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Brexit vs. Mental Health – Considering the mental health needs of the UK Central and Eastern European community

5 Apr

by Aaron Poppleton


In the UK, Brexit is the topic of the moment.  Regardless of outcome, the impacts are already being felt across the country. Around two million people from Central and Eastern Europe (CEE) currently live in the UK. As with many ethnic minority groups, there hasn’t been a lot of research looking into their health needs. This is particularly true for mental health and wellbeing – something which Brexit is thought to have made worse. Limited information makes it much harder to deal with challenges such as higher rates of depression, anxiety, alcohol misuse and death through suicide.

Alongside the NIHR Greater Manchester PSTRC’s work with marginalised groups, the UK Central & Eastern European Health Research Forum took place on the 19 February 2019. Researchers and CEE community members were invited to attend from across the UK and Ireland to discuss ways to improve community mental health awareness and research. The day consisted of a series of presentations and small group discussions, with topics including:

  • “Brexit is coming… How can we explore, maintain and strengthen well-being / mental health within the CEE community?”
  •  “Developing strategies for self-harm and suicide prevention in the UK-CEE community”

Attendees shared a wide range of academic and personal experiences, which provided plenty of food for thought.

What’s next?

The day culminated in a whole meeting discussion on “where do we go from here?”. Attendees felt it was important to continue the momentum of the day through creating a formal network of academics with an interest in the mental health and wellbeing of the UK CEE community. It is intended this will happen through a group webpage and online meetings focussed on particular community mental health needs. The mental health of children and adolescents will likely be an early topic for discussion.

The immense value of public and patient involvement was discussed. It is proposed that lessons learned from events and research projects undertaken within the community will be widely shared. We hope to discuss this in a future community event to test and refine these ideas, removing as many barriers as possible to improve mental health and wellbeing.

Finally, a range of wider partners were identified, who will be approached to help with the practicalities of research, and to make support for the Central and Eastern European community a reality.

New PSTRC research: Mental health assessments and psychological therapies following self-harm

26 Mar

by Leah Quinlivan, Donna Littlewood, Liz Monaghan, Stephen Marks, Clive Turpin, Roger Webb, Nav Kapur

Quinlivanstudy image_500x333

Mental health assessments and psychological therapies can be beneficial in helping people keep safe and reducing repeat self-harm. Researchers in  the NIHR Greater Manchester PSTRC are conducting a study to understand what helps and does not help people receive assessments and aftercare following self-harm. The results of the study can then be used to inform the design of better services for people who self-harm, as well as the National Suicide Prevention Strategy.

Self-harm presentations to hospitals are a key patient safety issue in mental health services and may have serious consequences.(1) People who self-harm are at an elevated risk of suicide.(2,3) Repeat self-harm is common and usually happens quickly.(4,5,6)  Hospital services have an important opportunity to increase patient safety though good quality assessments and prompt aftercare.(7)

Clinical guidelines recommend that all individuals should receive an assessment of their individual needs and be offered psychological therapy following self-harm.(8) However, there are wide differences in the quality of care for people who self-harm, and not everyone receives an assessment or referral to psychological services.(9)

The study will investigate the gap between evidence and practice in how assessments and aftercare are provided following self-harm. As part of the study, Dr Leah Quinlivan is interviewing clinicians from 37 hospitals in England and is conducting an online survey of patients and carers. The study is ongoing and will continue until 2021.

The study was developed in conjunction with patient/carer and clinician advisory panels.  Liz Monaghan who is a member of the study’s patient/care advisory panel shared her thoughts about the importance of this study:

“As a suicide and self-harm survivor/service-user/carer, I welcome research which seeks to understand the complex factors, triggers and issues around this sensitive and difficult topic, all things which a good assessment should explore. I see the value of this research in improving service provision, shifting societal attitudes to mental health and informing good practice.

“By involving people like me with diverse lived experience of many aspects of mental health care, we have, as a group, been given an opportunity to shape and direct this research, hopefully adding relevance and insights about service provision which are only evident to those who have experienced it first-hand. It’s been great to be welcomed as a valued group within the research team and, for me, works as an important ‘re-vision’ of some of the worst times in my life. I am immensely grateful for the opportunity to take part in ways which are meaningful and empowering.”

This sentiment was echoed by Steven Marks, Advanced Nurse Practitioner Trainee and member of the clinician advisory panel, who said:

“I think this is a really valuable study because it’s tackling an important patient safety issue which needs to be addressed. Good quality, timely, and appropriate care for this client group is undoubtedly associated with positive outcomes related to self-harm reduction and suicide prevention. Involving frontline clinicians makes this research relevant and realistic, and helps to ensure that the findings are grounded in the reality of everyday clinical practice.”

