Monthly Archives: January 2015

Two new studies for 2015

The International Centre for Mental Health Social Research has been successful in obtaining funding for two new studies starting in February 2015. Both studies are evaluations of innovative mental health services to help build the evidence base for practice and to inform future commissioning decisions.

Peer support service

The peer support service provided by South London & Maudsley NHS Foundation Trust in the London Borough of Southwark matches people with psychosis with a peer to support their recovery.

The service started in June 2011 initially to help individuals who had accessed the crisis services and had opted for home treatment rather than a hospital admission. From September 2012 the service was extended to people in hospital. The aim was to match individuals just before their discharge, as this was the point that clinicians perceived them to be most at risk of relapse, anxiety and encountering other difficulties due to the sudden reduction in support. Individuals were entitled to six to nine months of peer support which was deemed to be sufficient time to support them through discharge and for any initial problems experienced post-discharge to be resolved.

The Southwark peer support scheme can be defined as a ‘peer delivered service’ whereby the frontline support is delivered by peers, and clinical and non clinical staff provide aid for the peer supporters.

The evidence for the effectiveness of peer suppport is not strong. A recent systematic review found little or no evidence that peer support helped to reduce hospitalisation,  reduce symptoms or improve satisfaction with services (Lloyd-Evans et al, 2014). However, there was some evidence that peer support was associated with improvements on measures of hope, recovery and empowerment.

In 2013 we published an interim evaluation of the Southwark peer support service. The initial evaluation examined routinely collected data, but there was insufficient to make any firm conclusions.

South London & Maudsley NHS Foundation Trust have now funded us to return and undertake a further analysis of outcome data which the service has collected. This will be supplemented by qualitative semi-structured interviews to explore individuals’ experiences of the service. It is a small evaluation and will be completed by late spring by our researcher Samantha Treacy.

Street triage evaluation

The Department of Health is funding pilots of street triage across England to help reduce use of s.136 Mental Health Act 1983. Street triage sees mental health professionals advise local police forces about their response to calls involving people with mental health problems. The aim is to divert people from police custody where this is not required and facilitate access to mental health treatment. In Leicestershire, for example, an early street triage pilot has seen a 33% reduction in s.136 detentions.

The Scarborough street triage pilot has been running for over 9 months and is a partnership between Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and North Yorkshire Police (NYP). We have been working with them to design an evaluation which will help both services understand if, and how, street triage works in the first year of its operation.

We have been successful in obtaining funding from the N8 partnership of eight northern universities co-production programme (which is funded by the Economic and Social Research Council). This research programme aims to learn how co-produced research between academics and non-academics might help to shape the future of social science research.

Embedding research findings into policy and practice is the ultimate aim of applied social science. While projects frequently include knowledge exchange as part of their funded activities to increase the impact of their findings, few have the opportunity to reflect on whether this process achieves its desired outcome. This small evaluation includes reflective learning on the co-produced process of embedding research findings in practice to investigate how jointly agreed and delivered messages are received and acted upon by mental health practitioners and police officers.

This project will utilise multiple methods including the analysis of routinely recorded information on police and NHS databases, qualitative interviews, participant observations and reflective diaries to achieve the following objectives:
1) To evaluate the impact of street triage on rates of s.136 Mental Health Act 1983 in Scarborough and district
2) To evaluate the short-term outcomes of people seen by street triage in terms of their
contact with the police and mental health services in Scarborough and district
3) To understand how the co-design and co-delivery of street triage contributes to its
4) To co-design and co-deliver briefing sessions to police officers and street triage
practitioners to discuss research findings
5) To reflect on the immediate impact of the co-produced evaluation on policy and practice in the police and NHS

This evaluation will be conducted by Annie Irvine in the Social Policy Research Unit, supervised by ICMHSR Director Dr Martin Webber. Annie will work in partnership with data analysts in NYP and TEWV to undertake some aspects of the evaluation. We also look forward to working closely with NYP and TEWV to learn how co-produced research can produce insights lacking in traditional academic research. The evaluation will be completed by summer 2015.

