Shared goals for mental health research: what, why and when for the 2020s

The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews

Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.

Poverty proofing healthcare: A qualitative study of barriers to accessing healthcare for low-income families with children in northern England

Poverty impacts negatively on children's health and future life chances. Access to the UK's National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, are working with partners to reduce the impacts of poverty on NHS access. This collaborative study aimed to understand barriers to healthcare access faced by families living on low incomes to validate and support further development of a Poverty Proofing© healthcare tool. Twenty-four parents and eight Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to healthcare: hidden costs, securing appointments and developing relationships with healthcare providers. We conclude that low-income families experience both financial and other barriers to accessing NHS healthcare and that these barriers are exacerbated for low-income families living in remote/rural areas.

Providing men at risk of suicide with emotional support and advice with employment, housing and financial difficulties: a qualitative evaluation of the Hope service

BACKGROUND

Men at risk of suicide often face difficulties with finances, employment, or housing, yet support services are usually psychologically based. This study evaluated the Hope service which provides integrated psychosocial support alongside practical, financial and specialist advice.

AIMS

To examine how the Hope service supports men at risk of suicide and factors that influence its impact and usefulness.

METHODS

Twenty-six qualitative interviews with 16 service users, six Hope staff, two specialist money advice workers funded to work for Hope and two NHS referral staff, thematically analysed.

RESULTS

The Hope service provided an essential service for men at risk of suicide, with complex needs including addiction, job loss, homelessness, debt, relationship-breakdown and bereavement who often would otherwise have fallen through service provision gaps. Working in a person-centred, non-judgemental way elicited trust and specialist advice tackled problems such as housing needs, debt, benefit claims and employment, enabling men to regain a sense of control over their lives. Some men shared histories of abuse, for which specialist counselling was hard to access.

CONCLUSIONS

Hope provides an effective integrated support package for suicidal men. Funding for services like Hope are important to tackle structural issues such as homelessness and debt, alongside emotional support.

Trends in comorbid physical and mental health conditions in children from 1999 to 2017 in England

INTRODUCTION

Children with long-term physical health conditions (pLTCs) are at increased risk of mental health conditions but less is known about time trends in the mental health of this group of children.

METHODS

We used data from three comparable, population-based surveys of children conducted in 1999, 2004, and 2017. We examined whether the proportion of children aged 5-15 years old with comorbid mental health conditions (measured using the multi-informant Development and Well-being Assessment tool) and pLTCs (measured using parental report) in England increased from 1999 to 2017 using linear regression analysis.

RESULTS

Our analysis used data from 8662 (1999), 6401 (2004) and 6219 (2017) children, respectively. The proportion of children with comorbid pLTCs and psychiatric disorders was 0.050 (95% CI = 0.045, 0.055) in 1999, 0.054 (95% CI = 0.049, 0.060) in 2004, and 0.059 (95% CI = 0.053, 0.065) in 2017. The linear regression model revealed a non-significant effect of time on the proportion of children with comorbid pLTCs and psychiatric disorders from 1999 to 2017 (B = 0.0004785; SE = 0.0001256; p = 0.163).

CONCLUSION

The estimated prevalence of school-aged children with comorbid pLTCs and mental health conditions in England remained stable since 1999, highlighting the need to prioritize mental health resources for children with physical health comorbidities.

The importance of shared research goals for a world in which no one is held back by mental health problems

The importance of shared research goals for a world in which no one is held back by mental health problems.

Amplifying the voices of young people from Black, Asian and other minority ethnic backgrounds in mental health research

A commentary on the Mental Health Research Goals paper, emphasising the importance of the involvement of young people at all stages of mental health research pertaining to their demographic. Examples are highlighted from the UKRI Emerging Minds Network's research challenge on the impact of racism on young people's mental health in the UK, which has implications for research on racism and youth mental health specifically but also mental health research generally.

Why mental health research matters: a commentary on 'shared goals for mental health research: what, why and when for the 2020s'

This brief commentary welcomes the UK national goals for mental health research and suggests that the UKRI funded mental health research network approach is a good starting point to achieve these goals.

