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Theme: Mental Health & Dementia
This NIHR funded Programme aims to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder. This project is conducted by a national team of experts lead by Professor Max Birchwood, and locally by Professor Nicky Britten and Professor Richard Byng. Devon research support is being provided by Ruth Gwernan-Jones and Helen Lloyd. The research is hosted by Birmingham and Solihull Mental Health NHS Foundation Trust, with work streams taking place in south Devon in collaboration with Devon Partnership Trust.
People with schizophrenia and bipolar disorder (manic depression) often live very different lives from the general population. Around 66% live in poverty and isolation, most rate their quality of life as poor, and only 12% are employed. These troubling findings are related to the direct effects of mental illness, the side effects of medicines on both physical and mental functioning and peoples’ prejudices/attitudes about mental illness. Previous work suggests that many individuals with lower levels of need have minimal and poorly co-ordinated primary and specialist care. Many service users and professionals feel that too much focus is placed on medication and not enough on other aspects of life. Once stabilised on medication, services don’t always then focus on supporting these individuals to take the next steps in their recovery and fulfil their potential. PARTNERS2 aims to help primary care and community based mental health services work more closely together.
To achieve this the PARTNERS2 team are developing a system of collaborative care based in GP surgeries where about 70% of adult service users are seen regularly by an experienced mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist. This person would see the service user regularly, help them help themselves and facilitate recovery in the broadest sense and, where required, call on the talents of other parts of the health service, particularly secondary mental health care and voluntary/community organisations. This simple idea needs to be carefully developed and tested and then set up as a pilot trial to see if it makes a difference to the care provided, testing a range of outcome measures.
The project has a number of work streams:
1. WORK STREAM ONE: ASSESSMENT OF LOCAL CARE PATHWAYS AND CURRENT SERVICES (0-12 MONTHS)
Purpose: to describe the process of current care, help better target those who would most benefit from collaborative care and assess potential risk and safety issues.
Methodology: observational retrospective cohort study (notes review), development of an economic decision analytic model and focus groups with service users and carers.
2. WORK STREAM TWO: DEVELOPMENT OF A CORE OUTCOME SET (0-15 MONTHS AND STATED
PREFERENCE SURVEY 15-30 MONTHS)
Purpose: to develop a core outcome set and measures for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting.
Methodology: currently there is no gold standard for the development of core outcome sets. Our approach is therefore based on current practice and includes focus groups with key stakeholders, a Delphi process, systematic review and stated preference survey.
3. WORK STREAM THREE: DEVELOPMENT OF THE SYSTEM OF COLLABORATIVE CARE (0-30 MONTHS)
Purpose: to define and develop the key components of collaborative care for people with schizophrenia or bipolar disorder in an English context.
Methodology: iterative development of the model building on the team’s recent Cochrane review using a range of qualitative and quantitative data.
4. WORK STREAM FOUR: FEASIBILITY (0-24 MONTHS)
Purpose: to test the feasibility of patient and practice recruitment and commissioning.
Methodology: qualitative work involving semi structured interviews, and patient and practice structured surveys.
5. WORK STREAM FIVE: REFINE PILOT TRIAL DESIGN (25-30 MONTHS)
Purpose: to draw the findings of the previous four WS into a pilot trial protocol and process evaluation.
Methodology: data synthesis and economic analysis.
6. WORK STREAM SIX: CLUSTER RANDOMIZED PILOT TRIAL AND ANALYSIS (31-60 MONTHS)
Purpose: to establish the proof of concept of the intervention, estimate effects within a pilot trial and inform the design a definitive trial of collaborative care.
Methodology: pilot cluster randomised controlled trial and process evaluation.
Find out more on the Plymouth University project page.
The project recently published the following paper:
Keeley T, Khan H, Pinfold V, Williamson P, Mathers J, Davies L, Sayers R, England E, Reilly S, Byng R, Gask L, Clark M, Huxley P, Lewis P, Birchwood M, Calvert M. Core outcome sets for use in effectiveness trials involving people with bipolar and schizophrenia in a community-based setting (PARTNERS2): study protocol for the development of two core outcome sets. TRIALS 2015; 16: 47.
Professor Max Birchwood, Dr Ruth Gwernan-Jones