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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

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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 leah.quinlivan@manchester.ac.uk, 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.


References

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.

Academic opinion piece: What risks exist for patients if ‘Surveillance Capitalism’ takes over healthcare?

27 Feb

by Gavin Daker-White, Research Fellow in the NIHR Greater Manchester PSTRC

The recently published book, “The Age of Surveillance Capitalism,” by Shoshona Zuboff(1) has been dubbed the “Das Kapital of the digital age,” by one book jacket reviewer. The underlying premise of the book, as summarised in one review, is that Tech companies seek to “control every aspect” of human behaviour, for profit. Many readers will be familiar with the problems that have followed from this model for users of Facebook. Recent scandals have involved privacy breaches and the selling of data from Facebook members’ social networks to third parties. These included groups seeking to influence voting behaviour. Those working in health may be familiar with the story of the NHS care.data program, which was scrapped following interventions by the UK National Data Guardian who had concerns about data sharing.

Colleagues I speak to appear to view digital health as an “unstoppable force,” perhaps like capitalism itself. But what will be the effect on the NHS and the provision of free healthcare by the state? To date, academic articles on digital health have focused on security, privacy and trust issues as being the main downsides or barriers to “uptake” by patient consumers of health services. From a “patient safety” perspective, the risks of having one’s medical data or other personal data compromised are not insignificant and could involve identity fraud (with consequential loss of assets), higher insurance premiums or (depending on the nature of the diagnoses or health conditions involved) even blackmail.

Zuboff alerts us that there is so much more to lose by hurtling down this track however. What are the risks to individuals of a society run on totalitarian lines and controlled by corporations and machinic algorithms? As researchers, how do we measure external control by corporate sponsored actors, the degradation of democracy, the loss of individual privacy and autonomy, or even the accelerated privatisation of NHS health services? One defining feature of “digital” systems appears to be a kind of extension of the rentier approach, whereby human bodies and health conditions become a data harvesting gold mine and revenue stream for shareholders in Tech companies. In my view, strapping the NHS firmly to this mast (as the current Secretary of State for Health has promised to do) is likely to lead to total privatisation of the service by default.

In academic writing, digital health interventions are commonly presented as ways of deepening patient activation or involvement in care, or else harnessing or promoting self-management. In translational health care, an intervention needs an underlying model or philosophy to show conceptually how it can work to change behaviour. What happens when the “underlying model of care” becomes “control of humans for profit,” and how on earth could such an approach claim “patient centredness” or “partnerships in care and decision-making” according to current notions of what constitutes good health care?

As I write this, the UK media are reporting that the police are planning to use algorithms to predict whether or not somebody arrested for an offence is likely to reoffend. One wonders what the confidence intervals are around the results of this computer jiggery pokery? Will individuals who were found to have been wrongly branded “likely to reoffend” receive forms of compensation or legal redress? Crime is not healthcare, although one could conceive of circumstances in which a predictive diagnosis, such as one for Dementia, could lead to confiscation of personal assets (e.g. to pay for social care) or even deprivation of liberty, although perhaps only in an imagined dystopian and not-too-distant future. Such as the one Zuboff alerts us to.

Zuboff is no Marxist. Indeed, a strength of her approach appears to be that her critique is conducted from the “insider” perspective of somebody who believes that capitalism can be reformed through increased democratic accountability. From a healthcare perspective, this begs questions about how patient or advocacy groups could wrest control of digital health from corporate interests, such that any benefits can be realised without the tangible harms that could result from an algorithmic technocracy concerned with profit, coercion and control.


References

(1) Zuboff, S. (2019) The Age of Surveillance Capitalism: The fight for a human future at the new frontier of power. Profile Books.

4

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.

How was it for you? Reflections on involvement

21 Feb

This edition’s reflection comes from Stephen Barlow, a member of the public who is involved in the Marginalised Groups: Mental Health theme’s research advisory panel.

Stephen Barlow_Reflections on Involvement_cropped

Why did you become involved in the ‘Mutual Support for Mental Health’ research advisory panel (supporting the mental health workstream  in the PSTRC)?

I’ve had mental health problems for years and frankly the treatment I’ve received has mostly been poor. There are a range of reasons for this from lack of funding to frankly incompetence. If I can do anything to make future treatment better I will always get involved.

How do you think the Greater Manchester PSTRC has benefitted from your involvement – what difference do you feel that you made?

To me the benefit to the university is that myself and the rest of the group look at the project as members of the public, by which I mean that we look at what has been written ‘normally’ not in ‘uni speak’. In that way we translate the jargon into normal terms understandable to the whole public, not only academics.

How do you feel that you have benefitted from your involvement?

I feel that I’m part of something important and helping future treatment, and meeting people with similar stories to me.

Would you recommend becoming involved in research to other patients? If so, why?

Yes, simply because you could be part of something that could shape better treatment in the future.