International Symposium on Evidence in Global Mental Health

The International Centre for Mental Health Social Research (ICMHSR) brings together researchers from the University of York with those around the world to develop a programme of research which has the potential to influence mental health policy and practice both nationally and internationally. This week we have brought together four of our international collaborators for the first time.



ICMHSR supported one of its partners, Rajagiri College of Social Sciences in Kerala, India, to organise an International Symposium on Evidence in Global Mental Health which was held from 7-9 January 2015. Led by ICMHSR collaborator Fr Saju Madavan, staff and students from the Rajagiri School of Social Work hosted an international meeting attended by about 250 people. This conference was part of their annual series of DYUTI (meaning ‘spark of life’) forums.

Rajagiri were superb hosts and attended to every detail to make both national and international delegates feel welcome. Every aspect of the visit including transportation, accommodation, food, visits, cultural and social activities were taken care of. Their hospitality was far superior to that provided by any international conference and made us feel part of the Rajagiri family in a very short space of time.

Scientific programme

The scientific programme included papers of a quality found at other international social work conferences. Its focus on the social work role in addressing the ‘effective treatment gap’ (the difference between the number of people with a mental health problem and the availability of effective interventions) in low and middle income countries was important and unique. It raised the profile of global mental health problems amongst social workers and reminded the community of researchers in global mental health that social workers have an important role to play. The conference featured presentations from India, USA, Australia and Belgium, but I only mention those here which involved ICMHSR collaborators for the sake of brevity.

Day 1

Inaugural session

Inaugural session

ICMHSR collaborators played a full role in plenaries and workshops during the conference. Dr Martin Webber (Director) gave a special address to open the conference. He explored the role of mental health social workers in the global mental health agenda and argued that there is untapped potential within the profession. He used evidence from ICMHSR research to argue that social workers have the potential to contribute to closing the treatment gap in low and middle income countries, but more work is required to develop, evaluate and implement culturally appropriate social interventions.

Adopting the mantra ‘Start Local, Think Global, Act Local’ he argued that international research evidence could inform the design of solutions to local problems. Warning against the wholesale adoption of social interventions from different countries which may not be culturally appropriate, action should be locally determined. Finally, he argued that research should be used strategically to develop and evaluate interventions in the local contexts in which they are to be used.

Day 2

On the second day ICMHSR collaborator Dr A.T. Jotheeswaran (Public Health Foundation India) gave a plenary paper on the mental health of the ageing population. He discussed his work in India where he has trained health workers to diagnose common difficulties associated with chronic mental and physical health problems in older people. He has also designed interventions which health workers deliver to address these difficulties and is in the process of evaluating these in a randomised controlled trial.

In the afternoon, Dr Martin Webber and Meredith Newlin (ICMHSR Researcher at University of York) led a workshop on scaling up mental health programmes. They presented the findings of the Connecting People studies and the feasibility of adapting the Connecting People Intervention for use in Sierra Leone (now as a response to the Ebola outbreak) to help alleviate psychosocial distress. They led a discussion with delegates about how intervention models can be transformed for use in different socio-economic and cultural contexts. They suggested that ‘scaling up’ should be viewed as the whole process of developing new ways of working, evaluating them and utilising them in different communities or countries, and not just the final part of this process.

Whilst this workshop was running, ICMHSR collaborator Dr A.T. Jotheeswaran held a workshop on mental health research. He discussed different research designs and their role in developing an evidence base for social work’s contribution to global mental health.

These workshops were followed by a plenary panel discussion featuring ICMHSR collaborators Dr Martin Webber and Dr A.T. Jotheeswaran and other colleagues who shared their thoughts on the research priorities in the field of global mental health, particularly of relevance to social work. There was general agreement amongst panel members that social workers have the potential to contribute to reducing the effective treatment gap. However, as a profession we need to improve the rigour of our research so that it can make a valuable contribution to the evidence base for global mental health.

