Multidisciplinary research priorities for the COVID-19 pandemic
Authors: Gill Bell, Mayura Deshpande, Heidi Hales, Duncan Harding, Gabrielle Pendlebury, Oliver White
Journal: The Lancet Psychiatry (2020)

We read with interest Emily A Holmes and colleagues' call for action regarding research around the current national COVID-19 pandemic.1Holmes EA O'Connor RC Perry VH et al.Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.Lancet Psychiatry. 2020; (published online April 15.)DOI:10.1016/S2215-0366(20)30168-1Summary Full Text Full Text PDF PubMed Scopus (3645) Google Scholar Their suggestion that UK research funding agencies collaborate with researchers, people with lived experience, and others to establish a high-level coordination group and ensure that priorities are actioned, is welcomed by us as Child and Adolescent Forensic Psychiatrists. Young people who present with complex forensic mental health needs are particularly difficult to engage, even without the current restrictions arising from COVID-19. Paradoxically, this national health crisis might provide a unique opportunity to gain data that would not otherwise be available. Information gained at this time might allow for the long-term optimisation of psychological and digital interventions for individuals who are difficult to engage, challenging, and a high-risk group for neglect, violence, and criminal exploitation; with whom adolescent forensic mental health services work. Young people who present with complex and high forensic risks are a highly vulnerable group, often experiencing early trauma, repeated loss, attachment issues, learning difficulties, and mental health problems.2Ryan M Tunnard J Evidence about the health and well-being needs of children and young people in contact with the youth justice system.https://webarchive.nationalarchives.gov.uk/20170302205337/Date: 2012http://www.chimat.org.uk/resource/item.aspx?RID=111768Date accessed: May 21, 2020Google Scholar, 3Chitsabesan P Kroll L Bailey S et al.Mental health needs of young offenders in custody and in the community.Br J Psychiatry. 2006; 188: 534-540Crossref PubMed Scopus (175) Google Scholar As of 20 May, 2020, the current reduced access to support and structure arising from school closures and agencies working in different ways (remotely, reduced direct contact), with lower staffing numbers, is exacerbating these young people's vulnerability. Challenging behaviours were previously mitigated by the provision of protective factors including education and other pro-social activities; the absence and reduction of these activities might translate into increased violence in homes or placements. Gaining a greater understanding of the wider impact of COVID-19 on this group of young people is an opportunity to understand how short-term support can be provided using different ways of working. This understanding will most likely lead to optimisation of long-term service delivery. Holmes and colleagues highlight that children and young people with neurodevelopmental difficulties are at particular risk from social distancing, specifically spending long periods at home and not being able to attend school. We suggest that this risk also applies to young people who present with complex, high-risk forensic mental health needs. We want to highlight two specific vulnerable groups with whom we work. The first is a group of vulnerable, isolated young people with social, communication, cognitive or emotional difficulties, or both, which increase their risk of exploitation by others. The COVID-19 pandemic has resulted in further reduction of social care specialist residential placements, coupled with decreased activity of courts, police, and admissions to secure welfare accommodation, which means that community workers are facing higher expectations to deliver and implement community risk management plans. Specific risks relevant to this patient group are wider than their risk of direct offending or harm to others, and include being groomed into gang-related activities (including County Lines and other criminal exploitation) and online manipulation. Child criminal exploitation into County Lines activity involves young people being asked to transport and deal drugs from one city hub into another community at risk to themselves and profit to the adult running these activities. The risk of adolescents going missing has also increased. We are concerned that these longer-term risk behaviours might only become apparent in the next 6–12 months, once the societal impact of COVID-19 becomes clear. The second group involves young people who show challenging behaviour within their family homes or at local authority placements. A reduction in multi-agency support and therapeutic offers from schools, respite placements, youth groups, and secure youth justice placements, means that these young people are probably spending more time in the community, where their risk profile is more likely to increase. This change is compounded by the UK public health directive to self-isolate, resulting in reduced specialist professional support. The effect on these young people is also most likely to be long term, arising from their need for increased future input to help address traumatic events they might have gone through during this pandemic, including understanding the impact of loneliness and disconnection from the community. We therefore suggest that young people who present with complex forensic mental health needs are particularly vulnerable in these extraordinary times. We suggest that a coordinated action plan should be developed, with input from the UK children's social care services, educational services, and the criminal justice system, to support this vulnerable group. We support the call for this plan to commence with a greater understanding through research and data collection. GB is the national clinical lead for the Adolescent Medium Secure Network at NHS England. OW is the national clinical lead for Community Forensic Child and Adolescent Mental Health Services at NHS England. All other authors declare no competing interests. Multidisciplinary research priorities for the COVID-19 pandemicThe need for real-time mental health monitoring is emerging as a key research priority in psychiatric research. The Lancet Psychiatry Position Paper by Emily Holmes and colleagues1 identifies several "multidisciplinary research priorities for the COVID-19 pandemic", proposing that real-time mental health monitoring (ie, through the use of smartphones and related connected technologies) is a central priority for understanding and managing the psychological impacts of the current crisis and future pandemics. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicEmily Holmes and colleagues' Position Paper1 in The Lancet Psychiatry outlines some important mental health research priorities for the coronavirus disease 2019 (COVID-19) pandemic. This pandemic presents an unusual, large-scale opportunity to examine the far-reaching impact of the language that we use to describe human distress because the impact of COVID-19 has been widely pathologised. The media has discussed a "pandemic of severe mental health disorders",2 and there is a widespread perceived need to offer psychological interventions. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health scienceThe coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicWe appreciate the proactive outlook of Emily Holmes and colleagues1 in setting priorities for mental health science in the COVID-19 pandemic in their Lancet Psychiatry Position Paper.1 A paper of this kind necessarily uses a broad brush, and we agree particularly with the need for harmonised data and interdisciplinarity. We further agree that the pandemic is likely to have pervasive and diverse effects on the mental health of young people globally, including those in education and those not in education. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicWe laud the aims of Emily Holmes and colleagues1 to highlight the impending mental health consequences of COVID-19, especially the call to ensure there is a joined-up multidisciplinary response. The authors note the impact of COVID-19 on vulnerable groups. For people from Black, Asian, and Minority Ethnic (BAME) groups, there are already significant mental health inequalities. These inequalities warrant a specific research response above and beyond that expressed in this report. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicThe Position Paper outlining mental health research priorities for the COVID-19 pandemic was timely and useful.1 I write to add that research is urgently needed to evaluate the mental health impact of different public health approaches to COVID-19. The world seems to have generally approached the COVID-19 pandemic from a humanitarian perspective; perhaps because the contagiousness of COVID-19 means that it has been widely perceived as personally salient. To focus on threat and try to immediately save as many people as possible from COVID-19-related deaths is an understandable and effective approach. Full-Text PDF Multidisciplinary: research priorities for the COVID-19 pandemicIn The Lancet Psychiatry, Emily A Holmes and colleagues1 set a formidable and very important challenge to "explore the psychological, social, and neuroscientific effects of [coronavirus disease] COVID-19 and spell out the immediate priorities and longer-term strategies for mental health science research". We absolutely must answer their call to action, but the authors1 have not addressed the next generation who are in utero during the outbreak in their Article. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicI read with great interest the recently published position paper by Holmes and colleagues,1 outlining most appropriately the multidisciplinary priorities for mental health research in response to the COVID-19 pandemic. I concur that we are already seeing the fallout of COVID-19, reflected in more acute presentations with perceived greater risk. This distress is driven in many cases by the consequences of reduced service provision or the loss of economic livelihood. Undoubtedly, mental health is a priority and a coordinated, focused, and robust approach is needed. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemic – Authors' replyWe are encouraged and stimulated by the responses to our Position Paper on COVID-19 mental health science. Some key messages are consistent: the mental health effects of COVID-19 are likely to be profound, long lasting, and will touch all sectors of society. Moreover, there was consensus that only by harnessing a truly multidisciplinary response will we be able to mitigate the mental health risks effectively. How best to respond will be a challenge that requires most of us to think and work differently, and for our scientific, research, and practice communities to come together to create novel solutions. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicIn their Position Paper1 in The Lancet Psychiatry, Emily Holmes and colleagues have laid out a comprehensive outline for mental health research, with a focus on a multidisciplinary approach to guide policy and practice using a bio-psychosocial approach, and have suggested research areas making use of existing research infrastructure and aligning ongoing research with COVID-19 priorities. Full-Text PDF Multidisciplinary research priorities for the COVID-19 pandemicThe COVID-19 pandemic and measures to contain the spread of the virus have led to marked changes in our social worlds, within a very short timeframe. There is widespread worry, fear, and distress among populations worldwide. Not surprisingly, there is growing concern about the consequences of the pandemic on mental health. In their Position Paper, Emily Holmes and colleagues1 set out their priorities for research, to inform the development of effective strategies that could mitigate the effects of the pandemic on mental health. Full-Text PDF