The report, led by researchers from the Universities of Bristol, New South Wales, Glasgow, and Swagֱ�� and involving an international team of experts, is published today9/10/24).

Self-harm remains neglected worldwide.  There are at least 14 million episodes every year, with the greatest number in low- and middle-income countries (LMICs).

It is defined as instances of people hurting or injuring themselves intentionally, regardless of the reasons.

However, shame and stigma can often stop people from seeking help. Self-harm can occur at any age but is most common in young people and is increasing in this group.  Self-harming behaviour leads to an elevated risk of death by suicide. People attending health services only represent the ‘tip of the iceberg’ for self-harm. 

The Commission makes a number of recommendations that could change the experience of people who have self-harmed for the better.

They include suggestions for more compassionate and effective delivery of health and social care services as well as whole of government approaches to address the causes of self-harm and reduce stigma.

The commission also highlights the necessity of seeing self-harm through a global lens, responsible handling of the topic of self-harm in all types of media, and the involvement of people with lived experience in designing and delivering care.

Prof Nav Kapur, Professor of Psychiatry and Population Health at the University of Swagֱ�� has helped lead a number of NICE guidelines on self-harm and suicide prevention.  He co-led the Commission with Professors Paul Moran, Helen Christensen and Rory O Connor.  The report includes over 40 authors from around the world. 

Prof Kapur said: “It was great to be part of the team which produced this Commission.  I’ve been working in services for self-harm for 30 years but what was striking for me with this piece of work was the integration of mental health and public health with global, indigenous, and lived experience perspectives”.

The (UMHC) was created by Student Minds in partnership with leading higher education bodies and thousands of staff and students. Swagֱ�� was amongst the first group of universities to sign up as members of the , which brings together universities committed to making mental health a university-wide priority, to share practice and create cultural change. 

The is a voluntary accreditation scheme that supports universities to understand their areas of strength and development to inform ongoing improvement in mental health and wellbeing, recognising good practice along the way. 

As part of the assessment process, we conducted a robust, evidenced-based assessment of our whole-university approach against the principles of good practice within the , including any challenges, weaknesses, and areas of improvement. A self-assessment report, a student-led report and a two-day onsite visit from Student Minds which involved over 100 staff and students, were all part of the assessment process.

Overall, Student Minds stated: “in many areas we can be confident that the University is sector-leading” and that they were “encouraged that the University is going in the right direction.” Student Minds felt that “the University is largely doing well to meet the Principles of Good Practice and is doing an incredible job to work towards having a whole university approach to mental health.”   

In awarding the University with the UMHC Award, Student Minds highlighted several examples of excellent practice, including: 

• Within the External Partnerships and Pathways theme, Student Minds “were particularly impressed with the University ’s commitment to the partnership work across the Greater Swagֱ�� Universities Student Mental Health Service. This is widely being acknowledged as novel, innovative and sector leading.” 
• Within the Progression theme, Student Minds “recognised as excellent practice that the University now offers 3.5 years (versus the standard 3 years) of funding to funded PhD students in recognition of the positive impact of this on completion and PGR student wellbeing.” 
• Within the External Partnerships and Pathways theme, Student Minds noted that “the University is part of a sexual violence network across Swagֱ�� that includes the HEI’s, police, council, and NHS. This approach is potentially sector-leading and an example of excellent practice in developing external partnerships.”

Speaking about the UMHC Award, Sarah Littlejohn, Director of Campus Life and UMHC Lead said: “The UMHC Programme has given an additional focus and impetus to our existing institutional priority of student and staff mental health and wellbeing. It has helped to shine a light on our whole-University approach, encouraging us to reflect on our current practice across all the different framework themes. We are proud to have achieved the UMHC Award which marks the latest part of our journey in our commitment to continuous improvement around mental health and wellbeing, and our dedication to its ongoing development.” 

The University will continue as members of the UMHC Programme and will now start to use the Award Outcomes Report to inform and feed into our work in this area. Our priorities for the next 6-12 months will focus on the UMHC Framework themes of Student Voice and Participation, Learning, Teaching and Assessment and Inclusivity and Intersectionality. 

Aisha Akram, Wellbeing and Liberation Officer, University of Swagֱ�� Students’ Union commented: 'I'm really pleased that we have received this award and I particularly appreciate the commitment to including myself and my fellow officers at the Students Union within countless panel discussions, in order to ensure that the University's commitment to the student experience with our support service is driven by student feedback. 

“We will continue to work with the University to ensure that we all stay committed to working in this area and building on the recommendations offered to us. I'm excited to enhance collaboration between the Students’ Union and the University to push for the best possible student experience.”

Head of Colleague Wellbeing, Helen Brewis, said:  “I’m delighted we have achieved the UMHC Award, reflecting the commitment we place on the wellbeing of our students and colleagues and how we have worked as a whole university community on our approach to mental health.

"Over the last two years, we have significantly developed our approach to supporting our colleagues’ mental health and wellbeing. The process of working towards the award has helped us to reflect on what is working well and where we can do more. We look forward to using the recommendations from the Award Outcomes Report to continue developing our approach to promoting and supporting good mental health and wellbeing at work.” 

• For further information about UMHC Award holders, please visit the  
• For further information about the UMHC Programme, please email UniversityMHCharter@manchester.ac.uk.

The ChUSE[1] trial, led by Dr Sarah Parry, strategic research lead at Pennine Care NHS Foundation Trust’s young people's mental health research centre, Professor Filippo Varese of the University of Swagֱ�� and in collaboration with Greater Swagֱ�� Mental Health NHS Foundation Trust, follows six-years of research with children and parents.

Dr Sarah Parry explains: “Distressing sensory experiences are a common development phenomenon, although these experiences can be frightening and confusing, especially for children already struggling with their mental health.

“Very few children who have distressing sensory experiences will ever receive a diagnosis of early-onset psychosis; but the associations between voice hearing and psychosis in our culture can cause great anxiety for families of children who hear voices.”

The new talking therapy, the ChUSE intervention, has received over £260,000 in funding from the National Institute for Health and Care Research (NIHR), and will provide much-needed support for parents and children.

Anxiety and stress about distressing sensory experiences can adversely impact the ability of young people and families to cope, which is why it is so important children and families can access timely and tailored support.

Many mental health practitioners feel ill-equipped to offer psychological therapies for distressing sensory experiences for younger children due to a lack of child-centred research to inform national clinical guidelines.

Delayed access to support often increases anxiety further, exacerbates family stress, and often worsens the original symptoms.

Professor Filippo Varese from Swagֱ��, adds: “In the UK, we have made great progress in offering psychological support to people who begin to struggle with hearing voices and other unusual and distressing perceptions for the first time.

“These treatments, however, are only available to young people that are at serious risk of future severe mental health problems. The ChUSE trial represents an important step forward in extending psychological support to a much wider group of children and young people and their families.”

The trial will work with 60 children aged 8 to 15 years old and their parents in Greater Swagֱ�� over the next 12 months. They will take part in the ChUSE talking-therapy intervention and parent support sessions, to develop new skills for coping and space to talk about.

The results will then be used to develop future therapeutic approaches for young people in in children and young people’s mental health services with distressing sensory experiences across England.

You can find out more about the trial at .

[1] ChUSE - Children and young people with unusual sensory experiences

“A ban would cause young people to find alternatives to existing social media platforms that may be harder for parents, educators, researchers and legislators to study and monitor,” said Dr Eiko Fried, Associate Professor in Clinical Psychology at Leiden University. “Rather than imposing restrictions, efforts should be directed towards educating young people, their guardians and educators on navigating the digital landscape safely, and on regulations which ensure that social media companies design age-appropriate features and algorithms.”

The aim of Population Health Improvement UK is to find innovative and inclusive ways to improve the health of people, places and communities and reduce health inequalities through the development and evaluation of long-lasting and environmentally sustainable interventions.

Population Mental Health is one of four initial research themes in the network. These themes are operationalised through investments in research clusters that bring together universities, government organisations, voluntary organisations and community partnerships, across the UK.

King’s College London (Institute of Psychiatry, Psychology & Neuroscience) and Thrive LDN are co-directors of this interdisciplinary research theme which aims to understand, identify and affect real-world policy change, to better address population-based improvement of mental health in the UK.

The other three themes in PHI-UK are Healthy Urban Places, Commercial Determinants of Health & Equity, and Enhancing Policy Modelling.

Research in the PHI-UK Population Mental Health theme is underpinned by three challenge areas: children and young people’s mental health, prevention of suicide and self-harm, and multiple long term health conditions, with a central focus on tackling mental health inequalities.

Principal Investigator and theme Director Dr Jayati Das-Munshi, from the IoPPN and the ESRC Centre for Society and Mental Health, King’s College London said: “This is an exciting initiative to tackle a growing need to address public mental health challenges facing the UK today. We will strengthen our partnerships across local government, public health, voluntary organisations and universities across the UK. We will work with our stakeholders and people with lived experience, to harness large-scale data, to understand which population interventions hold the greatest promise, leading to good mental health for all.

At Swagֱ��, will co-lead the ‘Prevention of Suicide and Self-harm’ challenge and will co-lead the ‘Data, Linkages and Causal Inference’ cross-cutting platform.

Professor Webb said: “I am excited to be involved in this innovative collaborative research programme. My studies will evaluate the impact of population-level policies and public health interventions on suicide and self-harm inequalities.”

Professor Sutton said: “The UK has such rich data on the causes, conditions and consequences associated with mental health, and I look forward to working with colleagues across the UK in discovering what we can learn from them together.” 

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The new analysis shows that between 2019 and 2021, 46,200 people lost their lives due to Death of Despair in England – the equivalent of 42 people every day.

However, in the North East of England more than twice as many people lost their lives due to Deaths of Despair compared to London.

Deaths of Despair is a collective term for deaths from alcohol, drugs and suicide, which tend to occur much more frequently in socially deprived communities.

The study, led by academics from Health Equity North (HEN), Swagֱ�� and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Swagֱ�� (ARC-GM) examined local authority data to identify geographical trends and risk factors that contribute to these kind of deaths.

The analysis found that northern regions and coastal areas of England are experiencing a much higher burden of mortality from these avoidable causes.

Out of the 20 local authority areas that experience the highest rates of Deaths of Despair, 16 are in the North, and all of the top 10 areas are in the North.

Conversely, none of the 20 local authorities with the lowest rates of Deaths of Despair are in the North.

The analysis also looked at associated factors that predict the risk of these kinds of deaths; living in the North was the strongest predictor. Local authorities with higher proportions of unemployment, white British ethnicity, people living alone, economic inactivity, employment in elementary occupations, and people living in urban areas had higher rates of Deaths of Despair.

The study found that:

• On average, 14.8 per 100,000 more people die from Deaths of Despair in the North compared to the rest of England
• Even after accounting for multiple social and economic factors, living in the North of England was associated with a 5.8 per 100,000 increase in Deaths of Despair rate
• More than twice as many people died from Deaths of Despair in the North East of England than they did in London (54.7 per 100,000 and 25.1 per 100,000 respectively)
• The highest rate of Deaths of Despair in England (at local authority level) is in Blackpool – almost 2.5 times the national average
• Three areas in England, all in the North, experienced more than double the average Deaths of Despair – Blackpool (83.8 in 100,000 deaths), Middlesbrough (71.6 per 100,000 deaths) and Hartlepool (70.5 per 100,000 deaths)
• Alcohol-specific deaths made up almost half of Deaths of Despair in England, accounting for 44.1% of all such deaths
• Deaths of Despair accounted for 2.9% of all deaths in England
• Deaths of Despair were highest among people aged 45-54 (55 per 100,000)
• Deaths of Despair accounted for 2 in 5 deaths in people aged 25-29 (41.1% of all deaths)
• Coastal local authorities had a significantly higher average Deaths of Despair rate than inland local authorities (41.6 per 100,000 compared to 31.5 per 100,000)

The study is believed to be the first of its kind to explore geographical patterning and contributing causes of deaths of despair in England.

The researchers are calling on government to prioritise preventative policies which address the longstanding inequalities across England, with fair funding allocation distributed according to need.

Christine Camacho, lead author and PhD Fellow NIHR ARC-GM, said: “Our study shows that some of the risk factors of deaths of despair have a more pronounced impact in the North of England, where inequalities in health and wealth are persistent and have widened during recent decades.

“As well as specific public health interventions to prevent deaths from drugs, alcohol and suicide, we need to move further and faster with Levelling Up in England to tackle the underlying inequalities which are leading people to die from despair.”

, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at Swagֱ��, said: “Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored – it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature.

“This research provides policymakers with a novel insight into the associated social factors of deaths of despair, which can help when developing comprehensive strategies that not only target specific risk factors but also consider the intricate relationships among these causes, contributing to more effective prevention and intervention efforts.”

The findings, published in Lancet Psychiatry today (13/03/2024) and funded by the and Wellcome, could indicate that most children are in a low risk group and won’t require long-term support, providing reassurance for children and their parents and caregivers.

However, the figures might also reflect an unmet need for some children and adolescents.

The study tracked the outcomes of around 370,000  3-18 year olds over five years using anonymised primary care health records from the Clinical Practice Research Datalink Aurum database.

All of the included children had symptoms of a possible psychiatric condition, such as depression, anxiety, Autism or ADHD. The research tracked the children’s contact with healthcare services to find out what happened over the ensuing five years.

Almost 208,000 (51%) of the children and adolescents who presented with psychological symptoms to general practitioners had few subsequent healthcare contacts over the next five years and were very unlikely to be prescribed medications, or referred to specialist services for their mental health.

The largest of seven groups identified by the researchers, these children and adolescents also had the lowest risk of future hospitalisation for either self-harm or suicide and were more likely to be younger, male, and from non-White ethnicities.

The next largest group (13% of the overall sample) had some ongoing contacts with the GP but didn’t receive medications. The other groups identified had either declining rates of contact over five years, or prolonged high levels of contact with GPs or specialists, or escalating rates of contact. Each of these groups made up less than 10% of the overall sample.

Children and adolescents from Black, South Asian, and other non-White ethnicities had lower rates of ongoing GP contact and there were similar, less pronounced differences for mixed-ethnicity children and adolescents.

The findings are published as increasing numbers of children are seeking help for mental health symptoms, as well as ADHD and autism. The results provide some insight into what happens next for these children and suggests that for most of the young people, the problems they experience will be transient, or that they may receive the support they need outside of medical settings.

Lead author Dr Morwenna Senior from Swagֱ�� said: “Our findings shows that a majority of children and adolescents with mental health symptoms have low or declining rates of ongoing contact with GPs and specialists.

“Increasing numbers of young people are experiencing mental health problems. At the same time, more children and families are seeking support from medical professionals for mental health conditions, ADHD and Autism.

“While this is concerning, previous research also suggests that for many young people, the prognosis is good and symptoms are likely to improve over time and this also fits with our findings.

“Though it’s not clear if a proportion of this figure is because children are not receiving the medical support they need, this study can provide some reassurance to parents and children that many, if not most children will get better. It is also reassuring that the children in the low-contact group were the least likely to be hospitalised for self-harm, or to die by suicide.”

Dr Senior added: “Future research is needed to understand whether children and adolescents with low-contact trajectories have unmet needs, that we are not measuring, and whether they receive further help elsewhere. Linked datasets can be used to examine relationships between different groups of children and adolescents presenting with  psychological symptoms, and their educational, social, as well as clinical outcomes.

She said: “We argue that services should differentiate between children and adolescents for whom early support might prevent deterioration from those whose symptoms are likely to resolve without further help.

“That could usefully inform changes to service configurations and preventive practice in services where resources are often stretched.

“For children whose problems are likely to resolve, reassurance and psychoeducation may be enough; whereas, for others, more intensive interventions might prevent deterioration in symptoms. We hope that our results will help distinguish these groups and better allocate limited resources.”

Dr Senior said: “These findings also add to substantial evidence that people’s experiences and use of health care for psychiatric conditions in the UK varies according to ethnicity.

“However, in our sample, it is difficult to determine the reasons for these differences. It might be that there were differences in how helpful children and their families found the support they were offered; or there may be differences in how and where people access support. For example, support within education or from family networks could play a bigger role for Black and South Asian children and their families.

• In September 2023, there was a 27% rise in new autism referrals over the last year. 
• In July 2022, more than 125,000 people were waiting for an autism assessment by mental health services, an increase of 34% since the previous October. By July 2023, this number had risen to more than 143,000. Figures published in September 2023, show there were 157,809 patients with an open referral for suspected autism.
• 93% of children did not receive an appointment within 13 weeks of being referred. 
• The number of children yet to receive an appointment after 13 weeks has increased by 36% since Covid-19, and there has been a 21% increase in the last twelve months.  
• More than one in four parents have waited over three years to receive support for their child.
• The evidence shows that children born to mothers without educational qualifications will receive an autism diagnosis two years later than their peers, and that issues around timely identification and support are exacerbated for girls, who are more likely to be misdiagnosed and diagnosed later than boys, or not at all.
• Children and young people from ethnic minority backgrounds are experiencing lower rates of identification of autism and often experience more severe difficulties.

The report warns that the failure to provide the right autism support can lead to poor long-term outcomes for autistic children, including an increased prevalence of connected conditions such as mental ill health and a greater risk of school exclusion or not attending school. Data from the Swagֱ��ed Bradford database included in the report reveals that children who had been referred but were still waiting for an assessment were at greatest risk of being excluded from secondary school. 

Autistic children who had a diagnosis were less likely to be excluded from school, compared to those awaiting an assessment, suggesting a diagnosis and subsequent support has a protective effect. With waiting times increasing, there is a growing risk to education outcomes, with evidence suggesting that many autistic children are ending up in expensive Alternative Provision.

