MeTowardsn tal

HealthHealth Se rvice and Queen’s Anniversary Prize Po pulation Resea rch at the In stitute Developing and evaluating of Psychiatry high-quality, topical teaching Number 5 | 20 10 Should you tell your boss about your mental health?

Estia Centre marks 10 th anniversary

Global effort to combat stigma

Supporting victims of violence

What do young carers want? Welcome to this issue of Towards Mental Health

Graham Thornicroft is a Professor of Community Psychiatry and Head of the Health Service and Population Research Department.

Welcome to the 2010 edition of Towards Mental l i

Health . It tells you about some of the work of m a J the Health Service and Population Research n a h

Department at the Institute of Psychiatry, e R King's College . Our Department has recently been honoured to be awarded the 2010 Queen's Developing and evaluating Anniversary Prize for Higher and Further Education. This distinction is an indicator high-quality, topical teaching of the quality, reach and impact of our work, and I would like to thank all members of our research teams and our many partners in the 84 countries with whom we collaborate A new MS c in Global Mental Health is to be launched jointly worldwide for their contributions to this success. by HSPR and the London School of Hygiene and Tropical If you wish to visit our Department, or study Medicine. The latest addition to the expanding portfolio with us, or discuss research or teaching links, please do contact us. Meanwhile, I trust that of teaching and training within HSPR follows the launch this issue of Towards Mental Health contains information that will be interesting and useful of the Centre for Global Mental Health in 2009 (see page for you. 5) in collaboration with the London School of Hygiene and Tropical Medicine. The new taught programme will be delivered jointly by both organisations and students will ultimately learn how to contribute to improving mental health care in low and middle income countries.

he person who is charged with getting health strategy New Horizons , and this new the new MS c off the ground (hopefully module reflects that priority. It’s important by September 2011 ) and co-ordinating to us to give students a maximum amount T all educational activities in HSPR is of choice too,’ says Stuart. Development Stuart Lancashire (above) . work is continuing to see if it is viable to As Head of the Department’s Section for turn the new module into a stand-alone Teaching and Learning, Stuart is responsible MS c in Public Mental Health in future. for advising on the feasibility of, and facilitating Three short courses created by the new ideas for education: there are other new Mental Health Nursing team are already MS cs in the pipeline, and many proposals to on HSPR ’s books. That team now has nurse supplement the package of short courses already tutors and is collaborating with South London offered. ‘We need to make sure the Department and Maudsley NHS Foundation Trust ( SL aM) has the capacity to offer all teaching and training and Oxleas NHS Foundation Trust to focus to a high standard,’ he says. ‘We don’t want on designing courses that specifically meet to be a mass producer of education – our main the needs of the workforce. Thus the team priority is quality and innovation. We have huge was commissioned by SL aM to develop expertise and experience to draw upon within a short course to give health professionals the Department, and want to offer high quality the knowledge and skills they need to support education in areas that are cutting edge and children and adolescents with a dual diagnosis reflect current thinking.’ of mental health problems and substance misuse, Published by Health Service and Population Research at the Institute of Psychiatry, King’s College London So, for example, a new module on public and a short course targeted at mental health David Goldberg Centre mental health has been developed and is now workers supporting older adults with a dual De Crespigny Park on offer to students studying for the MS c in diagnosis. ‘We piloted the two courses, then Denmark Hill London SE5 8AF Mental Health Service and Population Research , evaluated them, and demonstrated they improve www.hspr.iop.kcl.ac.uk (previously called Mental Health Services attitudes and confidence, and enhanced skills,’ Written and designed by Jane Smith and Sophie Gibson Research ), one of two long-established MS cs said Stuart. ‘This is really giving the NHS what Inside Out, 020 7655 0885 housed in HSPR . (The other is Mental Health it wants, identifying training needs, developing Printed by Calverts April 2010 Social Work with Children and Adults ). courses that meet those needs and are relevant ‘Public health and preventative work has to Trust strategies, and then evaluating them. Throughout the publication, the Health Service and Population Research Department is referred to as ‘ HSPR ’. become a priority for the Department of Health ‘All our training programmes are The Institute of Psychiatry is referred to as ‘I oP’. for the next 10 years, as outlined in its mental systematically evaluated so their gains 3

