Title: NIHR Global Health Research Group on developing psycho-social interventions for mental health care, Bart's and The London School of Medicine & Dentistry
Funder: Department of Health and Social Care

Abstract: INSTITUTION 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. The core of the research group, the Unit for Social and Community Psychiatry, 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 ELFT (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%). LINKS TO PARTNERSHIPS We will link to centres in Bosnia-Herzegovina, Colombia and Uganda. The University of Sarajevo (Bosnia-Herzegovina) is part of a network across South-Eastern Europe with which we have worked before, e.g. in 2 large EU funded research projects and in the evaluation of services in 7 countries with the WHO. The Javeriana University in Bogotá (Colombia) is part of the Latin American Clinical Epidemiology Network (LatinCLEN), and we have links with a further network for training young researchers in community mental health care across South America (RedMaristan). The Makerere Medical School (Uganda) is leading on a regional consortium of universities and research institutes (THRIVE) through the African Academy of Science/Alliance for Accelerating Science in Africa. The Butabika Hospital is a teaching hospital of the Makerere University. Since 2003, ELFT has provided extensive support with staff exchanges for the hospital, organised through the Butabika-East London Link. Within this programme we will establish partnerships with research centres in 3 LMICs and the wider networks with which the partners are associated. ACTIVITIES We will work with centres in 3 LMICs. At each centre a research group including senior academics will be trained, supervised and supported. The centres will complete situation analyses on mental health funding, provision and policies, and collaborate with local stakeholders to involve supportive organisations and people who may be trained in delivering psychosocial interventions, including different professional groups, e.g. nurses, social workers and pharmacists, and non-professionals, i.e. volunteers, peers, and family members. Each centre will adapt, specify and design proof of concept studies for 3 types 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 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. Each study will be conducted as appropriate to the local context, but be in line with the MRC framework for developing and evaluating complex interventions and adhere to high methodological standards. Working on 3 studies will widen the methodological expertise, provide a range of practical experiences and explore specific local benefits. The overall focus 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. To some extent the partnerships have already been established. With the University of Sarajevo, we have previously conducted EU funded studies, and with services in Butabika, ELFT has a long standing partnership. In both cases, there are personal connections and the research group is familiar with the local context. The collaborations with the University of Javeriana and the Makerere Medical School will be consolidated during the initial phases of the programme and utilise the centres’ position in the LatinCLEN network in South America (and links with Red Maristan) and the THRIVE consortium in East and Central Africa. At each centre we will establish, train and support a group of three researchers, with direct involvement of two senior academics, and administrative support. We will provide training, supervision and guidance both in London and at each centre. The training and work of the centres will involve senior staff, further clinicians, and other stakeholders such as different professional groups, NGOs, and patient and carer groups. The research skills in the partner centres will increase through both on-going training and practical experiences with research studies. Priorities and ideas of stakeholders at each centre will be explored and incorporated to strengthen local ownership. The skills in the partner centres will increase through training and practical experiences. 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 will facilitate innovative research that is relevant to LMICs, lead to direct improvements of mental health care, and help to establish a sustainable role of research in the development of mental health care in those countries. In London, we will have the applying research group members with their different own groups and 2 post-doc researchers managing the partnerships and advancing the overall expertise in research on complex interventions for people with severe mental illnesses in LMICs. We expect that mutual learning and a comparative evaluation, exploring commonalities and differences across the 3 centres and supported by a QMUL funded PhD studentship, will provide synergetic research benefit. The proposed programme with a similar, but flexible overall approach in 3 different LMICs should lead 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. 6 month targets: Formal agreements with each partner; visits to each partner centre; a workshop at each site with academics, clinicians and other stakeholders exploring further the potentials and risks for the planned programme, local priorities and options for collaborations with existing organisations; completion of a detailed programme plan, including a preliminary design for the three proof-of-concept studies; defined application process for commissioned further research. 18 months objectives: completion of first teaching seminar in London; completion of further workshop with stakeholders and monitoring visit at each site; study protocols completed and ethics approvals obtained; funding for further commissioned research allocated; programme website set up and running; situation analyses of mental health service funding and provision, and of mental health policies including education and training of practitioners in each country completed. 3 year objectives: data from 3 studies at each site collected and analysed; results written up, disseminated through website and networks, and submitted for peer-reviewed publication; further funding for commissioned research invested; further teaching seminars and workshops at each site with monitoring visit completed; groups at each site working with higher level of independence; collaboration in wider regional networks initiated; applications for further funding completed and submitted. COMMISSIONED RESEARCH We will support each partner centre in identifying priorities and needs for further investment to implement and potentially widen the studies on resource-oriented interventions, and to pursue further research on resource-oriented interventions. 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. The requested fund of £200k should be appropriate and sufficient to cover such costs. By month 18, the funding will be allocated requiring the agreement of both the applying research group and the advisory group. SUSTAINABILITY The sustainability of interventions, which are low-cost and utilise existing social resources, will be 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 can be generated through successful grant applications of the centres to international funding bodies. Sustainability of our group will be achieved through the strong support of QMUL and ELFT with further jointly funded core posts, and the prospect of extensive future grant income

Lay 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). Our main aims: 1) We aim to improve local knowledge and skills in carrying out research studies. This will be achieved by establishing a team of researchers, who will plan, organise and carry out the research activities in each partner country. The research team based in the UK will run 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 will also run teaching weeks every year in London that will bring together the research teams from our three partner countries, for training and further discussions about the research activities. A researcher from each country will be invited to a longer residential stay in London every year to develop their research knowledge and skills and promote learning from one another. 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. 2) We aim to explore and advance understandings of global mental health. This aim will be primarily addressed through an academic workshop exploring future scenarios for global mental health and regular seminars in London for experts from different fields to broadly discuss this topic. 3) We aim to improve care for patients living in the community with severe mental illness. We will explore 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 country will aim to test the effectiveness, acceptability and feasibility of each approach. At each centre, we will support local researchers to involve other stakeholder groups, Non-Governmental Organisations and policymakers in the discussion and practical implementation of the research. We expect that at the end of the programme, each centre will have completed three studies, established a research group, found ways to link their activities with other national organisations and submitted applications for further funding. 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.

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