Annex 1: Cross-disciplinary Mental Health Network Plus grants

Transcription

1 Version: April 2019 Annex 1: Cross-disciplinary Mental Health Network Plus grants MARCH: Social, Cultural and Community Assets for Mental Health Dr Daisy Fancourt The 'MARCH' Network proposes that Assets for Resilient Communities lie at the heart of Mental Health (M-ARC-H), and is dedicated to advancing research into how these assets enhance public mental health and wellbeing, preventing mental illness and supporting those living with mental health conditions. Specifically, it will advance our understanding of the impact of social, cultural and community assets including the arts, culture, heritage, libraries, parks, community gardens, allotments, leisure centres, volunteer associations, social clubs and community groups (of which there are an anticipated 1 million in the UK). The network will bring together a Disciplinary Expert Group of researchers with a Policy Group of major national policy bodies, a Patient Public Involvement Group of national mental health charities, and a Community Engagement Group of national organisations. Across three years, our network will unite research with policy and practice to tackle critical questions of research priorities, methods, and implementation in this field; understand and resolve barriers to mobilising community assets; and provide training and support to the next generation of researchers. Specifically, our network will address questions organised in two core work streams: WS1: Cross-disciplinary research and challenges o (a) What evidence is there, from a cross-disciplinary perspective, for how and why community assets impact on public health and wellbeing and the lives of those living with mental health problems, and where are the gaps for future research? o (b) How can we use a cross-disciplinary approach to provide meaningful data to different stakeholders and users? WS2: Equity of engagement and access innovation o (a) Who amongst the UK population, demographically and geographically, currently engages with these programmes and how does participation vary dependent on mental health? o (b) What are the current barriers and enablers to engagement at an individual, organisational and policy level and how can we develop innovative approaches to enhance engagement, especially amongst the vulnerable? This research will be complemented by a rich portfolio of impact, engagement and training activities (see 'Impact Summary'). This network aligns with strategic priorities of the AHRC and ESRC as well as having a secondary relevance to the priorities of the MRC (through its consideration of the role of community assets and social prescribing to support medical approaches to mental health), NERC (through its exploration of the impact of green spaces) and EPSRC (through its focus on the opportunities provided by technology for driving research forwards). 1

2 It has also been designed in response to the Network Plus Research Agenda. In addition to the objectives already discussed, it is responsive to many of the mental health challenges cited in the agenda. For example, the call specification noted that only 25% of people with mental health problems receive ongoing treatment. Whilst there are recognised economic and resource constraints with delivering sufficient mental health services, this Network proposes to focus on the role that existing community assets could play in providing support to a much wider range of people in the UK, including those on waiting lists. As another example, the call specification raised that 70% of children and adolescents with mental health problems have not had appropriate interventions at an earlier age. This Network will involve working with policymakers and community organisations to see how research could help overcome barriers to access, with the aim of engaging more young people and those who are hard to reach. Overall, the network will seek to understand and support future research into how community assets could be mobilised to encourage more resilient individuals and communities, with a greater understanding of and capacity for selfmanagement of mental health. Loneliness and social isolation in mental health: proposal for a network for cross-disciplinary collaboration and capacity development Professor Sonia Johnson People are said to be lonely when they feel unpleasantly lacking in meaningful connections with other people. They are described as socially isolated when they have little social contact. Lonely people are more likely to be socially isolated, but the two do not always go together. Researchers have found that these states have significant impacts on physical and mental health. Some of this research is about loneliness and some about social isolation we plan to look at both alongside each other, as it can be difficult to disentangle their effects. The strongest evidence is on the impact of loneliness on physical health. For example, people who are persistently lonely tend to die earlier and have more heart disease. There is less research on loneliness and social isolation in mental health, but it's clear there are many links. For example, people who are lonely and/or socially isolated are more likely to become depressed, and depressed people who are lonely/lacking in social support recover less well than others. So by helping people to feel less lonely, some people could be prevented from developing mental health problems. Among people who already have mental health problems, strategies aimed at reducing loneliness and/or social isolation may help recovery. Some such strategies have been developed, for instance by charities. However, we don't yet have good evidence about how good these strategies are at reducing loneliness and social isolation, and about which are best for which people. We also don't know much about the extent to which they prevent people from developing mental health problems, or improve life for people who already have them. Challenges in trying to improve this evidence are the many different influences on loneliness and social isolation. For instance, people's genetic make-up, the way they tend to think about other people, their caring responsibilities, their disabilities, the architecture and layout of the area they live in, and their income and education are just some of things that influence whether people become lonely or isolated. 2