The report also describes how a major barrier to existing systems is the perceived need for a medical diagnosis of autism before any child can receive support, with the perception among schools that this is a requirement, preventing some children from accessing support. Given the long waiting lists, many autistic children are not receiving the support they need because they do not have a formal diagnosis.

It makes three key recommendations to Government which have the potential the decrease the long-term costs associated with not acting early:

• Building effective partnerships between education and health professionals for assessing and supporting autistic children. This should include delivering assessments in education settings and making a holistic offer of support in schools and nurseries before and after a formal diagnosis is made.
• Providing and extending access to mandatory Continuing Professional Development (CPD) courses for health, education, and social care professionals that improve understanding and awareness of autism (and related issues). These courses should include information on how to create “neurodiverse friendly” environments, and particularly raise awareness of autism in girls and ethnic minority groups. Additional training should be co-produced by individuals with lived experience and delivered to professionals and integrated into undergraduate health and education professional training to improve the identification of autistic girls.
• Creating formal partnerships at a local authority level comprising sector leaders (including schools, health, voluntary services, faith, universities, educational psychologists, and businesses) to oversee a prioritised governmental ward-level approach to addressing the autism crisis. The partnership should focus on its most disadvantaged wards and provide leadership in trialing data-driven, community and family co-produced, “whole system” approaches to improve autism support with and through education settings.

“The number of autistic children seeking support is at a record high and the number waiting for an assessment has rocketed since Covid,” said Anne Longfield, Executive Chair of the Centre for Young Lives. “The autism assessment crisis is leaving thousands of children without the support they need and parents having to battle their way through a nightmare process that can take years to resolve.

“The pressure and stress this is putting on families and children can have terrible and damaging consequences for mental health and for children’s education chances. Autistic children with a referral who are waiting for an assessment are at significantly greater risk of exclusion from school, with all the further risks that can bring. If waiting times continue to increase, so can the risk of increased exclusion and poorer educational outcomes for autistic children.

“The evidence shows the need to move to a system of support that responds to the needs of autistic children, rather than waiting for diagnosis before any help appears. Without urgent reform, we cannot hope to improve the life chances of the next generation.”

The results of the study, a major clinical trial carried out during the COVID pandemic, showed rapid and enduring improvements in mental health and quality of life when older people received weekly phone calls over eight weeks from a specially trained coach who encouraged them to maintain their social connections and to remain active. 

The study, led by a team based at the and at Tees, Esk and Wear Valleys NHS Foundation Trust, also including Swagֱ��,  found levels of depression reduced significantly and the benefits were greater than those seen for antidepressants.

Participants in the study reported their levels of emotional loneliness fell by 21% over a three-month period and the benefits remained after the phone calls had ceased, suggesting an enduring impact.  

Mitigating the psychological impacts of COVID

The Behavioural Activation in Social Isolation -  started within months of the 2020 pandemic and was the largest trial ever undertaken to target and measure loneliness in this way. The study, published in the journal , represents a rapid advance in evidence to understand what works in preventing loneliness. 

People invited to take part in the BASIL+ study were aged over 65 with multiple long-term conditions.  They had been asked to shield during COVID and were at a high risk of loneliness and depression.   

The BASIL+ trial was supported by a £2.6M award from the National Institute for Health and Care Research (NIHR) and was the only mental health trial prioritised by the NHS as part of its Urgent Public Health programme - a cornerstone of its fight against COVID.  Hundreds of older people were recruited to the BASIL+ trial from 26 sites across the UK during the COVID pandemic of 2020-21. 

The epidemic of loneliness - global health concern

Politicians and policy makers have become increasingly aware of the importance of loneliness, but have struggled to know ‘what works’ in its prevention.  The World Health Organization has just ’ and has launched an .  It is anticipated that the results of the BASIL+ trial will feed into this process, since BASIL+ is the largest trial ever undertaken to combat loneliness.   The Jo Cox Commission, established in memory of the murdered politician, and there is a , with a Ministerial appointment.

The research was jointly led by  Professor Simon Gilbody from the University of York and Hull York Medical School and Professor David Ekers from Tees, Esk and Wear Valleys NHS Foundation Trust. Professor Gilbody said: "We now know that loneliness is as bad for your health as smoking 15 cigarettes a day and depression is a silent killer.  All of us working on the BASIL+ trial had older parents and relatives who became socially isolated during lockdown.”

“Based on our previous research, we had a good idea what might work”, Professor Ekers added. “With the support of the NHS and the NIHR we were able to test this in a large rigorous trial.  The results are now available and this is very exciting.  The UK led the world with the vaccine discovery trials.  Similarly in mental health we have advanced the science of ‘what works’ in the area of loneliness, and we have learned much from the dark days of the pandemic.”

“An important step forward”

, Honorary Professor at the Mental Health and Addictions Research Group at the University of York and , Professor of Clinical Psychology at Hull York Medical School and University of York designed and led the telephone support programme.  Professor McMillan said: “an ounce of prevention is worth a pound of cure, and this trial shows how we can prevent both depression and loneliness.”

, CEO of the National Institute for Health and Care Research, which funded the study, said: "These results are an important step forward in understanding what works in tackling and preventing loneliness and depression. The research is also a great example of how public money allows researchers, healthcare professionals and the public to work together across institutions and organisations to deliver results that will really make a difference to people's health and wellbeing."

, the BASIL+ trial manager from the Department of Health Sciences, University of York, added: “This is what the UK does well and it shows how the NHS, Universities and third sector organisations were able to work in partnership during the pandemic to tackle the big health challenges.” 

, who led the collaboration at The University of Swagֱ��, said: “These BASIL+ trial results represent the culmination of a strong collaboration between northern universities to tackle one of the major threats to health and wellbeing.  We will continue to work together to ensure the results of our work translate to improve the lives of older people after the pandemic.”

The BASIL+ partnership included leading researchers from the Universities of Leeds, Keele, and Swagֱ�� and also the charity AgeUK. 

The findings – published in the British Journal of General Practice  – will enable doctors to carry out quicker referral, assessment, and treatment of the debilitating and risky condition that used to be known as manic depression.

The early warning signs, identifiable over a number of years before diagnosis, include previous depressive episodes, sleep disturbance, substance misuse, receipt of three or more different types of psychotropic medications in a year, escalating self-harm episodes, frequent primary care consultations and missed scheduled GP appointments.

The findings could help improve delays between the early manifestations of bipolar disorder and its diagnosis and effective treatment, currently estimated to be around 6 years on average.

The research team was funded by the National Institute for Health and Care Research (), a major funder of global health research and training and was based in the NIHR Greater Swagֱ�� Patient Safety Research Collaborations. The investigators analysed routinely collected electronic primary healthcare data between January 2010 through to July 2017.

They identified 2,366 people with and 47,138 people without a bipolar disorder diagnosis in England.

The work supports the remit of the recent Bipolar Commission Report , which is calling for major reform to develop a dedicated healthcare pathway for specialist treatments and lifetime support for people with bipolar disorder.

Up to 3% of the UK population experience bipolar disorder at some point during their lives.

Many affected people who are undiagnosed experience a range of adverse health and social outcomes including poor social adjustment, multiple hospital admissions, poor physical health, interpersonal violence, and increased risk of self-harm and suicide.

Dr Catharine Morgan, a Research Fellow at Swagֱ��, said: “Bipolar disorders are serious mental illnesses characterised by instability in mood. They can impact on the lives of patients and their families to a seriously detrimental degree.

“Early treatment, however, can be crucial in averting years of hardship and elevated risk for patients; our study provides crucial information that could help GPs to consider a diagnosis of bipolar much earlier to enable timely effective treatment and referral on for specialist assessment.”

Anya Francis, a University of Swagֱ�� researcher who facilitated the lived experience advisory panel (LEAP) for the research and has experienced bipolar II disorder said: “This work was inspired by sharing my personal experience of missed opportunities to spot the early warning signs of bipolar and receive a timely diagnosis.

“The early warning signs  included such as sleep disturbances, anxiety, irritability, and high energy levels). My personal hope is that the findings from this study can be used in primary care settings to encourage clinicians to ‘Think Bipolar’ and outcomes for others.”

Carolyn Chew-Graham, Professor of General Practice Research at Keele University and who also sits on the Bipolar UK Advisory group said: “Better referral pathways from primary to specialist care are desperately needed both for patients and GPs, when a diagnosis of bipolar is suspected, if patient are to receive the timely help they need. ‘Think bipolar’ is a strong message to send out to GPs. The findings from our study support the recent call from the Bipolar Commission Report for dedicated care for people with bipolar disorder .

“There is evidence that a delay in diagnosis of bipolar can be up to nine years, with a third of people who are eventually diagnosed with bipolar will have attempted to take their own lives because of the distress that they feel and the delay in getting appropriate care.”

The paper: Identifying prior signals of bipolar disorder using primary care electronic health record, published in British Journal of General Practice, is available  

The study conducted jointly by Swagֱ��, Keele University, University of Exeter, and mental health research charity The McPin Foundation is published in the Lancet Child and Adolescent Health today (20/06/23).

The analysis of UK GP records of young people aged 10 to 24 years between 2010 and 2022 showed that since March 2020, eating disorders were 42% higher than would be expected based on previous trends for females aged 13-16, and 32% higher for those aged 17-19.

The increase in incidence of self-harm was also greatest among females aged 13-16, with the number of episodes being 38% greater than expected.

In contrast, there was no evidence of an increase in self-harm incidence in females in the other age groups and no increase in rates of eating disorders or self-harm was observed in males.

For the 10-year period before the pandemic, diagnoses of eating disorders in females were more common in those from more affluent backgrounds than those from more deprived communities, say the team.

This socioeconomic difference has widened following the onset of the pandemic: since March 2020, eating disorder diagnoses for females living in the least deprived communities were 52% higher than expected, compared with 22% higher for those living in the most deprived areas.

Unlike eating disorders, rates of self-harm were higher in the most deprived areas in the 10-year period prior to the pandemic, but unlike for eating disorders, the socioeconomic differences narrowed rather than widened after March 2020. 

Self-harm and eating disorders, as well as being major health issues in their own right, are coping mechanisms that are often indicative of underlying psychological distress, and they share multiple risk factors.

The study is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research and the NIHR Greater Swagֱ�� Patient Safety Research Collaboration.

Lead author Dr Pearl Mok from Swagֱ�� said: “The reasons for the increase in eating disorder diagnoses and self-harm episodes amongst teenage girls during the pandemic are likely to be complex and could be due to a mixture of issues such as social isolation, anxiety resulting from changing routines, disruption in education, unhealthy social media influences, and increased clinical awareness.

“Our study is large, but episodes of self-harm that were not treated by health services were not captured in our data, so the rise in self-harm incidence might have been even greater than we observed. However, it is also possible that cases of self-harm not coming to the attention of services may have exhibited a different pattern.

“We found that the increase in eating disorders and self-harm was greater in less deprived than in more deprived areas. This may reflect differences in service provision and challenges in accessing clinical care, rather than greater increases in risks for self-harm and eating disorders during the pandemic amongst those living in the least than in the most deprived communities.”

The study was conducted using a database of anonymised primary care electronic health records of over 9 million patients aged 10-24 years from 1881 general practices in the UK.

The team of researchers tracked the number of eating disorder diagnoses and self-harm recorded monthly by GPs from January 2010 through March 2022, around ten years before the onset of the COVID-19 pandemic and two years after its start.

Rates of eating disorders and self-harm episodes observed since the onset of the pandemic from March 2020 to March 2022 were compared with the numbers predicted using data from the ten years before. Differences between observed and predicted number of cases were assessed to give an indication of the pandemic’s potential influence on outcome incidence.

An advisory group of young people with lived experience of mental health difficulties, parents, and carers, helped shape the study and interpret the findings.

Dr Shruti Garg, Child and Adolescent Psychiatrist and co-investigator from Swagֱ�� said: “The staggering rise in eating disorder diagnoses and self-harm episodes among teenage females highlights an urgent need to improve early access to services and for timely intervention.”

Prof Carolyn Chew-Graham, academic GP and co-investigator from Keele University said: “Early identification of mental health difficulties in children and young people by primary care clinicians is extremely important as this facilitates timely access to treatments. Sufficient support, however, from GPs and mental health services needs to be available to manage those presenting. Given the current pressures on the NHS, in both primary and specialist care, our study emphasises the need for sufficient capacity in mental health services to meet growing demand.”

Emma Garavini, Youth Public Involvement in Research Officer at the McPin Foundation and co-ordinator of the advisory group said: “We held regular meetings and communications throughout the project with the advisory group. Having the voices of young people, parents and carers inform the study with their insights and reflections highlights the importance and need for lived experience expertise in mental health research.”

“Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the two years following onset of the COVID-19 pandemic: a population-based study”, published in the Lancet Child and Adolescent Health, is published in the  Lancet Child and Adolescent Health .

The funding brings together National Institute for Health and Care Research (NIHR) infrastructure, Universities and NHS organisations to undertake high-quality early and experimental medicine research in mental health. This collaborative approach strengthens the expertise and reach of the NIHR Mental Health Translational Research Collaboration and ensures research involves patients and the public who better reflect the diversity of the population.

The University will play a key part in the research by leading on three out of the five national themes with significant investment: Capacity Building, Data and Digital, Children and Young People.

The work will be supported by the NIHR Swagֱ�� Biomedical Research Centre (BRC), as part of its new Mental Health research Theme, Greater Swagֱ�� Mental Health NHS Foundation Trust and Swagֱ�� University NHS Foundation Trust.

Dr Shruti Garg will lead the Capacity Building workstream, Professor Jonathan Green the Children and Young People theme, and Professor John Ainsworth the Data and Digital theme. Swagֱ�� digital health start-up CareLoop Health will play a major role as industry partner.

The ‘Mental Health Mission’, part of the government’s Life Sciences Vision, will accelerate mental health research across the UK and attract private investment, potentially benefiting millions of people.

The funding will be used to bolster research to improve the treatment and care for those with mental health conditions and to address key issues affecting patients and clinicians, including early psychosis and severe mood disorders which are currently under-researched.

John Ainsworth is Professor of Health Informatics and Head of the Division of Imaging, Informatics and Data Sciences at Swagֱ��. He is also Digital and Data Science Programme Lead within NIHR Swagֱ�� BRC’s Mental Health Theme. He said: "This is an exciting time in mental health research. With the investment in the Mental Health Mission we will be able to accelerate the development and evaluation of new interventions that will change people’s lives for the better.

“We are very proud that Swagֱ�� will be at the forefront of developments in data and digital technology, therapies and treatment for children and young people, and developing the skills of the next generation of researchers.”

Professor Jonathan Green from Swagֱ��, who is also Developmental Neuroscience Programme Lead within the Mental Health Theme at NIHR Swagֱ�� BRC, said: “One of our core goals with this substantial funding is to develop the skills and digitisation nationally to enable NHS-wide ‘platform trials’ of new treatments in both child and adult mental health, integrated within community services. This has then the potential to transform the speed of identification and adoption of effective mental health treatments throughout the nation.”

Dr Shruti Garg from Swagֱ��, who leads on work in the Developmental Neuroscience Programme within NIHR Swagֱ�� BRC’s Mental Health Theme said: “The Mental Health Mission funding provides an unprecedented investment not only to bolster mental health research but also develop a capable research active workforce. 

“We want to enable more doctors, nurses and allied health professionals to be engaged in research and bring innovative new treatments to individuals with mental health difficulties.”

Professor Shôn Lewis, Mental Health Theme Co-Lead at NIHR Swagֱ�� BRC and Professor of Adult Psychiatry at Swagֱ��, said: “Early translational research within mental health is urgently needed to identify new treatments and better ways of delivery. 

“At Swagֱ�� BRC, our Mental Health Theme is focused on the development of theory-driven new treatments based on prevention, personalised health, and integration with our other BRC research Themes. The Mental Health Mission investment will accelerate our research, helping us to drive health improvements and lasting change for our diverse communities.”

Professor of Psychological Medicine at Swagֱ�� will be co-chair of the Mental Health Mission alongside Oxford University visiting .

Professor Manji and Professor Abel said: “We are delighted to be working together to make the new Mental Health Mission a truly revolutionary force behind mental health research.

“We want the Mission to create tangible differences to the lives of patients, both in the UK and internationally.

“Between us, we bring a wealth of experience in mental health research and innovation, and a commitment to genuine collaboration with patients, industry and healthcare staff.”

The , published in July 2021, set out a proposal to make the UK the most attractive place in the world for Life Sciences Innovation. The Vision included priority healthcare missions for the government to solve in partnership with industry, the NHS, academia, and research charities.

 was launched in November 2022, to grow the Life Sciences sector and address the unmet need for innovative new mental health treatments and technologies.

Francis Creed, a professor emeritus of psychiatry at Swagֱ��, analysed the data of 120,000 people followed over 2-and-a half years to unpick the mystery around CFS/ME, Irritable Bowel Syndrome and Fibromyalgia.

“When people suffering from CFS/ME, IBS and Fibromyalgia come into contact with health professionals, negative attitudes can sometimes get in the way of treatment. but by understanding these complex conditions better, the stigma and mystery around them can be eased,” he said.

His latest study – published in the journal PLOS ONE – used data from the Dutch Lifelines cohort study to compare people who reported one of the unexplained disorders with people who reported one of three common medical illnesses: diabetes, inflammatory bowel disease and rheumatoid arthritis.

These illnesses lead to symptoms similar to the unexplained conditions: like ME, diabetes causes tiredness; irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) both lead to diarrhoea and stomach pain; and like rheumatoid arthritis (RA), Fibromyalgia causes debilitating joint and muscle pain.

All participants had a standardised interview to assess their mental health. A cross-sectional examination of the data revealed that the variables most closely associated with mental health problems were similar in all the conditions studied. These included indicators of:

• A tendency to develop mental health problems: previous anxiety and depression, stress and neuroticism.
• A psychological  reaction to the illness: severe difficulties arising from health problems including impairment of daily tasks.

