Research Studies Completed in 2008
NIHR Portfolio Studies
Doctor-patient communication in the treatment of schizophrenia: is it related to treatment outcome?
UK CRN ID no. 2282
R&D ref. no. K0602/10
Chief Investigator: Dr Rose McCabe – 02075404210 – r.mccabe@qmul.ac.uk
We propose to investigate whether the quality of doctor-patient communication in the treatment of schizophrenia influences the patient's outcome. We will focus on how people with schizophrenia and their psychiatrists communicate about the meaning of the patient's illness and its treatment. We will identify (1) how meaning is constructed in actual treatment encounters and (2) the association between meaning and treatment outcome over a 6 month period, i.e., the patient's willingness to take prescribed medication and follow other treatment recommendations (i.e., treatment adherence), the patient's readiness to contact and be contacted by mental health professionals (i.e., engagement with services) and whether the patient becomes sufficiently unwell to be rehospitalised (i.e., number of relapses). Our hypothesis is that the greater the frequency of and effort invested in addressing problems of meaning in a consultation, the more likely the patient is to adhere to treatment, be well engaged with services and the less likely they are to have a relapse in the 6 month period.
We will also investigate whether there is any relationship between the quality of the doctor-patient communication and the patient's outcome, as indicated by the severity of their symptoms.
Outcomes of Involuntary Hospital Admission in England (INVOLVE)
UK CRN ID no. 2282
R&D ref. no. K0606/7
Chief Investigator: Professor Stefan Priebe – 02075404210 – s.priebe@qmul.ac.uk
The study will provide empirical evidence about the practice of involuntary hospital admissions and their outcomes in England. It will benchmark outcomes of involuntary hospital admissions for different patient groups and in different contexts, and identify what patient characteristics and processes are associated with more or less positive outcome.
National Drug Treatment Outcomes Research Study (DTORS) - Qualitative Component
UK CRN ID no. 4576
R&D ref. no. K0610/3
Chief Investigator: Mr William O'Connor - 0207 549 9569 - w.oconnor@natcen.ac.uk
The study primarily seeks to examine outcomes of treatment provided for problematic drug users in terms of their drug and alcohol use, offending behaviour, physical/mental health issues and wider social issues. The research will explore what are the influences on different treatment outcomes, such as: route of referral, treatment history and participant background.
Transition from Child and Adolescent to Adult Mental Health Services (TRACK): A Study of Policies, Process and User and Carer Perspective
UK CRN ID no. 4118
R&D ref. no. K0610/2
Chief Investigator: Professor Swaran P. Singh – 02476150190 - s.p.singh@warwick.ac.uk
The overall aims of the TRACK study are to (a) identify the organisational factors that facilitate or impede effective transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS); and (b) to make recommendations about the set- up and delivery of services that will promote good continuity of care.
Own Account Studies
Measuring Psychotic Acuity using the Nurses' Psychotic Acuity Scale (NPAS)
R&D ref. no. N0707/1
Chief Investigator: Prof Len Bowers - 020 7040 5824 - L.Bowers@city.ac.uk
The main aim of the study is to assess whether or not the Nurses' Psychotic Acuity Scale (NPAS) measures effectively inpatients level of psychosis and whether this measurement if free from random error.
The City 128 Study of Observation and Outcomes
R&D ref. no. K04001-I
Chief Investigator: Prof Len Bowers - 020 7040 5824 - L.Bowers@city.ac.uk
Does the rates of use of special observation by ward positively relate to rates of self-harm; do positive staff attitude to difficult patients, greater ward structure, good ward leadership, team cohesion and reduced burnout associated with lower rates of self-harm; a study of direct costs of special observation and of its impact on the cost of providing acute psychiatric care; what are patient and staff views of staff security/containment measures; what are patient views on subjective feelings of safety and security on acute psychiatric wards.
The City 128 extension: locked doors in acute psychiatry, outcome and acceptability
R&D ref. no. N0707/2
Chief Investigator: Prof Len Bowers - 020 7040 5824 - L.Bowers@city.ac.uk
The main aim of the study is to assess whether patients, staff and visitors of psychiatric wards find it acceptable or unacceptable to lock the ward door.
Prisoner Cohort Study: Predicting Serious Reoffending Following Release
R&D ref. no. K02061-I
Chief Investigator: Prof Jeremy Coid – 020 7601 8138 - j.w.coid@qmul.ac.uk
Predicting serious re-offending in high risk offenders; aims of the study is to validate 'static' risk prediction instruments currently being piloted in assessment centres, as well as dynamic measures of risk once subjects are released into the community. M The study will look at associations between these measures and those of neuropsychological functioning
A Brief Qualitative Study of the Attributions and Emotions of Survivors Treated for PTSD Following the London Bombings in July 2005
R&D ref. no. K0604/2
Chief Investigator: Dr P d'Ardenne - 02076017019 - patricia.dardenne@elcmht.nhs.uk
This is an exploratory study aimed at identifying the themes and emotions from the narratives of patients with Post Traumatic Stress Disorder (PTSD), who were directly involved in the 2005 London Bombings and who are being treated with trauma focused Cognitive Behaviour Therapy (CBT).
