Rehabilitation and Recovery

Established: April 2005; 1st meeting 28th October 2005, regular meetings held subsequently

Convenor (Chair): Dr Helen Killaspy, Senior Lecturer in Rehabilitation Psychiatry, Department of Mental Health Sciences, University College London; Contact: h.killaspy@medsch.ucl.ac.uk

Members:
Helen Killaspy - Convenor (psychiatrist); Maurice Arbuthnott (Rethink representative); Paul Burgess (neuropsychologist); Sarah Cook (OT); John Curran (medical anthropologist); Tom Craig (psychiatrist); Steffan Davies (psychiatrist); Simon Dein (anthropologist); Jo Fox (service user); Frank Holloway (psychiatrist); Michael King (psychiatrist); Rachel Perkins (psychologist); Stefan Priebe (psychiatrist); Shula Ramon (MHRN scoping group on recovery); Julie Repper (nurse); Tony Ryan (nurse); Mike Slade (psychologist); Jerry Tew (MHRN scoping group on recovery); Jan Wallcraft (SURGE); Scott Weich (psychiatrist); Christine Wright (psychiatrist); Nick Wrycraft (nurse); Til Wykes (psychologist)

Remit and Aims
To focus on areas of topical concern in rehabilitation psychiatry.  Although the efficacy of a number of specific interventions used in rehabilitation has been established there is very limited literature relating to the specialty as a whole in terms of what it is, who it is for and who benefits from it.  Rehabilitation is notably missing from the NICE guidelines on the treatment of people with a diagnosis of schizophrenia and does not specifically feature in the National Service Framework for Mental Health England (DH, 1999).  However, admissions to rehabilitation facilities are often lengthy due to the complexity of the population referred and represent a very significant cost pressure for the NHS.  Investigation of factors associated with successful progression towards community discharge would allow standardised and coherent rehabilitation assessment and treatment packages to be developed with the intention of speeding recovery and reducing length of admissions.  Research into systems for reviewing care and potentially relocating service users back in their area of origin are urgently needed.  Since the number of service users under the care of rehabilitation services in any locality is relatively small, these areas for research need to be investigated through multicentre studies.  The MHRN provides an excellent framework for this sort of collaboration.

Current Status & Future Plans:
The group has been highly successful since its inception in October 2005 in achieving its aims of bringing together experts in the field to apply for funding for relevant studies. We have successfully:

1) "DEMoBinc" (Development of a Measure of Best Practice in Institutional Care): in March 07 won a 3 year large European Commission's 6th Research Framework Programme grant (1.5 million Euros) to carry out a pan-European study to develop a tool to assess the quality of institutional care in psychiatric and social care settings in ten countries at different stages of deinstitutionalisation, using the Recovery Model as the overarching framework for good practice.  The principal investigators and centres involved are:
1. Co-ordinator: Dr Helen Killaspy, (University College London, UK) 
2. Principal contractor: Dr Christine Wright (St George's University London, UK)
3. Principal contractor: Professor Dr.Thomas Kallert (Dresden, Germany)
4. Principal contractor: Professor Jorge Cervilla (Granada, Spain). 
5. Principal contractor: Professor Jiri Raboch (Prague, Czech Republic)
6. Principal contractor: Dr Georgi Onchev (Sofia, Bulgaria)
7. Principal contractor: Ass. Professor Giuseppe Dell’Acqua (Trieste, Italy)
8. Principal contractor: Professor Durk Wiersma (Groningen, Netherlands)
9. Principal contractor: Professor Andrzej Kiejna (Wroclaw, Poland)
10. Principal contractor: Ass. Professor Dimitris Ploumpidis (Athens, Greece)
11. Princpial contractor: Professor Jose Caldas de Almeida (Lisbon, Portugal)

2. Obtained funding from the Irish Mental Health Commission, in collaboration with Dr Ena Lavelle, Dublin, to carry out a prospective study of outcomes for service users with and without access to rehabilitation services in five geographical areas of Ireland.  This study also provides a vehicle for development of a new and clinically meaningful measure of social function.  The study commenced July 2007 and is funded for three years (180,000 Euros).

3. Members of the group have successfully applied for funding from the HTA (£807,000) for a large multicentre randomised controlled trial of art therapy for people with schizophrenia (the "Matisse study") which started in December 2006.  Dr Killaspy is Joint PI with Dr Mike Crawford (Imperial College), Professor King is a co-applicant and Maurice Arbuthnott is a member of the service user reference group.  This three year study is being run on the MHRN in four centres: North London (University College London and Camden and Islington Mental Health and Social Care Trust); West London (Imperial College London and West London Mental Health Trust); Avon and Wiltshire Mental Health Trust (local PI Tony Soteriou); and Queen's University, Belfast (local PI Dr Tony O'Neill).  The study will compare outcomes for people randomised to receive 12 months of weekly interactive group art therapy, weekly activity groups or treatment as usual.

4. We are currently finalising a proposal for submission for funding to the
Wellcome Institute in October 2007 to investigate the role of the frontal cortex in recovery from schizophrenia.  This study involves psychometric assessment of people with a diagnosis of schizophrenia to a) investigate the association between prefrontal impairment in area 10 and positive and negative symptoms of schizophrenia b) the association of impairment of this area and clinical outcomes.  Paul Burgess is leading this bid with co-applicants who are also members of the MHRN R&R group (Helen Killaspy, Michael King, Frank Holloway and Tom Craig), academic co-applicants from the Institute of Clinical Neuroscience and the Institute of Neurology, Queen’s Square (Chris Frith and Eileen Joyce) and collaborators who are rehabilitation clinicians at Oxleas NHS Trust, Peterborough and Cambridgeshire Mental Health Trust and St George’s and SW London Mental Health Trust.

 5. Three members of the MHRN R&R group are leading submissions to the 3rd  round of NHS Programme Grants funded by the NIHR in October 2007:  Mike  Slade (an evaluation of Recovery training for clinicians), Chris Wright (developing  a measure of Recovery Based Practice and assessing service user outcomes for  services with different degrees of Recovery focus) and Helen Killaspy  (effectiveness of rehabilitation services in England).  These three bids have co- applicants from the MHRN R&R group as well as other academic and clinical co- applicants and collaborators from elsewhere in the country and would, if funded  apply to be adopted by the MHRN.

Final report: The MHRN R&R Research Group has more than achieved its original aim to build a network of academics in the fields of Rehabilitation and Recovery who would develop two proposals and successfully apply for funding for at least one that would be run on the MHRN. The group had a timeframe of two years which will be reached in October 2007.  Now that this network has been established, it was decided at the last meeting of the group held in June 2006 that future work to develop proposals could continue without the need for further general MHRN R&R Research Group meetings.