3 Possible ways of helping are also very varied. Talking treatments seem to help some lonely people. Other ways of helping include supporting people in rebuilding former relationships, or in getting involved in the arts, sport or religious practice. Digital ways of connecting may help some people. Another approach is to try to make a whole community, or even a country, friendlier and less divided. No one is an expert in all fields relevant to loneliness and social isolation and their relationship to mental health, and that's why this call is a great opportunity for us to get together a network that includes many different kinds of relevant experts. We will hold a series of events where people bring together their expertise to map out what we already know between us about this field. We will also involve throughout our activities a group of people with personal experience of mental health problems. They will work with researchers, and with charities and public organisations who are active in this field, to work out the priorities for further research that brings together different types of expertise. Once we've mapped the evidence and established research priorities, we will advertise to researchers within and outside our network an opportunity to carry out small projects that will help move this field forwards. There are some excellent young researchers in this field who have joined our network we aim especially to support them and other potential future leaders in applying for funding. The final stage will involve presenting the network's work widely. This will include papers and a conference for other researchers, meetings with policymakers, and discussions with professionals and the public about our findings and potential next steps. Our blogger collaborators (the Mental Elf and Mark Brown) and our roles in policy research will help us at this stage. Violence, Abuse and Mental Health: Opportunities for Change Professor Louise Howard Violence and abuse are endemic globally. In the most recent Crime Survey in England and Wales, 2% reported past-year community violence (where most victims were men). Domestic violence or abuse (physical, sexual, psychological, economic and controlling or coercive behaviour) in the last year was reported by 7.5% of women and 4.3% of men, with victims of repeated or severe domestic violence and/or sexual violence more likely to be women. Most previous mental health research has neglected the impact of domestic and sexual violence on mental health and wellbeing, so our network will prioritise these, and their links with childhood experiences, and mental health in childhood and adulthood. We know that people with mental health problems are more likely to be victims of domestic or sexual violence, or have witnessed parental violence as a child; some mental health problems are also, much less commonly, associated with committing violent acts, though there is very little known about this in relation to domestic violence perpetration. The UK government has recognised that preventing and reducing the impact of domestic and sexual violence and abuse is an important way to improve mental health. This network aims to reduce the prevalence of mental health problems among children, working age adults and the elderly, by bringing together experts with different ways of thinking about violence, abuse and mental health some will have personal experience of 3

4 these issues, others will have expertise from the work that they do, and survivor researchers have expertise born of lived experience and their work. Understanding, preventing and reducing the impact of violence and abuse on mental health requires that we resolve problems that have prevented progress in the past. Firstly, different organisations mean different things when they talk about violence and abuse. This has meant that violence and abuse, and mental health, are measured in different ways by different organisations, and that information collected about violence and abuse does not tell us what we need to know. For example, mental health surveys sometimes ask about violence, but do not ask about the relationship between the victim or perpetrator, what type of violence was experienced, or how it impacted on mental health. Secondly, we have limited knowledge of how and why experiencing different types of violence and abuse increases the risk of developing mental disorders, or how new digital technologies are changing people's experiences of abuse and how this impacts on mental health. Thirdly, we do not have interventions that are effective in preventing or reducing violence experienced by people with mental health problems, or programmes that reduce the risk of mental health problems developing after experiences of violence or abuse. Network activities will address these challenges through: 1) working with people who have personal experience of violence, abuse, and mental health problems to learn from different perspectives, and generate fresh ideas and research questions, with a focus on the commonest types of violence domestic and sexual violence and abuse 2) trying to answer research questions through small grant competitions, workshops, conferences, and other events; some of these will lead to larger grant applications 3) sharing measurement approaches, including how to ethically and safely research this area, which will help data collection and analysis by health services, the criminal justice system, family courts, social care, charities, and researchers. We will also develop an online resource providing information about datasets that can be used in research in the future. We aim to make our results known by publicising them widely through our network and other organisations, including policymakers within NHS England, Public Health England and the National Institute for Health and Social Care Excellence, technology companies and the general public. Transdisciplinary Research for the Improvement of Youth Mental Public Health (TRIUMPH) Network Professor Lisa McDaid Childhood and adolescence are recognised as key life stages that set the foundations for health in adulthood and for the future social and economic development of the societies young people live in. Yet, young people face extraordinary pressures on maintaining health in an ever-changing environment, driven by changes in technology, communications and the media that they are exposed to. This has coincided with an increasing prevalence of mental health problems, especially among girls. 4