A second analysis compared the prevalence of mental health problems before the onset of the six disorders in a longitudinal study. This analysis allowed Prof Creed to see if underlying mental health problems preceded or followed the onset of the conditions.

It revealed the proportion with mental health problems was smaller than might have been expected: there was no evidence of mental health problems in three quarters of the people developing the unexplained disorders.

The findings, in conjunction with previous work, suggest that mental health problems play a part in the development of the illness in approximately a quarter of people developing chronic fatigue syndrome or irritable bowel syndrome.

Professor Creed said: “This work provides evidence that for many people, a  wide variety of physical and psychological factors are associated with these debilitating conditions.

“These may be other illnesses, such as gastroenteritis,  metabolic and thyroid disorders, chronic infections, asthma, allergies, impaired sleep and excessive preoccupation with illness as well as lifestyle issues. stress, anxiety and depressive disorders.”

Appreciating this multifactorial pattern , hopes Professor Creed, will enable health professionals to take a more holistic view of medically unexplained disorders, which can cause debilitating and life changing illness.

He added: “Although mental health problems are more common in ME, they only occur in a minority of people early in the course of the illness. The treatment approach should consider a wide range of possible factors just as sound treatment of diabetes and rheumatoid arthritis should include an assessment of mental health as well as the characteristic bodily problems.

“Although there are symptomatic treatments which may help these unexplained disorders, we should aim to understand fully their underlying causes. There are probably several different ways they may develop; a whole range of physical and mental factors are probably involved. Treatment approaches will become more effective as our understanding of the causes improves.

“Thinking about ME and the other illnesses as either “physical” or “psychological” in origin is not helpful and this artificial division could make it more difficult for sufferers to get appropriate help. This study might help to change that for the better.”

The paper Psychiatric disorders comorbid with general medical illnesses and functional somatic disorders: The Lifelines cohort study is published, in PLOS One 

And the barriers to access that they found, may impact significantly on the risk of them self-harming again or developing other mental health problems.

The study, which was co-designed with people who have experience of self-harm and attending mental health services, highlights long waiting times, poor communication, exclusion, and rejection for some patients, when trying to access much needed psychological therapies following self-harm.

The article is published in the journal BJPsych Open and was funded by the National Institute for Health and Care Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between Swagֱ�� and Northern Care Alliance NHS Foundation Trust.

The qualitative study of 128 patients and 23 carers revealed that lack of prompt aftercare after seeking help following self-harm and long waiting times contributed to uncertainty, worsening mental health, and further self-harm episodes for some patients.

Dr Leah Quinlivan, from Swagֱ��, a Research Fellow at the GM PSTRC’s Mental Health theme, led the study. She said: “This study has highlighted the urgent need to increase access to appropriate psychological therapies for people who have self-harmed.

“Our study’s findings suggest that access to psychological therapies remains low and challenging. Participants experienced failed promises from mental health services after reaching out to seek help following a self-harm episode.

“Many patients told us that lack of prompt intervention, distress and anxiety over long waiting times worsened their hopelessness, self-harming behaviour, and suicidal thinking.”

Elizabeth Monaghan, a co-author with experience of self harm said: “Research shows that self-harm is linked with higher suicide risk, and that attending A&E should lead to meaningful and timely support. But, sadly, this study showed that this is sometimes not offered or available and, worse, that delays and unhelpful interventions can lead to more distress, harm or suicide. 

“Involving people who have experienced of visits to A&E following self-harm ensured that researchers were able to hear first-hand how long waiting times and uncertainties about care and support can worsen symptoms, adding to their suffering. It’s vital that researchers learn from people directly affected by services.”

Sadika Asmal, a co-author who experienced self harm said: “The research highlights how crucial it is that more provisions and changes to current processes are made in a timely manner to support those in times of crisis, who are often experiencing unbearable emotional suffering. This is so that they can be offered the critical aftercare and psychological therapies they so desperately need. It is not enough to just assess people. The right kind of psychological therapy might help people try find the ultimate cause of their self-harm, which for some people is linked to childhood trauma.”

Dr Leah Quinlivan added: “The risk of further non-fatal or fatal self-harm is greatly raised immediately after someone has self-harmed, so clinical intervention needs to happen quickly to reduce the likelihood of it happening again and risk of death by suicide.

“However, there are few services dedicated to this group, which is why we have an urgent need to develop promptly accessible models of safe and effective care, from well-resourced and supported teams.

“Mental health services are rapidly transforming as part of the NHS Long Term Plan and Community Mental Health Framework, and self-harm is recognised as a key area for quality improvement and policy initiatives.

“Now, more than ever, we have the opportunity to transform services, particularly if we listen to people with lived experience and the professionals who care for them.”

A study by the same team was reported in an article that was also published two weeks ago in BJPsych Open (add link). That paper reports the views of practitioners who also overwhelmingly felt that barriers to accessing services and long waiting times may heighten risk of further self-harm for patients, as well making burnout among staff more likely.

The paper Liaison psychiatry practitioner views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study published on 20/02/2023 in BJPsych Open is available

The paper ‘Accessing psychological therapies following self-harm: Qualitative survey of patient experiences and views on improving practice’, which is published today in BJPsych Open, is available

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• The inequalities identified in Year 1 of the #BeeWell data have persisted; girls are reporting significantly lower levels of wellbeing than boys, and LGBTQ+ young people have significantly lower wellbeing than their cisgender heterosexual peers. The data remains consistent when comparing two different cohorts of Year 10 pupils across the two years.
   
• Wellbeing scores have declined slightly as young people have moved from Year 8 into Year 9. This is in line with wider research about how young people’s wellbeing declines as they get older.
   
• As young people get older, they are less likely to feel like they get enough sleep to feel awake throughout the school day. 41.8% of Year 9 students report that they aren’t getting enough sleep to concentrate at school, which is around 9 young people in an average class of 22. This is compared to 36% of Year 8 pupils who said they do not get enough sleep in 2021.
   
• There has been a decline in young people reporting that they have good places to spend free time. In 2021, 75.5% of young people in Year 8 agreed or strongly agreed that they had good places to spend free time, compared to 67.6% of those young people when they were surveyed again in Year 9 in 2022.

The #BeeWell survey results have overall remained consistent over the two years of the programme, meaning that there is an increased confidence on how accurate the findings are – as over 60,000 young people have told us their views.

In response to the findings, the #BeeWell Coalition of Partners and Greater Swagֱ�� schools have already begun to take action to respond to what young people across the city-region are telling us. This includes investment to support the wellbeing of LGBTQ+ young people, to encourage girls to get involved in physical activity, and the completion of a social prescribing and youth-led investment pilot in five neighbourhoods of Greater Swagֱ��.

With two successful years of Greater Swagֱ�� leading with the #BeeWell programme a second programme will be launched in Hampshire, The Isle of Wight, Portsmouth and Southampton (HIPS) from September 2023, in a new partnership with the four local authorities. The expansion of the programme marks the second Integrated Care System area to deliver the #BeeWell Programme and will help to establish any differences between different parts of the country. The programme is already being kickstarted in the region with the process of co-designing the local survey with young people already underway in 15 pathfinder schools.

Building on experiences and learning in Greater Swagֱ��, and national endorsements from the Fair Education Alliance and Times Education Commission, the new partnership with HIPS is the next step of #BeeWell's ambition to ensure that wellbeing is prioritised and measured consistently and rigorously in schools and communities in every corner of England by 2030.

“We have a 10-year plan to take #BeeWell to scale nationally and create a public policy agenda for young people that gives equal weight to wellbeing and attainment," Neil added. "The next step of this plan is our expansion to the Hampshire and Isle of Wight Integrated Care System area. This is critical to understanding local variation, issues of sustainability, scaling up, and synergy.  The learning generated will inform the development of the #BeeWell model to ensure our approach can be embedded and sustained across wider geographies over time, as we seek to fulfil our mission of making young people’s wellbeing everybody’s business.”

"The #BeeWell surveys have facilitated a real breakthrough in conversations about young people’s health, wellbeing, and activity,” said Cllr Mark Hunter, Greater Swagֱ�� Portfolio Lead for Young People. "The results have helped to shape some important changes in Greater Swagֱ�� to support young people and their wellbeing. This year’s findings show that more action needs to be taken to tackle the inequalities in wellbeing between girls and boys, and with LGBTQ+ young people. The support of Greater Swagֱ��’s schools has been integral to #BeeWell, and in Year 2 shows how schools have used the survey results to make positive changes for their pupils. I am looking forward to Year 3 of the survey and the positive changes the results will initiate.”

“The #BeeWell data has enabled us to understand our community with greater focus - we are able to react strategically to areas of fragility and celebrate the strengths and feedback we gain from our young people," said Glyn Potts MBE DL, Headteacher at Saint John Henry Newman Catholic College in Oldham. “Put simply, it is the closest we have to a microscope into the minds of our young people and enables us to be reactive to their needs and a stronger community.”

“The Youth Steering Group weren’t surprised that there remain inequalities in young people’s wellbeing in Greater Swagֱ�� - unfortunately, it is what we see in school every day, particularly pressure on girls," said Ruby, a member of the #BeeWell Youth Steering Group. “It’s good that the data remained consistent – it means things aren’t getting worse and gives us hope that things can get better.”

"The Youth Steering Group would like to open a conversation about how difficult it is for young people to find the balance between your emotions and all the things you have to get done in a day before you can get enough sleep. There are a lot of expectations on young people with homework, revision, caring for ourselves as well as others, especially as you get older. We want to extend this conversation to include adults' wellbeing, too, as they set expectations for younger generations on managing everything that matters to our wellbeing.”

For more background on the #BeeWell project, visit . 

People with heart disease, or who have had a serious heart problem, such as heart attack or open-heart surgery, often experience stress and anxiety due to their medical condition. Many of these patients are referred into a cardiac rehabilitation (CR) programme, either at a clinic or remotely from their home, to support their recovery. Currently, psychological support and specific mental health treatment offered as part of these programmes varies by site and is limited. Yet, treating anxiety and depression is crucial as research shows that this type of distress reduces quality of life, and increases the risk of further heart problems and even death.

The findings from the , build on previous research which found that . This study shows that MCT can be delivered both in a group-based and home-based treatment, widening patient choice for mental health support in cardiac rehabilitation services.

In this study, 118 cardiac patients were randomly allocated to receive Home-MCT plus standard cardiac rehabilitation treatment, while 122 patients were allocated to standard CR. Patients receiving Home-MCT were provided with a self-help manual that they worked through at their own pace. The manual included modules on developing techniques to reduce worry and rumination (dwelling on the past), and new ways to react to negative or distressing thoughts. In addition to the manual, patients receiving Home-MCT also received support phone calls from trained staff to provide opportunities for reflection and to consolidate learning.

Patients in the trial who received home-based MCT experienced significant reductions in symptoms of anxiety, depression and post-traumatic stress, compared to those receiving standard CR only. The results indicate that Metacognitive Therapy can be effective when delivered both by a therapist in a group setting (as shown in previous research), and when accessed remotely from home. This flexibility in how MCT can be delivered will enable healthcare providers to offer patients greater choice in how they access psychological components of CR programmes.

Harriet Dawson was 22 years old when she had open heart surgery following the discovery of a hole in her heart. She then took part in the MCT-PATHWAY study. She commented:

"It was very self-guided. You had check-in calls every couple of weeks and I liked that.... I preferred that it was home-based because I didn’t have to compare and contrast my answer. A lot of it was about managing your stress, managing your worry, and how much of it us under your control.

“There weren’t many resources out there for me, for someone at the younger end of the spectrum and female. My heart event is a life milestone for me now, but home-based metacognitive therapy has allowed me to take control of it and has allowed me to reflect on it properly.”

Joanne Varker, Cardiac Rehabilitation Specialist Nurse at Royal Bolton Hospital, one of the NHS sites involved in the study, commented:

“Being involved in the Pathway Study was of great benefit to many of our patients. We had never had the option of offering a home-based therapy that could greatly aid our patients' understanding of the psychological issues caused by their heart attack and help their overall recovery. As a team we enjoyed taking part and being able to offer this, and saw many positive outcomes from our patients"

Professor Adrian Wells, PATHWAY Chief Investigator commented:           

‘It’s not surprising that people living with or recovering from serious heart problems experience symptoms of anxiety, depression and trauma. They are often recovering from potentially life-limiting conditions and uncertainty which understandably causes distress. What’s important is that we recognise this and provide patients with effective, evidence-based treatment options. The results of our trial have shown that home-based MCT can help cardiac patients discover new and more helpful ways to process their distressing thoughts, whether they are undergoing treatment at home or at a clinic.”

The trial compared the ‘Take Control Course’ for up to 20 people - devised by researchers at the University of Swagֱ�� - with standard talking therapy. Both took place in six weekly sessions.

The study is published in the journal Cognitive Behavioural Therapy and funded by the Economic and Social Research Council.

The course – based on Perceptual Control Theory- follows a precise programme, teaching attendees about the importance of control in life – when to pursue it, when to let go and how to balance conflicting priorities.

They learn how to face longstanding fears and anxieties, and how to see the bigger picture and longer term goals, drawing on their own strengths.

Participants aren’t required to talk about their mental health, but can if they wish.

The randomised controlled trial, conducted by Swagֱ�� led team involved 156 people with were recruited from the NHS Improving Access to Psychological Therapies (IAPT) service.

They were offered either the Take Control Course or the established six sessions of one-to-one therapy provided by IAPT.

Participants, mostly referred by their GP,  were recruited from Salford Six Degrees Social Enterprise, a low-intensity IAPT Service.

After a six month follow up, there was no evidence of a difference in mental health outcomes between the two interventions. After another six months, however, there was not enough data to give conclusive results.

The measures used by the researchers included a Patient Health Questionnaire Depression Scale, Generalised Anxiety Disorder Questionnaire as well as other psychological tools.

Though, the course has been delivered by Six Degrees over the past eight years and has been adapted for use in high  schools for the Swagֱ�� Healthy Schools, this is the first time it has been assessed by a randomised trial. It has also been delivered online.

Lydia Morris, Clinical Lecturer at University of Swagֱ��, was the lead author, working with Warren Mansell, Honorary Reader at Swagֱ�� and Professor of Mental Health at Curtin University, Perth.

He said: “There are many effective talking therapies for common mental health problems such as anxiety and depression.

“However, training therapists are expensive, and some people prefer to meet in groups, rather than to talking to someone about their problems.

“The success of one to one talking therapies may often depend on the match between the therapist and client.

“The Take Control course, however is always delivered in exactly the same format.”

Dr Morris from co-developed the course as part of her PhD research.

She said: “This trial showed the Take Control Course could be an efficient alternative to one-to-one therapy for common mental health problems, as well as providing an evidence-based alternative for people who do not want individual therapy.”

Co-author Tanya Wallwork has been working with Salford Six Degrees over the past decade and was a co-author of the manual used by facilitators of the course:

She said: “As soon as I came across this course I knew how useful it could be. And the outcomes bear that out. Each week we use objective measures to assess the impact of using taking part in the course and the results are consistently good.

“The course came into its own during Covid when we started to give it via Zoom. It actually gives participants more choice-  as they can choose to be visible or not.”

One participant in the course said: “I found looking at goals and working out what’s important to me really helpful. Especially when I think something I worry about too much is just a small thing but using the upward arrow technique to work out why it’s important really helped me to look at the bigger picture rather than focusing on little things.”

The six sessions include:

• Discussing how life is about control -  working out what we want to have more control of, and what we can have less control of.
• What Blocks Our Control? Even worry, rumination and self-criticism are a problem only to the extent they get in the way of important life goals.
• Feeling in Control Short-Term versus Getting Control of Your Life. Goals are organized hierarchically
• Taking Control of the Things Around You. A flexible way to work out what we have in common with people despite our disagreements
• Building on Strengths, Qualities, and Resources. Encourage participants to recall the strengths, qualities and resources they have, especially at times when things are difficult for them
• Moving Forward: What Gets Me Stuck? What Helps? Participants complete a worksheet on the things that are helping them feel in control and signs that they are struggling, like a “relapse prevention” session in traditional CBT

The paper ‘A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial’ is available  

Mental health in England was hit badly over the course of the pandemic. But people in the North performed significantly worse in their mental health outcomes compared to those in the rest of the country.

• People in the North under 35 were more likely to have developed a psychiatric disorder over the course of the pandemic, an increase of 2.5% compared to a reduction of 1.3% in rest of England.
• There was a 12% increase in the numbers of anti-depressants prescribed during the pandemic in the North. During the pandemic, people living in the North were prescribed more anti-depressants proportionately than those in the rest of England (5.3 compared to 4.3).
•  Before the-pandemic, people from ethnic minorities and those from a white British background had similar mental health scores, Over the pandemic people from ethnic minorities had a larger fall in their average mental health (1.63 points compared to 0.87) and this was greater for those of an ethnic minority in the North (a fall of 2.34 compared to 1.45 for the rest of England).
• ·Women from ethnic minorities in the North had the worst mental health in the country. Their mental health scores fell by 10% at the start of the pandemic and their scores were 4% lower throughout the pandemic.
• Mental health fell equally in the North and the rest of the country during the pandemic (5% decrease), but it recovered more quickly in the rest of the country (to 1.3% decrease) than in the North (2% decrease).
• The report conservatively estimates the reductions in mental health in the North during the two years of the pandemic have cost the UK economy £2���� in lost economic productivity. This is £2���� more which has been lost than if the North had suffered the same mental health outcomes as the rest of the country.
• The gap between the lowest and highest earners increased during the pandemic and remains large.

