From Where to Here…?

Michael Sharpe, Professor of Psychological Medicine, University of Edinburgh

From Where to Here…?

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Mental illness

One in six of the population suffers from anxiety or depression

At least 1 in 4 GP consultations for mental ill health

Annual direct care costs £12.5 billion

Annual cost to UK society more than £77 billion

We need better ways of helping mentally ill people

We need research to help us do this

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What research do we need?

Research that is relevant– No only to cause but also to treatment– Relevant to different mental illnesses– Cover all aspects of treatment

Research that gives us high quality evidence– Good ideas– Well done studies– Large and representative samples

Research that is feasible– Results can be delivered

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What research do we have?

Research that is relevant?– Less than 5% of the trials on the Cochrane database are indexed under

mental disorder

Research that gives us high quality evidence?– Studies are generally far too small– The outcomes are too short term– They are too often based on hospital samples– Almost all are of drug treatment

Research that is feasible?– The majority of studies are not completed as planned

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How can we get better research?

Clearly, researchers simply need to work harder and faster to deliver more and better research !

But researchers also need to be able to deliver good research

What obstacles do they see ? Surveys by Dr Craig on CSO 2004 and by

us in 2005.

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Obstacles to better research? What might a Network provide?

Feeling it can’t be done– Galvanize energy and vision and make it feel possible

Lack of expertise staff and infrastructure– Provide design statistical and other practical expertise

Overwhelmed by paperwork– Offer guidance and help to address regulatory requirements

Isolated with limited capacity– Forge links between clinicians and researchers, centres and networks

Can’t get big grants– Offer advice expertise and support to make strong applications

Can’t recruit sufficient patients to studies– Provide manpower to assist

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Medical school

CRFs

Trials Unit

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A Proposal for a Scottish Mental Health Research Network

The challenges– Diffuse concept of ‘mental health’– Small clinical research community– Limited research culture in clinical services

The opportunities– Our population and organized services– Our potential for collaboration– Existing infrastructure

The ‘X’ factor– Determination to make it work

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The original bid for SMHRN

To Link– 4 clinical medical schools– NHS and academic researchers– Other networks

To Provide– Methodological and practical support– Guidance on regulation– Assistance with recruiting

To Supplement– CRFs – R & D departments– Research grants

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The SMHRN 3 year targets (2006)

1. Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research.

2. At least six new UK multicentre studies within 3 years.

3. At least three new multi-centre studies led from Scotland within 3 years.

4. The number of patients participating in multi-centre studies increased by at least 20% of baseline every year.

5. Active grant funding for multicentre MH trials in Scotland increased by at least 20% of baseline every year.

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The SMHRN achievements (2009)

1. Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research.

2. At least six new UK multicentre studies within 3 years.

3. At least three new multi-centre studies led from Scotland within 3 years.

4. The number of patients participating in multi-centre studies increased by at least 20% of baseline every year.

5. Active grant funding for multicentre MH trials in Scotland increased by at least 20% of baseline every year.

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What we have learned

It remains a challenge– To achieve focus in ‘mental health’– To keep political, CSO, University, NHS and Industry support– To recruit and keep good staff (let studies recruit their own)

It is a long term job– 10 years plus– It need a substantial commitment of senior time

We need to support success but also to grow new Scottish studies– Back winners – Promote PDGs and pilots

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Thanks to the original team

Edinburgh: Professor Michael Sharpe (Academic), Dr Alan Carson (NHS)

Glasgow: Dr Andrew Gumley (Academic), Professor Bob Hunter (NHS).

Aberdeen: Professor Ian Reid (Academic), Dr Ross Hamilton (NHS).

Dundee: Dr Alex Baldacchino (NHS), Dr Rob Durham (Academic)

Primary Care: Professor Jill Morrison (Academic Glasgow),

Public Health: Dr Cameron Stark (NHS Highlands Health Board)

Clinical Research Facilities: Mr Gordon Hill (Wellcome Trust CRF)

Statistics and methodology: Professor Gordon Murray

Manager: Dr Lucy McCloughan

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Also to those who joined later

Board members: Professor Keith Matthews (Dundee); Dr. Jonathan Cavanagh (Glasgow); Professor Stephen Lawrie (Edinburgh – biological psychiatry);

Network Staff: Nadine Dougall; Mark Hazelwood; Gillian McHugh; Ann Doust

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And also to

CSO: Peter Craig, Roma Armstrong; Beatrice Cant; Hilary Lapsley

CRFs: Anne Gordon; Fiona McArdle

NIHR MHRN: Til Wykes and colleagues

University of Edinburgh: Professor Stuart Ralston and Professor Eve Johnstone and colleagues in my research group (PMR)

Scottish Government: Denise Coia