Of particular interest is the participants’ attribution of meaning to their own and others' survival. Another objective is to examine how such attribution relates to their type of problem, the cognitive treatment provided and the final clinical outcome. The relationship between previous trauma history and attribution will also be examined as all patients will have completed a Life Events Checklist prior to their treatment.
Is the quality of the assessment and management of parent-child interactions in CAMHS associated with changes in the child's functioning?
R&D ref. no. K0605/5
Chief Investigator: Dr Hanspeter Dorner - hdorner@hotmail.com
The principal research objective is to clarify the way professionals in a generic CAMHS setting address potentially problematic parent-child interactions.
An evaluation of pilot services for people with personality disorder in adult forensic settings
R&D ref. no. K04114-I
Chief Investigator: Dr. Paul Moran - 020 7848 0568 - paul.moran@iop.kcl.ac.uk
This organisational study aims to investigate the operation of three new forensic psychiatric services for people with personality disorder. These services are based in the following mental health trusts: East London & the City (ELCMHT), South London & the Maudsley (SLaM), and Newcastle, North Tyneside and Northumberland (3Ns) Mental Health Trusts.
The specific objectives of the study are:
- To describe the characteristics of a consecutive sample of people referred and taken on by each of the three new services over a 6-month period, using routinely collected clinical data (the study design for this component of the project is a cross-sectional survey).
- To provide a detailed description of the new services, using triangulation of multiple sources of data (staff questionnaires, in-depth interviews with staff and collation of written material).
- To investigate the expectations and attitudes of a sample of staff working within the new services (the study design for this component of the project is a qualitative study)
- To follow up the consecutive series of people taken on by the services, in order to determine their levels of engagement with treatment offered, changes in behaviour, pattern of service use and to investigate their views about the acceptability and helpfulness of the new services (the study design for this component of the project is a cohort study)
- To compare the service costs incurred by people using the three services over a six-month period and to compare these costs with those incurred in the six months prior to the start of treatment (the study design for this component of the project is a cohort study).
Components, organisation, costs and outcomes of health care and community based interventions for people with posttraumatic stress following war and conflict in the Balkans (CONNECT)
R&D ref. no. K0603/4
Chief Investigator: Professor Stefan Priebe – 02075404210 – s.priebe@qmul.ac.uk
What are the health care and community based interventions for people with posttraumatic stress in the Balkans and European countries? How does the level of posttraumatic stress and quality of life predict use of interventions? What factors influence system change in people with chronic symptoms and what is the estimate cost-consequence of intervention in this group?
An Evaluation of the Focused Implementation Site (FIS) Programme
R&D ref. no. N0704/1
Chief Investigator: Professor Scott Weich - 024 7657 4708 - s.weich@warwick.ac.uk
To describe the early implementation of Delivering Race Equality in 8 of the 17 Focused Implementation Sites in England to establish (i) The nature and degree of facilitating organisational structures; (ii) service innovations; (iii) workforce development initiatives; (iv) inter-sector and inter-agency partnerships; and (v) information systems for ethnic monitoring.
Educational Projects
Section 4 of the Mental Health Act: Senior House Officer's and Approved Social Worker's views on the use of the emergency section in an inner London casualty department
R&D ref. no. K0612/2
Chief Investigator: Mrs Verity Di Mascio - 0207 682 0294 - vhenders@sgul.ac.uk
The aim of the current investigation is to explore the attitudes of Approved Social Workers (ASWs) towards the use of Section 4 of the Mental Health Act (1983) within in an inner London hospital.
The secondary aim of the current investigation is to explore the attitudes of Senior House Officers (SHOs) towards the use of Section 4 of the Mental Health Act (1983) within in an inner London hospital. This part of the study has already been conducted.
An 18 month follow-up of patients with personality disorder in adult medium secure forensic settings
R&D ref. no. N0712/2
Chief Investigator: Miss ZM Fortune - 0207 848 5109 - zoe.fortune@iop.kcl.ac.uk
The proposed study is an 18-month follow-up of a group of previously recruited participants. These participants originally took part in a study that was given prior ethical approval (05/MRE12/22) on 8th June 2005 by Thames Valley REC. We are now seeking ethical approval to conduct an 18-month follow-up of these participants, using identical methods.
The main objectives of the study are to follow-up a consecutive series of patients referred to new forensic services for people with personality disorders in order to determine:
- their levels of engagement with treatment
- changes in their behaviour
- their pattern of service use and
- their views about the acceptability and helpfulness of the treatments being offered to them within the services.
Understanding cannabis use in first episode psychosis
R&D ref. no. K0612/3
Chief Investigator: Miss Anna Hames
This study aims to investigate why some individuals continue to use cannabis after they have experienced a psychotic episode and why some individuals stop. The Theory of Planned Behaviour (TPB; Ajzen, 1985) is a psychological model that attempts to explain whether people engage in health-related behaviours. The primary research question is whether The TPB is a good model for predicting individuals' intentions to use cannabis and actual cannabis use over a 3-month period.