Work of HSPR wins Queen’s Anniversary Prize

are demonstrated, providing the evidence ‘People said they wanted to come here,’ he work of the HSPR research to show they work properly. We evaluate he says. Tgroup has won a prestigious them using standard research methodology September 2009 witnessed HSPR ’s first Queen’s Anniversary Prize for – and that is not standard practice. But it is Masterclass for junior academic psychiatrists Higher and Further Education. what the Institute of Psychiatry ( IoP) is best from across the UK and overseas, commissioned The awards are given every at – using its particularly high level of expertise by the National Institute for Health Research, two years to recognise work to develop evidence-based, innovative, cutting keen to tempt people into research careers. of outstanding excellence in edge training.’ The week-long Masterclass included teaching UK universities and colleges. Stuart started his career as a motor sessions, meetings with researchers to discuss King’s College London was mechanic, learning through an apprenticeship project proposals and a Dragon’s Den style one of 21 2009 winners announced and working in the trade for six years before event where participants pitched ideas to senior in November: the prize medal studying for a first degree in Philosophy and members of the IoP. One of those pitches almost and certificate were presented Sociology. He switched careers, joining the immediately became a collaborative project, by the Queen at Buckingham NHS as a nursing assistant before studying studying rare movement disorders in psychosis Palace in February this year. for a masters in Mental Health Social Work that are under-recognised and under-treated. The King’s entry highlighted at Oxford. While working as a mental health ‘We’ve established an alumni database and the work of HSPR and was called social worker in Greater Manchester, he are putting people in touch with one another Excellence in Mental Health Care: was asked to be part of a research project as well as keeping in touch with all of them Putting Evidence into Practice . at Manchester University, and took a year to alert them to opportunities to get involved The submission details examples out to join a team working on a trial comparing in work here,’ says Stuart. The Masterclass of HSPR ’s work both around the inpatient care with day hospital care for acutely has been recommissioned this year. world and at home, and begins: ill patients. And then there are the short, stand-alone ‘The Health Service and Population ‘About a year later, I was invited back courses. ‘People have very good ideas for Research Group is committed again, and I then became stuck on research short courses, and it is my job to see if they to enabling the recovery and and teaching,’ he says. ‘I went to work at are feasible and then make them happen,’ says improving the quality of life the University as a social research worker, Stuart, who is also responsible for marketing of people with mental health interviewing carers of people with severe and existing and new programmes and courses. problems and their families enduring mental illness, and then moved from A short course for mental health professionals throughout the world. We that job to the School of Nursing in Manchester, about reducing the use of coercive interventions passionately believe that working on a programme run at the University in mental health care will be on offer from people with mental health of Manchester and the IoP to train community September 2010 and was the suggestion of problems should be treated psychiatric nurses to offer effective care to Professor George Szmukler. Dr Diana Rose with dignity, as equals, and have people with a diagnosis of a severe mental from the Service User Research Enterprise access to effective treatments, illness.’ The development and evaluation is putting together a one-day course about tailored to their preferences of the original ‘Thorn course’ was funded how to engage service users and carers in and needs.’ by the Sir Jules Thorn Charitable Trust. research and service development. It will be The Queen’s Anniversary ‘Thorn nurses are the mental health piloted in summer 2010 and, if the evaluation Prizes sit within the national equivalent of Macmillan nurses in cancer,’ proves it to be successful, will be added to honours system. All universities says Stuart. ‘I worked on that project for the short course portfolio. and colleges in the UK are invited three years, and was here at the IoP every Everyone who contributes to educational to make a single entry, which then week for a day or two.’ In 1997 , he came programmes within HSPR is part of the goes through several rounds of full-time, joining the Mental Health Nursing Section for Teaching and Learning, which rigorous assessment. research team in HSPR, where he continued to is supported by two administrators and a run the Thorn programme until it transferred to Teaching and Learning Committee made I For more information about the King’s College London’s Florence Nightingale up of senior members of the Department. Queen’s Anniversary Prizes, visit School of Nursing & Midwifery. In 2007 , he This Committee makes executive decisions www.royalanniversarytrust.org.uk/ took a year out – which he spent in France about which new courses and programmes The Royal Anniversary Trust – before rejoining HSPR in his new role as should be developed and run. administers the scheme. co-ordinator of teaching and learning in 2008 . Stuart is also involved in the work of It’s a challenging job: in addition to the the WHO Collaborating Centre for Research existing and planned new MS cs and short and Training in Mental Health based in HSPR . courses, there is the HSPR Summer School He first became an honorary member in 2003, to organise. Launched two years ago as a when he helped with a three-year project to pilot with less than a handful of courses, the reform mental health services in Russia, and 2010 offering will include the same extended has gone on to be involved in work in Iraq programme of short courses as last year. ‘We and Pakistan, much of it demanding training are replicating the 2009 courses but taking of mental health professionals. on board feedback from students to make the ‘If you include the international training Summer School even better,’ he says. ‘Students carried out by the WHOCC, thousands of said they wanted more learning support sent people all over the world have benefited in advance, and that will happen. Prior access from the expertise of HSPR staff,’ he says. to learning materials is particularly important for people coming from abroad whose first language I To find out more about HSPR ’s may not be English.’ The other change is a teaching and learning programmes, shift of venue – from King’s Waterloo campus visit www.hspr.iop.kcl.ac.uk 2009 to the Institute of Psychiatry in Camberwell. When she graduated with a first degree in Maths, Morven had first taken a job as a research assistant. ‘It became clear though that they wanted me to be a statistician, but I hadn’t actually done much statistics in my l

i degree,’ she said. So she decided to undertake m a

J an MS c in Statistics at Imperial College, and n a

h then signed up for a PhD at the British Museum e R and the Institute of Archaeology (now part of UCL ) about the chemical composition of The role of the ‘number cruncher’ ancient bronze artefacts. Following the PhD, she secured the job at the British Museum, working on statistical analyses mainly to do with archaeology and Research studies could not be completed without the help of a art history. ‘I had been on digs for fun and this seemed an interesting area to go into,’ she said. statistician, a ‘number cruncher’ who interprets the data, puts The past remains an interest: outside of work, the results in perspective, and sometimes warns enthusiastic Morven studies Open University modules about the classical world. ‘I ’m not doing a degree, just researchers not to draw too strong a conclusion. studying individual modules to do with ancient Greece and Rome,’ she says. tatisticians generally get involved of a study, the next thing to do is to work When she decided to make the move into in most projects,’ says Morven on an analysis plan, setting out a framework mental health (‘there is more opportunity to use Leese ( above ), one of a small team for dealing with the raw data. ‘It depends statistics in medicine’), she needed additional S of statisticians based in HSPR . ‘We on the type of study, but this plan has to training. ‘The underlying theory is the same have a burst of activity at the beginning of include our proposals for dealing with missing for all branches of statistics, but you have to each study, then there is lull while the data information and people who have dropped out, learn about its specific application. Medical is collected, then we have another burst at for example. The document is important as it statistics is very specialist. There have been the end when the information is analysed. sets out the framework for analysis, and you certain techniques developed for medical ‘At the beginning, we need to be involved can’t go back and fiddle with it,’ she says. data, and there are conventions in their use in planning the project, in decisions about The analysis plan comes into its own at that you need to know.’ how to collect the data. There are a few the end of a study, when all the information While training, she joined what was fundamental decisions – one of them for has been collected. ‘In the old days, someone then called the PR iSM research team (now example, is how many participants should had to clean up the information when it came the Community Mental Health team in HSPR ). be included to make the results meaningful. in, to spot mistakes and query inconsistencies. After her training was complete, she stayed part- This is a crucial calculation. Ethically, you Nowadays, data collection systems are so time in HSPR for a while and also worked with don’t want to recruit too many people, but much better, and are normally set up to the IoP’s Forensic Mental Health researchers. you need enough to make it an effective have validation built in, so there are few She became a full-time employee in the study. What’s important is the information inconsistencies to be ironed out before Department, dedicated to HSPR studies, the research team is trying to glean. If it’s the analysis starts.’ about a decade ago. something subtle, you need to recruit 1,000 s Most calculations are made with Stata, ‘In theory, anyone in the Department of people, but otherwise a smaller sample may a computer package. ‘This programme is can ask us to work on their study, but my be sufficient. In order to do that calculation, favoured by statisticians as it gives very focus continues to be on Community Mental we need to know if there was a pilot study, comprehensive facilities,’ says Morven. Health projects. It is very interesting working or if there is previous research to help give ‘It’s an enormous package, and includes on different research projects – around 20 studies an idea of the intrinsic variability in the data, specialised software for specialised analyses.’ at any one time – because you are constantly and also what is to be expected in terms of And when those analyses are over, the last learning about new subject areas. the effect being looked for. You could call thing to do is to make a contribution to the ‘Some researchers like to be involved in it the “signal-to-noise” ratio. In psychiatry paper outlining the study and its conclusions. the statistical analysis. Others don’t have much in particular, you have to take account of ‘I normally write something for the “methods” knowledge about statistics, and find the data drop out numbers – people drop out because and “results” sections of a paper, and contribute they have collected very complicated to analyse. they are ill, or because they move away, or to the “discussion ”. For some studies, we have ‘And some of them just prefer to hand over because they decide to no longer take part. writing days when we all go away and discuss all the information to us – for them, statistics is ‘We also need to check the scientific the data together, and what it means. My role like a black art!’ validity of the measures to be used in a is also to express any uncertainty about the study to make sure the information that results, to put the figures in proper context, I The team of statisticians in HSPR includes will be collected will be reliable and worth and be impartial.’ Morven, Clare Flach and Michael Dewey. analysing. We look at how questionnaires, Morven first joined the Institute of A new statistician will be joining the team for example, have been validated, especially Psychiatry in 1994 , working part-time while in 2010 , and there will be an intern joining if they are new measures, and whether the training in medical statistics at the London over the summer months, both funded by people who are collecting the information School of Hygiene and Tropical Medicine. the National Institute for Health Research. will need training to make sure they are all It was a far cry from her previous job in At the IoP, all researchers also have access singing from the same hymn sheet, especially the research laboratory at the British Museum, to a central team of statisticians in the when they need to make their own ratings where tasks included working with chemical Department of Biostatistics, which includes of participants’ responses.’ analyses and analysing carbon dates of items the Mental Health and Neuroscience Clinical After the initial planning and setting up from the past, including the Turin Shroud. Trials Unit. 5

Striving for better treatment and care across the world

he Centre for Global The two Directors of the Centre for Global Mental Graham said: ‘To the best T Mental Health (CGMH) is CGMH are Martin Prince, Health. PL oS Medicine is an of our knowledge, the series is a new collaboration between Professor of Epidemiological open access, freely available, the first attempt to collect HSPR and the London School Psychiatry in HSPR , and Vikram international medical journal. comprehensive reviews of six of Hygiene and Tropical Medicine Patel, Professor of International More than 90 per cent of leading, and mostly neglected, (LSHTM) and was launched Mental Health and people with mental, neurological, MNS disorders in an open access in October 2009 , on World Senior Clinical Research Fellow and substance use (MNS) venue that allows immediate and Mental Health Day. at LSHTM . disorders in low and middle full access to everyone, including The virtual Centre aims to Many of HSPR ’s international income countries go untreated. those living and working in low foster international research research studies were presented The six-part series of articles and middle income countries.’ with the ultimate goal of ensuring at the launch of CGMH to illustrate aims to help close what is Graham also co-authored better treatment and care the sort of work that can make known as the ‘treatment gap’. the third article in the series – for people with mental health a difference. In each article, authors Packages of care for problems across the world. Dr Benedetto Saraceno, outline cost-effective ‘packages in low and middle income countries . The mainstay of the Centre’s Director of Mental Health and of care’ aimed at improving the The paper was written in work will be in poorer countries Substance Abuse at the World recognition and treatment of collaboration with colleagues where health services are under- Health Organisation, gave the these mental health problems. at Universidade Federal de Sao resourced and many people do launch keynote speech, and a Professor Vikram Patel Paulo in Brazil, the Schizophrenia not get the treatment they need. panel discussion was chaired from the LSHTM , and Professor Research Foundation in Chennai, CGMH will comprise the largest by Richard Horton, Chief Editor , Head of India and CBM International in programme of international mental of The Lancet. HSPR , were guest editors for Abuja, Nigeria. Professor Martin health research in the UK and • www.centreforglobalmental the series. Prince has written the fifth article will be seeking financial support health.org/ They hope the articles will in the series about . from major research funders. serve as a ‘valuable resource The PL oS Medicine series is A teaching programme will I The first of a major new series for health professionals, policy intended to be complementary to include the development of of articles exploring how best makers and health workers the new World Health Organisation distance-learning resources, to treat depression, epilepsy, working to improve the care Mental Health Gap (mh GAP ) and a new Masters degree in schizophrenia, alcohol use and treatment of those struggling recommendations on the use Global Mental Health (see page disorders, dementia and ADHD in with MNS disorders in settings of specific treatments in primary 2), to be launched by HSPR and low and middle income countries where specialist resources are and community health care in low the LSHTM , will come under was published in PL oS Medicine scarce and where treatment and middle income countries. its wing. to coincide with the launch of the gaps are large.’ • www.plosmedicine.org

Focusing on recovery

nyone interested in Research which is investigating being carried out as part of I If you’re interested in joining A research about ‘recovery’ how mental health services the REFOCUS programme,’ the Recovery Research Network, – recovering a life worth living, in England might change to said Mike. ‘At the moment, email [email protected] , or without necessarily having a become more geared towards the Network has about 120 visit researchintorecovery.com clinical recovery – is invited recovery. REFOCUS includes members – people with lived to find out more about both the to join the Recovery Research a national survey of existing experience of mental health, Network and the work of the Network, set up to foster services and a survey of people carers, clinical researchers, Recovery research team in HSPR . collaboration and spawn who use mental health services non-clinical researchers The website includes minutes of new projects, and increase to find out ways in which existing and managers.’ the Network meetings and copies access to information about services support, or hinder, their Members are invited to of the monthly update emails. existing work. The aim of the recovery. The REFOCUS team is meetings held in London every Network is to help transform also developing ways of helping six months and Mike and his team I The Recovery research team the sort of support mental mental health professionals convene them and support the in HSPR is working with the mental health services in England offe r. extend their knowledge and administration of the Network. health charity Rethink to organise ‘It’s an inclusive network of skills to better support the Members are sent monthly a conference in September 2010 . people interested in recovery- personal recovery of people email updates about research, Refocus on Recovery 2010 takes related research,’ said Mike they work with. And REFOCUS events and planned conferences. place in London from 20-22 Slade, one of the originators also includes the development Network members have already September and will present of the Network and Head of of a new tool to help evaluate set up working groups to explore international research about the newly-created Recovery the success of measures put different themes of recovery, recovery and showcase national research team in HSPR . in place to transform services. including one about spirituality. studies about changing practice. Mike is leading a five-year ‘The Recovery Research You can find out more about programme funded by the Network is separate but the conference by visiting National Institute for Health complementary to the work researchintorecovery.com 6 Should you tell your boss about your mental health?

