Title: Developing, refining and testing intensive group music therapy for acute adult psychiatric inpatients
Funder: Health Education England

Abstract: Background: Acute psychiatric inpatient care has been subject to many criticisms and reforms in the last few years (CQC, 2012; MIND, 2011; SCMH,2006). Lengths of stay are reducing rapidly and concerns have been raised regarding the quality and access to therapeutic activities (MIND, 2011; NHS Benchmarking Network, 2013). There is evidence that music therapy is effective in engaging patients with low therapy motivation, and treating negative symptoms and depression (Erkilla et al., 2012; Gold et al., 2013; Mossler et al., 2012). However, a minimum number of sessions are required to achieve clinical benefit and there is little evidence underpinning the practice of music therapy in acute environments (Carr et al., 2013; Gold et al., 2009). The applicant's doctoral study ascertained that increasing the frequency of music therapy was accepted by inpatients and by offering sessions three times per week, patients attended three times as many sessions whilst in hospital. The study provided an objective description of practice and identified interventions associated with positive appraisals by patients. Within the Medical Research Council framework (MRC, 2008) for the development of complex interventions, the first steps of identifying the evidence base, theories and modelling of processes and outcomes have now been completed. However, if the intervention is to be tested in a randomised controlled trial, further steps are now needed to formalise the intervention and to ascertain how to best implement this methodology in acute inpatient context. A feasibility study will enable the candidate to assess how best to design a larger trial and will provide information on how to best implement this to ensure methodological rigour (Bird et al., 2014; Lancaster et al., 2004). Aims: To develop a manual and training programme of intensive group music therapy for acute adult psychiatric inpatients. To assess the feasibility and gain experiences of implementing a randomised controlled trial methodology to assess intensive group music therapy on acute psychiatric inpatient wards. Plan of investigation (Work Package-WP): WP1: Update of a systematic review of clinical practice and outcomes of music therapy for acute adult psychiatric inpatients WP2: Development of a manual for delivery of intensive group music therapy for acute adult psychiatric inpatients utilising video microanalysis and focus groups with music therapists, patients and multi-disciplinary ward staff WP3: Development of a training package for clinicians WP4: Randomised-controlled trial feasibility study, assessing recruitment, outcomes and adherence to manual. Potential benefit to patients: The research will lead to improved practice of music therapy in acute settings and improved quality of inpatient care. Development of a manual and brief training package will mean that enhanced practice can be implemented quickly and cheaply to music therapists across the NHS as part of their continuing professional development. Potential benefit to NHS: This research will provide clinical guidelines for group music therapy in acute inpatient care, a training package that will improve the quality of care received by inpatients and information on the feasibility and variability of outcomes to inform future randomised controlled trials. If demonstrated to be feasible, a protocol for a full randomised controlled trial will be produced as a study deliverable. Such information may inform future music therapy and wider NHS research in acute inpatient contexts.

Lay abstract: Music therapy can reduce mental illness symptoms and may be an important part of inpatient care. Hospital stays are short, so frequent sessions are needed to make a difference. My PhD found how intensive group music therapy can be provided to appeal to patients and give positive experiences. To put these findings into practice, the next step will be to develop guidance for music therapists (a manual) and see if it is effective. This research will develop guidelines/training and run a small study to prepare for a larger effectiveness study. This will improve music therapy practice and care for inpatients.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH