Mental Health Research Update

It is estimated that 1 in 4 people in England will experience a mental health problem in any given year. Mental health problems are one of the main causes of the burden of disease worldwide (estimated at £16 trillion). In the UK they are responsible for the largest burden of disease (28%) at £70-100 billion each year, compared to 16% each for cancer and heart disease (www.mentalhealth.org.uk). It is clear mental health research is needed to improve the effectiveness of treatments for people experiencing mental health difficulties, as well as for finding ways of preventing poor mental health.

Attitudes to mental health

The stigma of poor mental health is changing for the better, although there is still room for improvement. The NHS Confederation key facts and trends in mental health (2016) states that Time to Change’s Attitudes to mental illness 2014 report illustrated that the number of people acknowledging they know someone close to them who has had a mental illness increased from 58% in 2009 to 65% in 2014. 40% of people surveyed said they would be comfortable talking to their employer about a mental health problem, although nearly half (48%) said they would feel uncomfortable, showing that there is still some way to go.

Often the first port of call for anyone experiencing mental health problems will be to access services within primary care and more specifically, seek help from their GP. As attitudes towards mental health change for the better, we could see an increase in such help-seeking. According to a Care Quality Commission (CQC) report from 2015, at any given time an average of one in four patients of a fulltime GP requires treatment for a mental health condition. They found nearly three million adults were on local GP registers as experiencing depression. GPs often have to make difficult decisions based on a short time in consultation with the patient. Although GPs are informed by the NICE guidelines that recommend the best treatment, based on research findings, what suits one person may not help another. Our knowledge of which treatment would work best for individuals can only improve through research.

It is sometimes felt that those with mental health problems would not want to take part in research because of how they are currently feeling, or that because of their current symptoms they might not appreciate being involved in research. We strongly advocate that everyone has the right to make that decision themselves and with the support of those around them. The NIHR has collated people’s stories about taking part in research. We are currently looking at collecting stories about taking part in research from people within the West Midlands.

Caroline Kemp is a carer for her daughter who has a severe form of bipolar disorder. She states that:

“Research changed my life because it’s given a whole new dimension to my life; I feel like a person again”

Collaborative working

The CRN primary care and mental health teams have been working closely together to ensure we provide a high standard of research involvement to patients, their family members and staff. To further this, the primary care team received mental health awareness training which received feedback such as ‘I feel the skills I have developed today will be invaluable. I have a much bigger insight into the issues surrounding mental health’.

PANDA-RCT

This study is seeking participation from West Midlands GPs. Depression is a common condition that affects between 2% and 3% of the population at any one time and is commonly treated with antidepressant medication. In England and Wales there were 47m prescriptions for antidepressants in 2011. Selective serotonin reuptake inhibitors (SSRIs) are the first line antidepressant recommended by NICE guidelines.

Some people with depression will recover spontaneously and it is not clear at present which people will benefit from a course of antidepressants. Furthermore it is not known whether the current diagnostic criteria for depression indicate benefit from antidepressants. As a result, general practitioners often have to make a difficult decision about whether an individual will benefit from an SSRI.

Study aims

This study is designed to refine the indications for the use of antidepressants in people with depression. Our aim is to investigate the severity and duration of depressive symptoms that are associated with a clinically important response to sertraline in people with depression. We plan to assess severity and duration using a standardised assessment that can then be used to guide prescription in primary care. We will include patients presenting in primary care aged 18-74 with depressive symptoms where both the GP and patient are unsure whether there will be significant clinical benefit from taking SSRI antidepressants. Participants will be required to take the antidepressant sertraline while response will be assessed. Some participants may receive a placebo instead.

Mental health and its effect on physical illness

It is well known that people with poor mental health also have an increased prevalence of physical illnesses. For example, for every 10 people in the general population who have cardiovascular disease, 25 people with severe mental health problems with have this also.

Infographics - http://mentalhealthpartnerships.com/resource/physical-health-risks-for-people-with-severe-mental-health-problems/. 

Dr Helen Tyrrell, Priory Gate Practice:

“Mental health problems are such a big part of our workload and are often very challenging. Research into improving or patients mental health and the treatments would provide us with more evidence about how we should approach managing these patients. Knowing which subgroups of patients would benefit from medication would be useful to avoid unnecessary possible side effects and the burden of taking regular medication on patients and also may provide a cost savings. Often our depressed patients do not look after themselves and proactive management into their general health and CVD risk factors will hopefully reduce their morbidity and mortality.”

PRIMROSE2

People with severe mental illnesses (SMI) die early from cardiovascular disease (CVD). They have increased CVD risk factors including abnormal lipids, diabetes, smoking and obesity. They make frequent contact with primary care, yet are less likely to be screened for risk factors or receive interventions such as statins.

 In a cluster randomised controlled trial, we will test the effectiveness of an intervention with GP practices working to reduce CVD risk in people with SMI. The intervention will include:

• physical health reviews

• prescription of medications such as statins and

• monitoring of adherence to recommended treatments

The study will recruit 350 patients with severe mental illnesses (Schizophrenia, Persistent Delusional Disorder, Schizoaffective Disorder or Bipolar Affective Disorder), aged 30-75 years old with raised total cholesterol, or total cholesterol/HDL cholesterol ratio, and one other risk factor, from 60 GP practices across England.

 All participants with SMI registered with GP practices in the trial will be screened for CVD risk. 70 general practices will be involved, 35 using the new intervention and 35 providing standard care. Over a period of one year, approximately five patients from each practice who meet the inclusion criteria will receive either the intervention or treatment as usual. The intervention will involve intensive management of CVD risk factors with regular appointments to monitor progress with reducing cholesterol, prescription and adherence to statins and signposting to services for weight management and smoking cessation where other CVD risk factors are detected. At the end of the study, we will establish whether practices trained in the intervention reduce total cholesterol more than standard care.

 For more information on any of the studies mentioned, or on mental health initiatives in general, please contact: Carly Craddock, Research Delivery Manager (DeNDRoN, Mental health and Neurological Disorders) phone: 0121 301 4320, email: carly.craddock@bsmhft.nhs.uk / carlycraddock@nhs.net