Day 3

The ICMHSR contributions on the final day started with a plenary session chaired by Dr Martin Webber. This featured four papers, three of whom from ICMHSR collaborators. Professor Jacques Joubert (a research neurologist from Melbourne, Australia, who is a new ICMHSR collaborator working with us on grant applications straddling the boundaries of mental health and chronic disease such as hypertension) presented his work on the role of social isolation as a risk factor for post-stroke depression, which increases the risk of further strokes. Social work interventions which help to alleviate social isolation can improve mental wellbeing and prolong lives.

Meredith Newlin introduced the Sababu intervention model which has been developed with the Mental Health Coalition in Sierra Leone in readiness for training psychiatric nurses in the country (there are no mental health social workers there). She discussed how the model and training is being modified in response to the Ebola outbreak to help the nurses provide a response to the psychosocial distress caused by the humanitarian crisis.

Finally, ICMHSR collaborator Professor Lynette Joubert from the University of Melbourne, Australia, presented her research on brief social work interventions for people who present to hospital Emergency Departments with self-harm. She discussed the findings of her randomised controlled trial which found that good social work practice helped to reduce re-presentations to Emergency Departments and the severity of depression of participants. The intervention is currently being evaluated in Wales to investigate if it can be adopted in a different country.

In the afternoon, ICMHSR collaborators Dr Martin Webber and Professor Lynette Joubert contributed to a plenary panel discussion on global mental health policy. Each briefly presented the social work contribution to mental health care in the UK and Australia respectively, with colleagues from USA and India talking about their respective countries. While there is some diversity of roles, there is a consensus that social workers play an important role, but this is not always supported or made explicit in mental health policy.

Finally, Dr Martin Webber was invited to offer some take-home messages in the closing valedictory to the conference. He suggested that we must continue to learn together and from each other. Exemplified by starting each day of the conference with a demonstration of yoga, Western countries have much to learn from the natural mind-body wisdom of people in India. In turn, we have a duty to work with colleagues in India to support the development of social work and community mental health services. In so doing, we should strive for excellence in our social work practice and research, and challenge ourselves to move outside of our comfort zones. Finally, he emphasised that we need to look after our own mental health and that of people around us. We all have mental health and we need to take care of it.

Research collaboration

(l-r) Dr Rameela Shekhar, Ms Meredith Newlin, Prof Lynette Joubert, Fr Saju Madavan, Dr Martin Webber

(l-r) Dr Rameela Shekhar, Ms Meredith Newlin, Prof Lynette Joubert, Fr Saju Madavan, Dr Martin Webber

The conference also fulfilled its role in bringing ICMHSR collaborators together to discuss research proposals. It facilitated a meeting of our Indian collaborators, Dr A.T. Jotheeswaran and Fr Saju Madavan, with Professors Jacques and Lynette Joubert from Melbourne. Dr Martin Webber chaired a meeting with them, Meredith Newlin and two other collaborators from India, Dr Rameela Shekhar (Dean of the School of Social Work at Roshni Nilaya, Mangalore) and Professor Keith Gomez (formerly of Loyola College, Chennai).

The collaborators quickly identified common research interests and made an action plan to undertake some pilot work in preparation for grant applications later in the year. We will be focusing on finding ways for social workers to support people in Kerala to manage long-term mental and physical health problems more effectively. We will draw on our experience in the UK, Australia and India to collaborate on new research which has the potential to have a positive impact on social workers’ practice and the local communities in which they are working in Kerala.

Reflecting on his week in India, Dr Martin Webber said:

On behalf of the International Centre for Mental Health Social Research I wish to again extend my warm appreciation and heartfelt thanks to Fr Saju and the faculty and students of Rajagiri School of Social Work for their hospitality and excellent organisation of the conference. It has been an excellent week and I look forward to continuing our work together.

You can read a personal perspective on his visit to India in Martin’s blog.