Report co-author Clare Bambra, Professor of Public Health at Newcastle University, said: “These findings reiterate that the pandemic has been very unequal. People in our most deprived communities have suffered most, in terms of death rates, dying younger and in on going ill-health such as long covid. These health inequalities reflect long-term inequalities in the social determinants of health, how we live, work and age.”

Dr Luke Munford, Senior Lecturer in Health Economics at the University of Swagֱ�� and NIHR ARC Greater Swagֱ��, who also co-authored the report, said: “Our mental health is important for us as individuals but is also important to our society. We have shown, again, that the pandemic was not equal – people in the North of England fared worse. We need to act urgently to address this or these unfair inequalities will grow and as already hard hit individuals and us as a society will unfairly suffer.”

The report urges that more needs to be done to address inequalities in mental health in the North, if ‘levelling up’ is to be achieved.

Among its key recommendations, the report’s authors are calling for an increase in NHS and local authority resources and service provision for mental health in the North, along with an increase to the existing NHS health inequalities weighting within the NHS funding formula.

Hannah Davies, Health Inequalities Lead at the NHSA and report co-author, said: “Increased deprivation in the North of England has added to a decline in mental health in the North of England over the course of the pandemic.

“The reasons for this are many: increased time spent in lockdowns, the type of work people in the North do but the driving factor is poverty.

“To reverse these outcomes immediate action should be taken to provide funds to mental health suppliers proportionate to the need in those areas and measure to reduce deprivation – particularly as the cost of living crisis tightens its grip further on the most vulnerable.”

The report is backed by the NHSA’s mental health trust members: Rotherham Doncaster and South Humber NHS Foundation Trust and Tees, Esk and Wear Valley NHS Foundation Trust.

Kathryn Singh, Chief Executive of RDaSH, said: “Our work at RDaSH is rooted in our communities and our teams have huge experience of how much impact COVID-19 has had on the mental health of those communities – the parallel pandemic. Our experience on the ground is very much borne out by the findings of report, where levels of deprivation were already high, and where the pandemic has exacerbated all the trends that were already in place.

“But I think we are in a good position to support the vital recommendations of this report, and I’m hopeful we can play our part in the innovation and vital investment needed into mental health in communities across the North, so that they can play their full part in the UK’s economy.”

Brent Kilmurray, Chief Executive of TEWV, said: “During the pandemic we saw not only an increase in demand for our services, but an increase in acuity – with people presenting to us with more severe mental health conditions.

“We provide services in some areas of very high deprivation, and we’re working with partners from all sectors across our region to find new ways to support these communities with their mental health. Community mental health transformation is hugely important and will help to provide more joined-up care, taking a person-centred approach to find new ways to support people with mental health issues.

“We know the impact that COVID-19 has had on people’s mental health and if you feel your mental health is being affected, please seek help and support as soon as possible.”

The NHSA convenes the Northern Mental Health Innovation Network, which brings together world class clinical, academic and industry experts across the North of England and showcases the North’s excellence in the field of mental health.

Led by and Swagֱ��, the £255,000 study is funded by the (NIHR).

The feasibility study will recruit 45 patients in Greater Swagֱ�� over 12 months, and will be one of the largest trials so far to use an imagery focused therapy approach in psychosis.

The research team hope the therapy will help the up to 74% of people with psychosis who see intrusive pictures in their mind, by helping them understand and change the images, and replacing them with more positive ones.

These “pictures in the mind’s eye” are often associated with distressing voices other people cannot hear and beliefs that others mean to harm them.

The talking therapy, to be given over 12 weekly sessions, uses purely imagined images in addition to images from a person’s past (or things they are worried about happening in the future).

Antipsychotic medication can treat some symptoms of psychosis, however, around 74% of patients stop using it or change medications within 18 months because of debilitating side effects, or not reporting a benefit, underlining the desperate need for effective therapies.

An initial test of the therapy on 10 patients over the last two years showed the approach known as iMAPS, was acceptable, with some patients reporting positive benefits in reducing psychotic experiences and symptoms.

Now the study team are moving to a larger study.

Chief investigator Dr Chris Taylor, a consultant clinical psychologist at Pennine Care NHS Foundation Trust and Honorary Clinical Lecturer at Swagֱ��, said: “Our research aims to improve the current treatments for people with psychosis.

“Cognitive Behavioural Therapy (CBT), one of the current NICE recommended psychological therapies, has demonstrated a robust, but small effect on psychotic experiences, such as hallucinations and delusions.

“We know intrusive mental images such as flashbacks and flash-forwards are common for people with psychosis, and early life experiences can lead to developing negative beliefs about the self and others.”

He added: “The iMAPS therapy approach works to tackle these images and past negative experiences directly, which we hope will also lead to a drop in psychotic experiences.

“In many ways, it’s true to say that pictures speak louder than words.

“Our feasibility study aims to find out from patients about their experiences of taking part in the trial, receiving the therapy and suggestions for improvements to plan for a bigger, definitive trial.”

The funding from NIHR's Mental Health Research Initiative was part of a rapid call for in order to tackle the disparity between regional needs and mental health research activity.

Professor Katherine Berry, Professor of Clinical Psychology at Swagֱ�� and Senior Co-applicant said: “It is excellent news that this research is starting in the North West of England.

“The project is the largest trial of therapy for people with psychosis that specifically targets distressing images. It represents a significant step for local mental health research. I'm personally really excited to be part of this project".

Thom’s story

When Thom was a student at a Northern University in his twenties, he was traumatised by the sinister featureless faces he saw in his mind’s eye.

He was forced to give up his course, because of the visions, which filled him with fear and dread and paranoia.

But when, over just eight weekly sessions, his therapist helped him to understand the images and imagine a sealed cell/armour wrapped around the faces, the fear and paranoia disappeared.

Thom went back to University and passed an undergraduate degree in psychology with flying colours, going on to take a Masters in the subject. He’s now hoping to work in role supporting others with mental health problems.

Thom said: “The therapy was really useful for me. It calmed me at a time when I wasn’t feeling calm at all.

“The therapy helped me take myself out of concentrating on what was in my mind’s eye and separate the images from those feelings of malign threat.

“I realised it wasn’t the figures but my feelings that were threatening me and realising that helped substantially.”

Dr Taylor said: The therapy worked very well for Thom, who now lives a successful and happy life. The approach appears acceptable to the initial people with psychosis who have tried it and we are encouraged by their feedback.

“iMAPS-2 is an important step on the journey to building evidence for the approach and his experience highlights  the potential we hope this therapy has to change lives for the better.”

The team of clinicians, academics, researchers, service users and carers will study the effects of Cognitive Behavioural Suicide Prevention therapy within prisons.

Suicide is the leading cause of preventable death in prisons in England and Wales with 86 prisoner deaths and 52,000 episodes of self-injury in 2021 alone, leaving prisoners five times more likely to take their own lives than the general population.

The Prevention of Suicide in Prisons: Enhancing Access to Therapy (PROSPECT) programme is a collaboration between , the University of Swagֱ��, the , and

It is funded by the (NIHR), the research partner of the NHS, public health and social care.

If proven to be effective, the promising new therapy could offer hope to those currently living in prison and also to the families, friends and professionals who care for them.

Cognitive Behavioural Suicide Prevention is a talking therapy delivered in once or twice weekly 1:1 sessions, each lasting 30-60 minutes with up to 20 sessions in total.

The therapy supports patients to develop a personalised understanding of the reasons for suicide.

It aims to provide short term, immediate benefit while also working towards longer-term gains through development of resilience to future suicidal episodes.

Dr Tim Kirkpatrick, a Research Fellow from Swagֱ��, said: “Suicide in male prisons is a serious problem and there is a great need to prevent it.

“The PROSPECT programme aims to improve treatments by promoting access to a promising new therapy: Cognitive Behavioural Suicide Prevention (CBSP) within prisons.

“If successful, the PROSPECT programme will help to reduce the personal, economic, and social costs of prison suicide.”

The trial will aim to test the CBSP therapy with men in four prisons from across the North of England, who have had recent difficulties with suicidal thoughts or behaviour.

Study participants will be randomly allocated to either receive the CBSP therapy in addition to their regular treatment offered to prisoners thought to be at risk of self-harm or suicide, or to receive regular treatment alone.

Alongside the trial, researchers will be conducting an evaluation of how the CBSP therapy is carried out in the prison environment, to better understand factors that help or hinder successful implementation in this specific context.

Dr Daniel Pratt, a Clinical Senior Lecturer in Psychology at the University of Swagֱ�� and Chief Investigator for the PROSPECT project, said: “This is the first prison-based trial in England that has sought to improve access to a psychological talking therapy for suicidal thoughts and acts.

“If this study proves the therapy to be effective, then we could see significant reductions in the number of suicide attempts and related deaths in prisons as well as improvements in prisoner mental health services.”

Dave Honeywell, an ex-prisoner who is now a lecturer at Arden University, said: “I was made blatantly aware there was a mental health crisis in prisons from my very first experience of prison in the early 1980s. It almost seemed an accepted part of prison life and certainly not taken seriously by the staff.

“When I returned to prison in the 1990s it really stood out how much things had worsened and clearly exacerbated by drug use. The availability of therapy in prison could at least give prisoners hope and options which was something I was never offered.

“My mental health suffered immensely in prison and if therapy was available, I was not aware of it because I would have been very eager to receive it. Not only would the availability of therapy be hugely important but all prisoners must be made aware that there is therapy available!”

You can find out more about PROSPECT

Led by University of Swagֱ�� researchers, the system will be tested across six Higher Education Institutions and their partnering NHS Trusts in England, Wales and Scotland. The work is also being conducted in partnership with The McPin Foundation.

Called CONNECT, the project whose principle funder is the Wellcome Trust, aims to recruit up to 1100 people who experience psychosis. People will test the remote digital data collection system over 12 months.

Developed at Swagֱ��, the remote digital data collection system combines active and passive remote symptom, emotional, physical and contextual monitoring, along with regular clinical assessments.

The data from the project will be used to develop a relapse prediction algorithm and an adaptive sampling algorithm (for maximising engagement and information obtained from digital remote monitoring) using machine learning / AI methods.

Early Warning Signs, commonly reported to emerge in the days and weeks before a relapse, include anxiety, dysphoria, insomnia, and the beginnings of psychotic experiences.

However, signs are often missed or identified too late, and each patient’s Early Warning Signs are different, which up to now has made it difficult to design a system which can predict a relapse and open the door to time-sensitive, preventative treatment.

The remote digital data collection system designed by the research team sends regular prompts requesting the user complete a digital questionnaire at set times in the week, taking around 90 seconds to complete.

They system will also test whether data collected passively (via wearables and the Smartphone sensors), such as sleep disturbance, inactivity, social avoidance or sedentary behaviour, helps improve the predictive algorithm.

Machine learning methods will be used to detect complex high dimensional non-linear interactions to predict individual patient warning signs of relapse.

The Principal Investigator, Professor Sandra Bucci, said: “Psychosis is a common reason for contact with secondary care mental health services in the UK and a leading cause of disability worldwide.

Up to 80% of people who experience psychosis relapse within 5 years. Each relapse is associated with a higher risk of functional and clinical difficulties.

There is an urgent need to be able to efficiently predict relapse to enable timely intervention and a personalised treatment response.”

John Ainsworth, Professor of Health Informatics at Swagֱ��, said: “The system we will be developing at Swagֱ�� provides real-time and in-context patient-generated symptom data, obtained through our remote digital data collection system technology”.

Professor Bucci added: “The system has the exciting potential of providing advanced warning of the need for support and intervention. It also has the potential to give mental health teams a clearer picture of the ebb and flow of an individual’s mental health trajectory.

Our remote digital data collection system could be a crucial advance in the care of people with psychosis.”

Lynsey Bilsland, Head of Mental Health Translation at Wellcome, said: “There have been huge strides recently into improving the outcomes for patients with psychosis but we still need further research into better detection of the early warning signs. Our support recognises the potential of the CONNECT system to enable early identification of patients at risk of relapse. The insight gained could be transformative to how we manage psychosis.”

The assessment of data from 157 studies of cognitive behavioural therapy led by University of Swagֱ�� and University of South Wales scientists is published today in the (29/03/22)

The study compared CBT alone and with one or two additional components such as social skills training, assertiveness training, relaxation techniques and psychoeducation.

All three protocols, they found, reduced depressive symptoms by a substantial 8.44 points on the Beck Depression Inventory, a 21 item self-reporting scale which measures symptoms of depression.

However only CBT with one or two additional components sustained the effects in the long-term, reducing depression to at least 5 or 8 points respectively after 6 months when compared to CBT alone.

In addition, CBT given with two extra components was more effective when delivered by non-mental health specialists such as nurses.

Age also appeared to affect the effectiveness of CBT: participants younger than 30 and younger than 59 responded better to CBT with two or one extra components respectively.

And the analyses also demonstrated that participants from lower socio-economic status responded better to CBT with two or one extra components.

Lead author Dr Ioannis Angelakis said: “Depression is the most common mental health condition with more than 264 million people being affected worldwide.

“It impacts negatively on people’s quality of life and is very costly for health and care systems, so understanding how to best to treat it is paramount.

“Our study shows that CBT can significantly reduce depression after treatment, however when given with one or two extra components it becomes effective in the long term.”

He added: “When enhanced CBT is given to younger people, policy makers should also focus on supporting non mental health professionals in giving this extra help.

“A nurse providing enhancements may also play the role of the main care co-ordinator for wider range of health problems

“That could explain why enhanced CBT seems more effective when they deliver it however more research is needed to understand this more fully.”

The MISST (Mental Imagery for Suicidality in Students Trial) is a collaboration between Greater Swagֱ�� Mental Health NHS Foundation Trust, University of Lancaster, and Swagֱ��.

It is funded by the National Institute of Health Research (NIHR), the research partner of the NHS, public health and social care.

Moving away from home, academic stress, and financial pressures can all impact on students, who sometimes struggle with their mental health at university.

A previous study found that up to 42% of students thought about suicide in the previous 12 months.

Universities offer counselling and mental health services which  are a source of support and help for struggling students, however, further effective therapies for preventing suicide are still needed.

MISST focuses on a novel talking therapy that is designed to help strengthen a person’s ability to recall and relive positive memories.

the therapy  is used as a way to counter the spiral of negative thoughts and feelings that can lead to suicidal thoughts.

Psychologists argue that by having the therapy, a person may be able to strengthen their ability to break free of spiralling  negative thoughts by immersing themselves in memories of more positive times.

Co-Principal Investigator Dr Jasper Palmier-Claus from Lancaster University said: “When people are suicidal, we know it can be hard for them to focus on positive experiences in the past, or imagine positive experiences in the future. There is a sort of tunnel-vision. The therapy aims to help people break free from this state by re-connecting with positive experiences in their life.”

The trial will aim to test the therapy with students studying in the North-West of England, who have had recent difficulties with suicidal thoughts or behaviour.

Participants will be randomly put into a group to either receive the new therapy, or regular treatment through their university counselling or support services.

MISST is a feasibility trial, which means the aim is to determine if a more powerful large-scale clinical trial would be possible to run. This includes checking what students think about the therapy and whether it is possible to recruit people to take part.

Co-Principal Investigator Dr Peter Taylor from Swagֱ�� said: “This is a first step, but an important one. This trial will give us the information we need to plan what we call a “definitive trial”, one that will then tell us how effective the therapy is. The aim is to work towards having effective therapies available for universities to help prevent student suicide.”

MISST was funded as part of a wider mental health research initiative run by the NIHR. You can find out more about it

Samaritans (116 123) samaritans.org operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org , write to Freepost RSRB-KKBY-CYJK, PO Box 9090, STIRLING, FK8 2SA and visit www.samaritans.org/branches to find your nearest branch.

The qualitative study of eight  young people, eight  family members and eight nursing staff by psychologists from Swagֱ�� and Pennine Care NHS Foundation Trust is published in high profile journal PLOS ONE.

The professional connection between a clinician  and a patient -  known as a therapeutic relationship - can help improve outcomes for mental health patients say the research team.

Progress in psychotherapy and mental health care in general has previously been shown to strongly link to the therapeutic relationship between clinical professionals and service users.

However, the study highlights how nursing staff sometimes do not have the time or support to develop therapeutic relationships with their patients.

To achieve that, the researchers urge the employment of adequate staff numbers, focused training and time in cultivating connections between nursing staff and their patients.

“This research underlines the established point that therapeutic relationships between patients and staff are just as important as the specific treatment they are receiving, if not more so,” said Dr Sam Hartley, an honorary clinical lecturer  at Swagֱ�� and Principal Clinical Psychologist with Pennine Care NHS Foundation Trust.

The young people, all based within child and adolescent mental health services across four sites in the UK, described how their relationships with nursing staff could impact on their progress through treatment.

The researchers interviewed the participants at length, and identified six themes which described therapeutic relationships, their development and maintenance.

One of the themes was centred around the feeling that therapeutic relationships are a treatment in their own right.

Dr Harley said: “Therapeutic relationships  are particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain.

“Our analysis indicates that young people, families and nursing staff all agree these relationships are crucial to good outcomes. These groups would be better served by a system that prioritises the formation and maintenance of effective therapeutic relationships.

“This requires adequate staff numbers, training and time in cultivating connection and doing ‘normal’ things together.

“Consideration should also be given to aspects of the workforce that might impact on this being successful, such as staff retention, where continuity of care and relationships might be impeded.”

She added: “The balance between being human and professional is a tricky one and could benefit from ‘live’ focused staff support alongside more static training and supervision.

“We hope that the testimonies of these patients, nurses and parents, and our analysis will serve to drive policy makers, service managers and clinicians to focus on therapeutic relationships, as essential to quality inpatient care, and afford them the structures, support and significance they deserve.”

Citation: Hartley S, Redmond T, Berry K (2022) Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff. PLOS ONE 17(1): e0262070. 

