Projects Initiated and Led by the Trust

NIHR Portfolio

Follow Up of First Episode Psychosis in East London.

UK CRN ID no. 7682

R&D ref. no. K0511/2

Chief Investigator: Prof Jeremy Coid - 020 7601 8138 - j.w.coid@qmul.ac.uk

  1. Can measures taken at first presentation with psychosis predict adverse outcomes at six year follow up (including observed and reported violent behaviour, criminal convictions, and pathways into secure psychiatric care, re-hospitalization and death)?
  2. Do these measures correspond to others including course of illness, consumer satisfaction and physical morbidity?

The objective is to identify those risk factors associated with these adverse outcomes and to identify protective factors which relate to better outcomes.  These findings could later constitute the basis of new interventions for patients with a psychotic illness.

 

Living with voices

UK CRN no. 7176

R&D ref. no. K1001/2

Chief Investigator: Dr Rose McCabe – 02075404210 - r.mccabe@qmul.ac.uk

We propose to explore the sensory nature of the auditory hallucinations ("Voices") of hearing people with a diagnosis of schizophrenia.  A secondary aspect of the study is to compare the experience of auditory hallucinations experienced by hearing people with that of deaf people.

 

An intervention to improve psychiatrist-patient communication (RCT)

UK CRN ID no. 8018

R&D ref. no. K1001/1

Chief Investigator:  Dr. Rose McCabe – 020 7540 4210 – r.mccabe@qmul.ac.uk

Developing and piloting a new intervention to improve psychiatrist patient communication about psychosis: an exploratory cluster randomised controlled trial

Can psychiatrists learn to use a particular communicative mechanism (repair) to communicate more effectively with patients with psychosis and does this influence patient clinical outcomes?

  1. Can psychiatrists apply this new way of communicating with their patients?
  2. Does it have an effect on the following intermediate outcomes: psychiatrist confidence in communicating with psychotic patients (Runkle et al. 2008); patient experience of the communication (PEQ: Steine et al 2001) and patient centredness (Brown et al. 2001) in the first consultation with each relevant patient after the 12 week training period.
  3. Does it have an effect on the following patient clinical outcomes: patient satisfaction with treatment (CSQ, Nyugen et al. 1983), the therapeutic relationship (STAR, McGuireSnieckus et al. 2007), treatment adherence (Buchanan 1992) and relapse (Nuechterlein et al. 2006) at 6 months follow-up.

 

Dialectical Behaviour Therapy for Patients with Borderline Personality Disorder and Self-Harm-a pragmatic exploratory trial

UK CRN ID no. 5111

R&D ref. no. N0711/1

Chief Investigator: Professor Stefan Priebe – 020 7540 4210 – s.priebe@qmul.ac.uk

Can people with BPD, who are known to be difficult to engage in service and research, be recruited into a randomised control trial within the NHS (where incentives used in the US to recruit do not exist)?

  1. More specifically, what are the recruitment rates when patients are randomly allocated to different conditions comparing the interventions with a one year waiting list, so that eventually everyone receives treatment?
  2. What is the drop out rate in both arms?

 

Financial incentives to improve adherence to medication (FIAT)

UK CRN ID no. 7033

R&D ref. no. K0907/3

Chief Investigator: Professor Stefan Priebe – 020 7540 4210 – s.priebe@qmul.ac.uk

The objective of the study is to establish the effectiveness and cost effectiveness of using financial incentives to improve adherence to anti-psychotic maintenance medication in community patients with poor adherence with whom all conventional methods to achieve adherence have failed. The primary outcome is adherence to anti-psychotic maintenance medication during the 12 month trial period. Adherence will be measured, objectively, as the percentage of prescribed depot injections actually taken.

 

Effectiveness of Body Psychotherapy (NESS)

UK CRN ID no. 9269

Chief Investigator: Professor Stefan Priebe – 020 7540 4210 – s.priebe@qmul.ac.uk

We propose a multicentre randomised trial of manualised Body Psychotherapy (BPT) for patients with schizophrenia. As recommended by NICE, the treatment will be compared with an active control condition to control for therapist attention, physical activity and non-emotional group interaction. Both conditions will be in addition to treatment as attention, physical activity and non-emotional group interaction. Both conditions will be in addition to treatment as usual.