Similarly, Clive Turpin, a Cognitive Analytic Psychotherapist stated that:

 “Having worked in the area of self-harm, initially on a research project that evolved into a clinical service, I have seen the benefit, and necessity, in bringing both parts together. Sometimes this can be very simple, other times more complex, but being in dialogue with both feels essential in improving people’s experiences of mental health services and ultimately trying to promote and facilitate understanding, hope and change. Although I no longer work in a dedicated self-harm service, it remains a part of my therapy work and I maintain my interests and commitments to promoting and supporting research and its integration into clinical practise”.

Working in collaboration with patient/carer and clinician advisors, dissemination and implementation plans will be developed with the goal of narrowing the gap between evidence-based policy and implementation in practice.

If you are interested in hearing more about the clinician interview study, please contact the lead researcher, Dr Leah Quinlivan by email, or phone: 0161 275 0727.

The website for the patient and carer online survey study provides more information and links to participate in the study.


1.       Bergen, H., Hawton, K., Waters, K., Cooper, J., & Kapur, N. (2010). Psychosocial assessment and repetition of self-harm: the significance of single and multiple repeat episode analyses. Journal of Affective Disorders, 127(1), 257-265.

2.       Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital management of self-harm patients and risk of repetition: Systematic review and meta-analysis. Journal of Affective Disorders, 168, 476-483.

3.       Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., et al. (2015). Suicide following self-harm: findings from the multicentre study of self- harm in England, 2000 – 2012. Journal of Affective Disorders, 175, 147-51.

4.       Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature death after self-harm: a multicentre cohort study. The Lancet, 380(9853), 1568-1574.

5.        Kapur, N., Cooper, J., King-Hele, S., Webb, R., Lawlor, M., Rodway, C., & Appleby, L. (2006). The repetition of suicidal behavior: a multicenter cohort study. Journal of Clinical Psychiatry. 67, 1599-1609.

6.       Steeg, S., Cooper, J., & Kapur, N. (2014). Early Intervention for Self-Harm and Suicidality. In P. Byrne, and A. Rose, (Eds.) EI of Nearly Everything for Better Mental Health Early Intervention in Psychiatry (pp. 255-266). UK. Wiley & Sons, Ltd.

7.       Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., . . . Shafran, R. (2018). The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science. The Lancet Psychiatry, 5(3), 237-286.

8.       NICE. (2012). Self-harm. The NICE Guideline on Longer-term management. National Clinical Guideline Number 133. National Collaborating Centre for Mental Health. London: The British Psychological Society and The Royal College of Psychiatrists.

9.  9.     Cooper, J., Steeg, S., Bennewith, O., Lowe, M., Gunnell, D., House, A., … & Kapur, N. (2013). Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ Open, 3(11), e003444.

Should Artificial Intelligence give reasons for decisions even if it affects accuracy – Citizens’ Juries deliberate

27 Feb

L Riste_Citizens Jury day 3 small groupwork_pZNJshV8

Is it necessary for artificial intelligence (AI) to give reasons for its decisions even if it means the results aren’t as accurate? When and why are explanations of AI decisions most important? A leading research team investigated these questions in Coventry and Manchester and the results could affect future national policy.

The National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (Greater Manchester PSTRC) and the Information Commissioner’s Office (ICO) commissioned Citizens Juries c.i.c to find out what the general public thinks. The findings of the research will inform guidance under development by the ICO and the Alan Turing Institute to help organisations explain decisions made by AI to the individuals affected. One question considered by the two juries was, if a computer gives a diagnosis, is it better to be given an explanation of how the computer reaches its diagnosis even if that means the computer’s diagnosis is likely to be less accurate?

Each jury was made up of 18 people from a cross-section of the public across two locations. The first week was the turn of Coventry and the second, the process was repeated in Manchester. The jurors came together for five days to hear expert evidence before making their recommendations.

Professor Niels Peek, Research Lead for Safety Informatics at the NIHR Greater Manchester PSTRC based at The University of Manchester, and Principal Investigator for this research, said: “AI is fast becoming extremely useful in healthcare diagnosis and, in some cases, can be more accurate than a doctor. The most advanced AI systems are now so complex that some aren’t able to give a reason for a diagnosis. If people are given a diagnosis or decision by a computer but aren’t able to ask for a reason, does that affect how much they trust it? Or, are they prepared to forgo an explanation if that means greater accuracy?

“We need to find out what the general public thinks about this and that’s why we’re conducting this research and asking for their feedback to ensure they have the opportunity to give their opinion on something that will affect patient safety.”

The two juries considered the importance of explanations and the trade-off between accuracy and explanations for decisions made by AI in four different scenarios:

  • Healthcare: diagnosis of acute stroke
  • Healthcare: finding matches between kidney transplant donors and recipients
  • Criminal Justice: deciding which offenders should be referred to a rehabilitation programme
  • Recruitment: screening job applications and making shortlisting decisions

Dr Malcolm Oswald, Director of Citizens Juries c.i.c, said: ”These are important questions now, and they will become ever more crucial as artificial intelligence increasingly affects our daily lives. It’s a complicated topic, and these citizens’ juries give us five days to bring expert evidence and the time for people to work together to reach reasoned recommendations that will inform national policy.”

