This programme focuses on developing the evidence base of mental health care and service user and carer involvement in mental health care research. Below are details of the past and current projects that fall under this programme.
Follow this link for information regarding the Mental Health Research & Knowledge Exchange Network (MHRKEN)|.
The views and experiences of services users regarding illicit drugs use in secure settings
Project leader: Dr Doug MacInnes
Partner: Oxleas NHS Foundation Trust
Background: The use of illicit drugs within medium secure units (MSUs) is a major problem although not one that makes the headlines as much as drug use within prisons. In fact, MSUs have often been ignored when it comes to drug use surveys, only included as part of wider studies of substance misuse. Yet the rate of misuse in MSUs is significantly higher than in the general population, with more than twice the lifetime prevalence. Drug-using service users are also younger than non-drug users admitted to medium secure units and continued illicit drug use is a significant predictor of relapse - with all the consequent costs for the individual and society. Obtaining accurate information, however, has been difficult due to the reluctance of users to report their own substance use, believing - rightly or wrongly - that the courts might look unfavourably on their cases if widespread use is reported.
Aim: To gain a better understanding of service users' use of illicit drugs in MSUs. To detail the participants' specific life experiences of illicit drug use. Also to describe the frequency, circumstances, effects and attitudes when illicit drug use takes place in an MSU.
Methods: Because drug users within MSUs are very sensitive about reporting their use and wary of outside professionals, normal research methods might be unsuccessful in giving a true picture of the situation. Therefore a collaborative research project is proposed with a service user member of the research team trained to take the lead in the collection of data through qualitative interviewing techniques. The service user will also take part in the data analysis, bringing expertise that the academic team lacks. Fifteen in-depth interviews will be conducted with in-patients according to a topic schedule, with purposive sampling used. It is proposed to have two meetings with each participant. The first will focus on discovering their attitudes and experiences of illicit drug use with specific reference to use in the MSU. The second meeting will relay the data from the first meetings, comment upon them and discuss whether the respondents' views had changed in light of any further consideration. Thematic analysis will be used to examine the in-depth interview data. The interviews will all take place in quiet, non-distracting environments such as individual offices or quiet rooms. The interviews will be taped and then transcribed.
Expected outcomes: The findings are expected to provide useful information for improving interventions, which should result in reduced overall use and relapse.
Survey of psychological health of first year undergraduates at Kent universities
Project leader: Dr Doug MacInnes
Background: Mental health problems often contribute to students failing to complete their studies, which means not only distress, lost years and possibly enduring problems to the sufferers, but a waste of money and resources to the institutions where they were studying and losses to the country from the lack of well-qualified graduates who should be contributing to the nation's economy and social welfare. If universities were to develop their mental health policies and support services in the light of the study's findings, they may be able to reduce the scale of these problems, meaning more successful graduates and fewer people in the general population suffering from mental health issues.
Aim: The general psychological wellbeing of the student population was studied, as was the type of mental health problems students in Kent experience. The stress factors which cause such problems were also determined as this is key to reducing the effects in the future. The project focused on measuring changes in the students' psychological health during the first six months in higher education - as this was thought to be a critical time - and students' support-seeking behaviour to determine how best to put the students in contact with professionals who can help them through their problems.
Methods: A prospective longitudinal survey with data collected at two time points was used. The surveys took the form of self-completion questionnaires. The first survey was conducted during the first term in 2007 and the second in spring 2008. The questionnaires were administered on university campuses in Canterbury and Medway. In total 731 students were surveyed. The first data recorded how stress affected performance and drug and alcohol use. The second set of data also assessed how a range of issues, such as physical health concerns and psychological problems affected academic performance.
Findings: The main stress factors were found to be academic pressures, often related to managing their coursework; and concern about employment in the future - although it should be noted that this research was carried out before the recession which began in late 2008 and which could add to such worries, which could mean a worsening problem during the economic downturn. When they sought help, students would usually turn to their personal tutors. Stress levels by the end of the second term were found to be much lower than in the first term, which suggests that the students were 'getting the hang' of academic life fairly quickly. The findings, which suggest increased provision of support in the earliest period of student life and increased training for personal tutors could relieve the students with problems and prevent them from dropping out, have been useful to universities trying to combat this problem.
An examination of the factors that influence the publication or non-publication of mental health nursing research presented at national or international nursing conferences
Project leader: Dr Doug MacInnes
Background: Mental health nurses are required to be able to identify and access the current evidence surrounding a particular topic and evaluate and decide upon the best care approach to people with mental health problems. This is aided by specific guidance on how to facilitate access to and deliver the best quality evidence-based care. This is most commonly acquired by accessing evidence through hand searching publications or through electronic sources. However, evidence indicates that only a small proportion of mental health nursing research is published and that many nurses carry out research that is not published. Although it is difficult to judge the quality of unpublished research the likelihood is that a number of high quality mental health nursing research projects are not published and are therefore not available to be evaluated as part of the evidence base of care. There has been relatively little examination of the reasons underpinning publication of nursing research.
Aim: To examine the factors that influence the publication or non-publication of mental health nursing research presented at national or international nursing conferences in the UK.