Patients will be identified by clinicians and referred for a screening interview by independent researchers. Recruited patients will be randomly allocated to either the experimental or control condition. There will be three data collection points, i.e. before treatment, after treatment and after a 6 month follow-up period.

The treatment assessed is manualised body psychotherapy provided in 20 group sessions over a 10 week period with 8 patients per group. All therapists delivering BPT will receive training in delivering the manual, and adherence to the manual will be assessed. The active control will be Pilates exercises in groups also of 8 patients each with the same frequency and length of sessions. All patients in both conditions will continue to receive treatment as usual.

 

Peer Support Project

UK CRN ID no. 8516

R&D ref. no. E1005/2

Chief Investigator:  Prof. Alan Simpson – 020 7040 5937 – a.simpson@city.ac.uk

A pilot randomised controlled trial to measure the effectiveness of peer support in increasing hope and quality of life in psychiatric patients discharged from hospital

Does the provision of peer support to patients discharged from psychiatric hospitals improves feelings of hope and general wellbeing and decreases incidence of relapse and readmissions to hospital.

We hypothesise that peer support will have a direct positive effect on service users’ feelings of hope, improve their social networks and quality of life with an indirect effect on service use, including reduced rehospitalisation, and decrease the risk of suicide.

We also wish to evaluate the effectiveness and impact of the intervention on the service users, the peer support workers and clinical staff, and the economic consequences of the intervention.

We hypothesise that peer support will be well received by service users and clinical staff and will increase the employment prospects of those undertaking the peer support role and related training and supervision. It is anticipated that reduced hospital use will lead to a cost saving from the intervention.

 

Own Account Studies

Secure in-patient admissions for people with learning disabilities

R&D ref. no. E1006/2

Chief Investigator:  Dr. Ian Hall – 020 8121 4444 – Ian.Hall@eastlondon.nhs.uk

This qualitative research study aims to explore the experiences of people with learning disabilities requiring inpatient services from throughout London who are placed away from their area of origin. This follows concerns regarding the impact of out-of-area placements for service users, their families, communities, and service providers. A semi-structured interview will be used to explore this service user group's experiences of life in hospital including aspects of the physical environment, safety and security, food, facilities, day time activities, education, opportunities for socialisation, clinical, cultural and religious needs, carer involvement and access to information. Participants will also be asked where they would prefer to live, if not their current hospital placement. Results will be used to inform policy and use of resources.

 

What do outpaitents want to know and learn about their illness?

R&D ref. no. AD1101/3

Chief Investigator:  Prof Stefan Priebe – s.preibe@qmul.ac.uk – 020 7540 4210

Currently the NHS has no standard and wellestablished model for learning opportunities for psychiatric patients.  Although there have been various initiatives for learning interventions, such as psychosis seminars (Brock & Priebe, 2005), psychoeducation programmes (Getachew, Dimic & Priebe, 2009), and information events involving information exchanges between patients, carers and mental health professionals, it is not quite clear which of these interventions, if any, really meet the information needs of patients.

To date there has been no systematic research on what information psychiatric patients really want to learn about their illness and how they would like to learn it. Yet, establishing the wishes of patients is essential to design the most appropriate learning opportunities that are both acceptable and effective.

Therefore, this study aims to explore what types of information psychiatric patients with either a diagnosis of schizophrenia or mood disorder currently receive, what more information they would ideally like to receive, from whom, and in what format. We intend to identify the frequency of patients’ wishes for different learning opportunities overall as well as in subgroups defined by diagnosis (schizophrenia vs. mood disorder) and living context (urban vs. rural). This will be achieved by administering a short ‘learning experiences’ questionnaire to 200 psychiatric patients attending either an urban or rural outpatient clinic.

In summary, the study aims to answer these questions:

  1. What previous experience have patients with schizophrenia/mood disorder had of learning about their mental illness?
  2.  Do they want to learn more about their mental illness? If so, what else do they want to learn?
  3. How would they like to learn this information? (I.e. From whom? In what format?)
  4. Are there differences depending on the diagnostic group (schizophrenia vs. mood disorder) and living context (urban vs. rural)?