Combating Stigma – is suitable for all people If you’ve got a diagnosis or a history of a mental health training for jobs in health and social care and problem, should you tell a potential employer ? A team in features interviews with service users and carers. The student nurses are being contacted HSPR is producing a booklet that can help people weigh four months after taking part in the sessions so researchers can gauge which type of training up the pros and cons and reach an informed decision. had most impact on their knowledge about mental health problems, and their attitudes he booklet will be the end result of Service users and mental health workers towards people with experience of mental the CORAL project, which is gathering recruited through early intervention services ill health. To do this, they are using MICA views and experiences of both service run by South London and Maudsley NHS (Mental Illness: Clinicians’ Attitudes ), one T users and mental health professionals Foundation Trust ( SL aM) are helping to of four measures of discrimination and stigma to guide the development of the new resource. shape the contents of the new resource. that have been developed and validated under Only about 20 per cent of people with Their testimonies – including service users’ the umbrella of SAPPHIRE . severe mental health problems have a job: personal experience of talking about their The SAPPHIRE programme also aims previous research has shown that employers diagnosis to employers, friends and family to find out more about different aspects of are reluctant to hire people with experience members, and staff’s professional experience discrimination to inform specific plans to of mental illness, and that mental health of supporting people seeking work – will give combat it. So, in the SPHERE study, staff in professionals may not encourage people to greater insight into the difficulties surrounding accident and emergency departments are being look for work – either because they fear it will a disclosure decision. interviewed in a bid to discover why physical be too much for them, or because they don’t see The Trustees of SL aM are funding the health problems are sometimes mistakenly vocational support as being part of their remit. first phase of the CORAL project, and the thought to be due to mental illness, leading ‘The decision to disclose is an important second phase is being run under the auspices to delays in a correct diagnosis and treatment. one,’ said Elaine Brohan, who is leading the of a large programme of work called SAPPHIRE . This is one of a series of analytical studies: CORAL project as part of her PhD. ‘Whether This embraces several studies focusing another was MOSAIC , which focused on to tell an employer and/or work colleagues on different aspects of stigma and discrimination finding the best type of message to include in can be a dilemma. against people with mental health problems, anti-stigma campaigns. A panel of 32 experts ‘If you do talk about your mental health and has financial support from the National – including people with experience of mental history, you may not get the job. But if you Institute for Health Research. health problems and mental health professionals never disclose, that means you can’t ask for The Perspectives study, for example, – took part in a ‘consensus development ‘reasonable adjustments’ to the job that you are is comparing the effectiveness of different exercise’. ‘Recovery-oriented’ and ‘see the entitled to under the Disability Discrimination styles of Mental Health Awareness training person’ messages were, in their opinion, the Act. for student nurses. Two hundred students message styles that are most likely to succeed. ‘If you don’t disclose, you may also live in from the Florence Nightingale School of fear of being “found out ”. And there is a risk of Nursing & Midwifery at King’s College I To find out more about the CORAL project, dismissal if people do not disclose their diagnosis London were randomly allocated to take email [email protected] or mental health history if they are directly part in either a session with a service user I To find out more about the Perspectives asked.’ and carer talking to them about their or SPHERE studies, email The aim of CORAL is to develop a decision experiences; a session where they viewed [email protected] aid that will give people a structured way a specially-made DVD , created by the I To find out more about the SAPPHIRE of working through the advantages and mental health charity Rethink and the programme, email [email protected] disadvantages of disclosure, when job- Institute of Psychiatry; or a lecture about I Combating Stigma is available from Rethink, seeking and in the workplace. stigma and discrimination. The DVD – www.mentalhealthshop.org

Highlighting service A decade of HSPR user-led research

SPR celebrated a decade of his is Survivor Research is had previously been the subject H working towards improving T a new book about research of research to begin to take the treatments and services for carried out by people who have lead in studies. It includes people with mental health experience of mental health examples of service user-led problems in 2009 . In November, problems themselves. Diana research and guidance for a special anniversary conference Rose, who jointly leads the carrying out such projects. was held to showcase the work Service User Research of the past 10 years and discuss Enterprise ( SURE ) in HSPR , I This is Survivor Research , current research and future plans. is one of the book’s editors. edited by Angela Sweeney, Professor Shitij Kapur, Dean of the Another of its editors is Angela Peter Beresford, Alison Institute of Psychiatry, described Sweeney who was previously Faulkner, Mary Nettle and Diana the work of the Department as part of the SURE team. The Rose, published by PPCS Books, ‘passionately pragmatic’ and book looks at the move over www.pccs-books.co.uk/ said HSPR had demonstrated recent years for people who that ‘things can be changed.’ 7

Estia Centre marks 10th anniversary

he Estia Centre was 10 years offered routinely to staff She was speaking at the T old in 2009 . At an anniversary in social care and mental anniversary event where conference in December, the health services in south members of the Estia team Centre marked a decade of London and also available gave a series of presentations working towards making sure on request to staff working about the work over the past the mental health needs of people in other services around the decade and about plans for with learning disabilities are met – UK and in other countries. the future. through specialist clinical services, Over the years, the Estia Peter Cronin from The research, and a programme of Centre has shared skills and Tuesday Group – a group of training and education for both experience through long-standing people with learning disabilities support workers and mental collaborations and consultancy who meet regularly to talk about health professionals. work around the world, helping staying mentally well and the Based on Guy’s Hospital to shape and develop specialist services they use – also spoke. campus at London Bridge, the mental health services for the The Tuesday Group is supported Estia Centre is part of South benefit of people with learning by members of the Estia team. London and Maudsley NHS disabilities and their families. Peter and other Tuesday Group Foundation Trust ( SL aM). ‘We do research that makes members take part in training Members of the Estia team a difference to what goes on organised by the Estia and also work in SL aM’s clinical services in day-to day practice,’ said speak at conferences to tell and in HSPR . There is also a Dr Jane McCarthy who leads professionals how they could I The Estia Centre: celebrating dedicated team at the Centre on research at the Estia. better work with people with 10 years is a special anniversary responsible for organising ‘Ultimately, we want to get learning disabilities. publication available from the Estia a large portfolio of training, good quality services.’ Centre, www.estiacentre.org