What interventions should we implement in England's mental health services? The mental health implementation network (MHIN) mixed-methods approach to rapid prioritisation

Introduction

Setting mental health priorities helps researchers, policy makers, and service funders improve mental health services. In the context of a national mental health implementation programme in England, this study aims to identify implementable evidence-based interventions in key priority areas to improve mental health service delivery.

Methods

A mixed-methods research design was used for a three step prioritisation approach involving systematic scoping reviews (additional manuscript under development), expert consultations and data triangulation. Groups with diverse expertise, including experts by experience, worked together to improve decision-making quality by promoting more inclusive and comprehensive discussions. A multi-criteria decision analysis (MCDA) model was used to combine participants' varied opinions, data and judgments about the data's relevance to the issues at hand during a decision conferencing workshop where the priorities were finalised.

Results

The study identified mental health interventions in three mental health priority areas: mental health inequalities, child and adolescent mental health, comorbidities with a focus on integration of mental and physical health services and mental health and substance misuse problems. Key interventions in all the priority areas are outlined. The programme is putting some of these evidence-based interventions into action nationwide in each of these three priority mental health priority areas.

Conclusion

We report an inclusive attempt to ensure that the list of mental health service priorities agrees with perceived needs on the ground and focuses on evidence-based interventions. Other fields of healthcare may also benefit from this methodological approach if they need to make rapid health-prioritisation decisions.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems in vulnerable young people

BACKGROUND

There is growing evidence of a beneficial effect of social group processes on well-being and mental health.

AIMS

To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people.

METHOD

This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16-35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini-Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals.

RESULTS

Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms.

CONCLUSIONS

The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.

Methodological procedures for priority setting mental health research: a systematic review summarising the methods, designs and frameworks involved with priority setting

BACKGROUND

Research priority setting aims to identify research gaps within particular health fields. Given the global burden of mental illness and underfunding of mental health research compared to other health topics, knowledge of methodological procedures may raise the quality of priority setting to identify research with value and impact. However, to date there has been no comprehensive review on the approaches adopted with priority setting projects that identify mental health research, despite viewed as essential knowledge to address research gaps. Hence, the paper presents a summary of the methods, designs, and existing frameworks that can be adopted for prioritising mental health research to inform future prioritising projects.

METHOD

A systematic review of electronic databases located prioritisation literature, while a critical interpretive synthesis was adopted whereby the appraisal of methodological procedures was integrated into the synthesis of the findings. The synthesis was shaped using the good practice checklist for priority setting by Viergever and colleagues drawing on their following categories to identify and appraise methodological procedures: (1) Comprehensive Approach-frameworks/designs guiding the entire priority setting; (2) Inclusiveness -participation methods to aid the equal contribution of stakeholders; (3) Information Gathering-data collecting methods to identify research gaps, and (4) Deciding Priorities-methods to finalise priorities.

RESULTS

In total 903 papers were located with 889 papers removed as either duplicates or not meeting the inclusion and exclusion criteria. 14 papers were identified, describing 13 separate priority setting projects. Participatory approaches were the dominant method adopted but existing prioritisation frameworks were modified with little explanation regarding the rationale, processes for adaptation and theoretical foundation. Processes were predominately researcher led, although with some patient involvement. Surveys and consensus building methods gathered information while ranking systems and thematic analysis tend to generate finalised priorities. However, limited evidence found about transforming priorities into actual research projects and few described plans for implementation to promote translation into user-informed research.

CONCLUSION

Prioritisation projects may benefit from justifying the methodological approaches taken to identify mental health research, stating reasons for adapting frameworks alongside reasons for adopting particular methods, while finalised priorities should be worded in such a way as to facilitate their easy translation into research projects.

Designing a library of lived experience for mental health (LoLEM): protocol for integrating a realist synthesis and experience based codesign approach

INTRODUCTION

People with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be 'living books', sharing their experiences in dialogue with 'readers' who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts.

METHODS AND ANALYSIS

We will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries' impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream 1.