 

Educational Projects

Responsibility beliefs and thought-action fusion in command hallucinations

R&D ref. no. A1103/1

Chief Investigator:  Zarina Abbas – 020 8525 1115 – Zarina.Abbas@eastlondon.nhs.uk

Local Point of Contact:  Dr Alessandra DeAcutis – 020 7 540 6782 – alessandra.deacutis@eastlondon.nhs.uk

This study aims to examine whether people with command hallucinations have greater responsibility beliefs and thought-action fusion (the belief that unacceptable thoughts are the moral equivalent to active out those thoughts, and that such thoughts can increase the likelihood of these events occurring) than people with non-commanding auditory hallucinations and non-clinical controls.  It also aims to examine whether there is a relationship between responsibility beliefs and thought-action fusion in people with command hallucinations.

 

Use of the Sensory Room in a Psychiatric ICU

R&D ref. no. PG1108/5

Chief Investigator:  Dr. Julia Jones – 020 7040 5485 – j.jones-4@city.ac.uk

Principal Investigator:  Suzanne Smith – 020 8510 8360 – Suzanne.Smith@eastlondon.nhs.uk 

The research will explore the use of a sensory room on a Psychiatric Intensive Care Unit (PICU).

A sensory room is a room where sensory stimulus such as lights, sounds, textures and staff support can be graded and used to work individually with a service user to encourage self regulation, calming and relaxation.

A PICU is a locked inpatient ward which admits service users sectioned under the Mental Health Act, who can not be managed on open acute wards due to risk to self or others.

The sensory room was introduced following the ward occupational therapist finding research (Champagne 2005) that demonstrated a reduction on seclusion rates and improved service user experiences. The PICU staff team also wanted to provide an alternative to using the seclusion room; which is containing service users in a locked low risk and non-stimulus room.

The research aims to determine whether the use of a sensory room changes seclusion rates and also to explore the experiences of both service users and staff who have used the sensory room on the PICU.

A mixed method approach will be taken. This will incorporate quantitative data (number collection); comparing seclusion room records 3 months pre and post the availability of the sensory room. Qualitative data (points of view and experiences) will then be collected from interviewing both staff and service users about using the sensory room on the PICU. All ethical issues in the study will be considered and addressed appropriately.

Following data collection from the seclusion records and completing the interviews, the quantitative data (numbers) will be analysed to see if seclusion increased or decreased and qualitative data (interview answers from participants) will be analysed to see if themes emerge.

The results will then be written up as part of the Principal Investigator's MSc dissertation and disseminated as appropriate.

 

Making Parenting Groups Accessible - understanding engagement

R&D ref. no. E1004/3

Chief Investigator: Dr Fiona McFarlane – 02032225600 - fiona.mcfarlane@eastlondon.nhs.uk  

To investigate differences and similarities in the views of parents who engage with a parenting group for parents of adolescents, and parents who do not, in order to see whether any differences between these two groups can help us to understand why some parents choose not to engage with the service offered.  We hope that this will lead to suggestions as to how services could be adapted in future in order to reach a greater proportion of the community.

In order to answer the above question we would like to compare the answers to the secondary questions below, for parents who do and do not engage with the intervention.

 

Parents with mental illness

R&D ref. no. E1005/1

Chief Investigator:  Maria (Lola) Perez-Gavino – 020 7055 8400 – lola.perez@eastlondon.nhs.uk

How do parents with mental illness perceive their children’s emotional and behavioural difficulties, and do they see these difficulties as related to their own?

 

An exploratory study of the experience of quality of life for refugees

R&D ref. no. AD1106/1

Chief Investigator:  Carleen Scott – Carleen.Scott@eastlondon.nhs.uk

Principal Investigator:  Dr. Sarah Heke – 020 3645 6928 – Sarah.Heke@eastlondon.nhs.uk

This research study aims to explore the experience of refugees who have been given a diagnosis of post traumatic stress disorder (PTSD) since they have arrived in the UK. A refugee is a person who has been granted leave to remain. All of whom are clients being treated for PTSD at the Institute of Psychotrauma.

The Institute of Psychotrauma is a specialist psychology service located in East London and is part of East London NHS Foundation Trust. The Institute of Psychotrauma currently sees 150 clients per year, with 40% of these clients classified as a refugee or asylum seeker (someone who does not yet have leave to remain).

Eight refugees will be invited to take part in the study, and be interviewed. The interviews aim to cover the following topics: enjoyment of life, personal safety, finances, capacity/access to work, satisfaction with self, personal relationships, and support networks. These are derived from the quality of life measures (specifically the World Health Organisation’s QoL measure, which has been found to be reliable and valid), and from key areas highlighted in the relevant literature, and will include the effect of PTSD on participants' lives. As such the interview questions aim to provide a detailed experience from each participant of their current circumstances.