5 The traditional sciences of psychology, psychiatry, and medicine often focus on understanding and solving health problems at the individual level, but many of the risk factors for poor mental health and wellbeing are driven by broader social and environmental factors and affected by the relationships we have, and the settings, neighbourhoods and communities we live within. A different approach is needed to find solutions to address these risk factors and improve mental health. It is important that this new approach takes young people themselves as the starting point to make sure that their voice is heard at every stage of the research process, including when we set research priorities, in codesigning interventions, running trials, and in dissemination. To achieve this, the Transdisciplinary Research for the Improvement of Youth Mental Public Health (TRIUMPH) Network will bring together young people, health practitioners, policymakers and those working with voluntary organisations, with academics from across clinical, social sciences, arts and humanities, design, and computer sciences disciplines. We will work together to find new ways to improve mental health and wellbeing, especially among vulnerable and disadvantaged populations where need is greatest. We will target our efforts at the peer groups, social networks and education settings with strongest influence on health behaviours in adolescence. The TRIUMPH Network will deliver a series of events and activities to focus our attention where mental health need is greatest. This will include workshops to understand the mental health problems facing young people, find possible solutions and take forward project ideas, and information exchange and community engagement events to share learning and increase the involvement of the groups and communities affected by youth mental health issues. Network funding will be used to support small research projects to seek and develop solutions to the mental health challenges that young people face and to prepare for larger funding applications to evaluate these. Young people will be invited, and supported, to take part in all of the activities of the Network. We will employ a Design Innovation approach using different visual methods and creative outputs to support engagement with young people from various backgrounds and to make the decision-making process more accessible. In employing a Research Associate with significant experience of participatory research with young people to lead on this work, we will ensure there is support in place for vulnerable young people who take part in the Network. The TRIUMPH Network will facilitate new research collaborations to strengthen the UK evidence base and, ultimately, to improve the mental health and wellbeing of young people across the UK. SMARtEN: Student Mental Health Research Network Dr Nicola Byrom Our vision is to change the Higher Education experience for all students and realise the ambition of an education system that supports students to thrive. Our network will build a comprehensive understanding of student mental health, including what good mental health means to students and the risk and protective factors that can be targeted to improve all students' mental health. There has been great political, public and professional concern about students' mental health. The mental wellbeing reported by university students is among the lowest across the population. The sector has seen a dramatic rise in help-seeking, with some institutions 5

6 reporting that one in four of their students are either being seen by the university counselling service or are waiting to be seen. In the five years from 2010 there was a 210% increase in students with experience of mental health problems dropping out of university, incurring tuition fee debt and yet unable to yield a 'graduate wage premium.' While there is an obvious loss of return on public investment when students drop out of university, there are also expansive opportunities for a Higher Education system to support young adults to thrive in the present and future. There is no clear narrative about the trends in student mental health or how best to respond. As such, developing effective solutions and allocating resources for a coherent institutional response is difficult and the potential for unintended consequences increases. The past 15 years have seen a rise in ad hoc arrangements of non-specialist, generic psychoemotional interventions at all levels of the education system, administered and promoted by a flourishing commercial market. Extensive discussion with stakeholders, including lecturers, heads of teaching departments and heads of university counselling and support services, shows ambivalence and disagreement about what is happening and how best to respond. Our cross-disciplinary team is committed to research and open-minded debate that looks at the balance between risk and benefit, addresses the contested and complicated questions and does not assume that any intervention must be a "good thing" in and of itself. The starting point for our network is that there is no single answer to understanding the challenges for student mental health, no single solution and no single discipline that can address all of the challenges. Our team brings together researchers with expertise in student wellbeing, psychology, epidemiology, social and economic research, anthropology, ethnography, informatics, social media, big data, arts, culture, education, behavioural science and mental health. As the network develops we will engage still more diverse experience and expertise. The focus of the network will be to understand student mental health and mental health problems. We will address three questions; (1) What is distinctive about the mental health experiences of students? (2) What factors influence student mental health? (3) What can non-clinical universal approaches to student mental health achieve? Engagement with students and key stakeholders (student support services, educators and clinicians) will maximise the benefits and impact of research and encourage knowledge exchange. Student engagement will be central to the network's core activities and include the development of a Student Research Team, a Priority Setting Partnership to establish students' priority research questions, two student-led mental health conferences and strong engagement across the other network activities. Network activities will focus on four 'plus' funding rounds with each round including workshops and activities to support knowledge exchange, encourage collaboration, facilitate user engagement, and support creative applications from early career researchers. The Nurture Network: Promoting Young People's Mental Health in a Digital World Professor Gordon Harold 6