ETHICS AND DISSEMINATION

Ethical approval was granted by Coventry and Warwick National Health Service Research Ethics Committee on 29 December 2021 (reference number 305975). The programme theory and implementation guide will be published as open access and shared widely through a knowledge exchange event, a study website, mental health provider and peer support networks, peer reviewed journals and a funders report.

PROSPERO REGISTRATION DETAILS

CRD42022312789.

Evaluating the provision of paediatric liaison psychiatry services in England

BACKGROUND

Liaison psychiatry provision for children and young people in England is poorly evaluated.

AIMS

We sought to evaluate paediatric liaison psychiatry provision and develop recommendations to improve practice.

METHOD

The liaison psychiatry surveys of England (LPSE) cross-sectional surveys engage all liaison psychiatry services in England. Services are systematically identified by contacting all acute hospitals with emergency departments in England. Questions are developed in consultation with NHS England and the Royal College of Psychiatrists' Faculty of Liaison Psychiatry, and updated based on feedback. Responses are submitted by email, post or telephone. Questions on paediatric services were included from 2015 (LPSE-2), and we analysed data from this and the subsequent four surveys.

RESULTS

The number of acute hospitals with access to paediatric liaison psychiatry services increased from 29 (15.9%) in 2015 to 46 (26.6%) in 2019, compared with 100% provision for adults. For LPSE-4, only one site met the Core-24 criteria of 11 full-time equivalent mental health practitioners and 1.5 full-time equivalent consultants, and for LPSE-5, just two sites exceeded them. Acute hospitals with access to 24/7 paediatric liaison psychiatry services increased from 12 to 19% between LPSE-4 and LPSE-5. The proportion of paediatric liaison psychiatry services based offsite decreased from 30 to 24%.

CONCLUSIONS

There is an unacceptable under-provision of paediatric liaison psychiatry services compared with provision for adults. Number of services, staffing levels and hours of operation have increased, but continued improvement is required, as few services meet the Core-24 criteria.

The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: a systematic review and meta-analysis

AIMS

There is substantial evidence showing an association between parental substance use and child substance use and/or mental health problems. Most research focuses upon maternal substance use, with the influence of paternal substance use often being overlooked. We aimed to investigate the differential effects of maternal and paternal substance use upon children aged 0-18 years.

METHODS

We used systematic review methods to identify observational studies examining the association between either maternal or paternal substance use and child substance use and/or mental health problems. The odds ratio (OR) effect measure was used, for ease of computation. We used a random-effects model with the inverse variance method to meta-analyse the findings from eligible studies.

RESULTS

We included 17 unique studies with a total of 47 374 child participants. Maternal and paternal substance use were both associated with increased odds of child any drug use [OR = 2.09; 95% confidence interval (CI) = 1.53, 2.86; n = 12 349 participants; three studies and OR = 2.86; 95% CI = 1.25, 6.54; n = 5692 participants; three studies, respectively], child alcohol problem use (OR = 2.16; 95% CI = 1.73, 2.71; n = 7339 participants; four studies and OR = 1.70; 95% CI = 1.36, 2.12; n = 14 219 participants; six studies), child externalizing problems (OR = 1.81; 95% CI = 1.01, 3.22; n = 1748 participants; three studies and OR = 1.60; 95% CI = 1.18, 2.17; n = 2508 participants; six studies) and child internalizing problems (OR = 1.60; 95% CI = 1.25, 2.06; n = 1748 participants; three studies and OR = 1.42; 95% CI = 1.12, 1.81; n = 2248 participants; five studies). Child any alcohol use was associated with maternal substance use only (OR = 2.26; 95% CI = 1.08, 4.70; n = 28 691 participants; five studies).

CONCLUSIONS

Both maternal and paternal substance use are associated with child substance use and mental health problems.

Mental health and disability research priorities and capacity needs in Ghana: findings from a rapid review and research priority ranking survey

Background

Identification of national research agendas for mental health and disability can be supported by well-designed research priority-setting studies. Few low- and middle-income countries (LMICs) have undertaken such studies.