Methods: A Delphi Approach to identify what were perceived as important factors contributing to non-publication of mental health nursing research; Recording and categorisation of conference research presentations delivered at four national and international nursing conferences in 2003; Semi-structured interviews or self report questionnaires with UK based mental health nurses who presented a research based paper at one of these conferences.
Findings: Five factors were viewed as important in determining whether a presentation was subsequently published: time, credibility, support, personal factors and work. The most widely reported factor was the support received from colleagues and the journal. Time and credibility were also found to be significantly associated with the likelihood of publication.
Types of support required by carers in two forensic mental health units
Project leader: Dr Doug MacInnes
Partners: The Bracton Centre, The Trevor Gibbens Unit, The Princess Royal Trust for Carers and Families/Friends and Carers Together in Research (FACTOR)
Background: People with severe mental health problems rely on their families more than on the health system for care. With 53% of mental health service users living with a family carer more than 15 years following their first admission, those families feel the strain physically, psychologically and emotionally. The result of a carer's altruism in looking after their relative is often stress and distress, leaving a second person suffering from the problems of the first. But family carers are vital to the sufferer and to the state - without them many people with a mental illness could not live independently and the overall cost of community care would be much higher. To help carers, the government has launched the Carers' Strategy and local implementation will require organisations to consider the plan and how it should be applied on the ground. The vision is that carers will be respected as expert care partners, having access to integrated and personalised services that they need for support. Under the Strategy, carers will be particularly involved in the diagnosis, care and discharge of sufferers.
Aim: The project will tell us what carers need in terms of support and information and how to deliver it, including when, where and how often. It will also show up any consistencies and differences between the two groups studied in terms of what they need, allowing a tailored, rather than generalised, approach in terms of delivery.
Methods: The project team will comprise of clinicians and carers from The Bracton Centre and The Trevor Gibbens Unit. A cross-sectional survey will be used to collect quantitative information to gauge the views of carers. A structured interview schedule will be used; it will be developed following consultation between clinicians and carers as the specific content of the questions will only be determined once the carer members of the project team are able to be involved in finalising the interview questions. The interviewers will write down the responses on the prepared questionnaire response sheet. The data will be placed onto a database and then onto a statistical computer package (SPSS15). The data will be analysed using primarily descriptive statistics based on the frequency of opinions noted by the carers.
Expected outcomes: This research will assist us in deciding on the best possible use of any new funds that may come with the Carers' Strategy to ensure carers are supported in the best way to make their work easier, ease their burden and to ensure they are themselves happy.
ULeSISS: A pilot trial to assess the effect of a structured communication approach on therapeutic relationships, user needs and levels of disturbance through increasing User Levels of Satisfaction in Secure Settings
Project leader: Doug MacInnes
Background: Forensic mental health patients in prisons and NHS services can be difficult, dangerous and extremely vulnerable people who can pose a risk to themselves or others but deserve the same standard of care as anyone else. This can prove problematic as they can be hard to engage in assessment, treatment and the research necessary to know how to help them; in addition, staff must meet their therapeutic needs while juggling legal, security and public safety issues. The Best Practice Guidelines in Medium Secure Units recently stated that the key to security within a forensic healthcare setting is relational security - the formation of a therapeutic alliance between staff and their patients which is based on patient care. The report also stated that patients within a medium secure unit (MSU) must be given the opportunity to have input into issues that affect them and their lifestyles within the unit.
Intervention strategies agreed between service users and clinicians bring good results in terms of better clinical outcomes, and better satisfaction with services. But these strategies often don't appear in forensic environments, with some commentators saying service users' views on their treatment are ignored. In the few studies examining the therapeutic relationship in these settings, service users have said there is poor communication with clinicians, the staff are often not interested and coercive practices are used. The result of these perceived failings is violence and therapy which simply doesn't work.
Aim: This will be a pilot trial to assess the effect of a structured communication approach on therapeutic relationships, user needs and levels of disturbance through increasing User Levels of Satisfaction In Secure Settings.
Methods: The proposed trial design is a 27-month prospective cluster randomised single blind clinical trial. The subjects will be in-patients in four forensic mental health care units. An intervention approach involves monthly meetings between the service user and key worker. The service user will complete a simple checklist prior to meeting their key worker. This will be used as the basis for communicating levels of satisfaction with the service; assessing the user's needs; and focusing on changes to the service user's care and treatment. Key workers will use solution focused brief therapy techniques. Formal assessments will be undertaken at three time points: when participants enter the study; immediately following the intervention and six months after the intervention. The initial recruitment will be for 80 participants, all male. Service User Satisfaction will be assessed using a 60 item self-report questionnaire. Behavioural outcomes will be measured by recording the number of untoward incidents involving the participants during the three months prior to the assessment at time points one, two and three. These will include such as seclusions, attempted escapes and suicide attempts. The initial analysis will consist of examining the descriptive statistical information from the monthly key worker meetings and the assessments undertaken at the three time points. It is also proposed to undertake ANCOVA and t-tests to analyse any differences between the pre and post intervention scores on each measure. Four focus groups will be used to determine users' satisfaction with the structured communication post-intervention.
Expected Outcomes: The pilot study will pave the way for a full study that should provide information vital to those planning improvements in the care and treatment of MSU service users. It could lead to reduced violence inside facilities and improved clinical outcomes for the patients.