A narrative will be derived for each participant from the semi-structured interview with the researcher incorporating the above topics. This aims to provide a psychological journey encompassing the exploration of the relationship between quality of life, migration status, and the experience of PTSD, which in turn should generate theoretical ideas to inform psychological interventions for this population.

 

The experience of caring during a mental health crisis

R&D ref. no. AD1110/3

Chief Investigator:  Prof. Alan Simpson – 020 7040 5937 – a.simpson@city.ac.uk

Principal Investigator:  Rikke Albert – 020 8 510 8884 – Rikke.Albert@eastlondon.nhs.uk

Why: During a mental health crisis, interventions by mental health teams, rely on the social network to provide support and care. Without the carers some clients may be admitted to hospital for treatment. At times, due to the severity of the crisis carers are not able to cope and the person in crisis may then be admitted to hospital which subsequently can have an impact on the person's recovery and increase a risk of disability. Caring is also recognised as being stressful and may lead to poor mental health for the carer.

By exploring the caring experience it may explain what, if anything, helped the person in caring for the mentally ill person during a crisis. The aim is by exploring what may or may not have helped further consideration can be made into what can improve the caring experience. Subsequently, it can help inform mental health services how best to support the carer caring during a mental health crisis.

What: The participants in the study will be carers who have supported a friend/ relative during a mental health crisis.

Where: The carers in the study will be recruited in London. The study will be conducted in carers centres and will find participants from those centres and mental health trusts carers groups.

How: The research will be carried out over one year and is based on the phenomenological method of research. It is part of a MSc in interprofessional practice mental health. The funding for the project will mainly consists of the primary investigator's study time and own time in completing it. The aim is to interview 810 carers. The interviews will last approximately one hour using some prearranged questions

 

Participation from the perspective of community-living frail older people aged over 80 years

R&D ref. no. A1103/6

Chief Investigator:  Paul Sugarhood – 020 8475 2020 – sugarhop@isbu.ac.uk

The conept of participation in life situations has become important in health care and rehabilitation, but has not been consistently defined or measured.  There is limited understanding of how it applies to very old people who experience illness or disability.  This is important because this group may be at increased risk of participation restriction.  The UK is an ageing society and very old people increasingly live in their own homes.  Those who experience functional decline might need rehabilitation that promotes participation.

This research aims to explore what activities, life situations or life roles constitute participation for this group, and what the supports and barriers might be.  Potential benefits include addressing participation more effectively in rehabilitation and moving beyond basic personal care and mobility, which might not be the only important outcomes fro very old people.

The study design is grounded theory.  The aim is to identify important ideas and categories about participation building from the ground up through participants’’ everyday experiences.  Recruitment will be from the rehabilitation services in one outer London borough.  Patients referred to these services include frail older people whose experience of participation may be challenged.  For inclusion, participants must be aged 80 years or over, live in their own home, be able to participate in an interview in English and have no cognitive impairment.

 

Crossing the Threshold: from being worried to seeking help

R&D ref. no. K1004/1

Chief Investigator:  Mrs. Ferelyth Watt -- 0207 515 6633 -- ferelyth.watt@eastlondon.nhs.uk

What concerns might a Bangladeshi parent have about their child aged 0-5 years and where might they seek help if needed?  How might a Bangladeshi parent try and deal with a worry their child revealed?  In my experience perceptions about a child’s normal development vary amongst parents in the Bangladeshi community and amongst first and second generation families, and these perceptions influence the kind of help that apparent might seek for their child.  These perceptions also influence how a parent might deal with a worry expressed by their child.  In my experience, Bangladeshi parents have found Child and Adolescent mental Health Services difficult to access.  I want to see whether more accurate information about the current perceptions about the emotional health and well being of children 0-5 years, might be used to facilitate the provision of accessible and relevant mental health services for this particular ethnic group in the London Borough of Tower Hamlets.  This is in keeping with current efforts to provide preventative and early intervention services for vulnerable children and families.  The research will use focus groups consisting of parents drawn from the local Bangladeshi population who attend children’s Centres.  Focus Groups are familiar to many local parents and are used extensively in children’s Centres to gather opinions about services.  The research will also consider the views of first and second generation Bangladeshi parents, to see whether or not perceptions of the two groups might differ.