An animated video summary is available

The large study of 10 to 19-year-olds between 2003 and 2018, published in the Journal of Child Psychology and Psychiatry, also puts forward a series of proposals to deal with the problem.

The study, funded by the NIHR Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between Swagֱ�� and The Northern Care Alliance NHS Foundation Trust (NCA).

It showed that 85% who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year; the equivalent figure was 75% for those youngsters who harmed themselves non-fatally.

Lower than expected rates of diagnosis of psychiatric illness, around a third in both groups, were probably down to a lack of contact with mental health services, rather than an absence of psychiatric illness, argue the research team. Depression was by far the commonest of the examined conditions among both groups, accounting for over 54% of all recorded diagnoses.

Also, while suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm.

And while self-harm risk rose incrementally with increasing levels of deprivation, suicide risk did not.

Suicide frequency did increase with age: two thirds occurred at 17-19. However, adolescents who self-harmed tended to be younger: almost 65% had their first recorded episode below age 17.

The study analysed the data of 324 adolescents who had died by suicide and 56,008 who had self-harmed, using the Clinical Practice Research Datalink, which contains interlinked general practice, hospital, and national mortality records.

Lead-author Lukasz Cybulski, a GM PSTRC PhD Fellow from the University of Swagֱ�� said: “That most adolescents who had harmed themselves or died by suicide were known to services in the preceding year highlights how important it is to identify their pathology and adequately treat it.

Ensuring timely access to effective treatment is a priority as we already know that people who experience psychiatric illnesses are at much higher risk of harming themselves or dying by suicide”

Co-author Dr Shruti Garg from Swagֱ�� said: “Late adolescence can be a particularly vulnerable time for young people experiencing mental health problems. Improving access and provision of transition mental health services so that young people do not fall in the gap between CAMHS and adult mental health services should be a priority

Professor Nav Kapur from Swagֱ�� and another of the study’s authors said: “Suicide and self-harm are complex behaviours with many potential causes. In young people, bullying, bereavement, health problems, and academic pressures can all be important antecedents.

“This means that a comprehensive approach to prevention is vital and one that requires coordination between families, schools, social services, and health professionals.”

“The association between deprivation and self-harm risk suggests that prevention must also target underlying social determinants, such as barriers to educational achievement, low income, unemployment, and crime.”

The most detailed study to date examining COVID-19 outcomes in people with different diagnoses of severe mental illness in the UK is published today (7/12/21) in the journal .

People with psychotic disorders showed 4.84 times higher odds of dying from COVID-19, compared to those without severe mental illness. The odds of dying from COVID-19 were 3.76 higher in people with bipolar disorder and 1.99 higher in people with major depressive disorder.

Among people with COVID-19, those with psychotic or bipolar disorders had the highest rates of infection leading to hospitalisation: 35.8% and 37.3% respectively, compared to 16.6% among with those without severe mental illness.

And among people with COVID-19 who were hospitalised, over half of those with psychotic disorders - 52.6% - did not survive compared to 37.5% among with those without severe mental illness.

The study was conducted in the UK Biobank, which is a large-scale biomedical database and research resource containing genetic, lifestyle and health information from half a million UK participants.

UK Biobank’s database, which includes blood samples, heart and brain scans and genetic data of the 500,000 volunteer participants, is globally accessible to approved researchers who are undertaking health-related research that’s in the public interest.

Of the individuals included in this study, 1,925 had a recorded history of schizophrenia or other psychotic disorders in their lifetime, 1,483 had bipolar disorder and 41,448 had major depressive disorder.

The samples were compared with 402,440 UK Biobank participants with no indicated history of these conditions.

UK Biobank participants were tracked from 31 January 2020, the first COVID-19 related death in the UK, until 28 February the next year.

A total of 16,282 people tested positive for COVID-19, while 2,885 were hospitalised and 1,081 died.

Though UK Biobank participants are now mostly over 65 years of age, and 95% white, the authors argue the results still have important implications for public health.

The higher rates of adverse COVID-19 outcomes among people with severe mental illness were partly linked to a range of factors including being male, belonging to an ethnic minority, older age and having certain respiratory and metabolic conditions.

However, over half of the excess risk could not be attributed to any of the sociodemographic, clinical or lifestyle factors measured, including a range of pre-existing physical health conditions.

Lead author Dr Lamiece Hassan from Swagֱ�� said: “This is the most comprehensive study yet to examine COVID-19 outcomes in people with different types of severe mental illness in the UK.

“It shows that people with severe mental illnesses, and particularly psychosis, experience significantly poorer outcomes resulting from COVID-19, which are only partly explained by pre-existing physical health conditions.

Co-author Dr Brendon Stubbs from Kings College London added: “Engagement and action from all people working in the COVID-19 and physical health area is needed to address these disparities, to adopt a proactive approach to protecting this population in both the short and long-term.”

“That could, for example, include providing tailored health interventions for people living with mental illness, increasing access to vaccination programs and/or increasing the availability of screening and treatment for COVID-19, along with other physical health conditions which may worsen the health and social implications from COVID-19 for these underserved populations.”

Dr Joe Firth from Swagֱ�� said: “The COVID-19 pandemic has further highlighted the poor physical health outcomes we see for people who experience severe mental illness. Clearly, there is an urgent need to provide enhanced care for this particularly high-risk group.”

The research**, published in The Journal of the American Medical Association Network Open (JAMA Network Open) today, was funded by the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between Swagֱ�� and The Northern Care Alliance NHS Foundation Trust.

The study found there was an almost six-fold increase in the likelihood of reporting fatigue to a GP following a positive PCR test and a threefold increase in the risk of sleep problems compared to those without a positive test, for people who haven’t previously visited their GP for any of these reasons in the past.

There was also an 83% increase in mental illness following a positive PCR test. However, there was also a 71% increase in the risk of mental illness for people who received a negative PCR test compared to the general population. Researchers believe this throws some doubt about whether COVID-19 is directly causing mental illness, because it is clear that those who get a test are more likely to have risk factors for mental illness, for example pandemic-related anxieties.

Dr Matthias Pierce, researcher at Swagֱ�� who led the work, said: “When we began this research project we wanted to investigate whether we could find any evidence in primary health care records that COVID-19 was linked to an increased risk of mental health illness, sleep and fatigue problems.

“While fatigue is clearly a consequence of COVID-19 the risk of experiencing sleep problems is also very high. However, we are sceptical regarding the extent that COVID-19 is directly causing people to become mentally ill, or whether those with a predisposition to mental illness are more likely to get tested.”

Professor Roger Webb, from Swagֱ��, who co-leads the Mental Health research programme at the NIHR GM PSTRC, said: “Our findings align with those generated by investigations conducted in other countries in revealing elevated risks of mental illness, self-harm, fatigue, and disrupted sleep patterns among people testing positive for infection during the pandemic. Establishing the mechanisms that have caused these outcomes to occur is the next major challenge for researchers in our field.”

Professor Carolyn Chew-Graham, a co-author on the paper, Professor of General Practice Research at Keele University and a General Practitioner, said “It is vital that general practitioners recognise the long-term impact of COVID-19 infection on their patient population. Offering follow-up to people who test positive for COVID-19 infection may help identify persisting symptoms, and sign-post people to the . The increased risk of developing mental health problems in people who tested negative may be due to health anxiety in these patients, and primary care has a role in identifying and supporting such patients.”

* Clinical Practice Research Datalink (CPRD-Aurum) dataset: a large UK primary care registry covering 19 million patients. It contains information on clinical events recorded by healthcare professionals, including diagnosis, symptoms and therapies.

** Is infection with COVID-19 causing an increased risk of psychological distress, psychotropic prescribing or sleep and fatigue problems? A study of patients in English primary care

The Awards mark the highest levels of excellence and achievement within the field of psychiatry, and are given to the Psychiatrist of the Year, Patient Contributor of the Year and PsychSoc of the Year, among others. 

Commenting on his Lifetime Achievement Award, Professor Appleby said: “It's a surprise and an honour to receive this award, I must thank the College. It's also a reminder, to me at least, of how much more we need to achieve in mental health, on safety and evidence and social justice."

Professor Louis Appleby is a Professor of Psychiatry at the University of Swagֱ�� and leads the National Suicide Prevention Strategy for England. He has been the Director of the National Confidential Inquiry into Suicide and Safety in Mental Health since its inception in 1996 and under his leadership, it has developed into one of the top units for suicide prevention research in the world.  

He currently chairs the National Suicide Prevention Strategy Advisory Group for England and has championed the involvement of people with lived experience of services and families who have been bereaved.

He held successive National Clinical Director roles in Mental Health and then in Health and Criminal Justice. His work led to the re-design of community services, the reform of mental health legislation, the commissioning of a number of NICE guidelines and more effective liaison between health and criminal justice. 

His wider NHS roles have included being a board member and non–executive director of the Care Quality Commission and working the General Medical Council to advise on suicide risk in doctors under investigation. He was also a member of the Mental Health Act review committee and was appointed by the NHS to examine the after-effects of the Grenfell fire on the local community. 

Dr Adrian James, President of the Royal College of Psychiatrists, said: “Professor Appleby is an extremely deserving winner of our Lifetime Achievement Award. His achievements are numerous and his contributions to psychiatry over the last 25 years have been immense. 

“He has been an important leader in suicide prevention, mental health policy and the NHS more widely. His inspiring work has had a huge impact on clinical practice, academic research and the lives of mental health patients and their carers.” 

The research*, published in the , involved searching electronic health records to uncover how many people in prisons have been affected by a potential problem related to their prescribed medication.

The research was funded by Greater Swagֱ�� Mental Health NHS Foundation Trust (GMMH) Research Capability Funding and the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between Swagֱ�� and The Northern Care Alliance NHS Foundation Trust.

Researchers worked with prison pharmacists who conducted searches of the electronic healthcare records of two large prisons to identify how often people were affected by 13 ‘Prescribing Safety Indicators’ (PSIs). For example, prescribing of antipsychotic medication without carrying out the essential physical health tests to monitor weight, blood sugar and cholesterol.

To develop the PSIs researchers looked at published studies and worked with prison healthcare staff to identify the common situations where potentially hazardous prescribing can occur.

Dr Richard Keers works with the GM PSTRC, and is a Clinical Lecturer in Pharmacy at Swagֱ��. He also co-leads the Suicide, Risk and Safety Research Unit based at GMMH where this work originated, and said: “Our research has shown that Prescribing Safety Indicators can be successfully implemented into prison electronic health records, and that they provide a significant opportunity to measure and improve medication safety for people in prisons as we have already seen in primary care.”

The results of the study revealed that more patients were affected by some PSIs than others. Understanding how the searches could be used more widely in prisons was also investigated with researchers interviewing 20 prison health care staff to explore this topic.

The staff they spoke to said that having people who can take on the leadership of the searches and working together as a team to respond to them was important.

Prof Darren Ashcroft, Director of the NIHR Greater Swagֱ�� PSTRC, said: “Our next step is to use these results to launch a new study. We are now working with a prison health care provider to test the introduction of the electronic health record searches and a way for staff to work together to respond to them across a large group of prisons nationally. This will take place over the next 18-24 months to see how effective this is at improving medication safety.”

* Implementing prescribing safety indicators in prisons: a mixed methods study

Researchers analysed a new de-identified database that pulls together healthcare information from general practices across Greater Swagֱ�� to identify trends around self-harm by sex, age group, ethnicity and deprivation. They found a potentially concerning treatment gap for self-harm among men and people living in the most deprived areas.

The study’s* findings were published in today. The investigation was funded by the UK Research and Innovation (UKRI) and the National Institute of Health Research (NIHR) COVID-19 rapid response call. It was also supported by additional funding and researchers from the NIHR Greater Swagֱ�� Patient Safety Translational Research Centre (GM PSTRC) - a partnership between The Northern Care Alliance NHS Foundation Trust (NCA) and Swagֱ��.

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at Swagֱ��, who worked with researchers from the GM PSTRC on this study, said: “We believe the fact the number of people accessing healthcare for self-harm didn’t return to pre-pandemic levels by May 2021 is unlikely to be because these people aren’t harming themselves. It is more likely to be because people aren’t seeking help or aren’t seeking help in the same way as they did before the pandemic.”

There has been research that’s looked at self-harm during the first wave of the pandemic. However, despite further waves of COVID-19 and ongoing national and regional restrictions that affected Greater Swagֱ�� into the autumn/winter of 2020 and the spring of 2021, little was known about how many people were visiting their GP after harming themselves during that time.

Dr Steeg, continued: “The findings of our study are concerning as the deepening health inequalities we observed during the first wave of the pandemic, in 2020, didn’t recover by the spring of 2021. This could reflect a hesitance to seek help from health services in the way people did before the pandemic.”

Researchers believe the potential treatment gap among men is particularly concerning due to the increased risk of suicide for men if they have harmed themselves.

This is the first study to be published that used the Greater Swagֱ�� Care Record, which brings together healthcare and social care information. It meant researchers could examine the number of times self-harm was recorded across primary care (for example, general practices) every month until May 2021.

Professor Niels Peek, lead of the Safety Informatics theme at the GM PSTRC, who was also part of the team that created the Greater Swagֱ�� Care Record, said: “This is an important milestone for the Integrated Care System in Greater Swagֱ��. It tells us that we can use data from the Greater Swagֱ�� Care Record to accurately assess the impact of the pandemic on the Swagֱ�� population.”

* Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: time series analysis of electronic healthcare records for 2.8 million patients in the Greater Swagֱ�� Care Record

https://www.sciencedirect.com/science/article/pii/S2589537021004557

Published in the journal the 34 patients, carers and clinical staff were interviewed by a team of researchers from Swagֱ��.

The study was funded by the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GMPSTRC).

NIHR GMPSTRC is a partnership between Swagֱ�� and Salford Royal NHS Foundation Trust.

Mental health service users also reported ‘working harder’ to avoid admission due to fears around environmental safety as a result of COVID-19.

“Even before the pandemic, there are lots of safety concerns associated with recent discharge from inpatient mental health services, for example suicide and self-harm,“ said lead author Dr Natasha Tyler, researcher at the GM PSTRC and Swagֱ��.

Dr Tyler added: ‘Our patients and carers felt that because of  the national need to free-up hospital beds, the quality of discharge and admission planning was compromised at times.

“That meant discharging patients from hospitals who were not ready to cope in the community or not admitting patients who needed in-patient care.

“The closure of most community support services meant patients had minimal opportunities for accessing care via alternative routes. This worsened their feelings of helplessness and loneliness.”

However, co-author Dr Maria Panagioti, from Swagֱ�� and NIHR GM PSTRC said there were some positive outcomes during the first lockdown:

Dr Panagioti said: “Despite some distressing findings, there were rapid changes in acute care, some of which resolved long-standing problems about patient safety.

“Virtual meetings, for example, enabled interdisciplinary teams and agencies to jointly discuss patient discharge which was often considered unrealistic prior to the pandemic.

“They also improved patients’ attendance by eliminating barriers such as travelling complications and social phobias.”

Co-author Andrew Grundy who has also used mental health services said: “Having personally lived through transitions from inpatient to community services myself, I know how worrying and how stressful this time can be, and COVID-19 has only added to these pressures.

“Our study sheds further light on service users’ own ‘safety concerns’ around rapid discharge, difficulties in accessing community services post-discharge, and feelings of loneliness and social isolation post-discharge, which they have experienced as a direct result of the first national lockdown.”

The paper Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England is available

Image by from

These findings, published in the American Heart Association journal, , are a huge step towards better informed and well-rounded care for heart disease patients, with the potential to improve not only mental health, but also the physical health of those recovering from heart disease.

Cardiac rehabilitation (CR) services aim to improve heart disease patients’ health and quality of life, and reduce the risk of further problems with their heart. Around 90,000 patients attend CR every year in the UK.

After a serious cardiac event, such as a heart attack, it is common to develop mental health problems; and around one-third of patients accessing CR services experience anxiety and/or depression. Research shows that this type of distress reduces quality of life, and increases the risk of further heart problems and even death.

Whilst CR services do have an educational component and an exercise component, they don’t currently include any specific mental health treatment to support patients with symptoms of anxiety and depression.

Added to this, mainstream mental health treatments, such as Cognitive Behavioural Therapy (CBT), are not very effective at improving the mental health of heart disease patients. One of the reasons for this is that CBT focuses on challenging negative thoughts and beliefs, which can be completely valid and realistic in people suffering from chronic and life-threatening heart conditions.

In response to this, Professor Adrian Wells, Consultant Clinical Psychologist at GMMH and Professor of Clinical and Experimental Psychopathology at UoM, who had developed a mental health treatment called Metacognitive Therapy (MCT), adapted this treatment for cardiac patients. MCT helps people to manage worries and low mood through reducing unhelpful styles of thinking, such as rumination (dwelling on the past) and worry (concerns about the future). It helps people to discover new and more helpful ways to react to negative or distressing thoughts so they are less likely to dwell on them, resulting in improved anxiety and mood.

The PATHWAY study evaluated the effectiveness of delivering MCT, alongside normal CR services, in treating symptoms of anxiety and depression in heart disease patients, in comparison to just receiving normal CR services alone.

Half of the 332 participants were randomly allocated to MCT plus standard CR treatment, and the other half were allocated to the standard CR. For those who were allocated to MCT, the therapy was embedded into their regular CR, and delivered by CR staff such as CR nurses, occupational therapists, and physiotherapists.

This took place at Swagֱ�� University NHS Foundation Trust, East Cheshire NHS Trust, Stockport NHS Foundation Trust and Pennine Acute Hospitals NHS Trust.

Findings showed for the first time ever that MCT plus CR is significantly more effective in improving symptoms of anxiety and depression in heart disease patients.

It also proved to be more effective in helping patients reduce unhelpful thinking patterns and trauma symptoms.