Global effort to combat stigma

ioneering work that aims Forty-seven per cent of those to tackle discrimination might I DISC – Discrimination and Stigma P to help end discrimination interviewed said they had found not make a difference unless there Scale – is a new research tool against people with mental it hard to make or keep friends, are policies to encourage people developed by HSPR to measure health problems continues 43 per cent said they had with mental illness to overcome discrimination and anticipated through the INDIGO network, experienced discrimination from anticipated discrimination and discrimination. It was used in now made up of researchers family members, 29 per cent in actually apply for jobs. the INDIGO survey of people from 47 countries. A new finding a job, 29 per cent in keeping Dr Tine Van Bortel in HSPR with schizophrenia and will study will gather the personal a job and 27 per cent said they is Project Co-ordinator of INDIGO - be one of the main measures experiences of more than had experienced discrimination Depression and is also charged of discrimination in the INDIGO - 1,000 people with a diagnosis of in intimate or sexual relationships. with co-ordinating ASPEN , another Depression study and in ASPEN . depression from around the world. What was also high – and study designed to ultimately For the first INDIGO survey, DISC The results of INDIGO -Depression consistent – across all countries reduce discrimination and also was validated in each country to will inform future proposals and was anticipated discrimination. involving many countries. ASPEN make sure translated versions policies designed to stamp out People believed they would brings together researchers who were understood accurately and unfair treatment because of encounter prejudice and unfair are part of the INDIGO network took cultural factors into account. prejudice, fear and ignorance. treatment, particularly when and based within 20 European DISC is one of a family of HSPR is the co-ordinator of applying for a job or seeking countries to ask people with new tools developed by HSPR the INDIGO (International Study a personal relationship. depression about their experience as part of their quest to fight of Discrimination and Stigma ‘This finding indicates the of unfair treatment because of discrimination. The others are Outcomes ) network, set up importance of including strategies their diagnosis, collect information MICA (Mental Illness: Clinicians’ through the World Psychiatric for stigma reduction methods about successful strategies to Attitudes ) which can be used Association Global Programme that increase the self-esteem reduce discrimination already to assess the attitudes of health Against Stigma and Discrimination of people with mental illness, and being implemented in different professionals towards people Because of Schizophrenia. has important implications for countries, and come up with ways with mental health problems; A paper published in The education of employers about to include service users in making MAKS (Mental Health Knowledge Lancet reported the results of mental illness,’ say the authors policies and laws designed to help Schedule ), which can be used INDIGO ’s first study – a survey of Global pattern of experienced end discrimination. to assess people’s knowledge of discrimination faced by people and anticipated discrimination ASPEN (Anti-Stigma Programme about mental illness; and RIBS with schizophrenia in 27 countries against people with schizophrenia: European Network) is financially (Reported and Intended Behaviour which showed that 72 per cent of a cross-sectional survey (Graham supported by the EU Public Health Scale ), for measuring people’s the 732 people interviewed said Thornicroft, Elaine Brohan, Diana Programme. behaviour towards people with they felt it necessary to conceal Rose, , Morven mental health problems. their diagnosis and almost all – Leese, for the INDIGO Study Group, I To find out more about ASPEN 95 per cent – had faced some The Lancet 2009; 373: 408-15). and INDIGO -Depression, contact kind of discrimination. The researchers say legislation [email protected] 8

Links between mental health and HIV care

oes mental health influence a that screened for depression, ‘People are advised to go don’t. If we can identify why Ddecision to get treatment when anxiety, panic disorder, alcohol straight away, but there are they don’t, we can begin to someone has tested positive for and drug use. The researchers no systems or records in place develop ways of supporting HIV ? A team of researchers has accessed medical records of that link the testing centre and people to get the results and interviewed nearly 2,000 people people they had interviewed the treatment centre, so people then get prompt treatment.’ in Goa in a bid to answer that six weeks after they had been may not go for treatment, or All the information has now question. tested. They wanted to find delay in going. We’re measuring been collected and Rosie is soon Those interviewed were being out first of all whether people that possible delay and drop out, to start analysing the data back tested for HIV at a large public had collected the results. and whether people’s mental in London for her PhD. She worked counselling and testing centre If they had done, and the health has anything to do with in Goa for two years as Project at Goa Medical College, one of results were positive, the it. Previous research has shown Co-ordinator, based at Sangath, the collaborators in the UMEED research team then found late presentation at services a non-governmental organisation (Investigating mental health, HIV out whether they had gone leads to earlier deaths. there that undertakes mental and access to care for HIV in Goa, on to seek treatment and ‘We’re also looking at health research, and another India ) project. Rosie Mayston start antiretroviral therapy. whether people actually get collaborator in UMEED . in HSPR is co-ordinating the ‘What’s supposed to as far as collecting their results, Other collaborators are project for her PhD, supported happen is that if people and whether their mental health the National Aids Research by a Medical Research Council test positive, they should has anything to do with that. Unit, India and Goa State Aids studentship grant. then go on to the antiretroviral People come for the initial test Control Society. UMEED has A small team of graduates therapy centre where the and pre-test counselling, and also been supported by funding were recruited and trained in disease can be assessed are then supposed to go back from the Institute of Psychiatry- Goa to carry out the interviews and a plan of treatment a week later to collect their based Psychiatry Research Trust with the help of a questionnaire decided,’ said Rosie. results. However, some people and the Parkes Foundation.

