Title: NIHR Global Health Research Group on developing psycho-social interventions for mental health care, Queen Mary University of London
Funder: Department of Health and Social Care

Abstract: Our Research Group is a partnership between Queen Mary University of London (QMUL), East London NHS Foundation Trust, and universities in Bosnia and Herzegovina, Colombia and Uganda. Our Group members are experts in different areas, including psychiatry, psychology, public health, geography and health economics. Our focus is to improve community mental healthcare for people living with severe mental illness by developing psycho-social interventions in low- and middle-income countries (LMICs). The programme will run from August 2017-August 2020 and is funded by the National Institute for Health Research (NIHR)._x000D_ _x000D_ Our main aims:_x000D_ _x000D_ 1) We aim to improve local knowledge and skills in carrying out research studies. This is being achieved by establishing a team of researchers, who have adapted, planned, organised and are carrying out the research activities in each partner country. The research team based in the UK has run several training workshops and seminars in each partner country to develop local research knowledge and skills, and also teach about social psychiatry, which is a new approach for our partners. The UK-based research team also hosts annual teaching weeks in London that will bring together the research teams from our original three partner countries, for training and further discussions about the research activities. Researchers from each country are invited for a longer residential stay in London every year to develop their research knowledge and skills and promote mutual learning’. Towards the end of the three year programme, we aim to run regional dissemination events in each partner country, which we hope will lead to further research activities with new and existing partners._x000D_ _x000D_ 2) We aim to explore and advance understandings of global mental health. This aim has been primarily addressed through an academic workshop exploring future scenarios for global mental health held in April 2018. The results of the workshop will be published. Additionally, the London team host regular seminars in London for experts from different fields to broadly discuss this topic. The PhD candidate associated with the Group has a focused interest in further exploring this aim. _x000D_ _x000D_ 3) We aim to improve care for patients living in the community with severe mental illness. We are exploring three approaches that help patients to draw from their existing resources. Firstly, DIALOG+ (intervention delivered on a tablet or smartphone using an App, designed to help mental health professionals to improve the structure of their routine meetings and their communication with patients); secondly, volunteer support (linking unpaid volunteers with single patients or groups or patients with support to use social networks or engage in leisure or meaningful activities; and family involvement (helps family members or friends to provide support and effective care to patients). Three studies in each of our original partner countries will aim to test the effectiveness, acceptability and feasibility of each approach. _x000D_ We have also established 3 new links with partner organisations in Pakistan, Peru and Argentina who will be specifically exploring the use of DIALOG+ in their own community mental health care settings. Pakistan will also be exploring the family involvement intervention. _x000D_ _x000D_ At each centre, we are providing support to the local researcher teams. Teams are also involving other stakeholder groups, Non-Governmental Organisations and policymakers in the discussion and in the practical implementation of the research. We expect that at the end of the programme, each centre will have completed the planned studies, established a research group, found ways to link their activities with other national organisations and submitted applications for further funding. _x000D_ _x000D_ We expect that the findings could have a substantial impact both on the mental health research community, and practical mental health care in these LMICs, with later translation into other countries.