Debra was referred to group Metacognitive Therapy, following open heart surgery. She said:

“I found the MCT to be very interesting, informative and beneficial. It's not a type of therapy I had experienced before; it was a very gentle and subtle therapy that, over several weeks, slowly changed my attitudes and beliefs around worrying and fretting. 

“It was very interesting and useful to hear how people's beliefs changed over the weeks. To see the differences at the end was quite impressive. 

“Although the therapy was quite some time ago, it has stayed with me and it's something I naturally practice now, almost subconsciously.

“Although it's human nature to have concerns about certain situations, I don't spend time worrying and fretting about things as I know that it's wasted energy that does not change the outcome.

“I think it's a very useful life skill that anyone would benefit from, but particularly those who have suffered from any traumatic event, be that physical or mental and those that suffer with anxiety.”

Effectiveness of the therapy was measured with the Hospital Anxiety and Depression Scale (HADS). The HADS questionnaire is often used to determine the levels of anxiety and depression in a person with physical health problems, using a scale of 0 to 21 for both anxiety and depression. A score of 0-7 is considered normal, with 8-10 being borderline, and 11 or over indicating clinical anxiety or depression.

The 163 individuals who were randomly allocated to MCT plus standard CR treatment showed a significant average decrease in their HADS score for anxiety and depression of 3.24 after 4 months and 2.19 after 12 months. This compares to the 169 who only received standard CR treatment, who had an average decrease of 0.52 after 4 months and 0.33 after 12 months.

Overall, there was an improvement in the mental health of one in three heart patients who received MCT alongside standard CR treatment, in comparison to only one in five of those who received standard CR treatment. A further finding was that MCT appeared to prevent some patients from developing mental health problems.

The link between mental and physical health has long been known, and these findings signal a major step in understanding and improving the overall recovery of heart disease patients.

Professor Adrian Wells, PATHWAY Chief Investigator said,

“Living with serious physical illness has profound effects on emotional wellbeing, how sufferers view themselves, their future and their quality of life.

“Through the generous time of patients, staff, co-investigators and service users, we have made a breakthrough in improving mental health outcomes in heart disease patients.

Metacognitive therapy offers an effective way of treating both anxiety and depression. We found that heart patients benefitted no matter whether they had mild or severe symptoms or a previous history of mental health issues, supporting the versatility of this treatment.

We have demonstrated that MCT can be translated to medical settings and this opens up the way for more effective integrated physical and mental health care with the potential to improve thousands of people’s lives”

Paula Bithell, Nurse Consultant at Pennine Acute NHS Hospitals Trust said:

“For some patients the psychological impact of being diagnosed with a heart condition can be just as significant as the physical implications.

“MCT is a method to address the thoughts patients may have following their cardiac event in a familiar environment, in a group setting with patients who are experiencing similar thoughts and feelings to themselves. It is delivered by their recognised health care professionals who are experienced in cardiac care.

“My colleagues and I found that patients benefited hugely from the group therapy, with patients reporting that attending the group MCT supported them in overcoming the psychological barriers that were preventing them from resuming normal activities.

“Following the treatment, patients reported feeling more confident to go out and socialise again, resume hobbies and employment.”

Professor Kathryn Abel, NIHR Clinical Research Network National Specialty Lead for Mental Health and Domain Lead for Mental Health at NIHR Clinical Research Network Greater Swagֱ��, said:

"Findings from this research are incredibly encouraging and present the first evidence that a psychological treatment may both prevent development of common mental disorder in cardiovascular disease as well as be effective in reducing psychological symptoms once developed in cardiac patients recovering from heart disease. Understanding the links between mental and physical disorders is an incredibly important aspect of the research endeavour for the NIHR mental health specialty and a priority for the Medical Research Council (MRC) Mental Health Research Framework.

I would like to thank all the study participants and research team members who have made this research possible."

Those living in the most deprived neighbourhoods along with ethnic minority groups were the most affected say the team based at Swagֱ��, King’s College London, Cambridge, Swansea and City University.

However, two thirds of adults were in groups whose mental health was largely unaffected by the pandemic finds the study published in The Lancet Psychiatry.

The team analysed monthly surveys between April and October 2020 on 19,763 adults to identify typical patterns of change in mental health, revealing five distinct groups.

The unaffected groups were more likely to be older, white, and from the least deprived areas, with men being especially likely to have consistently very good mental health. According to the research:

• 12% of the sample were in a group that experienced initial declines in their mental health at the beginning of the pandemic then recovered over the summer. Women and parents of school-aged children were particularly likely to be in this group, experiencing significant improvements in mental health around the time schools’ reopened.
• 7% of the sample experienced a sustained decline in their mental health.
• 4% of the sample had mental health that was consistently very poor throughout.

The groups experiencing a sustained decline or consistently very poor mental health were more likely to have had pre-existing mental or physical conditions. They were also more likely to be Asian, Black or mixed ethnicities, and live in the most deprived areas.

The researchers also found that infection with COVID-19, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health.

The research team analysed the UK Household Longitudinal Study from the University of Essex and the Economic and Social Research Council.

Dr Matthias Pierce, is lead author and research fellow from the Centre for Women’s Mental Health at Swagֱ��.

He said: “It’s clear from this study that in terms of mental health, the pandemic has had a disproportionate impact on minority ethnic groups, those living in deprived areas, others experiencing financial difficulties and those who already had poorer mental health.

“But also we find a large proportion of the population has remained resilient to the effects of the pandemic.”

He added: “The data we used are superior to other surveys because the UK Household Longitudinal Study uses a high quality representative random sample and includes groups such as the digitally excluded who might not otherwise participate.

“Other surveys, especially those which use social media, are often unrepresentative and can lead to unreliable results.”

Senior author, Professor Kathryn Abel from Swagֱ�� said: “We are increasingly aware that social and economic advantages have an important influence on how well people are able to cope with challenges that appear to have affected everyone equally.

“The health and social inequalities we already know about for women and for people in poverty relate to different burdens of stressful life events and different resources to deal with them.

“These remain relevant and are important reasons for the differences we are seeing in the mental health trajectories across the pandemic.

Sher added: “For people in ethnic minorities, their experience of the pandemic has meant dealing with both existing discrimination and inequalities alongside higher risks of severe illness, disability and, of course, death.

“This represents a devastating landscape for their mental health borne out in our findings.

“We must respond by making sure services are aware of these disparities and that their offerings are culturally sensitive and appropriate for the complexity of unmet need.”

The research, ‘Impact of the Covid-19 pandemic on the frequency of primary care-recorded mental illness and self-harm episodes in the UK: population-based cohort study of 14 million individuals’, was conducted by the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between Swagֱ�� and Salford Royal NHS Foundation Trust. The research was also jointly funded by the NIHR and the COVID-19 Rapid Response Initiative from the Medical Research Council and UK Research and Innovation.

The research looked for the first time people sought help for their mental health and this could be at their general practice or at a hospital A&E department. Researchers discovered that during the first full month of the UK wide lockdown, in April 2020, the number of incidents of depression recorded in general practice records dropped by 43%, anxiety disorders by 47.8% and prescribing of antidepressants also dropped significantly, by 36.4%.

Dr Matthew Carr from Swagֱ��, and lead for this study at the GM PSTRC, said: “It is widely believed that there was an increase in the number of people with symptoms of mental illness in April due to the extra pressures from the lockdown. However, our research has revealed a sharp reduction in recorded illness diagnoses and self-harm episodes. By September 2020 our data shows that these frequencies had returned to near normal in England.”

As well as identifying the general trend of people not seeking help during April 2020, the research also uncovered significant treatment gaps. This was greatest for people of working age and those registered at general practices in more deprived areas where the reduction in diagnoses coded was greatest.

Dr Carr, continued: “This research is so important because it shows the scale of the drop in the number of people seeking help, and, crucially, the treatment gaps”

Another important finding reveals the number of people presenting with self-harm was 37.6% lower than expected in April and the reduction was greatest for females and those aged under 45.

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at Swagֱ�� jointly led the research, and said: “It is understandable that people didn’t seek help at the height of the pandemic in the spring of 2020. However, GPs moved quickly to offer remote consultations for many appointments. The consequences of patients not receiving help when they need it could result in further struggles for those individuals, and therefore they must be encouraged to seek support if they are worried about their mental health

“This research has shown how addressing delays in diagnosis and treatment for mental illness and self-harm requires prioritisation, particularly for the groups of people we’ve identified as experiencing the biggest treatment gaps. As we manage ongoing fluctuations in Covid-19 rates, we hope our research findings can be used to inform public health messaging targeted at specific groups of patients which will help to improve patient safety in the near future.”

Professor Carolyn Chew-Graham, a GP in Swagֱ�� and Professor of General Practice Research at Keele University, and part of the research team, said: "This research mirrors my clinical experience. Consultation rates reduced in April and May, with people following the ‘Save the NHS’ message. Since the early summer we have noticed increasing demand and, particularly, increasing distress in patients.

“The impact of this work for primary care is that we need to make it as easy as possible for people who are distressed to consult their GP, but balance this with the need to keep footfall as low as possible in the practice, in accordance with NHSE guidance and COVID-19 restrictions. Primary care clinicians need to ensure that when consulting patients remotely, they offer time, empathy and understanding and facilitate people to disclose their concerns, which both parties might find more difficult in telephone or video consultations. Managing risk and dealing with uncertainty are now even more important for primary care clinicians.”

Nav Kapur, Professor of Psychiatry at Swagֱ�� and lead for the Mental Health Research programme at the GM PSTRC, said: "For me this paper tells one of the big and perhaps forgotten stories of the pandemic - the fall in health care use for mental health problems during the early part of lockdown. This is particularly important because we know from other work that, on average, population mental health got worse after March compared to pre-pandemic levels.

“It’s so important that we continue to carefully monitor the mental health effects of COVID 19 and I’m pleased that the NIHR Greater Swagֱ�� Patient Safety Translational Research Centre continues to make this kind of cross disciplinary collaboration possible."

Lucy Schonegevel, Deputy Campaigns & Policy Associate Director for Rethink Mental Illness said:

“GPs are often the first port of call for people struggling with their mental health, so it’s concerning to see a significant drop in appointments during the first lockdown. There’s a worrying disconnect here, as we saw demand for advice and information on our website double in the six months after lockdown was first introduced, in particular, there was an increase in the number of people seeking advice about self-harm.

“It’s crucial that the NHS continues to promote the message that it is open for business, despite the pressures of COVID-19, and that this message reaches everyone in need of support. Mental health is just as important as physical health and people should be encouraged to contact their GP as soon as possible to discuss any concerns. The effects of the pandemic on people’s mental health may be felt for years to come, so it’s crucial that everyone can access the right treatment at the right time through their GP.”

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The first ever trial in schizophrenia of the powerful immune suppressant drug, Methotrexate, produced what the team described as ‘promising’ effects on what are known as positive symptoms, such as hearing voices.

Though the team stress the sample size was too small to show if Methotrexate could work as an add-on treatment for schizophrenia, they found a ‘puzzling’ therapeutic effect on symptoms of early schizophrenia.

And that, they argue, warrants further investigation.

The findings published in the Journal of Translational Psychiatry shed new light on the devastating and difficult to treat condition, which causes distress and disability worldwide.

Schizophrenia is categorised by so called ‘positive symptoms’ such as hearing voices (hallucinations) and ‘negative symptoms’ (disordered thinking, poor motivation, poor social function).

Negative symptoms, which contribute significantly to the disability associated with schizophrenia are hard to treat with currently available medication.

The study was funded by the Stanley Medical Research Institute in the United States in collaboration with the Pakistan Institute of Living and Learning.

The trial took place in Pakistan, led by Professor Imran Chaudhry from Swagֱ�� who after years of service to the NHS relocated to Pakistan to continue to practice psychiatry.

The lack of available treatments for these symptoms encouraged Professor Chaudhry’s team to investigate new treatment options for schizophrenia.

Methotrexate is often used to treat inflammatory diseases such as rheumatoid arthritis and Crohn’s disease.

Inflammatory and autoimmune conditions are more common in patients with schizophrenia, possibly indicating that there is a shared underlying cause to these diseases.

“Methotrexate is thought to help treat autoimmune disorders by resetting the way T cells - an important part of the immune system – work”, said Professor Chaudhry.

“This action on the central nervous system may account for the improvement in symptoms we found in our study,” he added.

They used a low 10mg dose of the drug, which was given alongside the patients’ routine psychiatric medication.

No significant side-effects were reported by the patients taking Methotrexate, suggesting it was relatively well tolerated.

Nusrat Husain, Professor of Psychiatry and Director of Research in Global Mental Health at Swagֱ�� added: “We used the lowest clinically effective dose in autoimmune disorders which often needs to be increased so higher doses could produce a more powerful effect in schizophrenia.

“However, the health risks of methotrexate are substantial and require careful monitoring which is why we would rule out large unfocussed trials.”

Psychiatrist Dr Omair Husain, who is an honorary researcher at Swagֱ�� and an Assistant Professor based at The University of Toronto said: “Immune systems could be involved in schizophrenia and that raises fascinating questions.

“Perhaps one day we might be able to identify subsets of people with schizophrenia who may respond to treatments that act on the immune system.

“The small, unexpected effect we found in our study warrants further investigation which we now believe is feasible.

“Future work needs to focus on identifying these subgroups possibly through studies that use advanced brain imaging techniques and state of the art immune profiling techniques”.

The paper ‘A randomised clinical trial of methotrexate points to possible efficacy and adaptive immune dysfunction in psychosis’ is published in the J

Image: Gerd Altmann from Pixabay

The study, sponsored by Greater Swagֱ�� Mental Health NHS Foundation Trust (GMMH), and led by researchers at Swagֱ�� (UoM) and Swagֱ�� Metropolitan University (MMU), will look at how well the original Resilience Hub model works for providing mental health support to healthcare, social care and emergency service workers who have been impacted by COVID-19.

Findings will inform recommendations for effectively rolling out the Hubs across the UK, and will help us understand how we can use the same model in other future largescale crises.

The study is one of a number of COVID-19 studies that have been funded by the National Institute for Health Research (NIHR) as part of its Recovery and Learning call, totalling £5.5m in funding, to help better manage current and future waves of the COVID-19 pandemic and investigate its long-term impacts on the health and care system beyond the acute phase.

The 20-month research project will evaluate the Resilience Hub model in three regions: Greater Swagֱ��, hosted by Pennine Care NHS Foundation Trust (Pennine Care); Lancashire and South Cumbria, hosted by Lancashire & South Cumbria NHS Foundation Trust; and Cheshire and Merseyside, hosted by Mersey Care NHS Foundation Trust.

The Greater Swagֱ�� Resilience Hub was originally set up in response to the 2017 Swagֱ�� Arena bombing, to provide care and support for thousands of people whose mental health and wellbeing was affected.

Many healthcare workers, social care workers, such as Care Home staff, and emergency service staff have experienced mental health problems due to the stressful circumstances of the COVID-19 pandemic. The Resilience Hub model has now been adapted to provide mental health support to them throughout. This has been replicated in multiple UK sites to meet the mental health needs of key workers affected by the pandemic.

Yvette Hodge, an occupational therapist assistant for Pennine Care NHS Foundation Trust, turned to the Greater Swagֱ�� Resilience Hub as a source of support:

“I contacted the Resilience Hub and completed their wellbeing questionnaire. One of their therapists then contacted me and I just poured everything out to them – all my anxieties and worries

“The support and advice has really worked for me – I’m able to think about the here and now and take things step by step; rather than letting things overwhelm me.”

The research will assess how well the Hubs can support key health and social care workers who have been affected by COVID-19 across the three locations, and produce recommendations for effectively rolling out the Hub model across the UK.

Longer term, findings will help inform guidelines for using the model in any other future largescale crises, and will help us understand which groups have higher support needs, how we can maximise the number of people who take up the offer of support, and resolve any barriers that prevent people from accessing it.

Dr Filippo Varese, Co-Principal Investigator of the study and Director of the Complex Trauma and Resilience Research Unit at Greater Swagֱ�� Mental Health NHS Foundation Trust and the University of Swagֱ�� said:

“The pandemic has caused unprecedented strain on our health and social care services, and many key workers are now suffering because of the overwhelming challenges they have faced during the first waves of COVID. This research will find out if the Resilience Hubs represent an important asset for those key workers who most need support with their psychological wellbeing and mental health, both during and beyond the second wave of COVID-19.”

Dr Paul French, Co-Principal Investigator said:

“This is an excellent opportunity to utilise the findings from our original service initiatives and subsequent evaluation of the Resilience Hub to support key health and social care workers who are affected by caring for people with COVID-19.”

Prof Alan Barrett, Strategic Clinical Lead (Adults) for the Greater Swagֱ�� Resilience Hub, said:

“We are delighted that the evidenced approach used to support thousands of individuals caught up in mass terror incidents has been adapted and expanded to additionally support the heath and care workforce during these difficult times. Unlike other work scenarios, COVID-19 has significantly impacted the personal lives, in addition to the professional lives of those we are supporting, at a time when usual self-help strategies such as socialising or going to the gym are not available”

Hein Ten Cate, Clinical Lead for the Lancashire and South Cumbria Psychological Resilience Hub.

“We are really excited to have the opportunity to support our fellow colleagues working across health, social care and emergency service during these unprecedented and challenging times. We are all affected by the pandemic on some level and being able to reach out a helping hand to those who are finding it more difficult is very rewarding but more importantly the right thing to do”.

Dr May Sarsam, Clinical Lead for the Cheshire and Merseyside Resilience Hub, said:

“We’re still developing the Cheshire and Merseyside Resilience Hub, but we’re confident it will become a crucial resource for all healthcare, social care, primary care and emergency services staff in our region once it’s launched in the next couple of weeks. The mental health and wellbeing of staff often gets taken for granted but resources such as these will finally provide somewhere for those who are struggling to go to get help.”