Supporting victims of violence

SPR ’s Louise Howard is women and girls, and is due respond to domestic violence. than people with no experience H involved with a government to report early in 2010 with its The five-year programme of mental health problems. taskforce charged with making recommendations. Professor called PROVIDE (Programme on PROVIDE complements sure women who are the victims Dinesh Bhugra, President of Research on Violence in Diverse another study by Louise – of violence – including violence the Royal College of Psychiatrists domestic Environments ) is a who heads the Women’s Mental at home – get the support and and a member of the HSPR team, collaboration between HSPR Health team in HSPR – which is care they need from health is a member of the Taskforce’s at the Institute of Psychiatry investigating whether community- professionals. steering group. and research teams from the based advocacy can successfully She is a member of the The Department of Health University of Bristol, the London support victims of domestic Domestic Violence sub-group of says violence against women School of Hygiene and Tropical violence. The research seeks the government’s NHS Taskforce and girls is a public health issue, Medicine, NHS Bristol and Guy’s to find out if an experienced on Violence Against Women and estimating that 3 million women and St Thomas’ NHS Foundation domestic violence advocate, Girls . The remit of the taskforce experience some sort of violence Trust. Voluntary organisations based in community mental health includes recommending how best every year, including domestic throughout the UK are also teams, and offering advice and to make sure vulnerable women violence, rape, sexual violence, involved. information about personal safety, or victims of violence can get sexual harassment, female genital The £1.8 million programme can make a difference and help help and advice from health mutilation, forced marriage, has a number of studies, including reduce the abuse people suffe r. professionals, and the best crimes in the name of honour, one focusing on the prevalence way of training members of trafficking and sexual exploitation. of domestic violence experienced I Louise Howard spoke about the NHS workforce to do this. Two women are killed by their by people with mental health her research in this field on ‘Mental health professionals partners every week in England problems, and the experience BBC Radio 4’s All in the Mind often don’t discuss violence with and Wales. of service users who suffer abuse. (8 December 2009 programme): service users,’ said Louise. ‘They The government has also Louise is the lead author of a www.bbc.co.uk/programmes/ are often reluctant to ask because pledged increased funding for review published last year (2009) b006qxx9 of lack of expertise and lack of the 24 -hour National Domestic that found very little research has confidence. If people do tell them Violence Helpline, run by the been carried out about domestic I NHS Taskforce on Violence they are being abused at home, charities Refuge and Women’s Aid. violence experienced by people Against Women and Girls they are not sure what to do with Louise is a key player in with mental health problems, or www.dh.gov.uk/vawg that information.’ a new National Institute for about ways of supporting service The taskforce is part of a Health Research-funded research users in this situation, even though I 24 -hour national domestic cross-government programme programme which is investigating they have a higher risk of being violence helpline, 0808 2000 247 addressing violence against how best health services can the victims of domestic violence 9

Antipsychotic use in dementia condemned

n estimated 1,800 people and psychological problems as Awith dementia die each year they are developing so they can because they are prescribed seek help quickly. Local targets antipsychotic medication and need to be introduced so the two-thirds of those prescriptions prescribing of antipsychotics are likely to be unnecessary. This can be drastically reduced. was the finding of a government- If the recommendations are commissioned review of the use of implemented, they will, he says antipsychotic drugs as treatment in the report, ‘reduce the use of for some of the most distressing these drugs to the level where symptoms of dementia, carried benefit will outweigh risk and out by Professor Sube Banerjee, assure us that patients are being who leads the Mental Health and with dementia are treated with doctors and care home staff managed safely and effectively.’ Ageing research team in HSPR . antipsychotics each year, and so they can offer psychological Sube co-authored Sube was asked by the Sube estimates only about therapies instead of depending the government’s five-year Department of Health to 36,000 of them benefit from on drugs. ‘This over-prescription National Dementia Strategy , investigate the prescribing the medication. is a symptom of the failure of the unveiled in February 2009 . of antipsychotics to manage What the research does overall system of dementia care The government has since aggression, agitation, shouting, show is that antipsychotic in the UK ,’ he said. invested £150 million to start sleep disturbance, wandering medication can harm older, His practical recommendations implementing the Strategy, and repeated questioning – frail people with dementia – – which have been accepted by which seeks to prioritise early behavioural and psychological causing strokes and deaths. the government and supported diagnosis and give support to difficulties that are distressing His report – The use of by the Alzheimer’s Society – improve the quality of life for to both the individual with antipsychotic medication for include putting policies and people with dementia and their dementia and their carers. people with dementia: Time for procedures in place to ensure families. The investigation into He found that antipsychotic Action – calls for an end to routine antipsychotic medication is the use of antipsychotic drugs drugs are ‘too often used as a prescribing of antipsychotics; only prescribed for people was carried out under the first line response’ – even though more research to find out when with dementia when they auspices of the Strategy, the research shows their success they can be effective in treating really need them. More following increasing concern in treating these symptoms is the more severe symptoms of support is needed for carers about their over-use. limited. Some 180,000 people dementia; and more training for to help them spot behavioural

Website focuses on psychosis

entalhealthcare.org.uk research about psychosis, and medication have moved on M has been redesigned and written in plain English; significantly since my brother was relaunched. The website for • information on how to diagnosed in 1962, there is still not family members, friends and get involved with research; enough information and support other carers now focuses • links to other key websites. from the authorities or the medical exclusively on information All information on the website profession. about psychosis. is based on research carried out ‘Most information is shared by The relaunch of the site – to learn more about the causes carers through support groups originally set up by HSPR some of psychosis in order to develop and word of mouth, so something five years ago – was funded better treatments or improve like the new website is a big step website. She said: ‘There is still by a public engagement grant existing ones. in the right direction to helping an enormous amount of stigma from The Wellcome Trust. The site is easy to navigate, provide carers and families and and shame about psychosis, and The revamped website clear and easy to read. It uses friends of people with psychosis worry and upset when a relative now provides: simple language and explains with the information they need.’ is diagnosed with a severe mental • short filmed interviews mental health terms; provides mentalhealthcare.org.uk is a illness such as schizophrenia. with health professionals information about medication and joint venture between The Institute There are a lot of myths about and researchers talking what side effects can be expected; of Psychiatry and South London what it means if you have one of about different aspects of describes other treatments, such and Maudsley NHS Foundation these problems, so it’s helpful psychosis, treatment and care; as talking therapies, and sets out Trust ( SL aM), and has been to have information that you can • Ask the Pharmacist , Ask how mental health services work. relaunched in association with trust, information that helps you the Psychologist and Ask the ‘Access to reliable information Rethink, the campaigning mental know what you are dealing with. Psychiatrist pages where in the early stages of diagnosis health charity that runs support ‘Through this website, we aim visitors to the site can is crucial,’ said Marshall Whiting, groups for carers. to provide clear information about submit general questions; who supported his late brother Elizabeth Kuipers, Professor treatment, medication and other • summaries of HSPR and and now his eldest son, through of Clinical Psychology at the IoP, support available to carers and other Institute of Psychiatry schizophrenia. ‘Although therapies has led the development of the people with psychosis.’ 10 A not so leisurely retirement

