Patient-professional Treatment Partnerships in Mental Health.

Established: April 2005; first meeting July 2005

Convenor (Chair): Professor Robert Peveler, Professor of Psychiatry, University of Southampton

Members:
Members represent a wide range of disciplines including psychiatry, nursing, psychology, health economics and pharmacy:
Dr Marta Buszewicz (Primary Care/Pscyhiatry, University College London); Prof Anthony David (Psychiatry, IOP, London); Dr Richard Gray (Nursing, IOP, London); Prof Tony Kendrick (Primary Care, Southampton); Prof Michael King (Psychiatry, University College, London); Prof David Kingdon (Psychiatry, Southampton); Prof Irwin Nazareth (Primary Care, University College, London); Dr Lucy Simons (Southampton); Scott Stevens (User representative, Camden Health Consortium); Prof Theo Rayner (Pharmacy, Leeds); Prof Jan Scott (Psychiatry, IOP, London); Prof Lucy Yardley (Psychology, Southampton)

In addition this Group plans to recruit representation from users and carers to the steering groups of all projects and the overarching group, using contacts such as the IOP Service User Research Enterprise and with organizations such as Depression Alliance, Rethink and the Manic Depression Fellowship as appropriate.

Remit and Aims:
Non-adherence is a major cause of poor treatment outcomes, carer and exchequer burden across all disease areas, and treatment for mental disorders is no exception. This multidisciplinary research group will focus on the process of care (concordance) and its outcomes (adherence), including both psychological and pharmacological treatments, with the ultimate aim of promoting shared understanding between patients and professionals.

The work programme will investigate the prevalence, risk factors and management of non-adherence and sub-optimal self-care, to establish the extent of problems in different clinical settings, including primary and secondary care; investigate factors which limit uptake of treatments; and develop and evaluate adjunctive interventions, treatment modifications and service enhancements designed to promote understanding and improve outcomes.

Current Status & Future Plans:
Five writing groups have been formed:
1. Treatment adherence and interventions in bipolar disorder.
2. A group on treatment adherence in patients with schizophrenia.
3. A group on the impact of cultural and ethnic factors on the uptake of cognitive  behaviour therapy.
4. A group on engagement and treatment for common mental disorders and primary care.
5. A group on treatment partnerships in long term mental illness.

Grants applied for:
1. A clustered randomised control trial of the effectiveness of financial incentives to achieve adherence to antipsychotic depot medication in non-adherent patients. Submitted by S Priebe and colleagues to MRC in 2006. Application rejected.
2. Developing CBT +: what do you do when standard CBT is not enough? Submitted by D Kingdon to NHS R & D Research for Patient Benefit Programme. Application rejected.
3. Developing culturally sensitive Cognitive Behaviour Therapy by exploration and incorporation of health professionals’ and  service users’ views and opinions. Submitted by D Kingdon and submitted to NHS R & D Research for Patient Benefit Programme. Proposal rejected.
4. Facilitating optimal adherence to medication in bipolar disorder: a randomised controlled trial comparing medication adherence support technology (MAST) with standard care. Submitted by R Horne to NHS R & D Technology Assessment Trial Grant Scheme. Proposal rejected.
5. Research on acceptability of, and adherence with depot medication. J Scott Janssen Cilag Ltd., grant obtained of £40,000.
6. PhD Student Bursary “A Structured Clinical Interview for Psychosis Subgroups PhD support for Yoshi Kinoshita.
7. Dr Vivien Hunot has been refining an application to RfPB on the topic of adherence to antidepressant medication in primary care.

Proposals under development:
1. “Why do patients with psychotic disorder stay engaged with mental health services:  a qualitative study” from S Priebe & R McCabe at Barts & the London School of Medicine.
2. Theory-based intervention to facilitate optimal use of medication prescribed for bipolar disorder: R Horne at the Department of Policy & Practice, School of Pharmacy at the School of London.
3. Prof David Kingdon has met with Jenny Shaw and Max Birchwood to take forward work on therapeutic relationships in schizophrenia

One additional publication from the group has now been accepted for publication:
PERAHIA, D.G.S., QUAIL, D., GANDHI, P., WALKER, D.J. & PEVELER, R.C. A Randomised, Controlled Trial of Duloxetine alone versus Duloxetine plus a Telephone Intervention in the Treatment of Depression (Journal of Affective Disorders).

Other Outputs:
A variety of publications have appeared from members of the group over the past eighteen months. In addition Professor Rob Horne completed an SDO-funded systematic review of interventions for adherence.  All the writing groups have a clear plan of action and the large group will only meet infrequently to monitor their activity.

We have welcomed a new member to the group, Dr Lucy Simons (Southampton), who with colleagues at St George’s in London has been successful in obtaining support from NHS SDO for a study of the “WRAP” programme, empowering patients with long term mental illness to develop recovery action plans. 

Final Report: we will not have further meetings of the whole group, but will maintain contact by email lists and meetings of the smaller groups.  It has become clear that this topic area is struggling to attract significant funding in the current research climate, but efforts are still being made to achieve success in funding.