An investigation into acute psychiatric staff’s attitudes and self efficacy towards adults with learning disability, and the impact of these on proposed psychiatric care plans.
R&D ref. no. N0802/1
Chief Investigator: Miss S Irving - 0207 683 4393 - sue.irving@hackney.gov.uk
The principle research aims are:
- To investigate whether psychiatric staffs’ attitudes and self efficacy (confidence and perceived skill) toward adults with learning disabilities who are admitted to acute psychiatric wards is different than toward psychiatric patients who do not have learning disability.
- To explore whether there are any relationships between attitudes, levels of self efficacy and proposed psychiatric care (using case vignettes).
Dangerous and Severe; The development of a Therapeutic Community for high risk offenders. How different professions come to terms in a conflictual field.
R&D ref. no. N0801/1
Chief Investigator: Mr David Jones - 020 8510 2646 - david.jones@elcmht.nhs.uk
In this conflicted area, to consider the challenges such work poses for those who work in the field and to exaplore, with them, how staff view and enact their professional identities within a setting such as Millfields.
What are Occupational Therapists experiences of multi-disciplinary team mental health working?
R&D ref. no. N0801/2
Chief Investigator: Miss Ilana Mansour- 02073641183 ilana.mansour@elcmht.nhs.uk
Mental health reform has greatly influenced the traditional roles and ways of working for professionals. Occupational Therapists continue to face the challenge of working collaboratively, offering a seamless service, while retaining clear professional boundaries. In the researcher's experience of multi-disciplinary working, there is a conflict between maintaining professional identity and being a "team player" / doing more generic tasks applicable to all members of the team. In addition, poor understanding of the role of Occupational Therapy remains. For these reasons, the author feels that it would be of value to explore these issues and develop an understanding of the "lived experiences" of Occupational Therapists. In the first instance, the research aims to describe and understand occupational therapists individual experience and inter-relationships between themes. However, the research findings could influence practice locally; look towards making changes in practice to increase job satisfaction and staff retention in the Trust. The research does not aim to answer a specific question with a general statement. Rather it hopes to explore the experiences of the individual and the meaning behind these experiences.
Aims of research question are:
- To obtain an in-depth understanding of Occupational Therapists "lived experiences" of multi-disciplinary working.
- To describe these experiences and individual therapists perceptions of multi-disciplinary work.
Although there remains an ongoing debate on occupational therapy practice in mental health and literature in this area, research on what occupational therapists do on a day-to-day basis and their lived experiences in multi-disciplinary teams is limited. This research aims to develop this area and provide new information.
A Qualitative Investigation of the Psychological Impact of Stalking upon UK Healthcare Professional Practitioners in Secure Units
R&D ref. no. N0709/2
Chief Investigator: Mr. Leroy McFarlane - 0116 223 1639 - ljm35@le.ac.uk
The Stalking of Healthcare Professionals (for example, psychiatrists, doctors, nurses, psychologists) in secure settings in the United Kingdom has not been previously studied. Neither has it been qualitatively studied using Interpersonal Phenomenological Analysis. This approach involves trying to understand the experiences an individual has in life, how they made sense of them and what meanings those experiences hold (Smith, 2004).
The aims and objectives of the study is to inform the professional and academic community about how stalking can impact on victims' work and family life, give data to employers and professional bodies about how the victim perceives the support that they received from these organisations, and give information to training institutions such as universities and colleges as to how to forewarn future healthcare professionals about the possibility of being stalked during their professional and private life.
There are a number of principal questions that the study will consider:
- What do healthcare professionals who work in secure units think about their stalking experience(s)?
- What were their coping strategies and did they work?
- Did they receive any personal and professional support?
Parents' experience of responding to their children's reactions to parental mental health difficulties
R&D ref. no. K0702/1
Chief Investigator: Lizette Nolte– 02032225600 - Lizette.Nolte@eastlondon.nhs.uk
- What accounts do parents with mental health difficulties give of the choices they make about talking to or not talking to their children about their difficulties, what informs these choices and what have the effects of these choices been for them and their families?
- How do parents with mental health problems view their difficulties?
- How do these parents experience the effects of their difficulties on their children?
- How do they experience managing the effect of their difficulties on their children?
- What ideas, beliefs, views do they draw on when making decisions about managing the effects of their difficulties on their children?
- How do they think about their children's need to make sense of their parent's difficulties?
- Who do they believe is best placed to talk to their children about their difficulties?
- Who does talk to their children about their mental health difficulties and what is their experience of this? How do they think their children experience this?
- How do they experience telling/talking about or not telling/talking about their mental health difficulties with their children themselves? How does this change over time?
- What effects have they seen/experienced in response to the choices about talking/ not talking about their difficulties with their children?
Poverty: A Qualitative Analysis of Clinical and Counselling Psychologists Construction of Poverty and its Described Influence in their Interventions with Service Users.
R&D ref. no. N0710/2
Chief Investigator: Miss Naomi Sams – 07717884265 - u0529134@uel.ac.uk
The aim of this present study is to develop a better understanding of how clinical and counselling psychologists construct the concept of poverty in relation to mental health and how this influences their clinical work.