Sir David Goldberg says the best thing he ever did was doctor here. Others had not had specialist training at all, but were working in mental setting up a scheme to train doctors from Africa how health in their own country.’ The scheme outlasted him at Manchester, to be psychiatrists. That was when he was Professor but eventually folded in the mid- 1990 s. ‘I was of Psychiatry and Head of the Department of Psychiatry very pleased with that scheme,’ he said. ‘It was a tremendous success. We trained many and Behavioural Science at Manchester University, a job psychiatrists in Ethiopia, Nigeria, Tanzania, for example … at the time, there were few he held for more than two decades before returning to psychiatrists in some of these countries.’ the Institute of Psychiatry and in 1993 Everyone in HSPR knows Sir David’s name, even if they have not met him: the as Professor of Psychiatry, Director of Research and Department is housed in the ‘David Goldberg building’, a couple of doors along from the Development, and Director of Education. main Institute of Psychiatry building in De l

i Crespigny Park, round the corner from the m a

J Maudsley Hospital. When Sir David retired n a

h in 2000 , he had secured the money for the e R new building, but construction had not started. In retirement, he stopped doing clinical work and leading research projects, but his life for the past decade cannot be described as restful and relaxing. He has written about 40 papers and three books: The Maudsley Handbook of Practical Psychiatry (with Robin Murray); The Origins and Course of Common Mental Disorders (with Ian Goodyer); and Psychiatry in Medical Practice, 3rd Edition (with Linda Gask and Richard Morris). He has travelled, and continues to travel, around the world, sharing his expertise with young psychiatrists interested in research on a teaching programme organised by Professor Norman Sartorius, who is based in . The programme is funded by an educational trust and the week-long course seeks to teach the skills of public presentation and career advancement – how to get published, how to create a poster, for example. Sir David continues to teach too on the IoP MS c course in Mental Health Service and Population Research and, as Professor Emeritus, continues to advise HSPR he colleagues he has amassed since you’ve finished – basic human things every staff, get involved with specific assignments he began training as a psychiatrist decent clinician should do. and help out on research applications. (at the Maudsley) in 1963 can list ‘Psychiatric advances have been dramatic, ‘In the run up to the last RAE (Research T many prestigious accomplishments but the human bits are also important. It’s easy Assessment Exercise) for example, Professor and successes – and they did so when he was for doctors, trained in a biological reductionist Anthony Mann and I advised each member of given the Royal College of Psychiatrist’s first model, to forget that. It’s easy for them to try to staff about what was required by the exercise, ever Lifetime Achievement Award in 2009 . reduce the whole thing to a few chemicals that starting about three years before, interviewing But for Sir David, his two biggest triumphs have gone wrong. That doesn’t take away from each one to make sure they were doing what were firstly the Africa scheme and secondly, the importance of the process of understanding was needed. I helped Professor Nick Bouras teaching scores of ‘medical students how to each sick individual.’ set up Maudsley International, and am still treat patients courteously and respectfully’ The training scheme for doctors from involved with that – I sit on the steering during his time at Manchester. ‘It is a duty to African countries started in the early 1980 s. committee.’ talk to patients using language they understand, ‘I had asked the Royal College of Psychiatrists He also continues to chair the IoP-based words that are part of everyday speech,’ he if they were interested in doing this, but they charity, the Psychiatry Research Trust, and said. ‘In Manchester, I was in a position to weren’t, so I set it up myself,’ he said. Doctors is involved in decisions about the distribution make sure that doctors who qualified – 280 came to Manchester for two years, worked full- of money, mostly donated through legacies. a year – knew how to talk to patients, how time as NHS psychiatrists-in-training and were Even though he hasn’t been principal to be humane and polite. I had each set of paid as if they were British doctors. ‘I organised investigator on a research project since students for nine weeks and our staff taught a bank loan for each of them so they could get he retired, he continues to collaborate them how to do a medical interview, giving somewhere to live and cover travel costs until with a number of people around the world, them video feedback. Simple things – tell them they started earning here,’ he said. ‘Some of particularly those who are undertaking your name, make sure people understand what them were fully trained as consultants in their research that he considers worthwhile. ‘In you’re saying, recapitulate their history when own country, but went back to being a junior Austria, for example, I helped on several 11

projects about deaf people who are mentally For WHO , he is chairing a committee that is that demonstrate skills GP s need to help disordered – advising on research methodology going to make recommendations for an updated patients with mental health problems from and techniques, helping collect and analyse Primary Health Care version of the psychiatric the Institute of Psychiatry’s top academics data, and helping get the results published.’ illness section of the International Classification and other experts in the field of mental health. Since his retirement, he has also been of Diseases (ICD ). ICD is currently in its 10 th Now the Norwegian Department of Health involved with the production of two sets version, so the revision procedure will yield has invited him to visit to teach GP s later this of Guidelines from the National Institute ICD -11 . year, an invitation he has decided to accept for Health and Clinical Excellence – the ‘It’s taken me nearly two years to set up because – even though he doesn’t like the first one on depression, published in 2004 the committee, with psychiatrists who work process of travelling or staying in hotels – (and updated in 2009 ), and the second on with GP s in primary care and from every WHO it is work he enjoys doing. the treatment and management of depression region. We will meet three times a year and ‘When I retired, I stopped doing all the in patients with chronic physical health there will be a lot of work between meetings,’ things I couldn’t stand – chairing committees problems, published in 2009 . he said. because I had to, writing reports at short On top of all of this, he is involved with Working with GP s and giving them the notice, travelling in the rush hour. I hated the extensive updating of both the World skills they need to recognise and support people the bureaucracy, and now I still have to deal Health Organisation ( WHO ) and the American with mental health problems has been a life- with it, but that’s very different to being part Psychiatric Association ( APA ) classification long passion. ‘Across the world, psychiatrists of one, that’s very different to running one.’ systems for mental disorders. and specialist mental health professionals see The APA is updating its Diagnostic and less than one tenth of people with mental health I http://vimeo.com/8534942 is a film made Statistical Manual of Mental Disorders (DSM ), problems. Most people are looked after by their by Sir David’s colleagues to mark the Royal first published in 1952 , with four revisions GP in primary care,’ he says. College of Psychiatrist’s Lifetime Achievement since. The development of DSM-V is being Early on in his retirement, he directed Award. led by a taskforce and 13 works groups, each and produced Training Physicians in Mental reviewing scientific advances in specific fields Health Skills , a CD ROM /video training I Training Physicians in Mental Health Skills is and evidence from recent research. Sir David package specially designed and created for available from the Primary Care Mental Health is a member of the Mood Disorders Group. GP s. It includes five different presentations team in HSPR .