7 Promoting improved understanding of how children's daily lives are influenced by the digital world that now surrounds them, and how they experience family, peer and school life as a result, represents a substantial challenge and opportunity to facilitate positive mental health and development for children and young people. Historically, researchers have emphasised the role of supportive parenting and positive school experiences (including peer relationships) as primary social environmental influences on children's mental health, with most interventions targeting family and school-based influences aimed at remediating poor mental health outcomes for children and young people. It is increasingly recognised that the digital environment constitutes a new dimension or common denominator to these traditional agencies of socialisation influence on children's mental health. Yet, little progress has been made in equipping parents, teachers and the professional agencies that work with families and schools with new knowledge that harnesses potential strengths while offering protection from substantial risks posed to children by the digital world. How do we equip parents, teachers, practitioners, policy makers and youth themselves with information, support and resources that promotes positive mental health in a contemporary (and future) digital age? Addressing this core challenge represents the primary objective of our multi-disciplinary e-nurture network. While significant advances have been made in relation to highlighting and understanding the genetic and biological underpinnings of poor mental health and mental health disorders in recent years, it is recognised that the social environments children experience and interact with remain a substantial influence on their positive and negative mental health trajectories (even when genetic factors are considered). Three primary areas of social environmental influence on children's mental health have dominated past research and practice in this area. First, family socialisation processes, specifically parenting practices are recognised as a substantive influence on children's mental health. Second, peer influences are noted as an important influence on children's mental health. Third, school-based factors are recognised as a further influence on children's mental health and development. Increasingly, the digital environment is recognised as a factor that both infuses traditional agencies of socialisation for children and that can influence children directly. Policymakers have recently directed significant attention to the prevalence rates and support needs among children and young people who experience mental health problems. The digital environment and its potential for positive and negative influences on children's wellbeing, mental health and development has also received substantial research, policy and media attention. Building on this policy platform, the primary objectives of our network are to: (1) explore how the digital environment has changed the ways in which children experience and interact with family, school and peer-based influences and what these changes mean for children's mental health (2) identify how we can recognise and disentangle digital risks from opportunities when working with families, schools and professional agencies in developing intervention programmes to improve mental health outcomes for children and young people (3) identify how we effectively incorporate and disseminate this new knowledge to engage present and future practice models, and the design and development of digital 7