The Hubs provide support and information, including (with some local variation): outreach to key workers; wellbeing screening; self-help resources; assessment by mental health professionals; support accessing evidence-based treatments, such as talking therapies; facilitated peer support; and ongoing telephone & email support.

If you work in health or social care and are struggling with your mental health or emotional wellbeing as a result of the pandemic, visit your local Resilience Hub website for or to access support. The Cheshire and Merseyside Resilience Hub will be opening soon.

A radical counselling method could be an effective way to help children with mental health problems returning to school after the COVID-19 lockdown, according to University of Swagֱ�� psychologists.

The study, which analysed the outcomes and feedback from 16 students aged 11 to 19 to Method of Levels therapy (MOL), found it to be ‘feasible and acceptable’ when assessed over 6 months.

The findings, published in the British Journal of Guidance and Counselling, show the method could help more young people access timely support in a time of increasing pressure on mental health services.

Senior UK educators have recognised the seriousness of children’s mental health problems as a result of COVID-19.

Unlike conventional therapies, MOL doesn’t require detailed assessments, screening and diagnosis.

“Lockdown has been very tough for many children- and is likely to be linked to poor mental health because it takes away their sense of control”, said lead author and honorary researcher at Swagֱ�� Dr Anamaria Churchman.

“But this method gives it back to them by empowering them with the freedom to choose when and how often to access support.”

This is likely to increase service efficiency by allowing more young people to access support.

Unlike conventional approaches, MOL gives recipients choice and control over attendance by using a self-booking system.

It also allows them to choose what problems to work on, in their own timeframe. MOL therapists follow rather than lead the participant in talking about problems, and do not make suggestions or give advice.

She said: “There is much evidence to suggest that in the UK, adolescents’ mental health present an ever-growing concern - especially during the COVID-19 crisis.

“Even in 2017, research showed that one in eight children aged five to 19 years old had a mental disorder. It’s highly likely the situation worsened considerably under lockdown.

“Government sees this as an area of concern and schools are identified as an optimum hub for offering support.”

She added: “Conventional therapy is often hard to access, expensive, and can take away choice and control from young people.

“When 'expert teams’ decide the best treatment for young people without involving them in the decision, the results are often far from satisfactory, with young people dropping out, refusing to attend treatment or failing to make progress.”

Students booked a wide-ranging number of sessions at differing intervals and set personalised goals related to their emotional or mental wellbeing, showing differences in personal needs and preferences.

Conventional sessions typically offer everyone the same number of sessions and parents or teachers choose when and for how long young people access support- even though young people might not feel ready to talk, or prefer not to miss certain lessons to receive support.

Some of the young people reported needing more support, which, say the team, infers their needs are not being met when following an adult driven model.

However, when accessing MOL sessions, young people chose the number and frequency of sessions booked. This ranged from 1 to 18 based on their own, personal needs.

On completion, most young people displayed an increase in scores for empowerment and ability to resolve psychological conflict and overall distress levels decreased.

The benefits were sustained two months after completion of the six-month study. Full-scale trials will be needed next.

Confidentiality, the opportunity to talk freely and feel listened to, the opportunity to get things off their chest and to feel understood and respected were reported as being helpful.

Co-author Dr Warren Mansell said: “MOL can be applied to a wide range of mental health problems but hasn’t yet been tried on children and adolescents, so we’re pleased it seems to be effective.

“It’s another important application of Perceptual Control Theory which proposes that people function well when they are able to control important areas of their lives.

“We’d love this approach to be used in any setting where young people are present. It goes hand in hand with holistic approaches now being increasingly used in mental health.”

The paper ‘A process-focused case series of a school-based intervention aimed at giving young people choice and control over their attendance and their goals in therapy.’ is published in the British Journal of Guidance and Counselling

Electronic health records of approximately a quarter of a million people were analysed to identify the impact of COVID-19 on general practice (primary care) by a patient safety research centre between 1^st March and 31^st May 2020.

According to the research published in The Lancet Public Health*, for many common physical and mental health conditions, there has been a significant reduction in the rate of initial diagnoses compared to the expected levels for this time period. The biggest reductions were for mental health conditions and Type 2 diabetes as there were half the expected number of diagnoses.

For malignant cancer the reduction was 16 per cent for the time period analysed, but for the month of May there was a drop of 44 per cent. For circulatory system diseases such as stroke, heart failure and coronary heart disease there has been a reduction in diagnoses of 43 per cent.

The research, published in the paper, ‘Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study’, was conducted by the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The centre is a partnership between Swagֱ�� and Salford Royal NHS Foundation Trust.

The study used 10 years’ worth of data for Salford to create statistical models which gave predicted levels of new diagnoses for the health conditions identified in general practice to be routine.

Richard Williams, research lead for the study at the GM PSTRC, said: “We were aware that GP practices have been reporting a drop in the number of patients seeking medical help since the start of the COVID-19 pandemic. Thanks to electronic health records it is possible to investigate whether this is true across a large urban area like Salford.

“Importantly our research has revealed which conditions people are not seeking medical attention for. This means that, potentially, there are high numbers of people living with undiagnosed Type 2 diabetes, mental health conditions and circulatory system failure.”

Richard will join internationally renowned experts in a special Lancet journals session to present this work at the European Society of Clinical Microbiology and Infectious Diseases Conference on Coronavirus disease (ECCVID), taking place online 23-25 September.

Dr Owain Thomas, GP at a practice in Salford, said: “The research from the GM PSTRC looking at the diagnosis of physical and mental health conditions in primary care during the pandemic in Salford is so significant because it quantifies the effect COVID-19 is having on the diagnosis of routine health conditions in General Practice.

“Since the initial lockdown in March the whole way in which patients consult with their practice has changed - there has been a dramatic shift away from face to face consultations to keep everyone safe from the spread of COVID-19.

“However, it is important to recognise the unintended consequences of reducing patient contact with primary care face to face services. The conclusions of this research are a vital part in our understanding of the overall impact of Covid-19, the conditions we have looked at are usually many months or years in the making so the reduction in new diagnoses does not represent a reduction in the burden of these diseases, more the fact that they have not yet been formally recognised. This will have an impact individually on those patients - the longer a patient goes undiagnosed, the more complications they are likely to suffer. As we move forwards careful thought will be needed to plan services to find and support those patients who have not yet been diagnosed.”

Nav Kapur, Professor of Psychiatry at Swagֱ�� and lead for the mental health work at the PSTRC, said: “One of the great strengths of the GM PSTRC is the opportunity to look at safety across different settings and clinical conditions. For me the reduction in mental health diagnoses and consultations was particularly striking. Going forward, I think there are two urgent priorities. First, to understand why this has happened and second to monitor and mitigate the consequences of reduced healthcare use.”

Richard Williams, concludes: “It is vital that healthcare services use the findings in our research to proactively prioritise diagnosing patients who may be living with conditions which could be dangerous if left untreated. This will help to avoid health services become swamped when people feel confident enough to return to healthcare settings.”

To mark World Suicide Prevention Day on Thursday 10 September a patient safety research centre has created a virtual photographic exhibition, ‘Hope during the COVID-19 Pandemic: perspectives from people with personal experience of self-harm, suicide, and mental health.’

The exhibition of eight pictures is organised by a team from the National Institute for Health Research Greater Swagֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC) who work across the organisation’s mental health theme. The centre is a partnership between Swagֱ�� and Salford Royal NHS Foundation Trust.

The mental health theme at the NIHR GM PSTRC work in partnership with a patient involvement and engagement group, Mutual Support 4 Mental Health Research (MS4MH-R), who designed the exhibition with the help of researchers. All members of the group either have personal experience of self-harm, suicide, and mental health services or of caring for someone who has.

Dr Leah Quinlivan, Research Fellow at the NIHR GM PSTRC, said: “Our virtual exhibition is a great way to visually raise awareness of World Suicide Prevention Day during these challenging times, and the importance of involving experts by experience in mental health research. Living through the pandemic has been challenging and the message of hope is now particularly relevant. We aim to bring that message to others through sharing the pictures from people who really understand what it’s like to experience recovery through tough times.

“We are grateful to our group for helping to shape our research which aims to improve patient safety. They have bravely shared powerful images which are extremely personal to them and are sure to bring hope to others during these strange times.”

The exhibition aims to build on the successes of a similar event from the group which was held at Swagֱ�� Town Hall to mark World Suicide Prevention Day 2019.

Dr Louise Gorman who is a Research Associate at the NIHR GM PSTRC and works alongside Dr Leah Quinlivan said: “Last year we shared pictures of hope from our public involvement and engagement group for the first time. It was a success both for the members of our group but also for the members of the public who visited the exhibition. We’re hopeful that this year the images will reach more people and spread the message of hope while reminding them that research is underway to help.”

There are around 10 members of the public involvement and engagement group who meet regularly. The group which includes members from across the North West was formed two years ago as an important part of the NIHR GM PSTRC’s mental health theme’s research. They have continued to meet, while observing social distancing rules.

Stephen, group member whose picture is included in the exhibition, said: “The title of my picture is ‘light at the end of the tunnel”. It’s an image of the pier at Southport and for me is my light at the end of the tunnel and reminds me to stay positive. I hope it helps to inspire others.

“Being part of mental health research is incredibly important to me and has a positive impact on my life. I’m hopeful that I’m helping to improve understanding and treatment. I understand what it’s like not to have any hope so was keen to share a picture which represents the hope that has got me through the COVID -19 pandemic. This year has been so hard for so many so we need hope more than ever. If any of our work can plant that seed then I personally will be so proud.”

Nav Kapur, Professor of Psychiatry at Swagֱ�� and lead for the mental health work at the PSTRC, said: “Suicide prevention is one of our major mental health, public health, and societal challenges. Effective suicide prevention can only happen when we listen to the powerful and moving voices of people with lived experience. This is more important particularly now. “

There are two main studies underway by researchers at the NIHR GM PSTRC’s mental health theme. The first is investigating patient, carer, and clinician experiences of psychosocial assessment following self-harm, and their access to psychological therapies. The second, aims to examine how involving patients families in their mental healthcare can positively contribute to improved patient wellbeing and reduce their risks of self-harm and suicide. Both the studies are designed to improve safety and outcomes for patients.

Visit the virtual exhibition here -

Click on ‘start guided tour’ to begin the exhibition, and use the navigation buttons. The exhibition will be Tweeted from @PSTRC_GM.

A , led by researchers at Greater Swagֱ�� Mental Health NHS Foundation Trust, the University of Swagֱ�� and the National Institute for Health Research (NIHR), has found that young women are most vulnerable to postpartum mental illness.

The term ‘postpartum’ refers to the period following childbirth. Whilst childbirth is a leading cause of mental illness in women, up until now, how it affects women at different ages has been unknown.

This is the first study of its kind to compare rates of mental illness during postpartum periods and non-postpartum periods in women of different ages. The study examined UK general practice data from almost 2.7 million women in the UK. Postpartum periods were matched on age and general practice to non-postpartum periods and Cox regression models were then used to compare new mental illness between postpartum and non-postpartum periods.

The results showed strong evidence that the effect of giving birth on mental illness was age-dependent for depression, anxiety and affective psychosis, with the effect being far greater in young women.

In 15-19 year olds, depression was over seven times more likely to occur in postpartum periods than non-postpartum periods. 15-19 year olds were also 50% more likely to develop anxiety in postpartum periods than non-postpartum periods.

Childbirth also had over twice the effect on affective psychosis in women aged 15-24 compared to women overall.

These findings will aid the understanding of postpartum mental illness. This will inform the development of targeted support and allow clinicians to provide accurate information to women and their families.

Dr Eleanor Swift, ST4 Doctor in General Adult Psychiatry at Greater Swagֱ�� Mental Health NHS Foundation Trust, and NIHR Academic Clinical Fellow said:

“This study adds  new evidence that the effect of childbirth on mental illness is highly age-dependent. Young women are affected to the greatest extent, particularly for depression and anxiety.

“This is important because postpartum mental illnesses has been repeatedly linked to poorer outcomes for mother and child and these risks make planning parenthood more daunting for women.

“We hope that having a better understanding of which women are most at risk of postpartum mental illness can help provide clearer information and target treatments to the right groups of women to reduce health inequalities.”

Children of mothers with mental illness are significantly less likely to receive preventative health vaccinations during the first five years of life, according to a University of Swagֱ�� study.

The research, from the University’s Centre for Women’s Mental Health, has important implications for the uptake of a vaccine for COVID-19, which may become available in 18 months’ time.

Last year, in , the Swagֱ�� team estimated that one in four children in the UK has a mother with a mental illness meaning that a quarter of UK children could be affected.

The findings also come at a time of increasing global concern about the general uptake of vaccinations – especially measles, mumps and rubella or MMR.

Though vaccines are provided for free in most countries, 15% of children remain unvaccinated globally, according to the WHO, often leading to serious illness, disability and even death.

Recent outbreaks of measles in Europe and the US indicate a significant decline in herd or collective immunity as a result of reduced vaccination uptake in infants.

The trends have been attributed to scepticism about the safety of vaccination, particularly following the discredited report by Andrew Wakefield in 1998 linking the MMR vaccine to childhood autism.

The Centre for Women’s Mental Health study, published in the European Journal of Epidemiology used data from around 480,000 mothers and children followed up to the age of five.

It revealed that the children of mothers with depression and psychotic illnesses were 14% less likely to receive necessary vaccinations at two years, compared to children of unaffected women.

And children of mothers with alcohol and substance misuse disorders were 50% less likely to receive necessary vaccinations at two years, compared to children of unaffected women.

It is the largest study ever to look at the association between maternal mental illness and childhood vaccination uptake.

The data were sourced from the Clinical Practice Research Datalink between 1993 and 2015 and examined vaccinations for Diphtheria, Tetanus, Whooping cough, Haemophilus influenza (A), Polio, as well as the MMR vaccine.

Lead author Cemre Su Osam, senior doctoral researcher from The University’s Centre for Women’s Mental Health said: “We know that people with mental illness are less likely to benefit from public health information, preventive health and public health campaigns.

“And as mothers take a central role in their children’s health, the extent to which their children access preventative healthcare is of public health concern.

“As people with mental illness are more at risk from COVID-19, these findings will be particularly important when or if a COVID-19 vaccination becomes available.”

Professor Kathryn Abel, is Director of the Centre for Women’s Mental Health as well as an honorary psychiatrist at Greater Swagֱ�� Mental Health Trust.

She said: “Public health policies and practice should be targeted specifically at groups less likely to access them and our work suggests that mothers with mental illness need support to access key preventive health measures like vaccinations for their children in the first 5 years of life.

“And as children exposed to maternal alcohol and substance misuse are at the greatest risk of not receiving necessary vaccinations, focussing preventive programmes on these mothers is important.”

Dr Matthias Pierce, Centre for Women’s Mental Health Research Fellow said: “For the first time, our study provides us with robust evidence that is needed to tailor a public health campaign about vaccinations to this key vulnerable group in order to reduce the risks of what are, after all, preventable diseases.

“These children represent an easily identifiable group at risk of not receiving preschool vaccination; while screening of women for mental illness antenatally and postnatally is now part of routine antenatal and postnatal primary care.”

The study was funded by the European Research Council

Follow the Centre for Women’s Mental Health at @CWMH_UoM.

The paper: ‘The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study’ is published in .the European Journal of Epidemiology.

Researchers at have worked with , an online mental health service for young people, to produce a report on digital mental health support for children and young people.

Launched in 2004, Kooth provides counselling, advice, and support to young people (aged 11-18) struggling with their mental health. It is run by XenZone, an innovator in digital mental health.

The report is a characterisation of the person-centred, holistic work carried out by Kooth on a daily basis. In defining the “Theory of Change” for Kooth , researchers have identified the characteristics and mechanisms of the service that lead to better mental health and wellbeing.

Some of the key findings from the report include;

• The physical absence of a therapist allows children and young people to express themselves, focusing exclusively on their situation and their feelings without fear of judgement or dismissal.
• The anonymity of the service means the young person feels it is safe to open up and can get to the key issues they wish to address more quickly.
• The site’s accessibility means that young people can use it when they need to, going back for more support as required. The young person therefore, is in control of the pace of support, which shifts the power dynamic away from the therapist.

This Theory of Change will be used to inform a new set of outcome measures XenZone is developing and intends to validate. The data collected will be used to make recommendations to the NHS on best practice for evidencing the impact of digital mental health support services in England.

Dr Terry Hanley led the research and co-authored the report. He said; “There is a growing need to define what mental health and wellbeing support looks like today so that we have an accurate understanding of the potential of new approaches and new modes of delivery.

“It also follows that we need to evolve our understanding of outcome measures so that we avoid using old systems to measure newer, broader services. The ambition of this project, therefore, was to articulate and share the Theory of Change for the Kooth platform; future work will address the outcomes required to evidence this work.”

Kooth is supported by Sir Norman Lamb. Speaking about the report, Sir Norman said; “It outlines the different routes they take and defines the most helpful mechanisms for change, which may lead to better outcomes and, ultimately, happier lives.”

He added; “It isn’t a study you’ll find anywhere else. The deep and rich data that XenZone has accumulated over the last 15 years is unique.”

The full report can be downloaded from .

An analysis of data from almost 46,000 people has found that weight loss, nutrient boosting and fat reduction diets can all reduce the symptoms of depression.

, an Honorary Research fellow at Swagֱ�� and Research Fellow at NICM Health Research Institute at Western Sydney University, says existing research has been unable to definitively establish if dietary improvement could benefit mental health.

But in a new study published in Psychosomatic Medicine, Dr Firth and colleagues brought together all existing data from clinical trials of diets for mental health conditions.

