperactivity that is fun for children to complete. Expertise. National NIHR health technology centre for mental health (MindTech) based in Nottingham. QbTech. Research question. Does feedback of QbTest results to clinicians, children and parents by CAMHS and community paediatric staff improve time to diagnosis, time to stabilisation of symptoms and cost effectiveness versus treatment as usual?
Qb Test: Objective Assessment of ADHD • Computerised assessment of attention and activity • Supports clinical decision making • Provides patients with objective reports on their condition 7
Other work in phases 1 and 2 • Dementia in forensic, prison and other secure settings – prevalence and needs • Implementation study and 3 year follow up of specialist mood disorder team for depression – cost effectiveness.
Observed and Fitted HDRS17 scores 22 24 Observed and fitted mean HDRS17 by group over 12 month follow up 18 20 Moderate MDD 16 17.24 *p = 0.024 Mild MDD 14 14.88 0 5 10 month TAU Intervention TAU_fitted Intervention_fitted *Both sensitivity analyses significant P<0.05 15
Phase 3 projects? • • • • Common mental health problem Important policy in all East Midlands counties If research showed benefit and affordable, would we implement? Consultation throughout East Midlands, scientific review.
Thank you for listening Richard.Morriss@nottingham.ac.uk www.clahrc-em.nihr.ac.uk @CLAHRC_EM This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this presentation are those of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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