Lay abstract: INSTITUTION _x000D_ A defining aim of QMUL’s strategy is the ‘the achievement of an international stature in knowledge creation and knowledge dissemination’ and a core objective is ‘furthering major collaborative research with overseas institutions’. Accordingly, QMUL has strongly supported the development of the Unit for Social and Community Psychiatry and its international activities. In 2012, the Unit was designated as a WHO Collaborating Centre, the only one specifically for Mental Health Service Development in the world. QMUL has promoted multi-disciplinary research on health care innovation through establishing the Life Sciences Initiative. In the REF 2014, the applying group was rated within UoA 2 (public health) among the top 5 in the country. _x000D_ _x000D_ The core of the research group is based at the Unit for Social and Community Psychiatry, which has 30 full time researchers. The involved Centres of Psychiatry and of Public Health and Primary Care bring a further 140 research and teaching staff. QMUL will provide all infrastructural support. As own contribution, QMUL will fund the work of the members of the group (Priebe 20%; Eldridge, Bhui, Patel, McCoy 6% each; Bird, Jovanovic 12% each) and a PhD studentship. The application is also supported by Eat London NHS Foundation Trust (in 2016 rated ‘outstanding’ by CQC and winner of HSJ award ‘Provider Organisation of the Year’). ELFT will fund the work of two employees (Giacco 12%, Baillie 3%). _x000D_ _x000D_ PARTNERSHIPS ESTABLISHED _x000D_ We have established strong links to centres in Bosnia-Herzegovina, Colombia and Uganda. In Bosnia-Herzegovina we are working with The Clinical Centre at The University of Sarajevo. In Colombia, we are partnered with The University of Javeriana and are working in several clinical sites in Bogotá and Cali. In Uganda, our main partner is Makerere University College of Health Sciences and we are working in Kampala at the Butabika Hospital and three other clinical sites based in Jinja, Masaka and Mitiyana. _x000D_ _x000D_ ACTIVITIES_x000D_ Work has begun with our partners at all sites in Bosnia-Herzegovina, Colombia, Uganda. At each centre a research group including senior academics has been trained, and continuous supervision and support is provided by the local Principal Investigators along with the UK team. The partners have completed situation analyses on mental health funding, provision and policies, within their contexts. All partners have identified and set up links with collaborating clinical centres and organizations to deliver a range of psychosocial interventions. All partners actively engaged with local stakeholders to involve supportive organisations and people who were then trained in delivering psychosocial interventions. This included different professional groups, e.g. nurses, social workers and pharmacists, and non-professionals, i.e. volunteers, peers, and family members. _x000D_ Each partner has adapted, designed and will be testing a range of evidence-based and resource-oriented interventions for people with severe mental illnesses in the community: 1) The DIALOG+ intervention, which is an easy to train IT supported method – developed by the research group - to guide the routine communication between a patient and a clinician or a trained layperson. DIALOG+ delivers assessment, planning, therapeutic intervention and evaluation in one procedure. 2) Befriending of non-professionals with single or groups of patients, utilising social networks and community support. 3) Family support through professional or non-professional staff. _x000D_ _x000D_ The interventions have been adapted to the local context but are in line with the MRC framework for developing and evaluating complex interventions and adhere to high methodological standards. The interventions are being tested in a range of Randomised Controlled Trials (RCTs) and non-controlled trials. Working on 3 studies will widen the methodological expertise, provide a range of practical experiences and explore specific local benefits. The overall focus is on developing and evaluating resource-oriented and low-cost interventions for people with severe mental illness will be largely independent of specific diagnostic groups and provide a realistic chance for LMICs to tackle the increasing burden of severe mental illness within their cultural and social context._x000D_ We are providing on-site and remote training, supervision and guidance both in London and at each centre. The training and work of the centres involves senior staff, clinicians, and other stakeholders such as different professional groups, NGOs, and patient and carer groups. The research skills in the partner centres are being enhanced through both on-going training and practical experiences with research studies. The priorities and ideas of stakeholders at each centre have been explored and incorporated to strengthen local ownership. _x000D_ The strong links with local stakeholders, the critical mass of trained researchers at each centre, the focus of the research on resource-oriented interventions, and the on-going collaboration with the experienced multi-disciplinary group in London is facilitating innovative research that is relevant to LMICs, and helping to establish a sustainable role of research in the development of mental health care in these countries. _x000D_ In London, we have research group members with their own different groups and 2 experienced researchers managing the partnerships and advancing the overall expertise in research on complex interventions for people with severe mental illnesses in LMICs. All partners and centres have developed an excellent working relationship and regular communication allows for mutual learning and comparative evaluation, exploring commonalities and differences across the centres. A QMUL funded PhD studentship within the Groups activities is also providing synergetic research benefit. The programme with a similar, but flexible overall approach in different LMICs has led to a better understanding of how best to link UK based research expertise with the adaptation and evaluation of complex mental health interventions in different cultural contexts._x000D_ _x000D_ COMMISSIONED RESEARCH_x000D_ We have supported each partner centre in identifying their priorities, interests and needs for further investment to widen and implement the studies on resource-oriented interventions. Therefore, the research plans currently being undertaken by each partner country are far more ambitious than originally planned and have required additional resources and inclusion of more sites to meet the increased scope of work. We are also pursuing further research opportunities on resource-oriented interventions with each partner site. Further research will aim to widen the research skills of the centre and maximise the benefit for the care of people with severe mental illnesses in each LMIC. _x000D_ We have further established links in 3 new partner countries. In Pakistan, we are working closely with a public health organization, Interactive Research and Development based in Karachi. We have also established links with a research organisation in Peru called CRONICAS-- Centre of Excellence in Chronic Diseases, which operates under Universidad Peruana Cayetano Heredia (UPCH), both recognized among the most prestigious research institutions in South America. In Argentina we have established links with the University of Buenos Aires. In each of the new partner countries we are working with the same aims and are planning to undertake smaller proof of concept studies testing the DIALOG+ intervention within their existing community mental health care settings and in Pakistan we will additionally be testing the Family Involvement intervention. _x000D_ The requested fund of £200k should be appropriate and sufficient to cover costs for the above mentioned activities. _x000D_ _x000D_ SUSTAINABILITY_x000D_ The sustainability of interventions, which are low-cost and utilise existing social resources, are being facilitated through collaboration with national stakeholders, including policy makers and NGOs. Research capacity at each centre will be sustained through an established critical mass of qualified researchers, a strengthened research role of senior academics, local ownership of research on resource-oriented interventions, and links with wider regional networks. Further funding opportunities are constantly being explored with the partners and 4 applications have already been put in of which two have been successfully awarded. The sustainability of our group is being achieved through the strong support of QMUL and ELFT with further jointly funded core posts, and the prospect of extensive future grant income.

Research activity codes: 5.9 RESOURCES AND INFRASTRUCTURE (TREATMENT DEVELOPMENT);6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION)
Health categories: MENTAL HEALTH