School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Ben HanniganReader in Mental Health Nursing

Web: http://www.cardiff.ac.uk/people/view/39197-hannigan-ben

Blog: benhannigan.comTwitter: @benhannigan

Some cumulative insights from the study of mental health systems

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Why study mental health?• Mental ill-health is very common: an estimated one in four is

affected at least once during their lifetime• In the EU, there are over 50,000 deaths by suicide each year

http://www.mentalhealthandwellbeing.eu/the-joint-action• Mental illness shortens lifespans (Thornicroft 2013)• In England, the total cost of mental health problems in

2009/10 (including the costs of care, lost economic output, and the human cost of diminished quality of life) was estimated at £105.2 billion (Centre for Mental Health 2010)

• In Wales, the total cost in 2007/08 was estimated at £7.2 billion (Friedli and Parsonage 2009)

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Funding mental health research• Large gaps in what is known about

mental health and illness• 85% of funding for UK mental health

research is from just three funders: the Wellcome Trust; the NIHR; and the MRC

• Annually, approximately £9.75 is spent on research per person affected by mental illness…

• …over 100 times less than cancer investments(MQ: Transforming Mental Health 2015)

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Mental health research priorities• Preventing mental disorders, promoting mental health and

focusing on young people• Focusing on causal mechanisms of mental disorders• Setting up international collaborations and networks for mental

health research• Developing and implementing new and better interventions for

mental health and well-being• Reducing stigma and empowering service users and carers• Research into health and social systems

(Wykes et al. 2015)

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Mental health research priorities• What are the psychosocial and community-based

interventions which help people live well with dementia?• A programme centred on the therapeutic impact and

contribution of mental health nursing: helpful and effective interventions, safe staffing, maximising nursing time through service organisation and the development of roles, the work of nurses assisting others in delivering support/interventions.

• A programme of public mental health research: what promotes mental health, prevents mental illness, and helps people living with mental illness to live better and longer?

(Mental Health Nurse Academics UK 2015)

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Developing a programme*• Past studies on the (a) workforce, (b) work, organisation and

user experiences in community mental health care, and (c) the establishment, work and impact of crisis services

• Current NIHR studies on care planning and coordination in community and hospital mental health settings (COCAPP and COCAPP-A)

• Recent NIHR evidence synthesis on risk in CAMHS (RiSC)• Current NISCHR (as was) study on social networks and shared

decision-making (Plan4Recovery)*with apologies to esteemed colleagues in HCARE pursuing

parallel programmes relevant to the wider mental health field!

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Making connections: theory, design and methods

• A systems approach: which emphasises the interconnections between policy, services and their organisation, work and user experiences…

• …or the connections between macro, meso and micro• The value of studying cases, at different levels: countries,

organisations, teams, people…• …and of studying cases within cases• Investigating in depth: qualitative and mixed methods• Co-production: working with service users

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

So what have we found?• The mental health system is

organisationally complex, and is dynamic • Ideas and practices are open to contest, and evidence is

sparse. For example:– for crisis services, and – in the management of

the less obvious risks for young people in mental health hospital

• Work in community care is sensitive to organisational context, divisions of labour are larger than people may sometimes think, and work and roles are in flux

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

So what have we found?• The system’s problems are ‘wicked’, and are hard to define (let

alone solve)• In community-based crisis services,

work is patterned by system features• Complex relationships exist between national policy, local

policy, and face-to-face practice and user experiences. For example:– in the production of care plans: see forthcoming COCAPP

final report

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Want to read the detail?• Check out my blog [http://benhannigan.com], where there

are plenty of posts and green open access versions of published papers

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

What’s next?• Follow-on studies from ongoing and recent projects…• …and new lines of enquiry building on existing and new

collaborations

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

ReferencesCentre for Mental Health (2010) The economic and social costs of mental health problems in 2009/10, London, Centre for Mental Health.Friedli, L. and Parsonage, M. (2009) Promoting mental health and preventing mental illness: the economic case for investment in Wales, Cardiff, All Wales Mental Health Promotion Network.Mental Health Nurse Academics UK (2015) Research priorities, https://www.jiscmail.ac.uk/cgi-bin/webadmin?A2=ind1510&L=MHNAUK&F=&S=&X=70FEC66284D807F1B9&Y=HANNIGANB%40CARDIFF.AC.UK&P=40746.MQ: Transforming Mental Health (2015) UK mental health research funding, London, MQ: Transforming Mental Health.Thornicroft, G. (2013) ‘Premature death among people with mental illness’, BMJ, 346:f2969 Wykes, T., Haro, J.M., Belli, S.R., Obradors-Tarragó, C., Arango, C., Ayuso-Mateos, J.L., Bitter, I., Brunn, M., Chevreul, K., Demotes-Mainard, J., Elfeddali, I., Evans-Lacko, S., Fiorillo, A., Forsman, A.K., Hazo, J.-B., Kuepper, R., Knappe, S., Leboyer, M., Lewis, S.W., Linszen, D., Luciano, M., Maj, M., McDaid, D., Miret, M., Papp, S., Park, A.-L., Schumann, G., Thornicroft, G., van der Feltz-Cornelis, C., van Os, J., Wahlbeck, K., Walker-Tilley, T., Wittchen, H.-U. on behalf of the ROAMER consortium (2015) 'Mental health research priorities for Europe', Lancet Psychiatry, 2, 11, 1036-1042.