Research in East London has influenced public and professional debates on policy and clinical issues in mental health care on local, national and international levels.
Researchers in the Trust published a large number of peer reviewed scientific papers with a range of important results. Most notably, they published the largest study ever to be conducted about a specific aspect of continuity of care, i.e. as the whether the same or different psychiatrists should be responsible for in- and out-patient care (Giacco et al. Epidemiology and Psychiatric Sciences, 2018, 1-9). The main result was that continuity of care leads to higher patient satisfaction after hospital admission, but is not linked with significant differences in long term outcomes.
Particular successes of research in the Trust during 2018/19 included a significant milestone for ELFT in service user involvement. The PRIDE study (Curwen et al. Research Involvement and Engagement, 2019, 5:5) was planned, conducted and published in collaboration between service users, clinicians and researchers and may be the first time service users actually not only defined the research topic but were also trained to become the research assistants and conducted the qualitative analysis of data.
ELFT continues to attract prestigious National Institute for Health Research (NIHR) research grants. In September 2018, the ERA trial started. It is funded by the NIHR’s Health Technology Assessment (HTA) programme. The trial is led by Catherine Carr and tests the effectiveness of art, music and dance-movement therapy delivered in diagnostically mixed groups for community patients. It is the largest and methodologically most rigorous trial ever conducted on arts therapies in such settings and run mainly in ELFT (with one further site in Avon and Wiltshire).
In May 2019, work commenced on an NIHR Health Services and Delivery Research (HS&DR) grant called Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM) which is being led by Stefan Priebe in collaboration with Jelena Jankovic in Birmingham.
The Trust was also awarded an NIHR Research for Patient Benefit (RfPB) grant to try Improving the Accuracy and Efficiency of Autism Assessment for Adults. This project is led by Will Mandy of University College London in collaboration with Jason Crabtree in ELFT’s Learning Disabilities services and the study began in September 2019.
The East London NHS Foundation Trust in partnership with the City, University of London organised a conference in November 2018 where renowned speakers and delegates from across the country took part in a thought-provoking conference held to explore and challenge a key issue in mental health care.
Professors Tom Burns, David Kingdon and Alan Simpson outlined the historical context to developments and explored whether the Care Programme Approach (CPA) model, now nearly 30 years old, is still relevant today following changes in thinking about the delivery of mental health care, the increasing involvement of service users, and a focus on recovery.
Professor Stefan Priebe presented the research evidence from trials on patient related outcome measures and a structured solution focused engagement (DIALOG+) underpinning recent developments, before Dr Sri Kalidindi concluded by summarising the importance of care planning in good rehabilitation services.
2. Contributions to National Debates in Mental Health Care
There are several on-going debates that have been sparked and informed by research in the Trust. Examples are:
- the use of financial incentives to improve medication adherence
- self-harm by inpatients on acute psychiatric wards
- the most appropriate care for serious violent and sexual offenders
- the implications of hazardous drinking; and
- the future of mental health care in the light of trends towards 're-institutionalisation' that has been shown across various countries in central and western Europe.
3. Contribution to Service Improvements in the Trust
Our research has also benefited patients in East London directly. The design of several services in the Trust have been heavily influenced by our research. This contributed to their successful commissioning.
- The Day Hospital in Newham, which has been shown to be more effective than conventional in-patient care
- The Dialectical Behaviour Therapy (DBT) Service for patients with Borderline Personality Disorder in Newham, which has been evaluated in a rigorous trial. The study prompted the NHS to fund increased capacity of the service.
- Non-verbal therapies, which were studied in two trials in the Trust. A successful study on Body Psychotherapy in the treatment of negative symptoms of schizophrenia contributed to the NICE recommendation for such therapies. It also influenced the strategy for non-verbal therapies of the Trust. The strategy is being implemented.
- Dialog/Dialog+ is a therapeutic intervention that improves the communication between a health professional and patient and, through that, outcomes of mental health care. It has been successfully implemented in a number of services across the trust.
4. World Health Organisation (WHO) Collaborating Centre
The Unit for Social and Community Psychiatry is a designated World Health Organization (WHO) Collaborating Centre. The Unit is one of currently only 14 mental health related WHO Collaborating Centres in Europe and the only one specifically for 'mental health services development' in the world. The role of the this Centre involved the publication of a Technical Guidance for Mental Health Promotion and Mental Health Care for Refugees and Migrants, which the WHO issued to all Governments in Europe (authors Domenico Giacco and Stefan Priebe), and the advisory role of Professor Priebe on the National Mental Health Strategy for Malta which was launched in December 2018.
The Unit is supported both by the Trust and Queen Mary University of London. It is based at the Trust's Newham Centre for Mental Health.