Objective

To identify mental health and disability research priorities in Ghana.

Methods

A mixed methods study comprising a rapid review, research priority ranking survey, and research capacity needs assessment survey was employed. Participants in the surveys included five expert pools identified from online search and existing database on mental health civil society organisations/non-governmental organisations. The research priority ranking was completed in two stages, using the Child and Nutrition Research Initiative (CHNRI) method to identify priority questions for immediate and short term (0 to 5 years) and medium to long term (>5 years) in stage two. Both surveys were deployed online using google forms. Analysis for the ranking survey involved computing total scores from the CHNRI criteria and generating ranks for the research questions.

Results

A total of 68 experts (97% response rate), generated 94 and 92 questions for the short and long term, respectively. Forty experts (58% response rate) completed the ranking stage. The top 10 ranked research questions included: 4 questions addressing health systems; 2 questions on epidemiology; and 4 questions on interventions. All research questions were considered urgent and should be conducted in the immediate to short term (0–5 years). The methodological capacity of researchers to conduct disability and mental health research is weak.

Conclusion

Our approach has generated an agenda for mental health and disability research priorities for Ghana and demonstrated that it is feasible to employ a systematic methodology for research priority setting that includes key parameters of context and research capacity.

Setting national research priorities for difficult-to-treat depression in the UK between 2021-2026

Background

Difficult-to-treat depression (DTD) presents a substantial health care challenge, with around one-third of people diagnosed with a depressive episode in the UK finding that their symptoms persist following treatment. This study aimed to identify priority research questions (RQs) that could inform the development of new and improved treatments, interventions, and support for people with DTD.

Methods

Using an adapted Child Health and Nutrition Research Initiative (CHNRI) method, this national prioritisation exercise engaged 60 leading researchers and health care professionals in the UK, as well as 25 wider stakeholders with relevant lived experience to produce a ranked list of priority RQs in DTD. The final list of 99 distinct RQs was independently scored by 42 individuals against a list of five criteria: answerability, effectiveness, impact on health, deliverability, and equity.

Results

Highly ranked RQs covered a range of novel and existing treatments. The three highest scoring RQs included evaluation of psychological and pharmacological therapies (eg, behavioural activation, and augmentation therapies), as well as social interventions to reduce loneliness or increase support for people with DTD.

Conclusions

This exercise identified and prioritised 99 RQs that could inform future research and funding decisions over the next five years. The results of this research could improve treatment and support for people affected by DTD. It also serves as an example of ways in which the CHNRI method can be adapted in a collaborative manner to provide a more active role for patients, carers, and health care professionals.

Innovations in community-based mental health care: an overview of meta-analyses

In the last four decades, mental health services for people with Severe Mental Illness (SMI) have seen asylums replaced by a balanced model of Community Mental Healthcare (CMH). Innovative approaches and strategies in the field of CMH have been extensively researched. However, this research has been hampered by issues limiting their capacity to inform clinicians and policymakers. We conducted an overview of meta-analyses of the effectiveness of innovative CMH models focussing on clinical and psychosocial outcomes in comparisons with standard care in adults with SMI. Based on the 12 eligible studies, we appraised, synthesised and graded the resulting evidence. There was moderate quality evidence that case management, Early Intervention Services (EIS) and caregiver-directed interventions were superior to standard care in reducing hospital admission. In relation to psychosocial outcomes, EIS showed high quality evidence of a small effect on global functioning. There was moderate quality evidence for a similar effect of Intensive Case Management, and for a large effect of family intervention. For quality of life, both EIS and self-management education had a small effect, with moderate quality. The level of research about effective CMH models is therefore substantial. However, several gaps related to innovative CMH not yet covered in meta-analytic synthesis, need to be filled.

Advancing research in adult secure mental health services in England

Forensic mental health services in high income countries are typically high cost and low volume, providing care to people with mental illness, personality disorders, learning disability and autism deemed to pose a risk to others. Research into how forensic mental health services work as a whole system is limited. Such research is urgently needed to guide policy makers and ensure that services operate effectively.