And the study provides convincing evidence that dietary improvement significantly reduces symptoms of depression, even in people without diagnosed depressive disorders.

Dr Firth said: “The overall evidence for the effects of diet on mood and mental well-being had up to now yet to be assessed.

“But our recent meta-analysis has done just that; showing that adopting a healthier diet can boost peoples’ mood. However, it has no clear effects on anxiety.”

The study combined data from 16 randomised controlled trials that examined the effects of dietary interventions on symptoms of depression and anxiety.

Sixteen eligible trials with outcome data for 45,826 participants were included; the majority of which examined samples with non-clinical depression.

The study found that all types of dietary improvement appeared to have equal effects on mental health, with weight-loss, fat reduction or nutrient-improving diets all having similar benefits for depressive symptoms.

“This is actually good news” said Dr Firth; “The similar effects from any type of dietary improvement suggests that highly-specific or specialised diets are unnecessary for the average individual.

“Instead, just making simple changes is equally beneficial for mental health. In particular, eating more nutrient-dense meals which are high in fibre and vegetables, while cutting back on fast-foods and refined sugars appears to be sufficient for avoiding the potentially negative psychological effects of a ‘junk food’ diet.

Dr Brendon Stubbs, co-author of the study and Clinical Lecturer at the NIHR Maudsley Biomedical Research Centre and King’s College London, added: “Our data add to the growing evidence to support lifestyle interventions as an important approach to tackle low mood and depression.

“Specifically, our results within this study found that when dietary interventions were combined with exercise, a greater improvement in depressive symptoms was experienced by people. Taken together, our data really highlight the central role of eating a healthier diet and taking regular exercise to act as a viable treatment to help people with low mood.”

Studies examined with female samples showed even greater benefits from dietary interventions for symptoms of both depression and anxiety.

Dr Firth added: “We’re not yet sure why not know why some of our data showed significantly greater benefits from diets for women.

“So more research is needed on this. And we also need to establish how the benefits of a healthy diet are related to improvements in physical health

“It could be through reducing obesity, inflammation, or fatigue – all of which are linked to diet and impact upon mental health.

“And further research is still required to examine the effects of dietary interventions in people with clinically-diagnosed psychiatric conditions.”

The effects of dietary improvement on symptoms of depression and anxiety: a meta-analysis of randomised controlled trials is published in Psychosomatic Medicine

A University of Swagֱ�� study into social fragmentation in England using data from the last two censuses has revealed an increase from 2001 to 2011, especially for the North of England.

The rise was mainly driven by increases in the average number of single people across the country and the numbers of privately rented households across the country.

Between 2001 and 2011, there was a 7.5% increase in single people and a 90% increase in the privately rented household statistic, say the research team.

The study, says its authors, has profound implications on mental health provision in England.

Social fragmentation, the absence of connections between individuals and society, was defined by the team as the numbers of private renters, single people, migrants and one person households in a community.

London, Yorkshire and Humber and the South Central, the study found, had the largest increases in private renting. Similarly, the North East, West Midlands and West Midlands had the largest increases in single people. London, however, had the highest levels on both factors.

Local neighbourhoods in Liverpool, Sheffield, Swagֱ�� and Leeds had the highest levels of social fragmentation in the country in 2011.

London had the most neighbourhoods ranking high in social fragmentation and five Local Authorities with the highest levels were all in London. They were City of London, Westminster, Kensington and Chelsea, Camden, Hammersmith and Fulham.

In comparison, areas in Northumberland, Warrington, Kettering, Solihull and the Southend-On-Sea had the lowest levels of social fragmentation. The Local Authorities of Rochford, Chiltern, East Dorset, South Staffordshire, and Hart were the least fragmented.

The study, published in , also found that urban areas are more socially divided than the countryside, where people are more likely to lead more isolated lifestyles.

Migration, however, did not appear to impact on levels of social fragmentation - as measured by the numbers of people that move into an area from within the UK and the numbers of people who move into an area from outside the UK.

Health economist Christos Grigoroglou says the increases in private renting are likely to be a result of poor availability of social housing, unaffordable housing for ‘generation rent’, increasingly common short term employment and rising student numbers.

And the increase in the numbers of young professionals, students and divorces over the period are likely to have contributed to the rising numbers of single people.

The PhD Student said: “Private renting and single people have been long recognised as having an impact on social fragmentation- especially in mental health.

“Single people are also known to suffer from worse mental health outcomes.

”This study shows how these factors have become more prominent in recent years, impacting significantly on levels of social fragmentation.

Data scientist Professor Evan Kontopantelis said: “Higher levels of social fragmentation have long been linked with suicide, self-harm, mental disorders, and psychiatric health service use.

“Therefore, understanding social fragmentation can be a powerful aid to the organisation of healthcare services, by identifying areas that need to be targeted from social and healthcare interventions.

“Of particular interest is mental health and interventions to improve it, since social fragmentation appears to be a salient risk factor for poor mental health.”

Children who experience physical, sexual, and emotional abuse or neglect are at least two to three times more likely to attempt suicide in later life, according to the largest research review carried out of the topic.

The analysis of 68 studies by psychologists at the University of Swagֱ�� and University of South Wales revealed that suicide attempts were:

• Three times more likely for people who experienced sexual abuse as a child
• Two and a half times more likely for people who experienced physical abuse as a child
• Two and a half times more likely for people who experienced emotional abuse or neglect as a child

Also from the research published in Psychological Medicine today, children who experienced multiple abuse are as much as five times higher to attempt suicide.

And as those people who experienced abuse as children get older, the risk of suicide attempts increases.

People not in contact with mental health clinicians were found to be at the highest level of risk.

The sixty-eight studies were carried out across the world, producing about 262 thousand adults aged 18 years or older, who were exposed to childhood abuse and neglect.

, from Swagֱ��, also based at the NIHR Greater Swagֱ�� patient safety translational research centre, led the research team.

She said: “Around one adult in every three has experienced abuse as a child”.

“This study conclusively gives us solid evidence that childhood abuse and neglect is associated with increased likelihood that they will be at risk of suicide as adults.

“And that has important implications on healthcare. Other studies have shown that in the US, for example, the economic burden of childhood maltreatment is estimated to be around $124 billion.”

“Current treatment for people with suicidal behaviour usually centres around Cognitive Behavioural Therapy.

“But that assumes people will seek help themselves. This research identifies that people who are not under the care of clinicians are at risk.

“So, we need a new approach to identify these people and to focus our efforts on effective community intervention.

Dr Ioannis Angelakis from the University of South Wales said: “These findings not only provided a clear picture of the connection between abuse or neglect in childhood and suicide attempts later on in life, but also recognised that efficient interventions should take a broader community-based approach.”

The paper Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis is published in Psychological Medicine

People over 65 who harm themselves are more likely to die by suicide than other age groups according to new research published in the by University of Swagֱ�� and Keele University academics.

Funded by the , the study analysed patient records using the (CPRD) and found that 4,124 patients harmed themselves between 2001 and 2014, mostly by taking overdoses of medication.

It showed that people over 65 who self-harm are 20 times more likely to die an unnatural death and 145 times more likely to die by suicide than people of the same age who had not self-harmed.

The study also found that only 12% of older patients who self-harmed had a record of being referred to a mental health service for aftercare. National Institute of Health and Care Excellence (NICE) guidelines suggest that the involvement of mental health specialists is important because older people who self-harm may have higher suicidal intent than younger people.

Physical health problems were more common in older patients who had harmed themselves compared to those who had not.

Following a self-harm episode, over one in ten of those aged 65 and over were prescribed tricyclic antidepressants which can be toxic when taken in overdose.

, who led the study and analysed the data said: “With the aging population rising and a lack of research in this age group, this study - - the first of its kind conducted in primary care – has gone some way in highlighting the risks of self-harm in older people.

“This study emphasises the need for early intervention, careful alternative prescribing and better support for older people who may see their GP following an episode of self-harm or for other health problems.”

, one of the authors of the paper who chaired the NICE guidelines for self-harm said: “We sometimes think of self-harm as a problem in younger people and of course it is. But it effects older adults too and the concerning issue is the link with increased risk of suicide.

“Older people might be particularly vulnerable as they are uniquely exposed to issues such as bereavement, isolation and physical as well as mental illness.

“They also might fear the consequences of becoming a burden to their family or friends, or not being able to function from day to day.”

He added: “We hope our study will alert clinicians, service planners, and policy makers to the need to implement preventative measures for this potentially vulnerable group of people. Referral and management of mental health conditions are likely to be key”

Professor Carolyn Chew-Graham, from Keele University one of the research team and a practising GP said: “Since drug ingestion is one of the main methods of self-harm, we highlight the need to consider less toxic medication in older adults for the management of both mental illness and pain related conditions.

“We also recommend maintaining frequent medication reviews following self-harm.”

“GPs are after all in a unique position to intervene as older patients come to the surgery more frequently than younger adults.”

Carers for people with cancer are between 5 and 7 times more likely to have mental health problems than the general population, according to a landmark new study.

The Dimbleby Cancer Care funded study identifies a major public health concern, according to the lead author Gunn Grande, Professor of Palliative Care at Swagֱ��.

The study, ‘Psychological morbidity* and general health among family caregivers during end of life cancer care: a retrospective census survey’ reveals 83% of family carers of people with cancer have clinically significant distress – compared to just 15% of the general population. The study retrospectively measured carers’ psychological health and general health during the patient’s last three months of life.

The study, which was supported by NIHR CLAHRC GM and carried out by the Universities of Swagֱ��, Newcastle and Groningen in the Netherlands, has been published in the journal, Palliative Medicine. The team received responses from 1,504 carers through a national four-month post bereavement postal survey in the autumn of 2015. The survey was sent via the Office for National Statistics to 5,271 relatives who registered a death in May 2015. Local carers groups helped shape the material.

The survey revealed:

• Psychological morbidity at clinically significant levels was substantially higher among carers than the general population (83% versus 15%), with prevalence 5-7 times higher across all age groups.
• Overall carers’ general health scores were lower than population scores, median 75 (interquartile range 50-80) versus 80 but differences were more marked at younger ages.
• Female carers had worse psychological morbidity and general health than male carers.

Gunn Grande, Professor of Palliative Care at Swagֱ��, led the study. She said: “We were aware that carers’ psychological health suffers when caring for the terminally ill, but we were surprised at the sheer scale of the problem. We found that the vast majority of carers suffered psychological morbidity at a level where further clinical investigation is recommended and where, for instance, their ability to concentrate, make decisions and deal with problems may be affected. If we can ensure that carers feel better supported, we are likely to reduce some of the more extreme stresses of caregiving, so that carers are more able to carry on their valuable work without being ‘broken’ by the experience”.

The Dimbleby Cancer Care Research Fund has awarded over £2.7million in funding since 2004 to research projects looking at all aspects of cancer care. Chair of the charity, broadcaster, Jonathan Dimbleby said:

“This latest research reflects what unfortunately we see every day through our work; caring for someone with cancer can have a huge impact on your own health. The role these carers play is vital, but they need better support, which is why Dimbleby Cancer Care exists.

“Caring for a loved one going through cancer can be both distressing and challenging and we are there to support them, be it through our information centres, our psychological support, complementary therapies and benefits advice teams or our recently launched Cancer Care Map website, which for the first time enables us to reach across the UK. It is clear from this research that ongoing support for carers is very much needed and would prevent a breakdown in caregiving and may ultimately, in the long term, produce cost savings for the NHS.”.

This is the second of three sets of findings to be published from the study. The first set, published last year showed that family carers of people with cancer on average provide almost 70 hours of care a week to look after their relatives in the last three months of life. The final results focusing on the economic value to society of their work will be published at a later date.

Dimbleby Cancer Care was set up in 1966 in memory of broadcaster Richard Dimbleby and is based at Guy’s Cancer Centre in Southwark, London. It provides practical and psychological support to people living with cancer and to their families and carers. The charity runs the UK wide online directory of support services  which helps people locate care and support services in their local area wherever they are in the UK and has its own information and support centres at Guy’s Cancer Centre and Queen Mary’s Hospital, Sidcup.

 is one of Swagֱ��’s - examples of pioneering discoveries, interdisciplinary collaboration and cross-sector partnerships that are tackling some of the biggest questions facing the planet. #ResearchBeacons

Swagֱ�� has been awarded £150,000 to develop new ways of supporting the wellbeing and mental health of postgraduate research students.

The funding, from the Higher Education Council for England (HEFCE), will allow the University to improve targeted wellbeing and mental health services to and, where needed, access to specialised NHS services.

Swagֱ�� has almost 4,000 postgraduate research (PGR) students, with over a third of these coming from outside the EU. Because of the different ways in which these students interact with the University and the particular pressures they may come under, the new project will seek to develop more specific policies and services.

These will include: developing a new monthly wellbeing check which will be completed by students and supervisors, and working with the existing PGR Representatives’ Network. There will also be resources, such as mindfulness tools which will be developed with outside specialists and made available to students and staff.

The project will employ two full-time members of staff – one in the Students’ Union and one in the University’s Graduate Education Team.

There will also be extensive consultation and regular meetings with students themselves. Aleksandra Besevic, a member of the PGR Representatives’ Network who is studying consumer behaviour in sustainable fashion, said: “I’m very happy that the University has secured the funding to improve postgraduate wellbeing. I have been working on student wellbeing in the Faculty of Science and Engineering which has made a difference to the community and bringing students together.

“Wellbeing is often overlooked by the students themselves, so it is important to have activities arranged by students for students. I hope this will improve postgraduate wellbeing across the whole University and foster a balanced working environment.”

The money for this project has come from HEFCE’s which provides targeted investment in activities led by universities and colleges. The fund supports a range of student and sector priorities, including innovation in higher education, efficiency and effectiveness, and student interest issues.

The University has already been successful in achieving Catalyst funding for projects around improving support for and another to tackle .

In this round 17 awards were made in total across the sector and Swagֱ�� was one of only four institutions to receive the maximum allocation of £150,000.

, Associate Vice-President (Research) and Director of , said: “The health and wellbeing of our students is something where the University, working with partners, has been highly innovative. This particular piece of funding will allow us to thoroughly scope out the needs of this group of students and put measures in place which are tailored to their particular needs.”

The project team will include University staff with expertise in wellbeing and mental health, working in partnership with selected external partners from: the Greater Swagֱ�� Mental Health NHS Foundation Trust, Vitae, MIND, BluSCI, Six Degrees, Student Minds and the Institute of Employment Studies.

The project is due to finish in early 2020 and results will be shared across the HE sector as new services are implemented.

Speaking about the latest round of funding, HEFCE Chief Executive, Professor Madeleine Atkins, said: “This programme to develop extra support for postgraduate research students is timely, and complements the resources HEFCE already provides to support student safeguarding and to address barriers to student success.

“We are delighted to support these innovative projects in the important area of mental health and wellbeing, and look forward to successful outcomes and the sharing of good practice for the benefit of all postgraduate research students.”

UPDATE: 18 April 2018

The University has also received £50,000 in funding for ‘Passivity, the Bystander and Religious Based Hate Crime’ a new project which will continue the work of and bring people together to discuss, analyse and understand ‘the bystander’ in relation to religious based hate crime.

Alongside the Students’ Union, staff and students will come together to improve religious literacy among students and staff, including myth-busting, support the development of effective role models for students of different religions or beliefs and develop and sustain positive campus relations between different groups.

Eventually the project will support the production of a series of materials and events that will be used on an ongoing basis across campus.

A scientific paper has revealed that some nutrients found in food may help reduce the symptoms of psychotic illness, when used in the early stages of treatment.

The systematic review, led by Dr Firth, honorary Research Fellow at Swagֱ�� and Research Fellow at NICM Health Research Institute, Western Sydney University examined if nutrient supplementation could provide effective 'add on' treatment for young people with psychosis.

The team brought together data from eight independent clinical trials of nutrient supplementation in 457 young people in the early stages of psychotic illness, such as schizophrenia.

The review is published in

Researchers found that certain nutrient supplements, used alongside standard treatment, may improve mental health in young people with psychosis more than standard treatment alone.

The study by Firth and colleagues is the first evaluation of nutrient supplementation trials in ‘first-episode psychosis’ (FEP).

Dr Firth said “Nutrient supplementation in the treatment of mental illness is something which can be surrounded by both cynicism and ‘hype’.

“We conducted this review just to see if there is any ‘real evidence’ if such nutrients can actually help young people with psychosis.

“Certainly, there is early indication that certain nutrients may be beneficial, not to replace standard treatment, but as an ‘add-on’ treatment for some patients”

One nutrient reviewed was Taurine, an amino-acid found in foods such as shellfish and turkey.

A clinical trial conducted in Melbourne in 121 young patients with psychosis found that 4 grams of Taurine per day reduced psychotic symptoms within just 12 weeks.

Certain antioxidant supplements, such as n-acetyl cysteine and vitamin C, may also be effective – particularly for patients with high levels of ‘oxidative stress’.

Studies on omega-3 supplements showed that although these appear to improve brain health in young people with psychosis, the evidence for actually reducing psychotic symptoms is conflicting.

“We have to be careful to replicate the results of these initial studies before jumping to firm conclusions” Dr Firth said.

Now, the team are aiming to do just that: launching a new clinical trial in which all of the potentially beneficial nutrients are combined within a single supplement, and provided to young people with psychosis.

He added: “Individual nutrients appear to have moderate effects on mental health, at best.

“A combined nutrient intervention, explicitly designed from the evidence-base in psychosis, may therefore confer larger and more beneficial effects for young people with this condition.

“We will be testing this in Sydney, Australia in 2018, to learn more about the potential role of nutrition in mental health for the future.”

The paper Adjunctive nutrients in first-episode psychosis: a systematic review of efficacy, tolerability, and neurobiological mechanisms is available