To find out more about the NIHR Greater Manchester PSTRC visit: and you can learn more about the breadth of projects Citizens Juries c.i.c. are working on at

Greater Manchester PSTRC involvement in NICE Guide

21 Feb

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

NIHR Greater Manchester PSTRC Director Stephen Campbell attended a meeting at the National Institute for Health and Care Excellence (NICE) in London in January to discuss the NICE Indicator Process Guide.

The Guide forms part of the process NICE uses to develop indicators from NICE Quality Standards, NICE guidance and NICE-accredited sources. Indicators used by NICE measure patient outcomes and reflect the quality of care linked by evidence to improved outcomes.

The process Guide describes how indicators should be developed and tested prior to use on routinely collected health data. It also provides guidance on the appropriate stakeholder involvement, including Patient and Public Involvement, service providers, health and social care professionals, for each topic.

A joined-up NIHR approach to patient safety research

21 Feb

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

On 6 February 2019, NIHR Greater Manchester PSTRC Centre Manager Karen Considine, Research Leads Niels Peek and Justin Waring, and Director, Stephen Campbell attended a Joint Workshop on Research for Patient Safety and Quality.

The meeting involved a wide range of organisations with a focus on patient safety, including representatives from the NIHR Imperial PSTRC and Yorkshire & Humber PSTRC, the National Institute for Health Research (NIHR), Department of Health & Social Care, NHS England, NHS Improvement, Academic Health Science Networks (AHSNs) and Patient Safety Collaboratives, as well as researchers from other NIHR funding streams such as Programme Grants and Policy Research Units.

The focus of the meeting was partnership working to ensure the maximum benefit for patients and members of the public, as well as meeting the needs of the health and care system locally and nationally.

The work of the three NIHR PSTRCs was showcased to provide examples of translational research and partnership working, and also the importance of involvement and engagement, co-design approaches and patient and public involvement.

The collective aim is to develop a better and more responsive way for the full network of organisations funded by NIHR to work with patients and providers. Through this collaborative approach, best practice can be shared to ensure the prevention of poor and unsafe care, and the provision of effective and safer care.

First event kicks off cross-PSTRC PhD network

20 Feb

by Carly Rolfe

PhD Forum event_networking and posters_cropped

There are three NIHR Patient Safety Translational Research Centres (PSTRCs) in England – Greater Manchester, Imperial, and Yorkshire and Humber. Each PSTRC funds a number of PhD Fellows, with the ultimate aim of increasing research capacity and innovation in the field of patient safety.

In order to provide PSTRC PhD Fellows with an opportunity to network, to forge links with other early career researchers and to give and receive feedback on research projects, a cross-centre PSTRC PhD Network was set up.

Led by Yorkshire and Humber PSTRC, the first PSTRC PhD network event took place on 5 February in Leeds. PhD Fellows were invited to give an oral presentation on their own programme of work, with constructive feedback being provided by a panel made up of senior PSTRC researchers and Research Leads.

Other key sessions were led by PSTRC researchers, covering topics as diverse as involving marginalised groups in patient safety research, maximising the impact of research, and the challenges of designing research on the economics of patient safety.

Greater Manchester PSTRC PhD Fellow Ahmed Ashour, said of the event:

“Getting the opportunity to showcase your work and see other students work in an environment like the one at the PhD network is extremely useful and motivational! I left the network meeting feeling inspired by the discussions with plenty of ideas and comments that I could not wait to get to work on!”

Citizens’ Juries: Using public opinion on Artificial Intelligence to inform policy

14 Feb

by Carly Rolfe

Jury illustration_iStock-859031624_cropped

Citizens’ Juries offer a novel way of gathering public opinion on important issues, which is used to inform decisions and policy-making at a national level. At the beginning of a Citizens’ Jury, a question is posed to public ‘jurors’. Expert ‘witnesses’ then provide detailed evidence for and against, providing jurors with a balanced view from which they ultimately make a decision on the issue.

This month, the NIHR Greater Manchester PSTRC, in conjunction with the Information Commissioner’s Office (ICO) and Citizens’ Juries c.i.c. is running two Citizens’ Juries, the first in Coventry and the second in Manchester.

The juries will pose four questions around the use of Artificial Intelligence (AI) for decision making in healthcare, criminal justice and recruitment. Specifically, jurors will be asked how important it is for AI to explain how it reaches its decisions, even if the ability to do so will make its decisions less accurate.

The results of the juries will feed directly into national guidance that the ICO is producing on citizens’ rights to an explanation when decisions that affect people are made using AI.

For more information, see the Citizens’ Juries page on the Greater Manchester PSTRC website, or the Citizens Juries c.i.c. website.