Presentation on Enhancing Mental Health theme research, by Professor Richard Morriss at the NIHR CLAHRC East Midlands launch event, 14 February 2014, Loughborough.

1. Enhancing Mental Health
(EMH) Theme
Richard Morriss,
Professor of Psychiatry and Community Mental Health,
Theme Lead CLAHRC East Midlands
University of Nottingham
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

2. Current prevalence of mental health disorders in Europe
Mental retardation
1.0
opiate dependence
0.4
OCD
GAD
0.7
Eating disorder
0.9
Cannabis dependence
1.0
1.7
Specific
phobia
Psychotic disorder
1.2
Personality dis.
1.3
6.4
PTSD
Social
phobia
2.3
2.0
Conduct disorder
Agoraphobia
3.0
Alcohol dependence
2.0
3.4
Somatoform disorders
ADHD
Panic
disorder
4.9
1.8
5.0
0
Dementia
5.4
Unipolar depression
6.9
Insomnia
7.0
Anxiety disorders
14.0
0
2
4
6
8
10
12
14
Wittchen et al 2011 European Neuropsychopharmacology
4
8
12

3. Enhancing Mental Health Theme
• All projects on common mental health conditions with both
national and local policy (from CCG and/or HWB plans) to
implement.
• Already evidence to show effectiveness
• Requires one piece of research to be completed before put into
practice e.g. evidence in secondary care, policy in primary care.
• CLAHRC research project also a model for how an intervention
would be carried out in usual practice.
• Uses same staff as in NHS practice, same setting, same
outcomes or most relevant outcomes
• 3 phases of projects, PhDs, direct involvement of practitioners,
service users in projects in research and implementation.

4. Repeat use of emergency care
Randomised controlled trial (RCT) of remotely delivered CBT for
health anxiety in regular users of unscheduled care vs treatment as
usual.
Policy. CCG incentivised to reduce emergency admissions. Emergency admissions and
contacts due to high health anxiety. IAPT given £400 million per year. Remote delivery of
psychological treatment (mobile phone, internet, skype) – AHSN priority
Expertise. RCT of CBT for health anxiety reduced health anxiety for 2 years (Lancet). CLAHRC
NDL regular attenders project
Research issue. Evidence base (6 RCTs) – none in UK primary or community care. CLAHRC
study – IAPT unacceptable. Remote treatment at right pace with right therapist
acceptable.
Research question. Is remote delivered 6-10 session CBT for repeat unscheduled emergency
care with health anxiety clinically and cost effective versus treatment as usual?

5. Repeat self harm and depression
RCT of feasibility and acceptability of remotely delivered CBT for depression and repeat
self-harm in young people (16-30 years).
Policy. CCG incentivised to reduce emergency admissions and most prioritise suicide
reduction. Suicides and admissions due to self-harm are on the rise. Depression and
self-harm predict suicide and repeat self-harm. NICE CG133 - offer 10 session of
problem solving therapy for repeat self-harm. No workforce to do this (IAPT and
secondary care psychological treatment exclude). Only 25% attend face to face
psychological treatment – 90% adolescents with depression with remote use.
Expertise. CBT for depression in people suicide risk piloted in CLAHRC NDL. RCT of
problem solving in this group done by staff in CLAHRC EM.
Research question. Is remote delivered 10 session problem solving based CBT for
depression and repeat self-harm feasible and acceptable and if so clinically and cost
effective?

6. ADHD and objective testing
RCT of new technology to improve diagnosis and management versus usual care in
children and young people with ADHD.
Policy. CCGs incentivised to adopt new technologies if evidence to support their use. Lack
of objectivity and variation in diagnosis and management of attention deficit
hyperactivity disorder (ADHD). 5% of all children. Children given stimulant medication.
Qb Tech (Anglo-Swedish SME company) developed more objective measurement of
attention and hyperactivity that is fun for children to complete.
Expertise. National NIHR health technology centre for mental health (MindTech) based in
Nottingham. QbTech.
Research question. Does feedback of QbTest results to clinicians, children and parents by
CAMHS and community paediatric staff improve time to diagnosis, time to stabilisation
of symptoms and cost effectiveness versus treatment as usual?

7. Qb Test: Objective Assessment of ADHD
• Computerised assessment of
attention and activity
• Supports clinical decision
making
• Provides patients with
objective reports on their
condition
7

8. Other work in phases 1 and 2
• Dementia in forensic, prison and other secure
settings – prevalence and needs
• Implementation study and 3 year follow up of
specialist mood disorder team for depression – cost
effectiveness.

9. Observed and Fitted HDRS17 scores
22
24
Observed and fitted mean HDRS17 by group over 12 month follow up
18
20
Moderate
MDD
16
17.24
*p = 0.024
Mild
MDD
14
14.88
0
5
10
month
TAU
Intervention
TAU_fitted
Intervention_fitted
*Both sensitivity analyses significant P<0.05
15

10. Phase 3 projects?
•
•
•
•
Common mental health problem
Important policy in all East Midlands counties
If research showed benefit and affordable, would we implement?
Consultation throughout East Midlands, scientific review.

11. Thank you for listening
Richard.Morriss@nottingham.ac.uk
www.clahrc-em.nihr.ac.uk
@CLAHRC_EM
This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied
Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this presentation are those of
the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.