Collaborating to help shape research into mental healthcare services
As an example, our research on people’s experiences of working in and using secondary mental healthcare during the Covid-19 pandemic has been highly influential and widely cited, particularly for its insights into remote care. Several THIS Institute fellows – including Phoebe Averill, Sean Manzi, and Mimi Suzuki – have mental health services as their focus.
We asked THIS Institute Director of Research Graham Martin, Research Associate Rosie Lindsay, and McPin Foundation Senior Service User Researcher John Gibson to talk about their current research on mental health services.
Embedding lived experience in mental health research
Graham starts by emphasising the shared approach at the heart of THIS Institute’s research. “There are many past experiences of research done ‘to’ people with mental health conditions, not with them. That’s not good. So, taking a collaborative approach to research and including patients, carers and staff is fundamental to THIS Institute’s studies. There’s a long history of user-led and peer research in mental health, and we’ve collaborated with the McPin Foundation on several of our projects.
“The team has worked closely with John Gibson from the McPin Foundation as a peer researcher. It’s wonderful how his personal insight can help service users open up during interviews in ways they might not with traditional researchers.”
Problems can stem from a difficult past meeting with an individual practitioner, to wider systemic issues within an overburdened healthcare system that sometimes lacks consistency in communications.
John Gibson
We’ve also worked with a wider group of ‘experts by experience’ such as carers or service users who offer advisory input. Rosie Lindsay sees close working with service users, as well as staff and others with lived expertise, as vital to good research. “We collaborated with the McPin Foundation on a lived experience advisory panel for a project evaluating a trial delivered in NHS Talking Therapies that aimed to improve outcomes for people who have common mental health disorders and psychotic experiences.”
The panel was instrumental in sense-checking our findings and considering the broader implications of our research for people with mental health conditions.
Rosie Lindsay
Diagnosing physical illness in people with a mental health condition
A major current THIS Institute programme of research is examining diagnosis of physical conditions in people with existing mental health conditions. People with a severe mental illness (SMI) diagnosis face reduced average life expectancy, largely associated with under-diagnosed and under-treated physical illnesses. But the influences on diagnosis have been under-explored. We set out to see how diagnosis of physical conditions in people with mental health conditions happens in practice in emergency departments and GP practices.
John contributed an invaluable lived experience perspective to the study. As someone with an SMI diagnosis, John is acutely aware of the barriers that people with mental health conditions can face when wanting to access health services for a physical health issue, particularly if they have had poor experiences in the past.
“Mental health conditions and the ways people deal with them are varied.” John reflects. “Some people prefer that their mental health is not considered when accessing services for a physical health problem. Others value being treated in a more holistic way, or welcome acknowledgement that a physical health issue can worsen a mental health issue.”
Graham comments:
There is a fair bit of evidence that implicit bias matters – that people might assume that a physical health complaint is down to the underlying mental health condition, or that they are more dismissive of people who present their condition in the ‘wrong’ way – but that’s not the whole story. Many features of emergency departments make getting care right for people with mental health conditions really difficult, from the time pressures on staff to the way that buildings are designed.
Graham Martin
“Our work delves into the full range of challenges – and hopefully offers useful suggestions for how to address them. Improving diagnosis will require tackling structural barriers, not just individual attitudes,” says Graham.
Improving services for the future
The Government’s 10 year health plan for England places strong emphasis on neighbourhood health, including, for mental health, bringing services together in the community, setting up mental health emergency departments and integrating mental health into physical health pathways.
But are these changes going to make care more person-centred and less fragmented? Integration isn’t easy, says Graham, and it’s certainly not a shortcut to saving money – at least in the short term. Graham notes that a move towards a neighbourhood health service will need investment, ongoing commitment, and careful planning so that marginalised groups benefit from this change. “The more evidence can be used to underpin these changes, the better” he says, “We’ve known for a long time that mental health does not have parity of esteem with physical health, and our work on diagnostic inequalities shows that places like the emergency department are often set up around physical health conditions – not good places to be if you have a mental health condition, let alone if you are in the midst of a crisis.”
John agrees that in healthcare settings, some issues that might be considered ‘minor’ could have a big impact for people with mental health conditions. Things like sitting in a crowded waiting room may feel stressful.
Also part of THIS Institute’s approach is including mental health services as part of bigger programmes of work. THIS Institute’s work on staff voice, for example, covers many different types of organisations. This is important, because the experience of raising concerns in an acute hospital could be very different from a mental health service.