What do young carers want?

hat’s it like for young people need support. Otherwise, their give to other people in a similar W who are living with someone caring role may have an adverse situation, and the good things with a mental health problem, and effect on their life outside the about being a carer. She will what sort of support would make home – on their school work also ask them what sort of their lives easier? and their social life, for example. support they think would Anisha Siromoney is asking ‘My research seeks to make a difference. young people aged 16 to 25 who understand the experience There are an estimated help – or have helped in the past of young carers and then use 175,000 young carers aged – to look after someone with that understanding to develop under 18 in this country, a mental illness to share their some sort of package of support,’ of whom 29 per cent help experiences with her, and say she said. ‘I’m particularly focusing support someone with a how they think young people on the distress that can be caused mental health problem, in similar situations could be by helping to care for someone she said. supported. with a mental health problem.’ ‘Parents who have severe The support she develops will mental illness often depend on be tested in a future research their children to help them and project. care for them,’ said Anisha, who Anisha – who has personal is carrying out the research experience of being a young for a PhD. ‘Children may have carer – is recruiting young to undertake domestic and people willing to either join l household tasks, or have to a group or be interviewed i m a

supervise their medication, face to face. The sort of things J n a

or be involved in sorting out she will be discussing with h e crises, and sometimes feel them include their knowledge R emotionally responsible for of their relative’s illness, the their parents.’ difficulties they faced and how Anisha (right) says that they coped with them, how previous research has shown caring for someone when that while caring can be a positive they were young affected experience, young people do them, advice they would and evidence for similarities and differences. An article on a related subject appeared in the December 2009 issue of the scholarly publication Biolinguistics . In HSPR , she puts in long hours to tackle a challenging workload that has included taking on the responsibilities of business manager for the Department for most of 2009 in addition to the duties of her real job. ‘The business manager role is about keeping the Department running,’ she says. She has been managing the Department’s budget and in charge of a bigger team of administrative staff. ‘I’ve had to learn even more. There is a very complicated financial allocation procedure, for example, and I’ve had to attend and contribute to many more meetings. There are more than 100 people in the Department, all of whom have space needs, want keys to their doors and working l i telephones! We are always short of space m a J so allocating it involves balancing lots of n a h

e different interests and skills of diplomacy.’ R But the business manager duties have been temporary and it is her real job that she feels Ann’s crucial role... passionate about. In her capacity as Graham Thornicroft’s right hand woman, Ann often finds herself as a conduit for sourcing information, and You won’t see the name Ann Law on the keynote speaker is therefore constantly investigating all and sundry for any of the many different streams list at mental health conferences. As Research Strategy of research and projects he is involved in. Manager, hers is a backroom, but crucial role in Health She attends management team meetings, management executive meetings and an Service and Population Research, working very closely annual awayday where senior members of the Department discuss the future direction with Department Head Professor Graham Thornicroft. of research and teaching. She has also travelled ‘Mine is a supporting role, backing up how Graham to conferences and meetings abroad to offer support to Graham. steers the department,’ she says. As well as publishing in the field of linguistics, her name is now beginning to nn joined the HSPR team in November Working with applied research was also appear on mental health papers. After helping 2005 after a brief stint in adminstration a bit of a culture shock. Her PhD was in to collect data for the second edition of the at Camberwell College of Arts. She linguistics, analysing ‘sentence-final particles’ Mental Health Matrix , she is joint author on A had finished her PhD at UCL a year in Cantonese. ‘The idea in linguistics is that a chapter of the updated and renamed book earlier, and had decided upon a career you observe something in a language and Better Mental Health Care . Her name also in a university environment. She applied use theories to understand and explain appeared on a paper based on the same material for the HSPR research administrator job that element,’ she says. Ann is Chinese in World Psychiatry , the journal of the World ‘without knowing anything about the and Cantonese is her mother tongue. She Psychiatric Association ( Steps, challenges and Institute of Psychiatry or mental health.’ grew up in Hong Kong: after completing lessons in developing community mental health ‘It was a very steep learning curve,’ she a first degree in English there, she came to care , Graham Thornicroft, Michele Tansella, says. ‘The administration job at Camberwell England in 1999 , originally intending to do Ann Law, Volume 7, Number 2, June 2008) . had primarily supported students and the a Masters degree, but ended up studying Graham Thornicroft, she says, is inspiring. skills needed here in HSPR were completely for the PhD instead. ‘It’s incredible that one person can do so much different. In her free time, she still pursues her in so many different areas. He really does care ‘My first set of tasks was to work on a interest in linguistics, working with her about his work, and also cares about people. lot of major grant applications with Graham, former PhD supervisor, who is now retired, He is very supportive.’ helping him pull together information and and publishing papers together. Parametric Are there drawbacks to the job? ‘The costings. Many of them were multi-country variation: Language and Birdsong (Neil Smith only drawback is that sometimes I just don’t projects, and I had to project manage the and Ann Law), for example, looks at what have enough time to learn about new concepts whole process, co-ordinating and seeking makes human language unique, and will properly, and I feel my knowledge about information from a lot of different people. appear as a chapter in a book soon to be certain areas is superficial,’ she says. ‘I had to learn new terms and concepts published by MIT Press. It was written And... as a linguist, what does she think in a very short period of time because of the after they had attended a workshop where about working in a field where acronyms deadlines involved. Some of the applications linguists and biologists discussed cognitive abound? ‘Linguists don’t do acronyms!’ were very complex!’ and neural mechanisms in birds and humans, she laughs.