8 platforms and interventions aimed at promoting mental health and reducing negative mental health trajectories for young people. The network will engage a collaborative, cross-sectoral approach to facilitating impacts by directly engaging academic, charity, industry, policy and front-line beneficiaries (e.g. families, parents, schools, teachers, children and young people). Emerging Minds: Action for Child Mental Health Professor Cathy Cresswell Approximately one in ten children and young people have a diagnosable mental health problem. Mental health problems in childhood and adolescence bring significant emotional, social and educational disadvantage, and present a risk for ongoing mental health problems in adulthood. As such, recent influential policy documents (including Future in Mind, The Five Year Forward View for Mental Health, Transforming children and young people's mental health provision: a green paper) highlight the need to prioritise the promotion of good mental health, and the prevention of and early intervention for mental health difficulties in children and young people Our vision is to see the number of children and young people who experience mental health problems halved within 20 years. The best way to meet this ambitious goal is to make full use of what is already known from developmental psychopathology research, and to draw on knowledge and expertise from other disciplines to establish the best ways to enable this research to reach and benefit large numbers of children, young people and families. In terms of mental health promotion, research has identified robust predictors of the emergence and persistence of mental health problems in children and young people. However, considerable challenges remain in the implementation of this knowledge to promote good mental health and prevent mental health difficulties among children and young people, including barriers associated with stigma and a lack of sustainable and scalable methods of delivery. In terms of early intervention, child and adolescent mental health research has also had success in the development of effective interventions for common mental health problems; however, only a small minority of children and young people with mental health conditions receive effective support. Furthermore, even where children meet thresholds for referral to specialist mental health services, they frequently experience long delays in accessing care. This Network will facilitate novel research to increase the reach of effective mental health promotion, and prevention of and early intervention for mental health problems across a range of settings. We will bring together academics from health research, arts, design, humanities and physical science disciplines in order to develop creative, sustainable stakeholder-led solutions based on an understanding of, for example, what has made health messages 'stick' (medical history, design theory, history of design); where, in what format and how to present information and interventions at scale in ways that maintain trust and security (media, sociology, information design, computer science). The Network will include a broad range of stakeholders, including children, young people and carers with relevant lived experience, third sector partners, practitioners, policymakers, heritage professionals and industrial partners. This will ensure that the research reflects the 8

9 needs of potential beneficiaries and the current practical and policy context, and that solutions are developed that are scalable and sustainable to promote widespread dissemination. Improving health and reducing health inequalities for people with severe mental illness: the 'Closing the Gap' Network+ - Professor Simon Gilbody People with severe mental illness (SMI) such as schizophrenia and bipolar illness die on average years earlier than those without such disorders. The causes of reduced life expectancy are things such as heart disease or diabetes (and its complications) or cancers associated with lifestyle factors. Rates of smoking and obesity are much higher in this population, and people with SMI often lead sedentary lives. Housing is often poor, and people do not benefit from the opportunities offered by exercise and interaction with the natural environment. The need to improve physical health is recognised in a document known as the Five Year Forward View (FYFV) for Mental Health, where it is described as 'one of the greatest health inequalities in England'. Any solutions to these complex problems require collaboration between researchers from different backgrounds and with different skills. For research to have impact, it is important that people with experience of SMI (and those who care for them) are involved from the outset. The University of York has a set of researchers with complementary perspectives who have not historically worked together. We will produce research that addresses and reduces this mortality gap. Our plan is to grow our Network with the help of the funds offered, and we will deliver a programme of research and collaboration. Our activities will be overseen by a steering committee with local, national and international expertise. The initial activities of our network will involve four areas of work: The first is led by international experts in how people interact with and benefit from natural environments ('green- and blue-space'). The second area of work will seek to harness the potential of the large amounts of information that are recorded on how people with SMI use health services and the natural environment ('big data'). We will make links between data that have not been connected before. The third area of work will explore the potential of digital technologies (such as smartphones and 'apps') to improve the physical health of people with SMI. The fourth area of work will explore the potential of the arts and creativity to understand and improve the physical health and wellbeing of people with SMI. Collaboration is at the centre of this Network, and we have put in place a plan to ensure that researchers work together to find creative solutions to the problem of the mortality gap. We have also identified issues which cut across the four research areas that we have prioritised. One factor which links each of the themes is the inequality that people with SMI experience when compared to the rest of the population. We have enlisted a research team with a very strong track record in this area. 9

10 Our Network will run over four years. During this time we will hold events which will encourage collaboration and where new members are added to the Network. Investments will stimulate new initiatives and collaborations. Research in this area is challenging and takes time. Our task will be made easier because we bring to this collaboration a number of resources including a group of people with SMI who have already agreed to be invited to take part in research. In preparing this bid we have assembled partners from the NHS, social care services, environment organisations, local government, business and the voluntary sector. We have formed a collaboration with an important national charity who represent the interests of people with mental ill health (the Mental Health Foundation). From the beginning we will think about how the results of our research can have impact in society. We see the CTG-Network+ as a springboard for a much larger and long-lasting programme of work to address health inequality for people with SMI. Whilst the work of the Network+ will start in the University of York, we will ensure that we form strategic alliances with people working in other universities in the UK (and internationally). 10